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Unhealthy diets common among prediabetics

Tristan Manalac
31 Oct 2018

Unhealthy eating behaviours appear to be relatively common among prediabetics in Singapore, Dr Wee Wei Keong said during an oral presentation at the recently concluded 16th Singapore Health and Biomedical Conference (SHBC 2018).

“About two out of every five of our prediabetes patients were not embracing healthy dietary practices,” a problem exacerbated by the lack of adequate education and awareness of the potential risks, according to Keong, who directs the Health Promotion & Preventive Care division at National Healthcare Group Polyclinics.

Administering self-completed surveys to 433 community-dwelling prediabetes patients across eight clinics in Central, Northern and Western Singapore, Keong and his team found that only 57.3 percent of their study sample were able to successfully fulfil the healthy plate requirements. A large proportion (40.4 percent) fell short of this goal.

In multivariable Poisson regression models, participants of Malay ethnicity (adjusted prevalence ratio [PR], 0.81; 95 percent CI, 0.70–0.95; p=0.008) and those who were not married (married vs single: adjusted PR, 1.38; 1.13–1.68; p=0.001) were significantly less likely to be adhering to healthy eating behaviours.

The same was true for participants who frequently ate out on a weekly basis (adjusted PR, 0.96–0.98; p<0.001) and those with high consumption of deep-fried foods (adjusted PR, 0.90; 0.82–0.98; p=0.02).

“These are the vulnerable groups,” said Keong. “This suggested to us that if … you wanted to focus lifestyle modification strategies, these are the groups that we ought to work on.”

Importantly, the surveys also revealed that only about a fourth (26.6 percent) of the prediabetic patients had ever received education about their condition, while almost half (49.2 percent) perceived that they were not at risk of eventually developing diabetes.

“This pointed to very clear communication deficiencies in our model of care,” Keong said.

There is thus a need to strengthen the communication and educational efforts and to reach more prediabetes patients, he added. This will involve improving the understanding of the disease, the risk of progression into diabetes, and the importance of lifestyle and diet modifications.

The present study had two phases: a quantitative arm, including self-accomplished surveys, followed by a qualitative arm involving in-depth interviews employing open-ended and scripted questions. Among those who consented to be surveyed for phase 1, 48 patients agreed to be part of phase 2.

Basing on the social-ecological models, researchers showed that there were five broad streams under which different barriers to healthy dietary behaviours fell: individual, interpersonal, organisational/institutional, community and societal/policy influences.

For instance, the lack of skills to prepare healthy food and the personal belief that healthy food is not appetising are categorised under individual influences, while the prohibitive costs of healthy food fall under institutional barriers.

However, of these streams, Keong focused on the role of interpersonal impact, particularly on the importance of influence from family. One respondent, for example, mentioned that because her husband preferred meat to vegetables, she tends to adopt the same diet.

“What the family eats affects their choice of food,” he said.

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