Evaluation of Nutritional Status in Drug Users Referred to the Center of Drug Dependency Treatment in Zahedan

1. Background

Drug addiction is a lifestyle disease that can lead to social and public health problems (1). Many studies on addicts have demonstrated nutritional deficiencies, including weight loss and changes in dietary patterns (2). Apparently, drugs do not affect energy intake directly, but probably affect the nutritional quality of the meals an addict chooses (3). The protein calorie malnutrition of many drug addicts is linked to factors such as female gender, intensity of the addiction, anorexia, poor diet, and an alteration of the addict’s social and familial links (3). Nutritional deficiencies can severely and permanent­ly affect different organ functions; in particular, energy, protein, vitamin, and mineral deficiencies can cause sev­eral nutritional disorders. Many drug addicts suffer from calorie and protein malnutrition (3, 4). The prevalence of malnutrition in drug addicts and the influence of their drug habit and lifestyle on their nutritional indices have been investigated (5).

Many studies have shown a relationship between drug addiction and education, income, and body mass index (BMI) (2). Most addicts suffer from nutritional and meta­bolic disorders. It is necessary to consider a proper diet based on individual characteristics that lead to different physiological changes. Addicts need good health, inspi­ration, support, and proper nourishment. The aim of the present study was to investigate the nutritional status in drug addicts referred to a center for the treatment of drug dependence.

2. Objectives

The aim of the present study was to investigate the nu­tritional status in drug addicts.

3. Patients and Methods

3.1. Subjects

In this descriptive, cross-sectional study, 54 drug ad­dicts (47 men and 7 women) were enrolled during the period of January to April 2007. All persons referred to the Center of Drug Dependency Treatment of Zahedan were informed of the study and asked for their consent to participate. They were multi-drug users of substances such as heroin, opiates, crack, and morphine, and they sought detoxification in the Central Drug Addiction Treatment Hospital (C.D.A.T) of Baharan, Zahedan, Iran. All were seen by a specialist, who described the study they would enter. The hospital specializes in detoxification therapy and provides facilities for drug addicts. Age, body weight, and barefoot height were measured using digital scales (Seca, Germany) and a non-stretch tape fixed to a flat vertical wall. BMI was calculated by dividing body weight (kg) by the square of the height (m²), and its percentile position in the BMI indicator was determined.

3.2. Nutritional Assessment

The cutoff points used to determine nutritional status in the subjects were the following: BMI ≤ 5^th percentile, wasting; 5^th to < 15^th, risk of wasting; 15^th to < 85^th, normal weight; > 85^th to ≤ 95^th, overweight; and > 95^th, obese (6, 7). The subjects responded to the nutritional question­naire based on the Pyramid Food Guidance System. They recalled the different food groups from which they con­sumed at 2 different time points. During the course of the study, a nutritionist and educated expert regularly advised the subjects. The food questionnaire, which provided information about food consumption, was admin­istered by a trained nutritionist.

Before putting the data into a computer, standard refer­ence tables were used to convert household portions to grams of consumed food. The Food Guide Pyramid offers a method for determining appropriate patterns for daily food choices based on the 5 major food groups from which recommended consumptions are selected: bread and cereals, 6–11 exchanges/day; fruits, 2–4 exchanges/day; vegetables, 3–5 exchanges/day; milk and dairy prod­ucts, 2–3 exchanges/day; meat, egg, dried beans, nuts, and substitutes, 2–3 exchanges/day; and small amounts of fats, oils, and sweets (8).

For each case, the food intake was determined accord­ing to the number of servings reported in each food group. These amounts were then compared to the rec­ommended allowances from the Food Guide Pyramid.

3.3. Statistical Analysis

Results are expressed as Mean ± SD. The statistical analysis was performed using SPSS 11.5 software, with ethical points for the subjects duly observed.

4. Results

Of the 54 drug addicts, 87% were men and 13% women, with ages ranging from 19 to 67 years. Mean age, body weight, height, and BMI were 34.4 ± 9.7 years, 63.1 ± 10.1 kg, 171.1 ± 11.6 cm, and 21.8 ± 4.4 kg/m², respectively (Table 1).

The BMI results showed that 40.4% men and 0% women were wasting; 21.3% men and 14.3% women were at risk of wasting; 34.1% men and 57.1% women were of normal weight; and 4.2% men and 28.6% women were overweight (Table 2).

The results also revealed the following mean consump­tions in the different food groups: bread, rice, and cere­als, 4.8 exchanges/day; vegetables, 0.8 exchanges/day; fruits, 1.3 exchanges/day; milk and dairy products, 1.9 exchanges/day; meat, eggs, dried beans, nuts, and sub­stitutes, 1.9 exchanges/day. According to the standard Food Guide Pyramid, 72.2% of the subjects were deficient in the bread and cereal group; 67.2%, in vegetables; 57.4%, in fruits; 40.7%, in milk and dairy products; and 24.1%, in meat (Table 3).

5. Discussion

The results of this study demonstrated malnutrition of different degrees: mild, moderate, and severe. As in­dicated by the BMIs, 65% of the subjects were wasting. Nazrul Islam et al. have reported that 60–74% of drug ad­dicts had below normal BMI and showed clinical signs of nutritional deficiency (1). Many addicts have caloric and protein malnutrition related to their poor intake of food and liquids (1, 3). Data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994, showed marijuana users to have BMIs slightly lower, and they also consumed less fruit and cheese (9).

The comparison of food intake with the Food Guide Pyramid demonstrated both macro- and micronutrient deficiencies. Alves et al. have suggested a relationship between nutritional status and food consumption of ad­dicts in methadone maintenance treatment (2). Those findings agree with the study by Smith et al. that noted low intakes of fruits and vegetables in drug users (10). The failure to meet healthy daily minimum intake levels of grains, fruits, and vegetables may be due to the fact that drug addicts focus only on satiety when they have feelings of scorn about their next meal (2). The results are supported by another study which showed low intakes of fruits and vegetables in drug users (11). Because the pa­tients in this study are undergoing treatment and take drugs regularly, they need to take vitamins and minerals to improve their health. Some of the opiate drugs reduce the absorption of such vitamins as A, C, and E. Deficiencies in antioxidant vitamins in drug addicts have previ­ously been reported (11). A number of following com­ponents in foods have been found to have antioxidant properties; they have specific activities and usually work synergistically to improve the antioxidant ability of the body (12). The findings here showed the ratio of intake of cereals and rice to be too low for producing energy. Although, the calorie intake was not determined in this study, lack of energy intake can cause deficiency in such macro- and micronutrients such as proteins, essential fatty acids, vitamins, and minerals. Santolaria-Feranoez et al. found the mean caloric intake to be 978 ± 89 kcal/day in females and 1256 ± 64 kcal/day in males. Acute organic pathology aggravates the poor nutritional status of drug addicts (3). In tandem with the deficient intake from the cereal group, a deficient consumption of food from the milk and dairy group and the meat groups was observed. These findings demonstrate the poor pattern of food consumption in these patients. In drug addicts, who of­ten have amino acid deficiency, the conversion process from protein to amino acids can slow or stop. Therefore, a deficiency of protein sources, especially animal protein can lead to malnutrition. Balanced meals high in com­plex carbohydrate, protein, and fiber and low in fat, with adequate calories for a healthy body weight, are recom­mended (8). An assessment of nutritional status includes any combination of biochemical and body composition measurements, dietary intake assessment, and metabolic studies (13). In conclusion, the present study revealed that drug addicts had different degrees of malnutrition and multiple nutrient deficiencies. Therefore, in parallel to clinical management, programs to promote an adequate nutritional status and to modify lifestyles, with supporting nutritional and educational programs, are recommended.