There is little information on the diets of African diabetic subjects (1), but any nutritional recommendation should be based on the patient’s eating habits (2). In 1999, we investigated 59 diabetic outpatients (30 women and 29 men) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania. Rural and urban areas were represented by 25 and 34 patients, respectively. Six patients had type 1 and 53 had type 2 diabetes. All were assessed using a food-frequency questionnaire.
The patients consumed plantains, highly extracted maize flour (“sembe”), white bread (wheat flour), and polished rice. Major vegetables were amaranth leaves, cabbage, spinach, and carrots. Kidney beans, cow peas, soy beans, and groundnuts were the main pulses, and orange, papaya, and banana the most reported fruits.
Unlike reports from other studies in Tanzania (3,4), beef was remarkably often consumed, followed by milk, fish and eggs. Of our study population, 92% consumed milk regularly, and >30% reported to frequently include fish in their diet.
Commonly, fat intake is low in Tanzania: 12.5% of energy comes from fat as reported by Mazengo et al. (3). However, nearly all patients surveyed used oils or fats for the preparation of meals—mostly sunflower oil (>80%).
In Tanzania, the total intake of carbohydrates accounts for 74–79% of energy (3). The proportion of starchy foods in meals can be reduced by increasing portion sizes of pulses, vegetables and fruits, as the latter foods were usually consumed in small amounts only. However, some patients may have difficulty with the small supply of pulses, vegetables, or fruits. The portion of monounsaturated fatty acids could be increased by including groundnuts and groundnut oil and by replacing meat by fish.
Most patients had BMI >25 kg/m2, indicating energy intakes above the requirements. The first priority for diabetic meal planning is to meet individual energy requirements and to balance the intake of carbohydrates with insulin activity. Of the patients, 64% reported consuming four to six meals, but the majority had less than five meals daily (68%). Individual nutritional advice for meal composition and timing seems to be necessary because of inflexible medical treatment. Weight reduction in overweight and obese patients as well as an intake of five to six meals at fixed times outline the first steps to improve metabolic control through nutrition in northern Tanzania. But nutrition education needs sufficient time for counseling and a sound knowledge basis.
References
Address correspondence to Michael Krawinkel, Institute of Nutritional Science, University Giessen, Wilhelmstrasse 20, D-35392 Giessen, Germany. E-mail: [email protected].
