SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 7 NUMBER 1 • MARCH 2010
21
night snack (46.7%), foods that are examples of starch or
carbohydrate (46.7%), the importance of fibre in the diet
(43.3%) and foods which are good sources of fibre (46.7%)
suggests that dietary education on these areas may have
been lacking and should be included and/or reinforced during
dietary education sessions. This highlights the importance of
considering exactly which areas of diet-related knowledge
are covered in questionnaires used in studies. An inability to
identify food sources of carbohydrate by half of the sample
was also reported by other researchers.
3
Other studies also
found that children were not able to accurately recall their
meal plans
5,6
with especially poor recall of snacks.
5
The significantly higher diet-related knowledge scores in
children
≥
eight years of age compared to children
<
eight
years of age suggests that diet-related knowledge increased
with age in the sample. This is in keeping with findings from
other researchers who also found an increase in diabetes
knowledge with an increase in age.
2-4
One would expect to
find an improvement in diet-related knowledge as children
get older, as they become more familiar with the key points
of dietary management with time. This finding also suggests
that there might be a specific age at which certain aspects
of diabetes management should be taught for optimal
comprehension and understanding by children with diabetes,
which is also supported by other studies.
3
The frequency of dietetic consultations may have
contributed to the difference in diet-related knowledge
between the two clinics. The higher mean diet-related
knowledge score among the subjects attending the IALCH
clinic could have been due to the fact that the IALCH subjects
attended the clinic on a monthly basis,
21
whereas the subjects
from Grey’s Hospital attended the clinic once every two to
three months.
22
More frequent clinic visits are more likely to be
associated with more frequent dietetic consultations, which
could also have contributed to the higher scores among the
IALCH subjects. It would have been useful to determine if
there was a statistical relationship between the frequency of
dietetic consultations and the diet-related knowledge scores,
but the frequency of dietetic consultations was not recorded
for the purpose of this study.
The fact that there was evidence of healthy weight,
underweight, overweight, at risk of overweight and stunting
shows that the sample had a diverse anthropometric status,
which is in keeping with findings that the problems of
obesity, overweight and moderate stunting co-exist among
South African children.
23
That nine of the 30 subjects were
found to be at risk of overweight is of concern, as being
overweight or obese increases the risk for insulin resistance
and dyslipidaemia, which in turn increases the risk of CVD.
11
An overweight diabetic may also find it more difficult to
achieve good glycaemic control.
24
Children with diabetes
have been found to be heavier than healthy controls at all
ages
25
and females are more at risk of being overweight
compared to males.
25-27
Although two of the 30 subjects that
were overweight were female in this sample, it is interesting
to note that seven of the nine subjects who were at risk of
overweight were male.
It is also of concern that four of the 30 subjects (13%)
were found to be stunted. This prevalence of stunting
was lower than the overall prevalence of stunting of 18%
among South African children, according to the 2005
National Food Consumption Survey – Fortification Baseline
(NFCS-FB).
28
However the prevalence of stunting in this
study does compare relatively closely to the prevalence of
stunting among children in KwaZulu-Natal, which was 15%
according to the 2005 NFCS-FB.
28
Stunting in children with
type 1 diabetes may result from chronic inadequate energy
intake, especially in younger children whose caregivers overly
restrict their dietary intake in an attempt to achieve good
metabolic control.
29
Conclusion
The overall diet-related knowledge of the samplewas relatively
good. Although the majority of subjects seemed to have basic
diet-related knowledge, there was a lack of knowledge in
certain areas, particularly in relation to macronutrients. The
majority of the sample (60%;
n
=
18) had a healthy weight
and a minority (30%;
n
=
9) were at risk of overweight. A few
of the children were stunted (13%;
n
=
4). Both diet-related
knowledge and anthropometric status should be assessed on
a regular basis in all children with type 1 diabetes, in order to
identify and rectify shortcomings in diet-related knowledge
and detrimental anthropometry and growth, respectively.
Although this study has provided useful and important
baseline data in an area that has not been well researched
in South Africa, further studies focusing on specific areas of
diet-related knowledge using larger sample sizes should be
carried out to expand on research in this area. It may also be
useful to assess the diet-related knowledge of caregivers in
future studies as this may also impact on the overall dietary
management of children with type 1 diabetes.
Table 5.
Anthropometric status of subjects (
n
= 30)
Males (
n
) (%) Females (
n
) (%) Total (
n
) (%)
Healthy weight
10 (33.3)
8 (26.7)
18 (60)
Underweight
0
1(3.3)
1(3)
Overweight
0
2 (6.7)
2 (7)
At risk of overweight
7 (23.3)
2 (6.7)
9 (30)
Wasted
0
0
0
Stunted
3 (10)
1 (3.3)
4 (13)
Healthy weight: BMI for age between 5th and 85th percentiles
20
Underweight: BMI for age
<
5th percentile
20
Overweight: BMI for age
≥
95th percentile
20
At risk of overweight: BMI for age between 85th to
<
95th percentile
20
Wasted: weight-for-height
z
-score
<
–2 SD of the median of the reference
population
19
Stunted: height-for-age
z
-score
<
–2 SD of the median of the reference
population.
19
