Assessing Relationship between Dietary Pattern, Antioxidant Micronutrients Status and Risk of Cardiovascular Diseases among Type 2 Diabetic Outpatients at Komfo Anokye Teaching Hospital

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Cardiovascular diseases are associated with type 2 diabetes mellitus and concurrently, responsible for 68% cause of mortality among type 2 diabetics. Antioxidant micronutrients level can delay or prevent diabetic complication such as cardiovascular diseases. The study aims to assess relationship between dietary pattern, antioxidant micronutrients status and risk of cardiovascular diseases among outpatient type 2 diabetics. A cross sectional study was conducted on 152 outpatient type 2 diabetic patients. The BMI, waist circumference, fasting blood glucose and serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), very low density lipoprotein (VLDL), coronary risk, atherogenic index of plasma, and serum zinc were determined. Data was collected with questionnaires. Dietary intakes of antioxidants were assessed using 24-hour dietary recall and food frequency questionnaire. Data were analyzed using SPSS version 23. Out of the 152 study population, 37 (24.3%) were males and 115 (75.7%) were females. Generally, 74.3% of type 2 diabetes patients had high FBG and 64.6% had high HbA1c. The prevalence of single dyslipidemia (63.8%), combined dyslipidemia (15.8%) and mixed dyslipidemia (1.3%) was found among study participants. Furthermore, 35.3% of type 2 diabetic patients had high coronary risk and 5.3% had high atherosclerosis risk. Coronary risk was strongly associated with TC, (r = 0.695, p value < 0.000) and LDL-C, (r = 0.783, p value < 0.000). Moreover, atherosclerosis risk was strongly associated with TG, (r = 0.775, p value < 0.0001), VLDL, (r =0.778, p value < 0.0001) and inversely associated with HDL-C (r=-0.283, p=0.003). A logistic regression showed TC, TG, LDL-C had significant effects on coronary risk (TC: OR= 2.640, 95% CI= 1.879-3.708, p value < 0.0001, TG: OR= 2.549, 95% CI= 1.342-4.841, p value =0.004, LDL-C: OR= 4.858, 95% CI= 2.902-8.135, p value < 0.0001 respectively). The mean intakes of zinc (5.04±2.76 mg/day), vitamin E (5.16±2.60 mg/day) and vitamin C (82.72±38.76 mg/day) were lowered among type 2 diabetic patients. Dietary vitamin E was directly associated with HbA1c, (r = 0.220, p value = 0.033), TC, (r = 0.260, p value = 0.011), LDL-C (r = 0.267, p value = 0.009) and TC/HDL-C ratio, (r = 0.217, p value = 0.036), after adjusting for age and gender. Also, when controlling for age, gender and dietary zinc; serum zinc was inversely associated with HbA1c (r = -0.227, p value = 0.05) and FBG, (r = -0.206, p value = 0.033). In conclusion, cardiovascular risk factors such as hyperglycemia, dyslipidemia, abdominal obesity, coronary risk were high among type 2 diabetic patients. Dietary intakes of antioxidant micronutrients as well as serum zinc were seen low among study participants. Poor dietary intakes of antioxidant micronutrients and reduced serum zinc, together with high cardiovascular risk factors may put outpatient type 2 diabetics at high risk of developing cardiovascular diseases.
A thesis submitted to the Department of Biochemistry and Biotechnology in partial fulfillment of the requirements for the award of a Master of Philosophy Degree in Human Nutrition and Dietetics