Empirical analysis of body constitution and food intake in persons with type 2 diabetes mellitus from a perspective of traditional Chinese medicine

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Empirical analysis of body constitution and food intake in persons with type 2 diabetes mellitus from a perspective of traditional Chinese medicine

 

Author: Wong, Yee Chi Peggy
Title: Empirical analysis of body constitution and food intake in persons with type 2 diabetes mellitus from a perspective of traditional Chinese medicine
Degree: D.H.Sc.
Year: 2015
Subject: Diet therapy -- China.
Diabetes -- Diet therapy.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xix, 267 pages : color illustrations
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2961714
URI: http://theses.lib.polyu.edu.hk/handle/200/8947
Abstract: Background: Dieticians help persons with diabetes mellitus (DM) to better control blood glucose with regard to nutrition component but have their limitations in regulating the "hot" and "cold" presentations. From a perspective of traditional Chinese medicine (TCM), "hot" or "cold" presentation is a reflection of an unbalanced state of Yin and Yang leading to deviated type of body constitution (BC), such as Yin-deficiency or Yang-deficiency. Deviated BC is "unhealthy" and occurs in different chronic diseases. Without regulation, either Yin-deficiency or Yang-deficiency type of BC can further induce other diseases, such as hypertenison, heart disease, impaired organs, poor memory, depression or cancer etc. Past researches found that Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency are the common types of "unhealthy" BC in DM population. Empirical evidences support that food has natures and flavors that are able to regulate "unhealthy" BC. Studies were conducted on the effectiveness of single food types in DM control. However, no studies have attempted to find out if daily food intake has an influence on the BC in persons with DM from a perspective of TCM. Since type 2 diabetes mellitus (T2DM) afflicts about 90% of DM population worldwide and 80% of the dietary counselling to persons with chronic diseases by dieticians are T2DM cases in Hong Kong public hospitals, it was necessary to understand the BC and daily food intake in persons with T2DM from a TCM perspective. Aim: The aim of this study was to understand the BC and daily food intake in persons with T2DM from a perspective of TCM. Methods: This study had adopted a two-phase mixed method design including an exploratory case study (N=18) between May 2011 and June 2011 and a descriptive correlation study (N=140) between October 2013 and December 2013. First phase: Eighteen persons with T2DM were recruited after they had met the inclusion criteria: aged over 18 years, not on insulin injection, no other chronic diseases and other medical treatments, such as non-diabetic medications, kidney dialysis, chemotherapy, radiotherapy or Chinese tonification. Each participant prepared a record of his or her food intake for a period of seven days, followed by receiving BC assessment from a registered Chinese medicine practitioner who has 25 years of clinical experience in TCM. Each case was then analysed covering BC type and presentations, food intake in natures and flavors and demographic and health characteristics. Cross-case analysis was performed across cases within similar BC types and among different BC types. Second phase: Based on the results of the first phase, Yin-Yang Assessment Questionnaire (YY-AQ) and Food Intake Questionnaire (FI-Q) were devised. These two questionnaires had initially passed the tests for content validity, comprehensibility, test-retest reliability and internal consistency reliability. At the survey of the descriptive correlation study, a total of 140 participants were recruited after they had met the recruitment criteria: T2DM, aged over 18 years, not on insulin injection and other medical treatments, such as kidney dialysis, chemotherapy or radiotherapy. Each participant was asked to fill in the YY-AQ, FI-Q and a modified demographic and health characteristics questionnaire by themselves, followed by data check by the researcher or trained helpers. Spearman's correlation coefficient (Spearman's rho) was used to analyze the correlation between the presentations of Yin-deficiency, Yang-deficiency, Yin-Yang-deficiency and natures of food intake. A value of P < 0.05 was considered statistically significant.
Results: The key results of the exploratory case study are as follows. First, 11 Yin-deficiency type of presentations and 17 Yang-deficiency type of presentations were identified. Second, 223 food types were collected and categorized into a comprehensive food table (TCM Food Table) ("Hot" food=30.0%; "Neutral" food=37.3%; "Cold" food=32.7%). Third, three cases with Yin-deficiency and higher intake of "Hot" foods, 12 cases with Yang-deficiency and higher intake of "Cold" foods and three cases with Yin-Yang-deficiency and higher intake of "Cold" foods were found. The key results of the descriptive correlation study showed that presentations of Yin-deficiency (Spearman's rho=0.35, P=0.000), Yang-deficiency (Spearman's rho=0.21, P=0.014) and Yin-Yang-deficiency (Spearman's rho=0.3, P=0.001) positively correlated with the "Hot" food intake with statistical significance. The presentations of Yin-deficiency (Spearman's rho=0.14, P=0.11), Yang-deficiency (Spearman's rho=0.2, P=0.05) and Yin-Yang-deficiency (Spearman's rho=0.16, P=0.06) also positively correlated with the "Cold" food intake but statistically insignificant. Conclusions: Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency types of BC were found in this study. It was observed that persons with T2DM and presentations of either one of the three BC types tended to select more "Hot" foods that were unable to regulate the presentations of Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency. Adoption of BC assessment and regulation with food properties from a TCM perspective to conventional dietary therapy for T2DM is an implication for dietetic practice. The TCM Food Table will be further developed. The YY-AQ had passed its initial validity and reliability tests. It is necessary to test it further to establish its construct validity, convergent validity, discriminant validity, test-retest reliability, internal consistency reliability, responsiveness and predictive validity and determination of the scoring system for its clinical significance, which will be followed by a randomized control trial on the effectiveness of integrated dietary therapy for T2DM and prospective investigations on the relations between BC and food properties from a TCM perspective for public health. The study had its limitations including similarity of some items in the YY-AQ and limited food selections, lacking of food flavors descriptions and amount of food consumption from the FI-Q.

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