Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study

Abstract

Background Diet is central to the management of type 2 diabetes mellitus (T2DM). Depending on the stage of the disease at which the recommended diet is initiated, optimal adherence can reduce HbA1c by about 1 to 2%. However, evidence on eating behavior is generally scarce including in Ethiopia. The present study aimed to assess the eating behavior of adults with T2DM in North Ethiopia. Methods This cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Socio-demographic variables were collected using structured questionnaires; an asset-based wealth index was used to determine socioeconomic status. Three dimensions of eating behavior were assessed using Likert-type items: food selection, meal planning and calorie recognition. Raw Likert scores in each dimension were transformed to percent scales to maximum (%SM). Participants’ behavior in each dimension was categorized into healthy and unhealthy taking 66.7% SM score as a cutoff. Overall eating behavior was determined by aggregating ranks scored in the three dimensions. Correlates of overall eating behavior were identified using Chi-square test and multinomial logistic regression with statistical significance set at P-value < 0.05. Result Only 1% of the participants had overall healthy eating behavior. Yet, overall unhealthy eating was apparent in 54.4%. By dimensions, healthy eating behaviors in food selection, meal planning and calorie recognition were seen in 43.5, 7.4 and 2.9% participants, respectively. Factors that were positively associated with having healthy eating behavior in one dimension relative to unhealthy in all were: receiving nutrition education [AOR 1.73; CI 1.09, 2.74], female gender [AOR 1.78; CI 1.03, 3.08] & being in 26–44 age category [AOR 3.7; CI 1.56, 8.85]. But, being in the poor [AOR 0.42; CI 0.16, 1.32] or average [AOR 0.54; CI 0.19, 1.55] socioeconomic strata were negatively associated. However, only receiving nutrition education [AOR 3.65; CI 1.31, 10.18] was significantly associated with having healthy behavior in two eating dimensions over unhealthy in all. Conclusion In North Ethiopia, the overall eating behavior of adults with T2DM is extremely poor. Diverse and integrated approaches including nutrition education during consultation should be implemented to address the gap.

High atherogenic risk concomitant with elevated HbA1c among persons with type 2 diabetes mellitus in North Ethiopia

“…Shreds of evidence show that strict glycemic control is crucial to prevent diabetes-related complications and hence reduce concomitant hospitalization and mortality [ 26 ]. On the other hand, poorly-controlled glycemia increases the likelihood of diabetic complications [ 27 ].…”

“…Moreover, they indicated that they use a combined diet and medication, 181(43%), approach as a means of controlling their sugar. However, their dietary self-care merely focuses on food selection [ 26 ]. About 36.8% (155) of them had one or more documented comorbidities of which hypertension was taking the lead, 101(24%).…”

Patient-centered nutrition education improved the eating behavior of persons with uncontrolled type 2 diabetes mellitus in North Ethiopia: a quasi-experimental study

“…Data on eating behavior was collected using a tool developed by Bhutanese investigators and customized to the setting by the research team ( 31 , 32 ) ( Supplementary Table 4 ). The Bhutanese tool had 19 Likert-type items.…”

“…Ranks obtained in the three dimensions were aggregated to assess overall eating behavior. Our earlier article ( 32 ) provides a more detailed discussion of the tools and measurement methods.…”