Evaluation of the dietary pattern of patients with type 2 diabetes in Northern Jordan: An inconvenient truth! Authors
First Online: 08 December 2013 Received: 04 August 2012 Accepted: 11 September 2013 DOI:
Cite this article as: Bawadi, H., Abu-Jamous, D. & Tayyem, R.F. Int J Diabetes Dev Ctries (2014) 34: 134. doi:10.1007/s13410-013-0149-8 Abstract
This cross-sectional study aimed to evaluate the dietary profile of patients with type 2 diabetes in northern Jordan. 750 patients aged between 22 and 84 years were recruited from the endocrinology clinics at King Abdulla University Hospital in northern Jordan. Dietary assessment was performed using valid semi-quantitative food frequency questionnaire (FFQ). Glycosylated hemoglobin, height, body weight and waist circumference were measured. Both, males and females, failed to meet the recommended target of glycosylated hemoglobin, BMI, and waist circumference. Patients reported high intakes of fruits (~4.5 servings/day) and grains (~17 servings/day); enough intakes of vegetables (~4 servings/day) and low intakes of milk (~1.5 servings/day), meat and beans (~1 serving/day). High intakes of fiber, simple sugar and sodium were observed. Macronutrient contribution to daily caloric consumption was 65 % from carbohydrates, 13 % protein, and 29 % fat (distributed as 8 % from saturated fat, 14 % from monounsaturated fat, and 3.5 % from polyunsaturated fat). In conclusion, the dietary profile for diabetic patients in Jordan failed to meet the recommendations in several aspects including, high consumption of carbohydrates, sugar, and sodium; and low intake of PUFA.
Keywords Jordan Diet Diabetes References
Reichard P, Nilsson BY, Rosenovist U. The effect of long term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. NEJM. 1993;329:304–9.
Ritz E, Orth SR. Nephropathy in patients with type 2 diabetes mellitus. N Engl J Med. 1999;341:1127–33.
Gæde P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. NEJM. 2008;358:580–91.
Vijan S, Hayward RA. Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med. 2003;138:593–602.
Xu J, Eilat-Adar S, Loria CM, Howard BV, Fabsitz RR, Begum M. Macronutrient intake and glycemic control in a population-based sample of american indians with diabetes: the strong heart study. Am J Clin Nutr. 2007;86:480–7.
Chan JL, Abrahamson MJ. Pharmacological management of type 2 diabetes mellitus: rationale for rational use of insulin. Mayo Clin Proc. 2003;78:459–67.
Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care. 2002;25:608–13.
Chandalia M, Garg A, Lutjohann D, Bergmann KV, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342:1392–8.
Janket S, Manson JE, Sesso H, Buring JE, Liu S. A prospective study of sugar intake and risk of type 2 diabetes in women. Diabetes Care. 2003;26:1008–15.
Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med. 2008;168:1487–92.
PubMed CrossRef PubMedCentral
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292:927–34.
World Health Organization. Waist circumference and waist-hip ratio: Report of a WHO expert consultation. Geneva: World Health Organization (WHO); 2008.
Willett WC, Sampson L, Stampfer MJ. Reproducibility and validity of a semi quantitative food frequency questionnaire. Am J Epidemiol. 1985;122:51–65.
Martin-Moreno JM, Boyle P, Gorgojo L. Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol. 1993;22:512–9.
Tjønneland A, Overvad K, Haraldsdóttir J, Bang S, Ewertz M. Validation of a semi quantitative food frequency questionnaire developed in Denmark. Int J Epidemiol. 1991;20:906–12.
WHO. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.
American Diabetes Association. Standards of medical care in diabetes. Diabetes care. 2005;28:S4–S36.
Musaiger AO. Arab centers for nutrition. The food dome: dietary guidelines for Arab countries. Nutr Hosp. 2012;27:109–15.
Joint WHO/FAO/UNU Expert Consultation. Protein and amino acid requirements in human nutrition. World Health Organ Tech Rep Ser. 2007;(935):1–265, back cover.
American Diabetes Association (ADA). Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care. 2000;23:S43–6.
WHO. Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series No. 916. Geneva: World Health Organization; 2003.
WHO. Guideline: Sodium intake for adults and children. Geneva: World Health Organization (WHO); 2012.
FAO. Fat and fatty acid in human nutrition. FAO report of an expert consultation on fats and fatty acids in human nutrition. 2010.
Alwan A, Kharabsheh S. Nutrition in Jordan: A review of the current nutritional trends and major strategic directions of the national food and nutrition policy. 1st Edn, WHO/MOH/MOA. 2006.
Garg A. High-monounsaturated-fat diets for patients with diabetes mellitus: A meta-analysis. Am J Clin Nutr. 1998;67:S577–82.
Madanat HN, Troutman KP, Al-Madi B. The nutrition transition in Jordan: the political, economic and food consumption contexts. Promot Educ. 2008;15:6–10.
Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004;79:774–9.
Department of Statistics (DoS). Household income and expenditure survey. Amman, Jordan, 2002.
Department of Statistics (DoS). Household income and expenditure survey. Amman, Jordan. 1992.
White PG. Title: A regional survey of the aquaculture sector in eleven middle east countries, produced by: fisheries and aquaculture department, consumption of fish and shellfish and the regional markets. 1998. (Available at December 9, 2012,
EL-Qudah J. Dietary intake of selected common vegetable foods and their total carotenoids determination. Am J Agric Biol Sci. 2008;3:729–33.
Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA. Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. JAMA. 1994;271:1421–8.
Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of ldl to oxidative modification in subjects with type 2 diabetes mellitus. Diabetic Med. 2004;21:142–9.
Vedovato M, Lepore G, Coracina A, Dodesini AR, Jori E, Tiengo A. Effect of sodium intake on blood pressure and albuminuria in type 2 diabetic patients: the role of insulin resistance. Diabetologia. 2004;47:300–3.
Seidell JC, Han TS, Feskens EJ, Lean ME. Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin- dependents mellitus. J Intern Med. 1997;242:401–6.
Seidell JC, Pérusse L, Després J, Bouchard C. Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec family study. Am J Clin Nutr. 2001;74:315–21.
Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics. 2004;114:e198–205.
PubMed CrossRef Copyright information
© Research Society for Study of Diabetes in India 2013