*Article* **Dietary Attitude of Adults with Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Cross-Sectional Study**

**Waqas Sami 1,\*, Khalid M Alabdulwahhab 2, Mohd Rashid Ab Hamid 3, Tariq A. Alasbali 4, Fahd Al Alwadani <sup>5</sup> and Mohammad Shakil Ahmad <sup>1</sup>**


Received: 7 February 2020; Accepted: 23 February 2020; Published: 24 February 2020

**Abstract:** *Background and Objectives:* There is a paucity of literature on the dietary attitude (DA) of patients with type 2 diabetes in the Kingdom of Saudi Arabia (KSA). Although the prevalence of diabetes mellitus (DM) is high in Gulf countries, there remains a lack of understanding of the importance of dietary behavior in diabetes management among patients. Understanding the behavior of patients with diabetes towards the disease requires knowledge of their DA. Therefore, this study aimed to assess and evaluate the DA of type 2 diabetes patients, and it is the first of its kind in the KSA. *Material and Methods:* An analytical cross-sectional study was conducted among 350 patients with type 2 diabetes. A self-administered DA questionnaire was used to collect the data. Psychometric properties of the questionnaire were assessed by face validity, content validity, exploratory factor analysis, and internal consistency reliability. The data were collected using a systematic random sampling technique. *Results:* The overall DA of the patients was inappropriate (*p* = 0.014). Patients had an inappropriate DA towards food selection (*p* = 0.003), healthy choices (*p* = 0.005), food restraint (*p* < 0.001), health impact (*p* < 0.001), and food categorization (*p* = 0.033). A poor DA was also observed in relation to the consumption of red meat (*p* <0.001), rice (*p* < 0.001), soup and sauces (*p* = 0.040), dairy products (*p* = 0.015), and junk food (*p* < 0.001). *Conclusions:* It is highly recommended that patients with diabetes receive counseling with an empowerment approach, as this can bring about changes in their dietary behavior, which is deeply rooted in their daily routine. Healthcare providers should also be well-informed about patients' attitudes and beliefs towards diabetes to design tailored educational and salutary programs for this specific community. Diabetes self-management educational programs should also be provided on a regular basis with a special emphasis on diet and its related components.

**Keywords:** dietary attitude; type 2 diabetes mellitus; diabetes self-management; empowerment approach; dietary behavior

#### **1. Introduction**

Dietary attitude (DA) is defined as beliefs, thoughts, and feelings about, behaviors toward, and relationships with food. It can influence people's food choices and their health status [1]. Different DAs affect human health in noncommunicable diseases and play a great role in determining cultural differences [2,3]. Local and international literature assessing the DA of patients with type 2 diabetes is very scarce. However, some studies have shown that assessing patients' DA may have a considerable benefit for treatment compliance and decreases the occurrence rate of complications as well [4]. Unhealthy eating habits, failure to follow a strict diet plan, and physical inactivity are the leading causes of complications among patients with type 2 diabetes mellitus (T2DM) [5]. A study conducted in Egypt reported that the attitude of patients towards food, compliance with treatment, food control with and without drug use, and foot care was inadequate [6]. Another study indicated that only one-third of diabetic patients were aware of the importance of diet planning and limiting cholesterol intake to prevent cardiovascular disease (CVD) [7]. A study conducted in the Kingdom of Saudi Arabia (KSA) reported that diabetic patients do not regard the advice given by their physicians regularly for diet planning, diet modification, and exercise [8]. There is a need for patients with diabetes to develop a positive attitude towards diet that would help improve glycemic control, and eventually increase their health-related quality of life [9].

Although the prevalence of diabetes mellitus (DM) is high in Gulf countries (Kuwait, Qatar, Bahrain, United Arab Emirates, and Oman), there remains a lack of understanding of the importance of dietary behavior in diabetes management among patients [10]. Understanding the behavior of patients with diabetes towards the disease requires knowledge of their DA. Therefore, this study aimed to assess and evaluate the DA of type 2 diabetes patients. Since this is the first study in the KSA to focus on this issue, the results can therefore serve as a baseline for similar studies conducted in the KSA and in the neighboring Gulf countries.
