1.1. BACKGROUND OF THE STUDY
Nutrition as the science of food and its relationship to health has been recognized in recent years as the cornerstone of socioeconomic development (Parks, 2009). Adequate nutrition is important for a variety of reasons, including optimal cardiovascular function, muscle strength, respiratory ventilation, protection from infection, wound healing and psychological well-being (Martin, 2006). Adequate nutrition entails a diet that contains the constituents (carbohydrate, fats, proteins, vitamins and minerals) that are required for body building, energy supply, body defense and regulatory functions in quantities commensurate with the body need. Malnutrition refers to either inadequate intake of nutrients due to lack of food, ignorance, socio-cultural factors, and diseases among other causes, resulting in underweight and other nutrient deficiency diseases; or intake of nutrients in excess of body requirements due to poor dietary habit (erroneously perceived as a sign of affluence), resulting in overweight and obesity. Poor diet (high consumption of sugar, salt, saturated fat, etc) and unhealthy lifestyle (smoking, alcohol consumption and physical inactivity) have been identified as major risk factors of cardiovascular disease and other non-communicable diseases (NCDs). Central to the aetiogenesis of diet induced cardiovascular disease is atherosclerosis, and the factor most important in causing atherosclerosis is a high blood plasma concentration of cholesterol in the form of low density lipoproteins (LDLs). Cholesterol is present in the diet of all people, besides the cholesterol absorbed from the gastrointestinal tract which is called exogenous cholesterol, an even greater quantity is formed in the cells of the body (principally by the liver), this is called endogenous cholesterol. An increase in the amount of cholesterol ingested daily increases the plasma concentration slightly. When cholesterol is ingested, the rising concentration of cholesterol inhibits the most essential enzyme for endogenous synthesis of cholesterol, 3-hydroxy-3-methylglutaryl CoA reductase, thus providing an intrinsic feedback control system to prevent excessive increase in plasma cholesterol concentration. A highly saturated fat diet increases blood cholesterol concentration by 15 to 25%. This results from increased fat deposition in the liver which then provides increased quantities of acetyl-CoA in the liver cells for production of cholesterol. It is therefore important to maintain a diet low in saturated fat as to maintain a diet low in cholesterol in order to decrease the blood cholesterol concentration (Arthur and John, 2010). This fact is corroborated by the findings in ‘the strong heart study’ that reported total fat, saturated fat and monounsaturated fatty acid intake as strong predictors of coronary heart disease (CHD) mortality in American Indians aged 47 to 59 years independent of other established CHD risk factors (Xu et al., 2006). Reports from several studies also show very strong association between diet and development of non-communicable diseases. In a study among female nurses, overweight or obesity was the single most important predictor of diabetes mellitus; also, lack of exercise, a poor diet, current smoking and abstinence from alcohol were all associated with a significant increased risk of diabetes, even after adjustment for the body mass index (Hu et al., 2009). Similarly, in another study in Taiwan by Hung et al. (2015), consumption of preserved and overheated foods was found to be associated with increased risk of esophageal cancer, whereas intake of fresh fruits, vegetables, and tea was inversely associated with this risk. Fruits and vegetables contain phyto-chemicals and antioxidants that protect the body cells from developing cancer. The leading cause of death globally is Non-communicable diseases, killing more people each year than all other causes combined. In Africa, nearly one in four people are hungry; the number of hungry people grew over this period from 175 to 220 million, with nearly 20 million added in the last few years. Only 16 million undernourished people reside in the developed countries (FAO, 2012). Ironically, overweight and obesity are linked to more deaths worldwide than underweight. Of these, over 200 million men and nearly 300 million women were obese. 35% of adults aged 20 years and over were overweight in 2008, and 11% were obese. Overweight and obesity are the fifth leading risk for global deaths. At least 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7 and 41% of certain cancer burdens are attributable to overweight and obesity (WHO, 2013a). However, previous studies among women in Nigeria, majorly examined lifestyle and prevalence of non-communicable diseases (NCDs) or their risk factors, there is a dearth of literature on their dietary pattern and its correlation (if any), with the observed high prevalence of NCDs among them, even though they are prone to consuming the high energy dense foods that they sell to people. This study was conducted to assess the association between dietary pattern, and obesity as a risk for diabetes among mothers in Imo state, Nigeria.
1.2 STATEMENT OF PROBLEM
Both obesity and diabetes mellitus are important independent risk factors for the cause of death in women. Obesity is the leading risk factor for type 2 diabetes. The Centres for Disease Control and Prevention report that 32% of white and 53% of black women are obese. Women with a body mass index (BMI) of 30 kg/m2 have a 28 times greater risk of developing diabetes than do women of normal weight. The risk of diabetes is 93 times greater if the BMI is 35 kg/m2. The presence of diabetes can increase a woman's risk of heart disease 2-fold. In addition, the presence of diabetes overshadows the protective effects of the premenopausal state. The national prevalence rates of diabetes have increased in parallel with the rates of obesity. Diet is one of the major factors now linked to a wide range of diseases including diabetes. The amount and type of food consumed is a fundamental determinant of human health. Diet constitutes a crucial aspect of the overall management of diabetes, which may involve diet alone, diet with oral hypoglycemic drugs, or diet with insulin. Diet is individualized depending on age, weight, gender, health condition, and occupation etc. The dietary guidelines as used in this review are sets of advisory statements that give quick dietary advice for the management of the diabetic population in order to promote overall nutritional well-being, glycogenic control, and prevent or ameliorate diabetes-related complications.
1.3 AIMS OF THE STUDY
The major purpose of this study is to examine association between dietary patterns and obesity as a risk for diabetes among mothers. Other general objectives of the study are:
1. To examine the association between dietary pattern and the occurrence of diabetes mellitus.
2. To examine the association between measures of obesity, diabetes and dietary pattern.
3. To examine the effect of dietary pattern and obesity as a risk for diabetes among mothers in Owerri west L.G.A.
4. To examine the Prevalence of obesity by Body Mass Index, Waist circumference and Waist-Hip Ratio between women of different age groups.
5. To examine the relationship between dietary patterns and Obesity as a risk for diabetes.
6. To examine how to improve health through balanced nutrition.
1.4 RESEARCH QUESTIONS
1. How is the association between dietary pattern and the occurrence of diabetes mellitus?
2. How is the association between measures of obesity, diabetes and dietary pattern?
3. What are the effects of dietary pattern and obesity as a risk for diabetes among mothers in Owerri west L.G.A?
4. Is there Prevalence of obesity by Body Mass Index, Waist circumference and Waist-Hip Ratio between women of different age groups?
5. What is the relationship between dietary patterns and Obesity as a risk for diabetes?
6. What are the ways on how to improve health through balanced nutrition?
1.5 RESEARCH HYPOTHESES
1.6 SIGNIFICANCE OF THE STUDY
This study has the following significance: Owing to the high level of type 2 diabetes and its prevalence in Imo State, Nigeria and the world in general, there is a need to study the diet intake of these patients so as to assist them to understand how to modify their diet. This will improve their health condition and also the development of the community.
1.7 SCOPE OF THE STUDY
The study is based on the association between dietary patterns and obesity as a risk for diabetes among mothers in Owerri West L.G.A.
1.8 LIMITATION OF STUDY
Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
1.8 DEFINITION OF TERMS
Body mass index (BMI) was calculated as weight (kg) divided by height2 (m2 ) and used as marker for nutritional status (Tsigos et al., 2008). Underweight was defined as BMI less than 18.5 kg/m2 , normal weight was defined as BMI of 18.5 to 24.9 kg/m2 , overweight was defined as BMI of 25.0 to 29.9 kg/m2 , while obesity was defined as BMI of 30.0 kg/m2 and above.
Dietary pattern: Patterns of dietary intake depicting foods eaten in combination with other foods, allowing for a more accurate assessment of an individual’s diet as opposed to an analysis of individual food items, food groups, or nutrients (Hu, 2013).
Glucose intolerance (aka impaired glucose tolerance aka impaired fasting glucose): Another term for pre-diabetes that describes a transition phase between normal blood glucose and diabetes (Impaired glucose tolerance, 2012).
Diabetes: A condition in which the body produces insufficient insulin to adequately control the amount of sugar in the blood. For purposes of this study, all references to “diabetes” will pertain to Type 2 diabetes and participants with Type 1 diabetes or gestational diabetes will be excluded (Diabetes, n.d).
Type 2 diabetes mellitus (T2DM): A chronic disease characterized by an abnormally high level of glucose in the blood. The normal range is 70-100 mg/dL, and a level greater than or equal to 126 mg/dL usually indicates diabetes (Type 2 diabetes, 2013).
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