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Do our elderly diabetic patients keep the diet?
Primary care evaluation from Hungary
The medical nutritional therapy has high importance in the management of diabetes mellitus. The aim of this study was to collect information on how the diabetic elderly follow medical advices regarding nutrition. A population of 291 persons were selected consecutively from primary care patients in Hungary. Ninety-five type 2 diabetes patients were compared to 196 non-diabetics, focusing on nutritional habits, life style elements and anthropological parameters. The diabetics were mainly overweight or obese and educated at lower levels. People with higher BMI (Body Mass Index) have eaten less frequently than people in the normal BMI range. The daily food frequency of diabetics was higher only on weekends and holidays. There were only minimal differences concerning food choices as well. The differences in the diet proved smaller than expected and recommended. The time spent with physical activity was low in general, especially among diabetics. The self-judgement showed that only 49% of diabetics kept their eating habit as healthy, vs. 63% of non-diabetics. The food choices were also modified by the economic situations of patients. It was observed that the majority of elderly diabetics did not pay enough attention to correct diabetic diet, therefore, they should be controlled more effectively by primary care staff.
The epidemiological importance and serious health consequences of obesity is one of the most important medical issues. This cross-sectional study, including retrospective elements, aims to measure the occurrence and to seek for the possible reasons of obesity among elderly people in Hungary. The 266 elderly subjects (109 man over and 157 women over 60 years) were consecutive selected in primary care setting. Questionnaire on eating habits and life style, dietary record, medical check-up, anthropological measurements were performed. During the aging the meal frequency becomes more regular. People with lower body mass index ate frequently than overweight (BMI: 25–30 kg/m 2 ) or obese persons (BMI>30 kg/m 2 ). Obese people represented a smaller proportion in the older decades. According to the retrospective body-weight analysis the increase of body weight was significantly higher in the obese group then in the overweight category and by normal weighted people. Daily energy intake was high in both genders. In the obese group the ratio of people educated in primary school only, was much higher. The food choices were influenced by economic reasons in two-third of the studied population. Thirty percent of obese people had obese parents and 24% of them had obese children. Unfavorable nutritional habits and sedentary life style may have a prior responsibility for obesity. Prevention and medical intervention should be started in time at primary health care level.
The aim of this study was to investigate the nutritional habits and lifestyle practice of elderly people living in their own home. Altogether 213 subjects (men over 65 years, women over 60 years), were recruited randomly from a primary care office in Budapest. Nearly 60% of people had three meals per day, but the number of meals increased during ageing. The most substantial meal was the lunch. Meals were prepared at home by 90% of the elderly. Lard for cooking was used by 44% of subjects. Additional use of salt was never mentioned by 18% of seniors only. Milk, dairy products, fish, fruits, fresh vegetables and vegetable dish were consumed far below the recommendations. All types of meat were radically decreased, especially beef compared to former Hungarian surveys and the data of the Hungarian Central Statistical Office. Almost one-third of the elderly took some kind of vitamins and/or mineral supplements. The average time spent with outdoor activity was only 12 h per week.In relation to non-infectious diseases connected with nutrition, the irregular consumption of food has to be underlined. The insufficient consumption of milk and dairy products may have an unfavourable effect on the bone status. Deficient consumption of fruits, vegetables and cereals may play a role in the development of cardiovascular diseases and certain types of tumours. The exaggerated salt intake has to be taken into account mainly in hypertension. The inadequate physical activity may be also responsible for decreased longevity of our population.
Nutrition and lifestyle-related diseases are some of the leading morbidities among the Hungarian population. People who want to lose weight often complain that healthy diet is expensive.
Our aim was to quantify the costs of three different types of diet for a three-day period. We compared “traditional Hungarian”, low energy, and diabetic diets, considering both energy content and expenses related to lifestyle.
According to our estimation: diabetic (including medication) and ”traditional” Hungarian diets were the most expensive. Low energy diet proved to be the most cost-effective despite the extra expenditures of higher physical activity.
Obesity is an important risk factor of cardiovascular diseases. Dietary intervention combined with life style changes were implemented in other countries and proved to be effective. Previously, there were no similar Hungarian experiences.The aim of our study was to screen overweight and obese patients in primary care settings, to involve them in an interventional program and to analyse the expected changes in the laboratory and anthropometric parameters.From 29 primary care practices, 2489 overweight or obese patients were recruited between April of 2004 and 2006.The characteristics of living circumstances, life style, eating and exercise habits were explored by questionnaire. Regular energy intake was counted and compared to estimated requirements. Metabolic and anthropometric parameters were measured. Experienced multi-disciplinary staff was involved, including internist, family physicians, dietetitian, experienced nurses and physical instructors. The interventions were: dietary (recommendation of low calorie diet) and increasing physical activity.One year later the body mass index decreased significantly by 0.56 kg m−2 average and remained about the same by the end of the second year. There was only a small decrease in waist circumference. The rest systolic blood pressure decreased significantly on average 5.9 mmHg by the end of the first year, while decrease in resting diastolic blood pressure was less. All metabolic parameters, except HDL-cholesterol decreased significantly: total cholesterol: by 0.23 mmol l−1, trigliceride: by 0.18 mmol l−1, blood glucose: by 0.15 mmol l−1.Primary care intervention proved to be effective. Better outcomes would be expected, when more resources, more focus in the media, more support from health authorities and sufficient manpower was available.
The aim of this study was to evaluate the nutritional status of elderly belonging to one primary care office. Twenty-seven men and 26 women, all over 60 years, were involved. Nutritional assessment, anthropometric measurements were performed, serum proteins, lipid and iron status and haematological parameters were determined. Energy and protein intake was sufficient, but the distribution of energy with a high fat and low carbohydrate was inadequate. Iron, copper, calcium, retinol and folate intake was lower, whereas sodium, ascorbic acid and cobalamin intake was higher than the Hungarian recommendation. The prevalence of obesity characterized by body mass index or waist circumference was higher in women than in men. The percentage of pathological levels of lipid parameters was also higher in women. No iron deficient erythropoesis was detected, but high serum ferritin concentration as a marker of body iron store was determined in some cases. General practitioners have possibilities to influence the nutritional habits of elderly, thereby reducing the incidence of obesity, cardiovascular diseases and stroke. Iron status of Hungarian elderly looks to be satisfactory, so supplementation without testing the iron status would be useless and harmful.
