Factors Associated With Adherence to Low Protein Diet Among Patients With Stage III-V of Chronic Kidney Disease in an Outpatient Clinic at Hospital Pakar Sultanah Fatimah

@#Introduction: Although the benefit of low protein diet (LPD) on chronic kidney disease (CKD) progression is well documented, patients’ adherence remains as the main challenge. Therefore, this study sought to identify adherence towards LPD among CKD patients and determine possible associating factors. Methods: This cross-sectional study was done at the Hospital Pakar Sultanah Fatimah in Muar, Johor, among stage III to V CKD patients. Three-day dietary recalls were used to quantify dietary energy (DEI) and protein intake (DPI). Factors investigated include socio-demographic characteristics, medical history, anthropometry and body composition measurements, dietary knowledge, appetite level, handgrip strength, perceived stress, and health locus of control. Associating variables were analysed with logistic regression analysis. Results: The final analysis included 113 patients (54% male) with a mean estimated glomerular filtration rate of 17.5±11.2mL/min/1.73m2 and the average age of 56.3±12.8 years. Mean DEI and DPI were 22.4±5.9kcal/kg/day and 0.83±0.28g/kg/day, respectively. Only 34.5% of patients adhere to the LPD diet with 59% exceeding the DPI recommendation. Poorer LPD adherence was associated with longer duration of hospitalization (OR 0.707, 95%CI 0.50-1.00, p=0.048), higher energy intake (OR 0.744, 95%CI 0.65-0.85, p<0.001), advance CKD stage (OR 0.318, 95%CI 0.13-0.77, p=0.012) and having better dietary knowledge (OR 0.380, 95%CI 0.170.85, p=0.018). Conclusion: LPD adherence of CKD patients in our institution is very poor signifying the need for engagement at the earlier stage of CKD to identify and stratify the patients for a targeted dietary intervention.

Adherencia a la dieta en pacientes diabéticos: efectos de una intervención / Adherence to diet on diabetic patients: effects of an intervention program

El presente trabajo tuvo como objetivo evaluar el efecto de un programa de intervención en la adherencia autoreportada a la dieta prescrita para pacientes diabéticos. Dado el costo y consecuencias de esta enfermedad, resulta muy importante lograr este objetivo que constituye la piedra angular del tratamiento. Desde la perspectiva interconductual,se diseñó un programa de intervención que se aplicó a 90 pacientes diabéticos captados en distintos centros de salud de la ciudad de México. El programa constó de una fase de pre-evaluación, en la que se midió el peso y se registraron prácticas alimenticias; una intervención en dos bloques, el primero educativo y el segundo en el que se entrenó en el manejo de algunas técnicas conductuales; y una fase de post-evaluación. Se encontró que cada bloque de intervención tuvo un efecto positivo en la adherencia autoreportada a la dieta y, por ende, el programa en su totalidad fue efectivo en esta muestra de pacientes. Los resultados se corroboraron con las medidas de peso en las que también se encontró una diferencia estadísticamente significativa entre el pre-test y el post-test. Se sugiere continuar buscando estrategias cada vez más efectivas para el logro de este objetivo.

The purpose of the present study was to assess the effect of an intervention program on the self-reported adherence to a prescribed diet for diabetic patients. Because of the impact and consequences of this chronic illness, it is important to make the necessary efforts in order to achieve this dietary adherence goal, since diet is one of the main bases for the treatment of diabetes. According to an interbehavioral approach, an intervention program was designed and applied to ninety diabetic patients from different Mexican public health institutions. This program was developed in three stages. The first stage consisted of a pre-test to assess body weight and habits related to daily meals. The second stage comprehended an intervention divided in two parts, the first one to provide patients with useful knowledge about diabetes and nutrition and the second one to train several behavioral techniques a post-test was applied to participants. Results showed that each intervention’s part had a positive effect on self-reported adherence to diet, and so the complete program. These results were supported by weight data. In this sense, it was found a statistically significant difference between pre and post-test values. It is suggested to continue these efforts in order to contribute on the solution of this public health problem.

Adherencia e impacto de la dieta sin gluten en niños con enfermedad celíaca / Adherence and impact of gluten free diet in children with celiac disease

The treatment of Celiac Disease (CD) is a strict and permanent gluten-free diet (GFD). Factors exist that influence adherence: motivation, information, costs, correct labeling and food availability. Objectives: Describe adherence and impact of GFD in children with CD. Patients and Methods: Prospective descriptive study, through application of a 28 question survey to children 12-18 y.o. with the disorder, and parents of children 3-18 with the disease. Results: Median age: 10.5 years, 1.8 years at diagnosis. 62.5 percent women. Adherence to treatment was seen in 42,5 percent of patients according to parents, 15 percent according to children > 12 yrs. vs 35 percent parents of children > 12 y.o. 80 percent of children state feeling no different on a diet, 70 percent find the diet hard to follow. 55 percent have difficulty following the diet, among them, 42,8 percent are not sure what they can eat, 51.5 percent state it creates financial distress in the family. About 55 percent believe it affects family life due to the following: 55 percent food limitation, 50 percent food preparation, 75 percent affect eating out, 35 percent affect traveling. 50 percent of parents have fed children a forbidden food, mainly at home (44 percent). Information regarding GFD is obtained at the hospital (85 percent). There is 32.5 percent adherence to CD foundations. Conclusions: GFD impacts children's lifestyle with difficulty in adherence and management.

El tratamiento de la enfermedad celíaca (EC) es la dieta libre de gluten (DLG) estricta y permanentemente. Existen factores que influyen en adherencia: motivación, información, costos, rotulación y disponibilidad de alimentos. Objetivos: Describir adherencia e impacto de DLG en niños celíacos. Pacientes y Método: Estudio descriptivo y prospectivo con aplicación de encuesta de 28 preguntas a niños celíacos > 12 años (12-18 años) y a padres de pacientes celíacos entre 3 y 18 años. Resultados: Edad media 10,5 años y al diagnóstico 1,8 años, 62,5 por ciento mujeres. Adherencia 42,5 por ciento según total de padres; 15 por ciento según niños > 12 años vs 35 por ciento padres de niños > 12 años. El 80 por ciento refiere no sentirse distinto, 70 por ciento encuentra DLG difícil de seguir. 55 por ciento le molesta seguirla porque no saben que comer (42,8 por ciento), siendo la principal dificultad de los padres económica (51,5 por ciento). Un 55 por ciento cree que influye en la vida familiar: limitación alimentos (55 por ciento), preparación especial (50 por ciento), comer fuera de casa (75 por ciento), viajes (35 por ciento). El 50 por ciento de padres ha dado alguna vez alimentos prohibidos a sus hijos, principalmente en casa (47 por ciento). La información de DLG la obtienen en hospital (85 por ciento). Existe 32,5 por ciento adherencia a fundaciones celíacas. Conclusiones: La DLG implica impacto en la vida de niños celíacos, existiendo dificultades en el manejo y regular adherencia a ella.