The effect of using okara to improve the quality of meal for diabetes patient in ha noi medical university hospital

Diabetes Mellitus has been increasing rapidly in Vietnam, we hypothesized that the main reason that Vietnamese people using fiber andvegetable less titan the amount of fiber rather than

It is an honorto become a student ofHanoi Medical University (HMU) Four years study in here I’m not only gain new knowledge, but also get nx>re skills and especially I have wonderful teachers and friends.

First and foremost I have to thank HMU Board ofPresident Department

of Undergraduate Training and Management forgiving me the opportunity toconduct and complete mygraduation thesis

1 am thankfill to Hanoi Medical University Hospital for giving me the

best conditions to collect the data

I would like to give thanks Jumonji University and Asia Nutrition and Food Culture Research Center for supporting my study' and give me onechance exchange inJapan

I am deeply indebted to my respected teacher Professor Yamamoto

Shigeru He is an experienced researcher and gave me valuable advice onresearch

Especially, my sincere thanks also go to Mrs Nguyen Thuy Link PhD

MD HMU my supervisor for support my study, for her patience, motivation, enthusiasm and immense knowledge Her guidance lielped me in

all the timeof researchandwriting of this thesis I have learned many things

from her I’m greatly indebted to Iler a lot and could not haw imagined

havinga betteradvisor and mentor formy graduation thesis

I am also grateful to volunteer patients who agreed to spend their time tocomplete the questionnaire and implementthe diets which we prepared Theircontribution is very important

I submit my heartiest gratitude to my investigators my wonderfillclassmates They were very' enthusiastic to participate in my research

considering it as their research Theyalso accompanied me duringthe period

of collecting difficult researchdata It is very fortunate to work with them.Finally I want to express the deepest thank my mother for her continuous and unparalleled love, supporting me spiritually throughout my

life I am forever indebted to my mother for giving me tire opportunities and experiences that have made me who I am sir encomaged me to explore new directions in life and seek my own destiny This journey would not have been

possible if not for her andIdedicate this milestone toher

Thank forall!

Hanoi 2021

Nguyen QuynhHoa

I declare tliat this thesis represents my own work and lias not been

submitted for any degree in any university previously The data and results

presented intliisthesis are to the best of my knowledge, tiue and accurate All sources of information of information which have been used in the tliesis and external contributions arereferenced and acknowledged

Hanoi 2021

Nguyen Quynh Hoa

: Body Mass Index

: the disability-adjustedlife year (DALY): Diabetes ketoadnosid

: European Society forClinical NutritionandMetabolism

: GlobalBurdenof Disease: Gastrointestinal diabetes mellitus:Glycemic F index

: glycemic loadInternational Diabetes Federation: Low densitylĨỊXíprotein

: Malnutrition ScreeningTool: Non-insulin-dependent diabetesniellitus: National Institute of Nutrition

: SubjectiveGlobal Assessment

: Years Lived with Disability’

: Years of life lost

: World Health Organization

1.2.1 Epidemiology of diabetes in the world

1.2.2 Epidemiology of diabetes inVietnam

2.22 The exclusion criteria • • ** 4 15

1717

18

2.4.3 Energyand protein, nutrient intake • •••••• ••••••••••a

2.5 Data collection processing • ••

3.2 Nutritional statusof study subjects

3.3.The energy and nutrient intake

CHAPTER 4: DISCUSSION - - 32

4.2 Nutritional status of studysubject

4.3 The energy& nutrient intakes from 2 diets

4.4 Fiber intake fordiabetes patients aaaa

Table 3.1 Demographic characteristic ofthestudy subjects 22

Table 3.2 Tire energyand nutrient intakes by weightingmethod 25

Table 3.3 Tire energy andnutrient intake bv the years of diabetes 26

Table 3.4 Average ofpoints for characteristics of sensory'evaluation 30

Table 3.5 the overall points of sensory evaluation for okara diet and hospital ofstudy subject bygender andage 31

Table 3.6 High vs Low Dietary’Fiber Intake on theIncidenceof Developing Type 2 Diabetes 36

LIST OF FIGURES

Figure 3.1 Nutritionalstatus ofstudy subject based on SGA tool 23Figure3.2 Nutritional status ofsubjects base on age group 24Figure3.3 The amount of fiberintake of study subjects base onthe gender 27

Figure3.4 The amountof fiber iiflake of studysubjects base on tie agegroup 28Figure3.5 The amount of fiberintake of study subjectsbase on the year of

Diabetes Mellitus has been increasing rapidly in Vietnam, we

hypothesized that the main reason that Vietnamese people using fiber andvegetable less titan the amount of fiber rather than tile recommendation ofWHO at about I0g/1000kcal/day Regaiding source, fiber comes mainlyfromvegetable However, most types of Vietnamese vegetable inVietnamare significantly lower in fiber, at about 2g fiber /lOOg vegetable So it is very difficult for Vietnamese people, especially with patients who has diabetes to

consume enough the amount of fiber regarding to the recommendation of

WHO In Study we tried to use okara to improve the amount offiber indaily

meal for diabetes patient and access the acceptíiùlity of patient with disheswhich contain okara We selected 20 patients diagnosed with diabetes in

Hanoi Medical University hospital We divide all participant into 2 group,

each groupusing3 days of okarameal and 3 daysof Hospital meal (not using okara)and take the sensory test in all patient At tlie baseline and final period,

anthropometric measurement, there was a significant higher in the amount of

fiberof patientwhousing okara, from 10,75 to 13.s (p <0,05) About sensorytest Points for okarameal sample were higherthan from hospital diet sample

on color, shape evenly, juiciness, tenderness, and overall And the differences have statistically significant for the mean points (p<0.05) Point for okara dietwas higher than hospital diet in taste 7,71 ±0.61 points and 7,0±0.72 points,

respectively (p<0.05) Using okara in dietary’ meal help to improve the

amount of fiber in diabetes patient and is one of the most easily solutionfor patient withdiabetes

Keyword: Okara fiber Diabetes Mellitus Hospital diet

Bệnh dái tháo đường dang gia lâng nhanh chóng ớ Việt Nam chúng tòi dưa ra giá thuyct nguyên nhân chính lã dongười Việt Nam sử dụng ít chất xơ

vã rau qua lum so với khuyến nghị cua WHO khoang lOg / lOOOkcal / ngày,

về nguồn, chất xơ chu ycu den từ rau cú Tuy nhiên, hầu het cảc loại rau cùa

Viột Nam đều có hàm luựngchat xơ tháp lum đáng kẽ chi khoang 2g chẳtxư

/ I(M)g rau Vì vậy người Việt Nam đặc biệt lá bệnh nhân tiêu dường rất khó

tiêu thụ đu lượng chất xơ theo khuyến nghi cùa WHO Trong nghiên cứu

chúng tỏi dà cố găng sư dụng okara de cai thiện lượng chãt xơ trong bừa án

hàng ngày cho bộnh nhân tiêu dường và tiếp cận sự chấp nhận cua bệnh nhân

với các món ăncó chửaokara Chúng tói chọn 20 bệnh nhân dược chân đoán

mấc bệnh lieu dường tại bộnh viện Dại học Y llã Nội Chúng tôi chia tất cànhùng người thamgia thânh 2 nhóm, mỗi nhóm sửdụng 3 ngày bừa ản Okara

và 3 ngày ăn bửa íìn tai bệnh viên (không sứ dụng okara) và tiến hành kiêm

tra cam quan ờ tất cá bệnh nhân Ó giai đoạn đầu và giai đoạncuối, đo nhãn

trắc học, lượng chai xơ cùa bệnh nhãn sư dụng okara cao hơn đáng kê từ10.75 lên 13.8 (p <0.05)•về kiêm tra cảm quan, diêm cho mẫu bừa ân okaracao hon mẫu bừa ăn tại bệnh viện về màu sảc hình dụng dồng đểu, độmọng,mềm, và tông thề Có sự khác biệt co ý nghía thống kẽ giừa diêm trung bính

về hình dạng dồng dêu mùi vị và mùi thinn và tòng thê VỚI p <0,05 Diêm

cho chẽ độ án kiêng okara cao lum chè độ ăn uông tại bộnh viện lân Inert là 7.4510.59 va 7.0910,72 Sư dụng bà dậu nành trong bừa fin giúp cài thiện

lượng chất xơ ở bệnh nhân nêu dường vả là một trong những giai pháp de

dang nhất clìo bệnh nhàn tiêudường

In Viet Nam the prevalence of diabetes is growing at alarming rates and

has almost doubled within the past 10 years Currently, it’s estimated that one

in every20 Vietnamese adults lias diabetes In addition, thenumber ofpeoplewith a pre-diabetic condition is three times higher titan tltose with diabetes |11 Severe complications, such as feet ulcers, gangrene andresulting amputations,

cardiovascular diseases, blindness andkidneyfailures arecommon in diabetespatients Thesecomplications are the main causes of death and disability for

people with diabetes It's estimated that about 422 million people have diabetes in the world, especially in low andmiddle-income countries [1]

undernutrition [2] According to International Diabetes Federation, 80.6% of people do not consume the recommendednumberof five servingsof fruit andvegetables, andthey have diets that arehighin salt, fat, andsugar [3] Studies

have found that 313% of the total deaths and 25.3%ofthe whole disability-

adjusted life years (DALY) inVietnamwere caused by an unhealthy diet [3J

The DALYcombines theestimates of years oflife lost due to premature death(YLL) and years lived in ill health or with disability (YLD) to count the totalyears of functional experience lost from diseases [4] Researchers have concluded that the leadingrisk factor fordiabetes-related diseases is lifestyleand dietaiy issues

Current evidence suggests that high-fiberdiets, especially of the soluble variety, and soluble fiber supplements may offer some improvement incarbohydrate metabolism, lower total cholesterol and iow-densitvlipoprotein (LDL) cholesterol, and have other beneficial effects in patients with non- insulin-dependent diabetes mellitus (NIDDM) Although there are a closelyrelationship between fiber intake and controlling diabetes, however, tlie amount of fiber intake in daily meal was significantly lower than the

recommendation of WHO We hypothesized that tire main reason of this

problem may come from popular vegetables in Vietnam are usually low in

fiber (<2g'100g vegetable), so it is very difficult for people absorb enough fiber from food and vegetable, especially indiabetes patients [5]

Due to the importance of fiber-nch food in improvement and controlling

diabetes (type 2) It is necessary to supply and usingmore fiber-rich food in hospital where the majority' of diabetes patients are hospitalized and treated

withdiabetes and controiling bloodglucoseindex However, most of diabetes

patients using hospital diets commonly absorb lower level of fiber intake [5]

Vietnamese usual vegetables used in hospital diet was not provide enough

fiber needed for patient Subsequently, this situation triggers negative influence to nutritional status of them at present and inthe future

In this regard, using Okara could be on feasible solution Okara soy pulp, or tofu dregs is a pulp consisting of insoluble parts of the soybean that

remain after pureed soybeans arefilteredin tile production of soy

milk and tofu We can also use them daily with various ways of processing,

combined with variety offoods, increasing the nutritional value ofthe dishes

Not only is the solution for the hospital to nutritional care for the

diabetes patients, patients shouldalso know okara (fiber - rich food) cooking recipe so they couldbe ableto prepare their own mealsat home

We expect using Okara in diet is more beneficial than the currentlyused only vegetable in everyday to help the diabetes patients improve their

daily meals, increasing their amount fiber intake in order to control diabetes

well andfinally improving their quality of life tluoughtheir diet

Therefore, wc decided to conduct "The effects ofusing okara food Io

Improve the quality of meal for diabetes patients in Hanoi MedicalUniversityHospital”, thepurposes ofthis study include:

CHAPTER 1: LITERATURE REVIEW

1.1 Overview ofdiabetes

1.1.1 Define of diabetes

Diabetes is a serious, chronic disease that occurs either when lite pancreas does not produce enough insulin (a hormone that regulates blood

glucose), orwhen the body cannot effectively use the insulin its produce [6],

Raised blood glucose, a common effect of uncontrolled diabetes, may over

time, lead to serious damage to the heart, blood vessels, eyes, kidneys andnen es More than 400 million people live withdiabetes in tire world

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset diabetes) is characterized by deficient insulin production in

the body People with type 1 diabetes require daily administration of insulin

toregulate the amount of glucose in their blood If they do not have access toinsulin, they cannot survive The causeoftype 1 diabetes is not known and it

is currently not preventable Symptoms includeexcessive urination and thirst,

constant hunger, weight loss, vision changes andfatigue [6]

Type 2 diabetes (formerly' called non-insulin-dependentor adult- onsetdiabetes) results from the body’s ineffective use of insulin Type 2 diabetesaccounts for the vast majority ofpeople with diabetes around the world [6] Symptoms may be similar to those of type 1 diabetes, but are often less

marked or absent As a result, the disease may go undiagnosed for several years, until complications have already arisen Formany years type 2 diabeteswas seen only in adults but ithas begun to occur hl children |S|

1.12 Riskfactors for diabtes

Type 1 Theexact causes oftype 1 diabetes are unknown It is generallyagreed that type 1 diabetes is the result of a complex interaction betweengenes and environmental factors, though no specific environmental risk factors have been shown to cause a significant numberofcases The majority

of type 1 diabetes occursin children and adolescents [10]

Type 2 The risk of type 2 diabetes is determined by an interplay ofgenetic and metabolic factors Ethnicity', family history of diabetes, and previous gestational diabetes combinewith olderage overweight and obesity ,

unhealthy diet, physical inactivityand smoking to increase risk [6]

Excess body' fat a summary measure of several aspects of diet and physicalactivity, is the strongest risk factor for type 2 diabetes, both in terms

of clearest evidence base and largest relative risk Overweight and obesity,

together with physical inactivity,are estimated tocause a large proportion of the global diabetes burden [7] Higher waist circumference and higher body mass index (BMI) are associated with increased risk of type 2 diabetes [9]

though the relationship may vaiy in different populations Populations in

South-East Asia, for example, develop diabetes at a lower level of BNfl than populationsofEuropean origin [11]

Several dietary practices are linked to unhealthybody weight and'or type

2 diabetes risk, including high intake of saturated fatty' acids, high total fat intake and inadequate consumption of dietary fiber High intake of sugar-sweetened beverages, which contain considerable amounts of free sugars,

increases the likelihood of being overweight or obese, particularly’ among

children Recent evidence further suggests an association between high consumption of sugar-sweetened beverages and increased risk of type 2

diabetes [12]

Early childhood nutrition affects the risk of type 2 diabetes later in life Factors that appear to increase risk include poor fetal growth, low birth

weight (particularly if followedby rapidpostnatal catch- upgrowth) and high

birth weight

Active (as distinct from passive) smoking increases the risk of type

diabetes, with the highest risk among heavy smokers Risk remains elevated

for about 10 years after smoking cessation, falling more quickly for lighter smokers

Gestational diabetes Risk factors and risk markers for ODM includeage (the older a woman of reproductive age is the higher her risk of GDM);overweight or obesity; excessive weight gain during pregnancy; a familyhistory ofdiabetes: GDM during a previous pregnancy; a history of stillbirth

or giving birth to an infant with congenitalabnormality; and excess glucose inurine during pregnancy Diabetes in pregnancy and GDMincrease the risk of

futureobesityandtype2 diabetes in offspring [13]

1.13 Complication of(liabrles

When diabetes is notwell managed, complications develop that tíưeaten health and endanger life Acute complications area significant contributor tomortality, costs and poor quality of life Abnormally high blood glucose can have a life-threatening impact if it triggers conditions such as diabeticketoacidosis (DKA) in types 1 and 2(141, and hyperosmolarcoma in type 2.Abnormally low blood glucose can occur in all types ofdiabetes and may

result in seizures or loss of consciousness It may happen after skipping a

meal or exercising more than usual, or if the dosage of aril-diabetic

medication is toohigh [ 15]

Over time diabetes can damage rhe heart, blood vessels, eyes, kidneysand nenes, and increase the riskofheart disease and stroke [6], Such damage

can result in reduced blood flow, which - combined with nerve damage

(neuropathy) in the feet - increases the chance of foot ulcers, infectionand theeventual need for limb amputation Diabeticretinopathy is an important cause

of blindness and occurs as a result of long- term accumulated damage to thesmall blood vessels in the retina Diabetes is among the leading causes of kidney failure

Uncontrolled diabetes in pregnancy can have adevastatingeffect on both

mother and child, substantially increasing the risk of fetal loss, congenitalmalformations stillbirth, perinatal death, obstetric complications, andmaternal morbidity and mortality Gestational diabetes increases the risk ofsome adverse outcomes formother and offspring during pregnancy’, childbirthand immediately after delivery (pre-eclampsia and eclampsia in the mother;large for gestational age and shoulder dystocia in the offspring) However, it

is not known what proportion ofobstructed births or maternaland perinataldeaths canbeattributed to hyperglycemia

The combination of increasing prevalence of diabetes and increasinglifespans in many populations with diabetes may be leading to a changing

spectrum ofthe types of morbidity that accompany diabetes (30) In addition

to the traditional complications described above, diabetes has been associatedwith increased rates of specific cancers, and increased rates of physical and

cognitive disability This diversificationof complications atrd increasedyears

oflife spent with diabetes indicates a need to better monitor the quality of life

ofpeople with diabetes and asse

1.2 Epidemiology OÍdiabetes

1.2.1 Epidemiology of diabetes in the world

Diabetes mellitus has been seen as a major public health problem and a

significant source of morbidity and mortality that is presentable and

underestimated According to The Global Burden of Disease (GBD), Tlie

global prevalence (age-standardized) of diabetes has nearly doubled since

1980 rising from 4.7% to 8.5%in the adult population In an analysis from a

research of Betty M Dress - Professor ofMedicine and Dean Emerita at the

University of Missouri-Kansas City School of Medicine in Kansas city Missouri [20] et al on global diabetes burden, biannual reports werepublished in January 2015 and provides a comprehensive review of diabetes

care and strategic goals from the DHSS Prevalence of diabetes varies across individual communities and counties, but Missouri lias an overall prevalence

of diagnosed diabetes mellitus in adults of 11.1% in 2014 [20] The

International Diabetes Federation estimated that there were 382 million

people with diabetes in 2013 [16] a number surpassing its earlier predictions

More than 60% of the people with diabetes live in Asia, with almost one-half

in China and India combined [18] The Western Pacific, the world’s most

populous region, has more than 1382 million people with diabetes, and the number may rise to201.8 millionby2035 [19]

According to Susan Van Dieren the article summarizes the burden of

type 2 diabetes, impaired glucose tolerance, and their vascular complications

It is projected that by 2025 there will be 380 million people with type 2 diabetes and 418 million people with impaired glucose tolerance [17]

Diabetes is a major global cause of premature mortality that is widelyunderestimated, because only a minority of persons with diabetes dies from acause uniquely related to the condition Approximately one half of patientswith type 2 diabetes die prematurely of a cardiovascular cause and

approximately 10% die of renal failure Globalexcess mortality attributable to

diabetes in adults was estimated to be 3.8 million deaths [21]

1.22 Epidemiology of diabetes In Me tnam

The prevalence fol diabetes, prediabetes, and gestational diabetes in

Vietnam arelow relative to other parts of tire world, buttheyareincreasing atalarming rates These changes have occurred in the setting ofeconomic and cultural transitions

In Van TIŨ Thuy Nguyen and el at research on diabetes in Vietnam, it

showed that In 2012, the prevalence of diabetes was 5.4% and prediabetes 13.7% In 2005 the prevalence of obesity was 1.7% [22] There is a dual

burden of over- and undernutrition observed in Vietnam (2) Diabetes is associated with an increased waist-to-hip ratio despite normal body mass

index Nutritional transitions occurred with increased protein, fat and fast

foods, and with decreased freshfruits andvegetables

According to International Diabetes Federation (IDF) Vietnam is one of the 36countlies andterritories of the IDF WP region.463 millionpeople have diabetes in the world and 163 million people in the \VP Region; by 2045 this will rise to212 million [22]

In Vietnam, health statistics revealUral noncommuni cable disease deaths have increased from 44.07% in 1976 to 73.41% in 2015 [24] In conưast.communicable disease death decreases from 53.06% to 11.4% during thesame period [24] Diabetes is a leading cause of death worldwide, and it

causes a 30% loss of life expectancy In Vietnam, diabetes is projected to be

one of the top seven diseases leading to death and disability in Vietnam by

2030 [24]

1.23 Nutritional status in diabetes patients

The type 2 diabetes epidemic has been attributed to Ulbanization and

environmental transitions, including work pattern changes from heavy labor

to sedentary occupations, increased computerization and mechanization, and improved transportation Economic growth and environmental transitionshave led to drastic changes in food production, processing, and distributionsystems and increased tire accessibility of unhealthful foods Fast food

restaurant establishments have experienced exponential global expansion in

recentdecades Even under very conservative assumption, the World HealthOrganization projects diabetes prevalence to expand fromthe current level of

382 million by55% to 592 million in2035(25]

Parts of tire world undergoing epidemiological transition have

experienced a livestock revolution, which leads to increased production of

berf pork, dairy' products, eggs, and poultry [26] Based on the UnitedNations Food and Agriculture Organization data, this change has beenespecially drastic in Asian countries Another characteristic of nutrition

transition is increased refinement of grain products Milling and processingwhole grains to produce refined grains such aspolished white rice and refinedwheat flour reduce the nutritional content of grains, including their fiber, micronutrients, and phytochemicals

adiposit)-In recentdecades, menand womenaround the globe have gained weight,

largely due to changes in dietary patterns and decreased physical activity levels.[2$J Excessadiposity' reflected by higher body mass index (BMI) is the

strongest risk factor for diabetes, and Asians tend to develop diabetes at a

much lower BMI than thoseof European ancestry [28[ The risk of diabetes

rises as excessive body fat ilia eases, starting from the lower end of a

gain since young adulthood is another independent predictor of diabetes risk

even afteradjusting for current BMI

Lifestyle intervention involving calorie-restriction and exercise to

promote weight-loss, as demonstrated in the Diabetes Prevention Program

significantly reduced conversion to diabetes among highly risk patients with

impaired glucose tolerance by 58°O [29] The beneficial effect of lifestyle

modification was documented in various populations including multiethnic

American Finnish Chinese, andIndian

While it hasbeen hypothesized that higher total fat intake contributes to

diabetes directly by inducing insulin resistance and indirectly by promoting weight gain, results from metabolic studies in humans do not support that

high-fat diets have a detrimental effect on insulin sensitivity In several

observational studies, totalfat intake was not associated withdiabetes risk In

the Women’s Health Initiative, tire incidence of diabetes was not reduced

among women who consumed a low-fat diet compared to the controlgroup The qualityof fat is more important than total fat intake, and diets that favor plant-based fats over animal fats are moreadvantageous In particular,greater intake of omega-0 polyunsaturated fatty acids (PLTA) was associated with lowerdiabetesrisk in the Nurses’ Health Study (28] Replacing saturatedfat with omega-6 PUFA was related to lower risk ofdeveloping diabetes

However, the relationshipbetween omega-3 PUFA anddiabetes risk liasbeen inconsistent [28]

1.23.4 Quantity and quality of carbohydrates

Prospective observational evidence suggests that the relative

carbohydrate proportion ofa diet does not appreciably influence diabetes risk However, a dietrich in fiber, especiallycereal fiber, may reduce diabetes risk

A meta-analysis of prospective cohort studies demonstrated an inverse

association between fiber from cereal products and type 2 diabetes risk Compared to cereal fiber, fiber from fruits had a weaker inverse

associationwitil diabetes risk

Carbohydrate quality' can be determined by evaluating the glycemic

response to carbohydrate-rich foods such as the glycemic index (GI) and the

glycemic load (GL) In meta-analyses of prospective studies, low G1 and GL diets were associated with lower risk for diabetes compared with diets with

higher GI and GL independent of theamount of cereal fiberin the diet

In the past decade, there has been considerable interest in the use of

high-fiber diets for improving blood glucose levels in patients with diabetes

With some exceptions " most ofthe studies have reported beneficial effects The addition of fiber to the diet was found to lower postprandial glucose

levels in normal subjects as well as in patients with type II diabetes In some

insulin-treated diabetic individuals, a high-fiber intake has been associated

with a reduction in insulin requirements, and in diabetic persons whose

insulin doses were kept constant, high- fiber intake has been reported to

increase tire number of hypoglycemic episodes The improvement in

carbohydrate metabolism lias been associated with normal or lower insulin

levels, lower levels of glucagon and GIP and elevated somatostatin levels.High-fiber diets have also proved effective in treating diabetic and

nondiabetic patients with hyperlipidemia Even normal subjects have

experienced a decrease in serum cholesterol and tri- glycerides after

consuming high-fiber diets However, this hypolipidemic effect of dietar)’ fiber has not always been found The apparent discrepancies in results appear

to be due to the complexity of dietary fiber Furthermore, the significance of

these reports is difficult to assess because they either were acute studies or

lacked suitable controls In the study of Marc Mcrea about the dietary fiber

intake and type 2 diabetes showed that Sixteen meta-analyses were retrieved

for inclusion 111this umbrella review In themeta-analyses comparing highest

versus lowest dietary fiber intake, there was a statistically significant

reduction in the relative risk (RR) oftype 2 diabetes (RR = 0.81-0.85), with the greatest benefit coming from cereal fibers (RR = 0.67-0.87) However, statistically significant heterogeneity was observed in all of these meta­analyses In the meta-analyses of supplementation studies using fl-glucan or

psyllium fibers on type 2 diabetic participants, statistically significant

reductions were identified in both fasting blood glucose concentrations and

glycosylated hemoglobin percentages and this study suggests that thoseconsuming the highest amounts of dietary fiber, especially cereal fiber, maybenefit from a reduction in the incidence of developingtype 2 diabetes.There

also appears to be a small reduction in fastingblood glucose concentration, as

well as a small reduction in glycosylated hemoglobin percentage for individuals with type 2 diabetes who add p-glucan or psyllium to their daily

dietary intake

1.3 Sen son test

Sensory’ evaluation is defined as “a scientific discipline used to invoke, measure, analyze and interpret reactions to characteristics of foods and materials as they are perceived by the senses of sight, smell, taste, touch, and hearing

Sensory evaluation is a key method to assess the flavor quality offoodsbecause it measures what consumers really perceive; however it is a

subjective method For example, one consumer may describe a sample as

unpalatable while another consumer may consider the same sample acceptable These differences are common in sensory’ evaluation and can be explained by nationality', culture, individualvariation,etc

The most widely used scale for measuring food acceptability’ is the 9’ point hedonic scale DaridPetyamand colleagues developed the scale at the QuartermasterFood and ContainerInstitute ofthe U.S Armed Forces, forthe

purpose of measuring the food prefer ences of soldiers [9] Tire scale was quickly adopted by the food industry’ and now is used notjust for measuring

the acceptability of foods and beverages, but also ofpersonal care products,household products, and cosmetics

The hedonic scale was the result of extensive research conducted at the

Quartermaster and the University of Chicago Jones, Peryam & Thurstone(1955) showed that longer scales, up to nine intervals, tended to be more

discriminating than shorter scales, and therewas some indication that a scale

with eleven intervals would be even more effective The nine-point version

became tire standard at the Quartermaster, because it fit better on the typing paper used toprint the ballots

1.4 Nutrition for patients at Hanoi Medical University Hospital

The Department of Nutrition & Dietetics Hanoi Medical University

Hospital, was established in 2014 providing nutrition for inpatients daily

With nearly 100 nutritional codes, including DD code (nutrition for patients

with diabetes) Inthisstudy, we use the codes DD12 and DD02 to add okara

with DD12 code, total energy is 1 TOOkcaLday total fiber is about

10-12g the amount of protein, carbohydrate and lipid are 90g 50g and 220g

respectively Additionally DD02 code including 1600-1700kcaL the amount

of fiber is about 10-1 lg and the figure for protein, lipidand carbohydrate are

about 85g, 45-50g 200g respectively

2.2.1 The inclusion criteria

• The diabetes patientsare inipatients morethan 5 dass

•Subjects have HBA1C >6.5%

• Subjects using hospital diet

• Subjects are not monitored or controlled by aspecialist

• Subjects voluntary to take part in stud}

2.22 The exclusion criteria

• Subjects are impatient less than 5 days

.Subjects are controlled or monitored inICƯ department

• Subjects who haveto useparenteral tube

2.23 Sample size

Convlenient sample

- Choosing subjects basedoninclusion criteria

- By choosing subject based on inclusion criteria, we have 10 subjects

foreach group, the total sample size is 20 patients

2.2.4 Research design

A cross-over study was usingin this study

Step 2:Purposive Sampling: rom inpatient's list,select 20 subjects who

meet with all of criteria of the study

Step 3: Randomly distribute the subjects into2 groups

2.3 Research instruments

2.3.1 The questionnaire

Thereare4 sections:

The first section is general information

The second section is used SGA tool to assess nutritional status of

patients

The third section is sensoryevaluationanswer form

The last section is theweight meals recall before and after patients eat

2.32 Scale

Body weight was measured with the patients in the standing position

wearing lightclothing and take offhis or hershoes Body weight was taken tothe nearest 0.1 kg This indicator was determined by Tanita BC-526AVH

scale (Tanita Tokyo Japan)

2.33 Height gage

Height was measured with a portable Seca 206 Bodymeter 'Wall-Mount

mechanical measuring tape (Vogel & Halke Hamburg Germany) to the

nearest 0.1 cm The heel, the calf, buttocks, shoulder and occipital

prominence (prominent area on the back of head) should be flat against tire broad(wall) The subject should be looking straight ahead The hands ofthe subject shouldbe by their side The headpiece should beplaced iimiy on the subject’s head

Body mass Index (BMI) was calculatoras the ratio of weight (kg) per

2.43 Sensor)' valuation

The scoring of each sample was performed on a single sheet using a

9-point hedonic scale (1= extremely dislike 2=dislike very much, 3» dislike

moderately 4=dislike slightly, 5= neither like nor dislike 6= like slightly, 7=

like moderately, 8= likevery much 9=extremely like)

Comparebetween okara diet and hospitaldiet about: