ABSTRACT
Introduction: The prevalence of obesity among people diagnosed with Type 2 Diabetes Mellitus (T2DM) has been widely documented. However, the specific composition of this bodyweight remains largely unknown. The study aimed to understand the body composition of T2DM patients using the bioelectric impedance analysis technique, comparing findings to sex and agematched controls. Materials and Methods: A comparative case-control study was carried out among 139 known cases of Type 2 diabetes aged 18 to 78 years randomly sampled from the diabetic clinic of Mbarara Regional Referral Hospital. We matched them to 139 hospital controls who were healthy non-diabetic attendants. Body composition parameters were computed and summarized as medians and interquartile ranges. Differences in the medians of body composition parameters were further assessed using the Mann- Whitney U test. Fat-free and fat mass indices were derived to offer a precise estimation of body composition parameters adjusted for height differences among study participants. Results: Cases had significantly higher median systolic blood pressure, pulse rate, weight, Body Mass Index (BMI), Waist-Hip Ratio (WHR), total fat percentage, fat mass amount, Fat Mass Index, visceral fat, and metabolic age than their counterparts, whereas controls had significantly higher median total body water percentage versus cases. The highest significant differences occurred in fat percentage composition (Cases: ß: 6.9 (95% C.I: 4.4, 9.4); Controls: Ref) followed by visceral fat (Cases: ß: 3.5 (95% C.I: 2.5, 4.4); controls: Ref) and Fat Mass Index (Cases: 95% C.I: 2.6 (95% C.I: 1.6, 3.7). Cases had significantly higher Fat Mass Index, visceral fat and fat percentage (all p<0.05) than controls. Conclusions: Routine assessment of body composition of T2DM patients needs to be done to assess the amount, type and pattern of weight gain to prevent increases in adiposity.
ABSTRACT
Introduction: The first-year post-diagnosis is the most challenging and stressful period in the lifetime of a young child and adolescent living with diabetes, given the adjustments that are meant to be adopted. Therefore, psychosocial factors affecting newly diagnosed children and adolescents need to be well understood and children supported to improve treatment adherence. However, evidence concerning psychosocial experiences among young patients with diabetes is scant in Uganda. This study explores the perceptions and experiences of newly diagnosed children and adolescents in Uganda. Methods: A qualitative exploratory design was employed. We recruited participants aged 6 to <18 years diagnosed within twelve months from three study sites: Mulago National Referral Hospital, Wakiso HCIV, and St Francis Nsambya Hospital. Twenty in-depth interviews were conducted, and textual data were analysed thematically using a framework approach. Results: We identified five themes: battling with symptoms, emotions at diagnosis, challenges in coping with diabetes management, changes I have made, and positive outcomes registered. The analysis found that young people living with diabetes experience a new world of adjustments, including insulin therapy, routine blood glucose monitoring, and dietary changes that are often difficult to deal with, especially in the first year after diagnosis. Discussion: Continuous psychosocial support to newly diagnosed young children and adolescents with T1DM is vital. Addressing psychosocial challenges may improve adherence to treatment regimens. Conclusion: Our findings have demonstrated the mixed experiences of newly diagnosed young children and adolescents living with diabetes, from anxiety and stigmatization to independence.
ABSTRACT
Background: Changes in body composition have been suggested as an intractable effect of Type 1 Diabetes Mellitus and its management. This study aims to compare body composition characteristics in a sample of young children and adolescents with Type 1 Diabetes Mellitus with healthy controls. Methods: In this case−control study, body composition was assessed using bioelectrical impedance among 328 participants. Anthropometric measurements included weight, height, upper arm, hip, and waist, circumferences; biceps; triceps; and subscapular and suprailiac skinfolds. From raw Bioelectrical impedance data, we calculated the impedance, phase angle, and height normalised resistance and reactance to assess body composition. Analysis of variance accounting for paired blocks was used to compare the two matched groups, while an independent Student's t-test was used for intragroup comparisons among cases. Results: Waist Hip Ratio, biceps, triceps, subscapular and suprailiac skinfolds were higher among cases than in controls. Cases showed a higher Fat Mass Index, higher fasting blood glucose and higher glycated haemoglobin. Cases also had a higher mean value of resistance (p = 0.0133), and a lower mean value of reactance (p = 0.0329). Phase angle was lower among cases than in controls (p < 0.001). Conclusion: Our diabetic children showed higher levels of adiposity than controls. The observed differences in body composition are explained by differences in the fat-mass index. Abdominal fat accumulation was associated with poor glycaemic control and a lower phase angle.
ABSTRACT
Background: Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes mellitus (T2DM). The extensive diversity in food culture and habits in India pose a challenge in devising a uniform low-calorie diet plan. Though there are a number of studies related to different diet therapies, there exists limited evidence on culturally contextualized low-calorie diet plans and their process in India. The objective of the study is to test the suitability, acceptability, and feasibility of a culturally contextualized low-calorie diet among women with high risk for T2DM in Kerala. Method: We employed a four-stage equal-status sequential design for this study. Firstly, in-depth interviews (n = 10) were conducted to understand the modifiable and non-modifiable components of the usual diet for diabetes prevention. Secondly, we developed a low-calorie diet plan (1500 kcal per day) based on the local preferences and availability. Thirdly, we piloted the diet plan among 18 individuals in the community to know its acceptability. Fourthly, in-depth interviews were done (n = 4) among pilot participants to understand the feasibility of pursuing it through facilitators and barriers to implementing the diet plan. Results: Low-calorie diet plan was suitable for this setting as the burden of diabetes is very high and the diet plan had dietary components similar to the usual diet. Though participants had an intrinsic motivation to follow a healthy lifestyle, several systemic challenges such as the high cost of healthy foods options (fruits and vegetables), rice addiction, and food preferences driven by peer pressure act as hurdles. Conclusion: Apart from culturally contextualizing the low-calorie diet, it is important that complementary strategic measures such as reorientation of the public distribution system and subsidizing fruit and vegetable production and cost are required for the suitability, acceptability, and feasibility of implementation. Supplementary Information: The online version contains supplementary material available at 10.1007/s13410-022-01134-8.
ABSTRACT
The purpose of the review is to explore the interlinkages between diabetes, insulin therapy, and body composition and discuss the need for body composition assessment as part of the routine nutrition and health assessment of children living with diabetes especially in resource limited contexts with a case study of Uganda. Changes in body composition have an intractable effect of Insulin Dependent Diabetes Mellitus and its management. The association between diabetes and body composition has the potential to lead to adverse health outcomes, especially in later years of life. Health practitioners shall devise strategies to efficiently monitor the body composition of young diabetics at an early stage to revert the life threatening complications among young diabetic patients.
ABSTRACT
Background: There is limited data from Africa on the effect of pre- and post-natal growth and infant feeding on later body composition. This study's aim was to investigate the effect of birth weight, exclusive breastfeeding and infant growth on adolescent body composition, using data from a Ugandan birth cohort. Methods: Data was collected prenatally from pregnant women and prospectively from their resulting live offspring. Data on body composition (fat mass index [FMI] and fat free mass index [FFMI]) was collected from 10- and 11-year olds. Linear regression was used to assess the effect of birth weight, exclusive breastfeeding and infant growth on FMI and FFMI, adjusting for confounders. Results: 177 adolescents with a median age of 10.1 years were included in analysis, with mean FMI 2.9 kg/m 2 (standard deviation (SD) 1.2), mean FFMI 12.8 kg/m 2 (SD 1.4) and mean birth weight 3.2 kg (SD 0.5). 90 (50.9%) were male and 110 (63.2%) were exclusively breastfeeding at six weeks of age. Birth weight was associated with FMI in adolescence (regression coefficient ß= 0.66 per kg increase in birth weight, 95% confidence interval (CI) (0.04, 1.29), P=0.02), while exclusive breastfeeding (ß= -0.43, 95% CI (-1.06, 0.19), P=0.12), growth 0-6 months (ß= 0.24 95% CI (-0.43, 0.92), P=0.48) and growth 6-12 months (ß= 0.61, 95% CI (-0.23, 1.46), P=0.11) were not associated with FMI among adolescents. Birth weight (ß= 0.91, 95% CI (0.17, 1.65), P=0.01) was associated with FFMI in adolescence. Exclusive breastfeeding (ß= 0.17, 95% CI (-0.60, 0.94), P=0.62), growth 0-6 months (ß= 0.56, 95% CI (-0.20, 1.33), P= 0.10), and growth 6-12 months (ß= -0.02, 95% CI (-1.02, 0.99), P=0.97) were not associated with FFMI. Conclusions: Birth weight predicted body composition parameters in Ugandan early adolescents, however, exclusive breastfeeding at six weeks of age and growth in infancy did not.
