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

Background: Improving the clinical outcome of people with type 2 diabetes mellitus by modifying their eating behavior through nutrition education is an important element of diabetes self-management. Significant data from the literature supports this idea, however in the Ethiopian setting, there is a practice gap. Therefore, the purpose of this study was to assess how patient-centered nutrition education affected the eating behavior and clinical outcomes of people with uncontrolled type 2 diabetes mellitus. Method: In this quasi-experimental trial, 178 people with uncontrolled type 2 diabetes were purposely assigned to the intervention (n = 89) or control (n = 89) arm. The intervention arm was given patient-centered nutrition education, whereas the control arm received the routine care. Eating behavior and clinical outcome indicators such as HbAc, lipid profile, anthropometric indices, and blood pressure were assessed in both groups at the start and completion of the intervention. All scale variables were tested for normality and log transformed when appropriate. The baseline characteristics of the intervention and control groups were compared using the t-test for continuous variables and the chi-square test for categorical variables. The effect of nutrition education was determined using a difference in differences (DID) approach. P < 0.05 was established as the criterion of significance. Result: Food selection (DID = 15.84, P < 0.001), meal planning (DID = 31.11, P < 0.001), and calorie needs (DID = 37.65, P < 0.001) scores were statistically higher in the nutrition education arm. Furthermore, their overall eating behavior score (DID = 27.06, P < 0.001) was statistically greater than the controls. In terms of clinical outcomes, the overall picture reveals that the intervention did not outperform over the routine care. However, in comparison to the controls, the intervention arm showed clinically significant improvement in HbA1c (DID = -0.258, P = 0.485). Conclusion: Patient-centered nutrition education has resulted in positive adjustments in the eating behavior of people with uncontrolled type 2 diabetes mellitus. Furthermore, it has shown a great potential for improving their glycemic control.

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

[This corrects the article DOI: 10.1371/journal.pone.0262610.].

Metabolic syndrome distributions in dietary diversity score groups and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia: a community based cross- sectional study.

BACKGROUND: Dietary diversity score has long been recognized as a key component of diets quality balances for healthy life status. However, diets with more variety of food items might increase calorie intake and body weight, which, in turn leads to central obesity (waist circumference).Therefore, this study aims to determine the prevalence of metabolic syndrome among dietary diversity score groups, and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia. METHODS: A total of 915 adults aged ≥ 18 years were randomly recruited in this cross-sectional study.The study was undertaken from June 17, 2019, up to July 27, 2019. To this end, the collected data were entered to Epi Data 3.1 and analysed using and SPSS 25 version. What's more, a multivariable logistic regression was used to assess associated factors of the unrecognized metabolic syndrome; adjusted odds ratio (AOR) with its corresponding 95% CI, at P-value ≤ 0.05. RESULTS: The occurrence of metabolic syndrome was 14.4%, and it is more prevalent in females, 11.15% than males, and 3.25%. The most prevalent components of the metabolic syndrome were low level of high-density lipoprotein, elevated level of triacylglycerol, and waist circumferences. Even though metabolic syndrome is not significantly associated with any of the dietary diversity score groups, its prevalence distribution varies among the groups (6.6% in middle, 5.8% in high and 1.9% in low dietary diversity groups). With potential confounders adjusted, by 75% female was significantly associated with the occurrence of metabolic syndrome than male (102 vs. 29, AOR = 0.25 at 95%CI: 0.15-0.40, P = 0.001). Whereas, age ≥ 35 years old (104 vs. 27, AOR = 2.91 at 95%CI:1.78-4.86,P = 0.001), large family size > 5 (65 vs. 10,AOR = 2.43 95% CI: 1.10-5.36, P = 0.03), overweight and obesity (121 vs. 10, AOR = 6.97, 95% CI: 4.50 -10.83, P = 0.005), elevated total cholesterol (103 vs. 28,AOR = 2.46, 95% CI: 1.47-4.11, P = 0.001), and consuming ( spices, condemns and beverages) ≥ 4 days per week (79 vs. 52, AOR = 0.52, 95% CI:0.33 -0.82, P = 0.005) were positively associated with the prevalence of metabolic syndrome as compared to their counterparts. CONCLUSION: Unrecognized metabolic syndrome was relatively high in the study community. The prevalence of metabolic syndrome varied among dietary diversity groups. But any of the dietary diversity scoring categories was not significantly associated with the occurrence of metabolic syndrome. Thus, awareness needs to be made to practice healthy diet and regular physical activity to maintaining normal body weight. Moreover, early screening of metabolic syndrome should be promoted.

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

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease associated with worse clinical presentation. However, the current investigation practices in Ethiopia have limitations to demonstrate the scope of the clinical burden. Hence, this study was aimed at assessing the glycemic status and coronary heart disease (CHD) risk of persons with T2DM using HbA1c and atherogenic index of plasma (AIP). METHOD: This institution-based cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Demographic, socioeconomic, and lifestyle data were collected through a face-to-face interview. Clinical information was retrieved from medical records whereas anthropometric and biochemical measurements were performed using the WHO protocols. Glycemic status was determined using HbA1c and CHD risk assessed using an atherogenic index of plasma (AIP). Gaussian variables were expressed using mean and standard deviation (SD), Log-normal variables using geometric mean and 95% CI and non- Gaussian variables using median and interquartile ranges. Categorical variables were summarized using absolute frequencies and percentages. Multivariable logistic regression was used to identify factors associated with glycemic control with a statistical significance set at 5%. RESULT: A total of 195 male and 226 female subjects were involved in this study. The results demonstrated that 77% (324) had HbA1c value ≥7% and 87.2% (367) had high atherogenic risk for CHD. Besides, 57% and 67.9% of persons with T2DM had metabolic syndrome according to International Diabetes Federation (IDF) and the National Cholesterol Education Program-Adult treatment panel III (NCEP-ATP III) criteria, respectively. About 36.8% had one or more comorbidities. Having healthy eating behavior [AOR 1.95; CI 1.11-3.43] and taking metformin [AOR 4.88; CI 1.91-12.44] were associated with better glycemic outcomes. CONCLUSION: High AIP level concomitant with poor glycemic control indicates increased risk for coronary heart disease among persons with T2DM in Northern Ethiopia.

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

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.

Predictors of Under Nutrition and Its Implication toward HIV Continuum Care among Adult People Living with HIV in Jimma Zone Public Hospitals, Southwest Ethiopia: A Mixed Method Study.

OBJECTIVES: The study aimed to see predictors of undernourished and its implication towards HIV continuum care. STUDY DESIGN: unmatched case-control study was conducted among 678 individuals in Jimma zone, southwest Ethiopia. METHODS: Randomly selected data of 339 PLWHA who had poor nutritional outcomes (cases) and 339 without undernourished (controls) were analyzed. Logistic regression was used to identify forecasters of undernutrition. The quantitative results were supplemented from key informants who work closely on HIV care, then data were coded and analyzed thematically. RESULTS: Rural residence (AOR:1.8; 95% CI: 1.2, 6.4), female (AOR: 2.9; 95% CI: 1.1, 4.3), unstable livelihood (AOR: 5.1; 95% CI: 4.2, 19.6), low meal frequency (AOR: 6.6; 95% CI: 5.2, 21.1), less diversified foods (AOR: 3.5; 95% CI: 1.2, 14.3), and advanced WHO clinical stage (AOR: 4.3; 95% CI: 3.6, 13.7) and were found to be independent predictors of undernourishment. No social support advanced clinical stage, and unstable livelihood adversely affect nutritional status of PLWHA from the qualitative data. CONCLUSIONS: The socio-cultural, economic, and health-system factors inhibit ideal patient nutritional status. Better tracking, enhanced livelihood and social support along with drug therapy, food aid needs to consider for PLWHA.

Effects of Nutrition Education on Improving Knowledge and Practice of Complementary Feeding of Mothers with 6- to 23-Month-Old Children in Daycare Centers in Hawassa Town, Southern Ethiopia: An Institution-Based Randomized Control Trial.

Undernutrition and hidden hunger threaten the survival, growth, and development of children, young people, economies, and nations. Inappropriate complementary feeding practice due to poor maternal knowledge and awareness in combination with low income and infectious disease is the contributing factor for child undernutrition. Hence, this study was aimed at determining the effect of nutrition education on improving the knowledge and practice of complementary feeding of the mothers with 6- to 23-month old children in daycare centers of Hawassa Town, Southern Ethiopia. An institution-based randomized control trial design was employed. Daycare centers were randomly allocated for the intervention group and the control group. Among the total daycare centers in the town, five were assigned to receive nutrition education and the rest five for the control group (CG). The simple random sampling technique used to select individual participants from each daycare center. Two hundred (200) mother-child pairs (100 for each group) were recruited. Sociodemographic and economic variables were collected by the structured questionnaire. Knowledge of appropriate complementary feeding was assessed by seven knowledge questions. Appropriate complementary feeding practice was assessed by adapting Alive and Thrive Infant and Young Child Feeding (IYCF) practice guidelines. Nutrition education was given for four consecutive months by using Alive and Thrive IYCF guidelines. Data were analyzed by the SPSS software program version 20. The chi-squared test was used to test the significant differences in the proportion of good knowledge and good practice of complementary feeding and good dietary diversity between two groups. The independent t test was used to test the significant differences in mean dietary diversity between two groups. At 95% confidence interval, p < 0.05 was considered statistically significant. The results revealed that the proportion of mothers with good knowledge of appropriate complementary feeding was increased from 59% at pretest to 96% at posttest and the appropriate complementary feeding practice was improved from 54% at pretest to 86% at posttest in IG. There was no change in the knowledge and practice of complementary feeding practice in CG after four months. The proportion of mothers with good complementary knowledge was 54% both at pretest and at posttest and good complementary feeding practice was 51% and 52% at pre- and posttest in CG, respectively. There was no significant difference (p > 0.05) on complementary feeding knowledge and practice between two groups at pretest, while the difference was highly significant (p < 0.05) at the posttest. In conclusion, providing nutrition education improved the appropriate complementary feeding knowledge and practice of mothers. In recommendation, government and other partners working on sustainable child nutrition reduction should focus on the nutrition education to improve the knowledge and appropriate complementary feeding practice including daycare centers.