Evaluation of dietary pattern of diabetic patients with chronic kidney diseases

Abstract

Introduction: Diabetic patients have many dietary restrictions specially those have renal failure. Poor dietary intake is a predisposing factor for increased morbidity and mortality in chronic kidney disease (CKD) at stage 5.In Bangladesh the number of the dialysis patients is increasing day by day. For these types of patients an appropriate diet plan is essential after knowing their dietary pattern. Aims: This study was undertaken to develop an FFQ for assessment of dietary pattern. To compare dietary intake from diet diary, recall and food frequency questionnaire. To evaluate the daily intake before after administering diet plan Methods: Total 50 diabetic patients those on dialysis were included from dialysis unit of BIRDEM for this study .Along with anthropometric measurements, demographic data, biochemical parameter, FFQ and recall they were advised to fill-up a three-day dietary diary to calculate nutrient intake. The FFQ was developed from dietary records of healthy and diabetic subjects collected in CRF project database. Daily calorie intake was calculated from 3 day diet diary, recall and FFQ. It was seen that FFQ and recall methods were more suitable than 3 day diet diary for proper calculation of calorie intake. Based on their dietary intake and biochemical parameter diet plan was given to each individual according to guidelines. Another recall was taken after 3 months to see the improvement of dialysis patients. Results: In the dialysis patients 66% were male and 34% were female and 92% of their monthly expenditure was above 50,000. Anthropometric comparison was made before and after administering the plan which showed significant improvement in thebiceps skin fold thickness (BSF) that increased from 6.78±2.60 to 6.81±3.01 (p<0.01) though triceps skin fold thickness (TSF) increased little bit (12.90±5.33 and 13.42±4.46mm; p=NS) and mid arm circumference (MAC) remained same (25.80±3.38 and 25.75±3.44cm, p = NS) after 3 months.Comparison of biochemical parameter of blood was madebefore and after diet plan of dialysis subjects .Fasting Blood Sugar (FBS) was 4.6±0 before diet plan which was not significantly increased 6.6±0 , (P=NS) after diet plan. The level of serum Creatinine (SCr) was 10.8±4.2 before diet plan and showed little improvement9.4±2.8 after diet plan, but it was not significant. Similar trends were also noticed in case of serum Albumin (ALB) (38.8±0.2 and 34.6±5, P=NS), Hemoglobin (Hgb) (9.3±1.3 and 9.9±1.5, P=NS), Calcium (Ca) (8±1 and 7.7±2.2, (P=NS), Phosphorus (P) 6.6±2.6 and 5.0±2.4, P=NS), Sodium (Na)(138±6.8 and 136±3.6,P=NS) and Potassium (K) (5.0±0.7 and 4.8±0.7, P=NS). Dietary pattern of diabetic dialysis patients of different food items over a month showed that among cereal group 37.11% of the patients consumed chapati and 29.11% consumed rice. In case of pulses majority (90.47%) were consumed lentil. Among vegetables intake pattern for parwar, bottle gourd, papaya, bitter gourd and pumpkin were 8.5%, 8.3%, 7.6%, 7.5% and 5.5% respectively and which for leafy vegetable red amaranth, ipomoea leaves , jute leaves, bottle gourd leaves and spinach were 1.4%, 1.2%, 1.2%, 1.1%, and 1.0% respectively . The intake frequency of animal protein showed that eggs were mostly taken (20%) then chicken (19%), egg white (17%) and milk (5%) and among fishes percentage ofintakeforrohu,pangas,tilapia,katla and magurwere 13% , 9% ,7% , 2%and 2% respectively. The daily calorie intake from 1 st recall 1274.96±219.80 was lower from 2 nd recall 1382±233.82 (p<0.02) but 2 nd recall 1382±233.82 was also lower than diet plan 1814.68±251.2182 (p<0.01). Macronutrient intake like CHO (168.33±52.22 and 188.99±44.69 g/d, p<0.03) and fat (40.47±20.65 and43.41±12.66 g/d,p<0.03) intake was significantly increased but protein intake (48.43±18.78 and 53.07±11.57g/d, p= NS) was similar. Dietary intake of calcium (430.04±463.69 463.69±262.69 mg/d, p =NS), potassium (1079.18±338.58 and 1059.49±283.94 mg/d, p=NS), phosphate (608.19±163.47and 663.17±160.80 mg/d p =NS) and iron (13.82±19.31and 20.27±37.85 mg/d p =NS) were almost similar. Conclusions: It may be concluded that the diet pattern ofdiabetic CKD patients those were on dialysis subjects were taken mostly chapatti, rice, lentils among vegetable parwar, bottle gourd, red amaranth etc. In case of animal part they took mostly egg, chicken and egg white, among fishes rohu was taken significantly. Comparison of dietary assessments showed that FFQ was better than 3 day diet diary but similar to recall method for proper calculation of calorie intake.Their intake of carbohydrate and fat and overall calorie consumption was lower at time of 1 recall but after administer of diet plan their intake was found to be increased in just 3 months but not to the level of the diet plan. So long term effect should be observed to help improving their overall nutritional status.