Individual dietary diversity score for diabetic and hypertensive patients in Cote d ’ Ivoire

Unlike developed countries, monitoring of the alimentation quality is important in developing countries. In recent years, several methods of assessing food consumption using simple tools the 24-hour diet recall have been proposed. This individual dietary diversity score (IDDS) is a simplified method for assessing the quality of diets, defined as the number of food groups represented in the diet over a period of time. We conducted an individual qualitative food consumption survey based on the 24 hours recall method. It was an Interviewer-administered questionnaire was used to collect information. The classification terciles of Dietary Diversity score was obtained from the 14 food groups recommended by FAO. 200 diabetic and 200 hypertensive patients regularly followed in the same hospital (University hospital of Treichville) were included in this study without any distinction about treatment. The average of individual dietary diversity score was to 5.6 ± 1.58 for diabetic against 6 ± 1.94 food groups consumed the day before by hypertensive. Hypertensive patients in our study seemed o better diversity their diet with 8% of them who had a high score against 0.5% for diabetic. The food groups most consumed by our population were cereals, white tubers, other vegetables, fish and oils and fats at the expense leafy vegetables, vitamin A fruits, other fruits and legumes, nuts and seeds. In terms of anthropometric factors, we found the influence of waist circumference on food diversification in diabetic and not from hypertensive. Considering the importance of dietary diversity to nutrition and health, these results show the need to mobilize efforts for ensuring that people have better access to and knowledge about adequate nutrition. Despite the fact that this study has to be performed and that comparisons with other countries are required to harmonize the methodology, our results show the interest of the use of a simple tool to assess the quality of the food within the population. Using of this tool is certainly a future solution for a rapid diagnostic of diets quality. DOI : 10.14302/issn.2379-7835.ijn-16-943 Corresponding author: Dr DERE Kwadjo Anicet Luc, Mail: dereluc@yahoo.fr, Phone: + 00 225 07 73 17 88


Introduction
In contrast to the developed countries where lifestyle diseases like obesity and chronic diseases have taken precedence, the developing world is still dealing with infectious diseases which are compounded by the presence of a nutritious transition (1; 2) . Indeed, the persistence of nutritional deficiencies and infectious diseases on one side and the emergence of other chronic metabolic disorders constitute a double burden detrimental to developing countries (3). This coexistence is associated at low level of economic development, urbanization, poor quality food and poor living conditions (4; 5).
Like in developed countries, the monitoring of food quality is important because malnutrition have a strong influence on mortality and morbidity. In addition to various deficiencies, over nutrition may lead chronic diseases such as diabetes mellitus, gout and cardiovascular disease including high blood pressure.
Thus, chronic diseases related to nutrition in general and both hypertension and diabetes mellitus in particular are a major public health problem in the developing countries. 79% of deaths worldwide attributed to chronic diseases occur in developing countries (6). Nutritional problems are common in poor people whose diets are primarily based on starchy foods and plants (7). These plant-based diets are low in micronutrients, rich in dietary fiber and phytates that inhibit intestinal absorption of micronutrients (8; 9).
However, studies on dietary habits in general and in particular sick Ivoirians are new and need to be evaluated to draw objective conclusions which could help in planning and policy actions.
Over the past, several methods of assessing food consumption using simple tools like the 24-hour diet recall have been proposed. This individual dietary diversity score (IDDS) is a simplified method for assessing the quality of diets, defined as the number of food groups represented in the diet over a period of time (10). The biochemistry department of Medical Sciences (Alassane OUTTARA University), Cote d'Ivoire studied IDDS of different layers of the population. In this study, the aim was to compare food behavior of patients with diabetes mellitus and hypertensive.

Study area:
This study was conducted in the Treichville University Hospital. The recruits of diabetics were done in the area of diabetology internal medicine and the recruitments of hypertensives were done in the cardiology institute of Abidjan.

Study type:
It was an individual qualitative food consumption survey based on the 24 hours recall method.

Population:
During the period of December 2011-April 2012, 200 diabetics and 200 hypertensive adult patients regularly followed in this hospital were included in this present study without any distinction about gender and treatment.

Dietary Assessment:
The 24-hours diet recall method was used to obtain information on dietary intake of subjects. It was conducted by interviewers trained to interview patients.
We asked patients to recall all food eaten and beverages taken in the previous twenty-four hours prior to the interview.  III).

Discussion:
Dietary diversity score consists of the total number of foods or food groups that contribute to the overall diet of an individual over a reference period (11) (22); they concluded that excess energy intake and body corpulence were more depending diets variety than fats intake alone. Predicting excess and imbalance of energy by qualitative study it isn't easy and we must reflect on other ways to characterize excess consumption and food behavior.

Conclusion:
Most of the patients when assessed on individual DDS do not score up to average based on 14 food groups. It is thus considered that the average number of food groups consumed by the subjects over the reference period is poor. We noted that hypertensives and diabetics patients had the same diet behavior.
Fruits and vegetables were the least consumed food groups unlike cereals, fishes, oils and fats. Considering the importance of dietary diversity to nutrition and health, these results shows that there is a need to mobilize efforts for ensuring that people have better access to knowledge about adequate nutrition. It is not surprising that eating a large variety of foods across and within major food groups has been recommended in most dietary guidelines because it is associated with a number of improved outcomes such as nutrient adequacy and better anthropometric indices. Is is important to conduct studies using a harmonized tool so that comparisons between different set-ups is possible.
Our study shows that a simple tool could be used to assess the quality of the food within the population.