Challenges faced by dietitians working in various cities of Pakistan

Background: Dietitians are trained professionals who play a crucial role in providing personalized food and nutrition guidance for people in different health conditions. They are invaluable members of society, as they have a significant impact on individuals' wellbeing and, ultimately, the health of entire communities within a country. Primary Study Objective: This paper investigates the challenges faced by dietitians in various cities of Pakistan. Methods/Design: It is a cross-sectional study conducted by NutritionFoundation of Pakistan (NFP). Setting & Participants: This study is based on the survey data obtained from students and graduates of the Human Nutrition and Dietetics program from different cities of Pakistan via an online questionnaire including questions about demographic variables and 10 items that inquired about perceived challenges faced by dietitians. The data was analyzed by SPSS 20 and presented as frequency and percentages for demographic variables and mean score with standard deviations (SD) for different variables of a 10-item questionnaire for perceived challenges by dietitians. Statistical significance was determined at the 0.05 level. Results: Results indicate that the province of Sindh (mainly Karachi city) has the highest number of respondents, succeeded by Punjab (mainly Lahore city). Severity scores for perceived challenges faced by Dietitians indicated that the primary challenge is the low salary that is specially faced by dietitians from Karachi and the least scored challenge is unavailability of resources for continuing nutrition education which is mostly faced by dietitians from Peshawar. Comparison of perceived challenges among Dietitians in the Dietetic role, non-dietetic role, not working and students’ revealed difference in scores among these groups based on their job, experiences and perceptions. Conclusion: The findings of this study clearly highlighted the challenges and issues faced by Pakistani dietitians. The main challenges turned out to be low salary, undefined promotion criteria and lack of opportunities. These investigations can lead to the development of polices for dietitians to promote their careerdevelopment and lessen the burden of nutrition related diseases in the country

Relationship among Fatness, Blood Lipids, and Insulin Resistance in Pakistani Children

Observations on associations between fatness and metabolic risks among South-East Asian adults have resulted in devising lower thresholds of body mass index (BMI) for them. Metabolic abnormalities, including type 2 diabetes, are now also appearing in children and are associated with obesity. There has not been much work done to identify indicators of metabolic risks among South Asian children. This study was undertaken to observe the relationship among fatness, blood lipids, and insulin resistance in Pakistani children. Fatness, lipids, and insulin resistance were assessed in 92 middle-class Pakistani school children aged 8-10 years. Height, weight, waist, hips, mid-arm circumference, and triceps skin-fold, measured in school, were used for calculating various indicators of fatness, i.e. BMI, waist hip ratio (WHR), and arm-fat percentage. Fasting blood samples were analyzed for total lipids, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and insulin levels. Homeostasis model assessment (HOMA) index was calculated to assess insulin resistance. Two separate multiple regression models of various risk indicators (family history, sex, BMI, WHR, arm-fat percentage) showed that only arm-fat percentage had a significant positive association both with insulin levels (b=2.04, p= 0.044) andLDL (b= 2.11, p= 0.037). Only five children were overweight(BMI-for-age>85th percentile according to National Center for Health Statistics 2000 reference). Neither overweight children nor those who were in the uppermost tercile of BMI-for-age differed significantly from other children in terms of presence of higher-than-desirable values of lipids or insulin. However, compared to those in the lowest tercile, children who were in the uppermost tercile of arm-fat percentage had a significantly higher frequency of high blood cholesterol (40% vs 67%, p=0.027), high LDL (33.3% vs 61.3%, p=0.026), and markedly higher proportion above average insulin levels (16.7% vs 35.5%, p=0.083). Arm-fat percentage could be developed as a practical tool for determining the risk status of children. However, further cross-sectional assessments are needed to ascertain accurate relationships among arm-fat percentage, lipid profiles, and insulin resistance in larger and varied groups of children

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15–19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.publishedVersio

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio

Food choices during Ramadan

Few studies have assessed the dietary Practices of people with diabetes during Ramadan (1). A sub study of Ramadan prospective diabetes study (2) which was conducted at the outpatient department of Baqai Institute of Diabetology and endocrinology, Karachi Pakistan in 2009 analyzed the food choices of patients with diabetes during Ramadan. Several irregularities regarding dietary intake and food choices were noted among the study participants. Although, the patients were counseled regarding diet before Ramadan, many did not follow the dietary advice. All patients had taken food at Iftar but majority of them preferred fried items like samosas, pakoras (fried snack), chicken rolls etc. these deeply fried items can lead to post Iftar hyperglycemia. Patients were also opted for fruit chat, dahibara and chanachaat at Iftar, higher load of these items can also worsen glycemic control. The striking finding was almost absence of meat (protein) intake at Iftar but study from India showed increment of all three macronutrients during Ramadan (3). This may result in higher intake of items from carbohydrate and fat groups resulting in hyperglycemia after iftar. Intake of vegetables at Iftar was also negligible and hence the diet was not well balanced. The food choices at sahoor included roti, paratha (fried bread), slices, khajla, pheni, meat, egg and milk. Though it is advisable to take complex carbohydrates, protein and fat at sahoor as these are slowly digestible and can prevent hypoglycemia during fasting but khajla pheni are extremely rich in fat and carbohydrate content and should be avoided (4). However, paratha in 2 teaspoon of oil can be taken at sahoor.Patients with diabetes who fast during the month of Ramadan should have pre Ramadan dietary guidance and counseling session in order to modify their food preferences and choices during the holy month of Ramadan (4).</span

Association of dietary patterns with glycated haemoglobin among Type 2 diabetics in Karachi, Pakistan

Background: Dietary habits and sedentary lifestyle are major risk factors for rapidly rising incidence of type 2 diabetes. Aim: This study aims to study the association of dietary patterns with glycated haemoglobin (HbA1c) among type 2 diabetics in Karachi. Setting: Individuals attending outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi, Pakistan. Design: Retrospective observational study. Methodology: A total of 3193 subject's data were available. Demographic, clinical parameters, food and nutrient intake were explored; patients were categorised into groups according to the adequacy of food intake. The nutrition care process at BIDE consists of getting details of 24-h diet recall. Academy of nutrition and dietetic food exchange system was used to estimate the food requirement, energy and macronutrient intakes. Statistical Analysis: Linear regression analysis was performed for establishing relationship of HbA1c. P < 0.05 was statistically significant. SPSS version 17.0 was used for the analysis. Results: Majority of the patients (89.5%) were above the age of 35 years, using oral hypoglycaemic agents (OHA) or insulin and being overweight or obese (88%). Mean HbA1c was significantly higher (P = 0.006) in cluster 1 (high cereal, vegetable and meat) as compared to cluster 2 (moderate cereal, high vegetable and moderate meat) and cluster 3 (low cereal, moderate vegetable and moderate meat). High percentage of dietary energy was found to be significant predictors of higher levels of HbA1c (P < 0.01). Females with type 2 diabetes using OHA or using OHA with Insulin following the prescribed diet pattern were associated with better glycaemic control. Conclusion: Significant association between dietary patterns and level of HbA1c was seen among type 2 diabetics. Dietary energy was found to be significant predictors of higher levels of HbA1c. Females with type 2 diabetes using OHA or using OHA with insulin following the prescribed diet pattern were associated with better glycaemic control

Relationship among Fatness, Blood Lipids, and Insulin Resistance in Pakistani Children

Observations on associations between fatness and metabolic risks among South-East Asian adults have resulted in devising lower thresholds of body mass index (BMI) for them. Metabolic abnormalities, including type 2 diabetes, are now also appearing in children and are associated with obesity. There has not been much work done to identify indicators of metabolic risks among South Asian children. This study was undertaken to observe the relationship among fatness, blood lipids, and insulin resistance in Pakistani children. Fatness, lipids, and insulin resistance were assessed in 92 middle-class Pakistani school children aged 8-10 years. Height, weight, waist, hips, mid-arm circumference, and triceps skin-fold, measured in school, were used for calculating various indicators of fatness, i.e. BMI, waist hip ratio (WHR), and arm-fat percentage. Fasting blood samples were analyzed for total lipids, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and insulin levels. Homeostasis model assessment (HOMA) index was calculated to assess insulin resistance. Two separate multiple regression models of various risk indicators (family history, sex, BMI, WHR, arm-fat percentage) showed that only arm-fat percentage had a significant positive association both with insulin levels (b=2.04, p= 0.044) andLDL (b= 2.11, p= 0.037). Only five children were overweight(BMI-for-age>85th percentile according to National Center for Health Statistics 2000 reference). Neither overweight children nor those who were in the uppermost tercile of BMI-for-age differed significantly from other children in terms of presence of higher-than-desirable values of lipids or insulin. However, compared to those in the lowest tercile, children who were in the uppermost tercile of arm-fat percentage had a significantly higher frequency of high blood cholesterol (40% vs 67%, p=0.027), high LDL (33.3% vs 61.3%, p=0.026), and markedly higher proportion above average insulin levels (16.7% vs 35.5%, p=0.083). Arm-fat percentage could be developed as a practical tool for determining the risk status of children. However, further cross-sectional assessments are needed to ascertain accurate relationships among arm-fat percentage, lipid profiles, and insulin resistance in larger and varied groups of children