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Massimino E, Izzo A, Castaldo C, Amoroso AP, Rivellese AA, Capaldo B, Della Pepa G. Dietary micronutrient adequacies and adherence to the Mediterranean diet in a population of older adults with type 2 diabetes: A cross-sectional study. Clin Nutr ESPEN 2023; 57:337-345. [PMID: 37739677 DOI: 10.1016/j.clnesp.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS There are few data on micronutrient intake in older adults with type 2 diabetes (T2D) and their adherence to the Mediterranean diet, a dietary pattern rich in micronutrients. In this cross-sectional study, we evaluated the prevalence of adequacy in micronutrient intake according to the recommendations, and the adherence to the Mediterranean diet in older adults with T2D. METHODS One hundred thirty-eight patients (47 women and 91 men) with T2D aged over 65 years were included. Dietary habits were assessed by three 24-h dietary recalls. The micronutrient intake, expressed as mean daily intake, and adequacy were compared with the dietary recommendations proposed by the Italian Society of Human Nutrition (LARN) and the European Food Safety Agency (EFSA). Adherence to the Mediterranean diet was evaluated by the MEDI-quest score. RESULTS An extremely low proportion of participants (∼1%) adhered to the recommendations for potassium and vitamin D intake. A low proportion of participants adhered to the recommendations for calcium (∼23%), magnesium (∼16%), selenium (∼17%), vitamin E (∼14%), riboflavin (∼28%), vitamin B6 (∼29%), folate (∼25%), and niacin (∼27%) intake. More than 60% of the population adhered to the recommendations for iron, copper, vitamin A and B12 intake. Only 53% of the population showed high adherence to the Mediterranean diet. CONCLUSIONS Our data indicate that a very low proportion of older adults with T2D meet the recommendations for ten micronutrients (calcium, potassium, magnesium, selenium, vitamin D, vitamin E, riboflavin, vitamin B6, folate, and niacin) with an unsatisfactory adherence to the Mediterranean diet. Nutritional approaches aimed at favoring adherence to dietary recommendations and increasing the consumption of foods rich in micronutrients should be implemented in older adults.
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Affiliation(s)
- Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Anna Izzo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Carmen Castaldo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Anna Paola Amoroso
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy; Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy.
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Kozela M, Matras A, Koziara K, Małecki MT, Pająk A. Prior Diagnosis of Diabetes but Not Its Control is Associated with Higher Depression Score Among Older Individuals. Diabetes Metab Syndr Obes 2023; 16:2051-2059. [PMID: 37441414 PMCID: PMC10335292 DOI: 10.2147/dmso.s403521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose The study assessed the relationship between prior diagnosis of diabetes and its control with depression score, differences in socioeconomic, lifestyle, health characteristics and diabetes control by adherence to treatment in population-based sample of older individuals. Patients and Methods The analysis of the sub-sample of Polish cohort of the HAPIEE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study was conducted; 464 participants were interviewed and random first 360 (78%) underwent physical examination and blood sample tests. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The robust regression method was applied to assess the association between depression score and diabetes diagnosis as well as diabetes control. Results There were 97 participants (21.0%) at mean age of 73.6 years (SD=6.31 years) with prior diagnosis of diabetes. Mean HbA1c concentration was 6.65% (SD=1.0) The majority of patients (55.7%) used oral medication with diet. Nearly 20% declared the use of oral treatment alone, and 10.3% used combined treatment of oral medications, insulin, and diet. In this study, 86.6% of the participants with diabetes confirmed self-monitoring of blood glucose levels and 58.8% were on high-quality diet. No differences in socioeconomic, lifestyle, health characteristics or control of diabetes by adherence to diabetes treatment were found. After adjustment for age and gender, diagnosis of diabetes was associated with greater depressive score by about 2 points (β=2.02, 95% CI=0.16;3.88). However, no significant association between depression score and any indicator of diabetes control was found. Conclusion In older individuals with diabetes, depression score was higher compared to those without diabetes, but it was not related to poorer diabetes control. No differences in socioeconomic, lifestyle, health characteristics and control of diabetes by adherence to diabetes treatment may suggest that in this age group some other, less known factors are substantial for achievement of treatment targets.
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Affiliation(s)
- Magdalena Kozela
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Matras
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Koziara
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
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Edenbrandt AK, Ewers B, Storgaard H, Smed S. Dietary changes based on food purchase patterns following a type 2 diabetes diagnosis. Public Health Nutr 2022; 25:1-12. [PMID: 35713020 PMCID: PMC9991834 DOI: 10.1017/s1368980022001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study explores whether type 2 diabetes (T2D) diagnosis affects food consumption patterns in line with the dietary recommendations provided to individuals in relation to a diagnosis. DESIGN Based on detailed food purchase data, we explore which dietary changes are most common following a T2D diagnosis. Changes are investigated for several energy-adjusted nutrients and food groups and overall adherence to dietary guidelines. SETTING We use data on diagnosis of T2D and hospitalisation in relation to T2D for a sample of adult Danes registered in the official patient register. This is combined with detailed scanner data on food purchases, which are used as a proxy for dietary intake. PARTICIPANTS We included 274 individuals in Denmark who are diagnosed during their participation in a consumer panel where they report their food purchases and 16 395 individuals who are not diagnosed. RESULTS Results suggest some changes in dietary composition following diagnosis, as measured by a Healthy Eating Index and for specific food groups and nutrients, although the long-term effects are limited. Socio-economic characteristics are poor predictors of dietary changes following diagnosis. Change in diet following diagnosis vary with the pre-diagnosis consumption patterns, where individuals with relatively unhealthy overall diets prior to diagnosis improve overall healthiness more compared to individuals with relatively healthy diets prior to diagnosis. CONCLUSIONS Adherence to dietary advice is low, on average, but there is large variation in behavioural change between the diagnosed individuals. Our results stress the difficulty for diagnosed individuals to shift dietary habits, particularly in the long term.
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Affiliation(s)
- Anna Kristina Edenbrandt
- Department of Economics, Swedish University of Agricultural Sciences, Uppsala750 07Sweden
- University of Copenhagen, Department of Food and Resource Economics, Copenhagen, Denmark
| | - Bettina Ewers
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | | | - Sinne Smed
- University of Copenhagen, Department of Food and Resource Economics, Copenhagen, Denmark
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4
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Effects of nucleus accumbens insulin inactivation on microstructure of licking for glucose and saccharin in male and female rats. Physiol Behav 2022; 249:113769. [PMID: 35247443 PMCID: PMC8969111 DOI: 10.1016/j.physbeh.2022.113769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
Abstract
Insulin of pancreatic origin enters the brain where several regions express a high density of insulin receptors. Functional studies of brain insulin signaling have focused predominantly on hypothalamic regulation of appetite and hippocampal regulation of learning. Recent studies point to involvement of nucleus accumbens (NAc) insulin signaling in a diet-sensitive response to glucose intake and reinforcement of flavor-nutrient learning. The present study used NAc shell microinjection of an insulin inactivating antibody (InsAb) to evaluate effects on the microstructure of licking for flavored 6.1% glucose. In both male and female rats, InsAb had no effect on the number of lick bursts emitted (a measure of motivation and/or satiety), but decreased the size of lick bursts (a measure of reward magnitude) in a series of five 30 min test sessions. This effect persisted beyond microinjection test sessions and was shown to depend on previous flavored glucose consumption under InsAb treatment rather than InsAb treatment alone. This suggests learning of diminished reward value and aligns with the previous finding that InsAb blocks flavor-nutrient learning. Specificity of the InsAb effect for nutrient reward was indicated by failure to affect any parameter of licking for flavored 0.25% saccharin solution. Finally, maintenance of rats on a 'Western' diet for twelve weeks produced a decrease in lick burst size for glucose in male rats, but an increase in lick burst size in females. Possible implications of these results for flavor-nutrient learning, maladaptive consequences of NAc insulin receptor subsensitivity, and the plausible involvement of distinct insulin-regulated mechanisms in NAc are discussed.
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Gebreyesus HA, Abreha GF, Besherae SD, Abera MA, Weldegerima AH, Kidane EG, Bezabih AM, Lemma TB, Nigatu TG. Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study. BMC Endocr Disord 2021; 21:99. [PMID: 34001064 PMCID: PMC8127210 DOI: 10.1186/s12902-021-00750-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diet is central to the management of type 2 diabetes mellitus (T2DM). Depending on the stage of the disease at which the recommended diet is initiated, optimal adherence can reduce HbA1c by about 1 to 2%. However, evidence on eating behavior is generally scarce including in Ethiopia. The present study aimed to assess the eating behavior of adults with T2DM in North Ethiopia. METHODS This cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Socio-demographic variables were collected using structured questionnaires; an asset-based wealth index was used to determine socioeconomic status. Three dimensions of eating behavior were assessed using Likert-type items: food selection, meal planning and calorie recognition. Raw Likert scores in each dimension were transformed to percent scales to maximum (%SM). Participants' behavior in each dimension was categorized into healthy and unhealthy taking 66.7% SM score as a cutoff. Overall eating behavior was determined by aggregating ranks scored in the three dimensions. Correlates of overall eating behavior were identified using Chi-square test and multinomial logistic regression with statistical significance set at P-value < 0.05. RESULT Only 1% of the participants had overall healthy eating behavior. Yet, overall unhealthy eating was apparent in 54.4%. By dimensions, healthy eating behaviors in food selection, meal planning and calorie recognition were seen in 43.5, 7.4 and 2.9% participants, respectively. Factors that were positively associated with having healthy eating behavior in one dimension relative to unhealthy in all were: receiving nutrition education [AOR 1.73; CI 1.09, 2.74], female gender [AOR 1.78; CI 1.03, 3.08] & being in 26-44 age category [AOR 3.7; CI 1.56, 8.85]. But, being in the poor [AOR 0.42; CI 0.16, 1.32] or average [AOR 0.54; CI 0.19, 1.55] socioeconomic strata were negatively associated. However, only receiving nutrition education [AOR 3.65; CI 1.31, 10.18] was significantly associated with having healthy behavior in two eating dimensions over unhealthy in all. CONCLUSION In North Ethiopia, the overall eating behavior of adults with T2DM is extremely poor. Diverse and integrated approaches including nutrition education during consultation should be implemented to address the gap.
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Affiliation(s)
- Hagos Amare Gebreyesus
- Department of Nutrition & Dietetics, Jimma University, Jimma, Ethiopia.
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | | | | | | | | | - Eshetu Girma Kidane
- Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Tsinuel Girma Nigatu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
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McLeod M, Stanley J, Signal V, Stairmand J, Thompson D, Henderson K, Davies C, Krebs J, Dowell A, Grainger R, Sarfati D. Impact of a comprehensive digital health programme on HbA 1c and weight after 12 months for people with diabetes and prediabetes: a randomised controlled trial. Diabetologia 2020; 63:2559-2570. [PMID: 32886192 DOI: 10.1007/s00125-020-05261-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS The aim of this RCT was to evaluate the effectiveness of a digital health programme (BetaMe/Melon) vs usual care in improving the control of type 2 diabetes and prediabetes in a primary care population. METHODS We conducted a randomised parallel-group two-arm single-blinded superiority trial in the primary care setting in two regions of New Zealand. Eligible participants were identified through Primary Health Organisations and participating practices. Eligibility criteria were as follows: age 18-75 years, HbA1c 41-70 mmol/mol (5.9-8.6%), not taking insulin, and daily access to the internet. BetaMe/Melon is a 12 month mobile-device and web-based programme with four components: health coaching; evidence-based resources; peer support; and goal tracking. Participants were randomised into the intervention or control arm (1:1 allocation) based upon baseline HbA1c (prediabetes or diabetes range), stratified by practice and ethnicity. Research nurses and the study biostatistician were blind to study arm. Primary outcomes of the study were changes in HbA1c and weight at 12 months, using an intention-to-treat analysis. RESULTS Four hundred and twenty-nine individuals were recruited between 20 June 2017 and 11 May 2018 (n = 215 intervention arm, n = 214 control arm), most of whom were included in analyses of co-primary outcomes (n = 210/215, 97.7% and n = 213/214, 99.5%). HbA1c levels at 12 months did not differ between study arms: mean difference was -0.9 mmol/mol (95% CI -2.9, 1.1) (-0.1% [95% CI -0.3, 0.1]) for the diabetes group and was 0.0 mmol/mol (95% CI -0.9, 0.9) (0.0% [95% CI -0.1, 0.1]) for the prediabetes group. Weight reduced slightly at 12 months for participants in both study arms, with no difference between arms (mean difference -0.4 kg [95% CI -1.3, 0.5]). CONCLUSIONS/INTERPRETATION This study did not demonstrate clinical effectiveness for this particular programme. Given their high costs, technology-assisted self-management programmes need to be individually assessed for their effectiveness in improving clinical outcomes for people with diabetes. TRIAL REGISTRATION www.anzctr.org.au ACTRN12617000549325 (universal trial number U1111-1189-9094) FUNDING: This study was funded by the Health Research Council of New Zealand, the Ministry of Health New Zealand and the Healthier Lives National Science Challenge. Graphical abstract.
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Affiliation(s)
- Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Virginia Signal
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeannine Stairmand
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Donna Thompson
- Department of Public Health, University of Otago, Wellington, New Zealand
- , Masterton, New Zealand
| | - Kelly Henderson
- Department of Public Health, University of Otago, Wellington, New Zealand
- , Hamilton, New Zealand
| | | | - Jeremy Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
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López-Olmedo N, Jonnalagadda S, Basto-Abreu A, Reyes-García A, Alish CJ, Shamah-Levy T, Barrientos-Gutierrez T. Adherence to Dietary Guidelines in Adults by Diabetes Status: Results From the 2012 Mexican National Health and Nutrition Survey. Nutrients 2020; 12:E3464. [PMID: 33198057 PMCID: PMC7697878 DOI: 10.3390/nu12113464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 01/21/2023] Open
Abstract
The aims of the present study were to compare the adherence to dietary guidelines and evaluate potential differences in nutrient profiles among adults by diabetes status. We used the Mexican Alternate Healthy Eating Index (MxAHEI) to evaluate adherence to dietary guidelines. We calculated the MxAHEI scores (total and by dietary component) with scales from 0 (non-adherence) to 100 (perfect adherence) based on a food frequency questionnaire. Mean daily intakes of macronutrients and micronutrients (g, mg, mcg/1000 kcal per day) were also estimated by diabetes status. Sex-specific, multivariable linear regression models were estimated to test whether MxAHEI scores as well as nutrient intakes were different by diabetes status. Mexican adults had low adherence to the dietary guidelines irrespective of their diabetes status (score < 50 points). Among men, the MxAHEI score was 2.6 points higher among those with diabetes than those without diabetes (46.9; 95% confidence intervals (CI): 44.6, 49.2 vs. 44.3; 95% CI: 44.2, 45.6, respectively). Among women, the total MxAHEI score was similar in individuals with diabetes compared to those without diabetes. Lower intakes of carbohydrates and added sugars and higher intakes of protein, calcium, and zinc were observed in individuals with diabetes. Our findings support the development of strategies focused on promoting dietary patterns that can help to prevent and control the disease.
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Affiliation(s)
- Nancy López-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico; (N.L.-O.); (A.B.-A.); (A.R.-G.)
| | | | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico; (N.L.-O.); (A.B.-A.); (A.R.-G.)
| | - Alan Reyes-García
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico; (N.L.-O.); (A.B.-A.); (A.R.-G.)
| | | | - Teresa Shamah-Levy
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico;
| | - Tonatiuh Barrientos-Gutierrez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico; (N.L.-O.); (A.B.-A.); (A.R.-G.)
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8
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Storz MA. Adherence to Low-Fat, Vegan Diets in Individuals With Type 2 Diabetes: A Review. Am J Lifestyle Med 2020; 16:300-310. [DOI: 10.1177/1559827620964755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
Low-fat, vegan diets seem to be particularly effective for glycemic control and may significantly lower hemoglobin A1c levels in individuals with type 2 diabetes. However, health care providers report low levels of practice and argue that this diet is hard to follow. This controversy on the acceptability of low-fat vegan diets appears to be a significant barrier to its broader clinical implementation. This review investigated dropout and adherence rates in intervention studies using a low-fat vegan diet in individuals with type 2 diabetes. In contrast to the common belief that this diet is poorly accepted, this review suggests different findings. Dietary adherence appears to be good with approximately 50% of individuals meeting the criteria for high adherence in most studies. Adherence to a low-fat vegan diet was higher than adherence to conventional diets in several studies. Group support and regular supervision improve adherence. Moreover, relatively low dropout rates were found—indirectly indicating good acceptance and high patient interest in this particular dietary modification. Although this review has several important limitations, it appears inappropriate to associate low-fat, vegan diets with poor adherence in individuals with type 2 diabetes. With good and regular support, adherence rates are more than solid and physicians should advocate for this diet more frequently.
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Vitale M, Calabrese I, Massimino E, Shivappa N, Hebert JR, Auciello S, Grioni S, Krogh V, Sartore G, Signorini S, Rivellese AA, Riccardi G, Vaccaro O, Masulli M. Dietary inflammatory index score, glucose control and cardiovascular risk factors profile in people with type 2 diabetes. Int J Food Sci Nutr 2020; 72:529-536. [PMID: 33045863 DOI: 10.1080/09637486.2020.1832054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We examined the relationships between the dietary inflammatory index (DII®), dietary habits and cardiovascular risk factor profiles in people with type 2 diabetes mellitus (T2DM). Energy-adjusted DII (E-DII™) scores were calculated from a Food Frequency Questionnaire in 2568 T2DM patients from different parts of Italy. Analyses were conducted according to quartiles of sex-specific E-DII scores. Higher, more pro-inflammatory, (quartile 4) E-DII scores were associated with overall poor quality of the diet characterised by higher content of refined carbohydrates, added sugars, saturated fat and cholesterol and lower unsaturated fat, fibre and polyphenols compared to quartile 1. Higher E-DII scores also were associated with higher waist circumference (105.4 vs. 103.5 cm; p = 0.002), triglycerides (154.6 vs. 146.1 mg/dL; p = 0.005), diastolic blood pressure (80.05 vs. 78.6 mmHg; p = 0.04) and lower HDL-cholesterol (45.3 vs. 47.4 mg/dL; p = 0.04). In conclusion, E-DII is a potent marker of overall quality of the diet and is associated with an unfavourable cardiovascular risk factor profile.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - James R Hebert
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - Stefania Auciello
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - Vittorio Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | | | | | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Olga Vaccaro
- Department of Pharmacy, Federico II University of Naples, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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10
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Lambrinou E, Hansen TB, Beulens JW. Lifestyle factors, self-management and patient empowerment in diabetes care. Eur J Prev Cardiol 2020; 26:55-63. [PMID: 31766913 DOI: 10.1177/2047487319885455] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although management of diabetes mellitus is improving, inadequately managed cases still exist. Prevention of diabetes mellitus requires an integrated and holistic approach based on the origin of the disease. In Europe only half of diagnosed patients with diabetes mellitus have good glycaemic control. Inadequate glycaemic control is significantly increasing the use of healthcare resources, the medical costs and mortality rates. A review was conducted in order to summarise and discuss central themes for prevention. A search of the databases PubMed, CINAHL, Cochrane and Google Scholar between January 2010-May 2019 was undertaken. The following keywords: 'diabetes mellitus', 'cardiovascular diseases', 'empowerment', 'self-management education' and 'lifestyle factors' were used in different combinations to identify eligible articles. Important variables for the prevention of diabetes mellitus and its complications are self-management of diabetes mellitus and the management of risk factors. Education and support for self-management are fundamental when caring for people with a chronic disease like diabetes mellitus. In order to achieve effective self-management including lifestyle modification it is also crucial to motivate people. In this review, the role of the three main pillars in diabetes care are identified and discussed; patient empowerment, self-management education and lifestyle modification in the management of people with diabetes mellitus.
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Affiliation(s)
| | - Tina B Hansen
- Department of Cardiology, Zealand University Hospital, Denmark.,Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Joline Wj Beulens
- Department of Epidemiology and Biostatistics, Amsterdam UMC, The Netherlands.,Amsterdam Public Health Research Institute, The Netherlands
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11
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Mohammed AS, Adem F, Tadiwos Y, Woldekidan NA, Degu A. Level of Adherence to the Dietary Recommendation and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in Eastern Ethiopia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:2605-2612. [PMID: 32801812 PMCID: PMC7384875 DOI: 10.2147/dmso.s256738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dietary modification is the cornerstone and initial recommendation in the management of diabetes mellitus. Adhering to the recommended dietary practice has a significant role in diabetic control, but not uniformly practised. OBJECTIVE To assess dietary adherence and glycemic control among type 2 diabetic patients on follow-up at Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted from 22 August to 23 October 2019, at DRH. Data were collected through an interviewer-administered questionnaire. The Perceived Dietary Adherence Questionnaire (PDAQ) was used to estimate the level of dietary adherence. Glycemic control was measured using fasting blood glucose. Multivariate logistic regression analyses were employed to identify factors associated with dietary adherence. RESULTS Of the 307 included patients, 62.5% were poorly adherent to the recommended diet. Lack of dietary education (83.38%) and inability to afford a healthy diet (71.33%) were the perceived barriers to practice dietary recommendation. More than half (54.7%) failed to achieve the recommended fasting blood glucose target. In multivariate logistic regression, patients who were adherent to dietary recommendations were 3.56 times more likely to have good glycemic control. Those patients living in urban areas, having monthly income greater than 1000 Ethiopia Birr, family history of the disease, duration of treatment greater than 10 years and who received counseling were more likely to have good dietary adherence. CONCLUSION The level of adherence to the dietary recommendation and glycemic control was low. Healthcare providers should be proactive in tackling the barrier for non-adherence and should promote adherence to dietary recommendations in T2DM patients.
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Affiliation(s)
- Ammas Siraj Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Tadiwos
- Department of Pharmacology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nigist Alemayehu Woldekidan
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amsalu Degu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Science, United States International University Africa, Nairobi, Kenya
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12
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Alcubierre N, Granado-Casas M, Real J, Perpiñán H, Rubinat E, Falguera M, Castelblanco E, Franch-Nadal J, Mauricio D. Spanish People with Type 2 Diabetes Show an Improved Adherence to the Mediterranean Diet. Nutrients 2020; 12:nu12020560. [PMID: 32093385 PMCID: PMC7071466 DOI: 10.3390/nu12020560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to assess the dietary pattern (i.e., Mediterranean Diet (MedDiet) and healthy eating) in people with type 2 diabetes (T2D) compared with those without diabetes. In addition, we explored clinical factors associated with the dietary pattern. This cross-sectional study was performed with a sample of 476 participants (238 with T2D and 238 participants without diabetes, matched for age and sex). The alternate Mediterranean Diet (aMED) score and the alternate Healthy Eating Index (aHEI) were calculated. Statistical analysis included comparison between groups and multivariable models. Participants with T2D showed higher aMED and aHEI scores (mean (SD): 4.3 (1.5) and 43.9 (6.5), respectively) in comparison with the control group (3.5 (1.8) and 39.4 (7.4), respectively; p < 0.001). In addition, a higher proportion of participants with T2D in higher tertiles of aMED (21.8%) and aHEI (39.9%) was observed compared with participants without diabetes (11.3% for the aMED, and 19.3% for the aHEI; p < 0.001). The adjusted multivariable analysis revealed that T2D (p < 0.001), increasing age (p = 0.006 and p = 0.030, respectively), and physical activity (p = 0.009) were positively associated with higher aMED and aHEI scores. Dyslipidemia and female gender were positively associated with aMED and aHEI (p = 0.031 and p < 0.001, respectively). The specific multivariable analysis for the group with T2D yielded a positive association of age (p < 0.001) and dyslipidemia (p = 0.021) with aMED. Regarding the aHEI, only female gender was positively related with this score in diabetes participants (p = 0.025). Participants with T2D showed a higher adherence to the MedDiet and a healthier eating pattern.
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Affiliation(s)
- Nuria Alcubierre
- Department of Nutrition and Dietetics, Avantmedic, 25008 Lleida, Spain;
| | - Minerva Granado-Casas
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, 25198 Lleida, Spain;
| | - Jordi Real
- DAP-Cat Group, Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain;
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain;
| | - Hèctor Perpiñán
- Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, 46010 Valencia, Spain;
| | - Esther Rubinat
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, 25198 Lleida, Spain;
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain;
- Department of Nursing and Physiotherapy, Serra Hunter Lecture, University of Lleida, 25198 Lleida, Spain
| | - Mireia Falguera
- Primary Health Care Center Igualada Nord, 08700 Igualada, Spain;
| | - Esmeralda Castelblanco
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain;
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain;
- Correspondence: (J.F.-N.); (D.M.); Tel.: +34-933-293-912 (J.F.-N.); +34-935-565-602 (D.M.)
| | - Didac Mauricio
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, 25198 Lleida, Spain;
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain
- Department of Medicine, Barcelona Autonomous University (UAB), 08035 Barcelona, Spain
- Correspondence: (J.F.-N.); (D.M.); Tel.: +34-933-293-912 (J.F.-N.); +34-935-565-602 (D.M.)
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13
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Vitale M, Masulli M, Rivellese AA, Bonora E, Babini AC, Sartore G, Corsi L, Buzzetti R, Citro G, Baldassarre MPA, Bossi AC, Giordano C, Auciello S, Dall’Aglio E, Iannarelli R, Tonutti L, Sacco M, Di Cianni G, Clemente G, Gregori G, Grioni S, Krogh V, Riccardi G, Vaccaro O. Pasta Consumption and Connected Dietary Habits: Associations with Glucose Control, Adiposity Measures, and Cardiovascular Risk Factors in People with Type 2 Diabetes-TOSCA.IT Study. Nutrients 2019; 12:nu12010101. [PMID: 31905885 PMCID: PMC7019547 DOI: 10.3390/nu12010101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/18/2019] [Accepted: 12/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Pasta is a refined carbohydrate with a low glycemic index. Whether pasta shares the metabolic advantages of other low glycemic index foods has not really been investigated. The aim of this study is to document, in people with type-2 diabetes, the consumption of pasta, the connected dietary habits, and the association with glucose control, measures of adiposity, and major cardiovascular risk factors. Methods: We studied 2562 participants. The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. Sex-specific quartiles of pasta consumption were created in order to explore the study aims. Results: A higher pasta consumption was associated with a lower intake of proteins, total and saturated fat, cholesterol, added sugar, and fiber. Glucose control, body mass index, prevalence of obesity, and visceral obesity were not significantly different across the quartiles of pasta intake. No relation was found with LDL cholesterol and triglycerides, but there was an inverse relation with HDL-cholesterol. Systolic blood pressure increased with pasta consumption; but this relation was not confirmed after correction for confounders. Conclusions: In people with type-2 diabetes, the consumption of pasta, within the limits recommended for total carbohydrates intake, is not associated with worsening of glucose control, measures of adiposity, and major cardiovascular risk factors.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, 37138 Verona, Italy;
| | | | - Giovanni Sartore
- Dipartimento di Medicina, University of Padova, 35100 Padova, Italy;
| | - Laura Corsi
- Dipartimento di Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, 16043 Genova, Italy;
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 04100 Rome, Italy;
| | - Giuseppe Citro
- UO Endocrinologia e Diabetologia, ASP, 85100 Potenza, Italy;
| | - Maria Pompea Antonia Baldassarre
- CeSI-MeT-Centro di Scienze dell’Invecchiamento e Medicina Traslazionale-University G. D’Annunzio of Chieti, 66100 Pescara, Italy;
| | - Antonio Carlo Bossi
- UOC Malattie Endocrine e Centro Regionale per il Diabete Mellito, ASST Bergamo Ovest di Treviglio, 24047 Treviglio, Italy;
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, 90127 Palermo, Italy;
| | - Stefania Auciello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Elisabetta Dall’Aglio
- Dipartimento di Medicina Clinica e Sperimentale, University of Parma, 43100 Parma, Italy;
| | - Rossella Iannarelli
- UOSD Diabetologia e Malattie del Metabolismo, Ospedale San Salvatore, 67100 L’Aquila, Italy;
| | - Laura Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, 33100 Udine, Italy;
| | - Michele Sacco
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), 65124 Pescara, Italy;
| | | | - Gennaro Clemente
- IRPPS Research National Council, Penta di Fisciano, 84025 Salerno, Italy;
| | | | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy; (S.G.); (V.K.)
| | - Vittorio Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy; (S.G.); (V.K.)
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
- Correspondence: ; Tel.: +39-081-746-3665; Fax: +39-081-746-4736
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14
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Ewers B, Trolle E, Jacobsen SS, Vististen D, Almdal TP, Vilsbøll T, Bruun JM. Dietary habits and adherence to dietary recommendations in patients with type 1 and type 2 diabetes compared with the general population in Denmark. Nutrition 2019; 61:49-55. [PMID: 30684852 DOI: 10.1016/j.nut.2018.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of the present study was to examine dietary habits and adherence to dietary recommendations in adult patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with the general population in Denmark. METHODS The study was cross-sectional and included 426 patients with T1D and 348 patients with T2D recruited from an outpatient diabetes clinic in the capital region of Denmark. Dietary habits were assessed by a food frequency questionnaire and compared with dietary data from 2,899 participants without diabetes from the Danish National Survey of Dietary Habits and Physical Activity. RESULTS Patients with diabetes had a 20-50% lower intake of added sugar and alcohol, and a 10-20% higher intake of fibre and vegetables compared with the general population (p<0.001 for all). Patients with T2D had a 37% lower intake of alcohol compared with T1D (p<0.001). Adherence to dietary recommendations (e.g. fibre, saturated fat, vegetables, fruit and fish) were low in all groups but lowest in the general population. CONCLUSION The Danish diet is too high in saturated fat and too low in dietary fibre, vegetable, fruit and fish compared to dietary recommendations in both patients with diabetes and the general population. However, our data demonstrate that patients with diabetes consume a healthier diet compared to the general population: Limiting the intake of added sugar and alcohol, and increasing the intake of vegetables and dietary fibre.
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Affiliation(s)
- Bettina Ewers
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | - Ellen Trolle
- The National Food Institute, Technical University of Denmark, Soeborg, Denmark
| | | | | | | | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Meldgaard Bruun
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; Department of Medicine, Randers Regional Hospital, Denmark
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15
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Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD, Tegegn HG. Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital. Clin Diabetes Endocrinol 2018; 4:21. [PMID: 30519484 PMCID: PMC6267803 DOI: 10.1186/s40842-018-0070-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/06/2018] [Indexed: 12/28/2022] Open
Abstract
Background Limited data are available regarding the level of adherence and barriers to dietary recommendations in individuals with type 2 diabetes in Africa including Ethiopia. Therefore, this study aimed at assessing the level of dietary adherence and its barriers among patients with type 2 diabetes in northwest Ethiopia. Methods A prospective hospital-based cross-sectional study was conducted from August to October 2017 at Debre Tabor General Hospital, Northwest Ethiopia. The Perceived Dietary Adherence Questionnaire (PDAQ) was used for dietary adherence measurement. Multivariate logistic regression was done to identify the barriers influencing dietary adherence. Result A significant percentage (74.3%) of the study participants had poor adherence to dietary recommendations. The highest mean score was obtained for the question regarding consuming foods high in sugar with a mean 5.49 ± 1.20 times a week. On the other hand, our participants had a low consumption of fruits and vegetables and foods high in omega-3 fats with a mean of 1.84 ± 1.96 and 0.1 ± 0.62 times a week respectively. According to the survey of participants, lack of knowledge, lack of diet education, inability to afford the cost of healthy diet and poor awareness about the benefit of dietary recommendations were the most cited reasons for poor dietary adherence. In multivariate logistics regression, low level of educational status, the presence of co-morbidities, lack of previous exposure to dietary education and low monthly income were statistically significant factors associated with non-adherence. Conclusion The rate of non-adherence to dietary recommendation among patients with T2DM was found to be high in northwest Ethiopia. Hence, providing customized health education about the potential benefit of proper dietary recommendations in controlling blood glucose is recommended. Health care providers should be proactive in promoting adherence to dietary recommendations in patients with T2DM.
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Affiliation(s)
- Asnakew Achaw Ayele
- 1Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, BOX 520 Gondar, PO Ethiopia
| | - Yohannes Kelifa Emiru
- 2School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Belete Achamyelew Ayele
- 4Department of Epidemiology and Biostatics, Institute of Public health College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | - Henok Getachew Tegegn
- 1Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, BOX 520 Gondar, PO Ethiopia.,5School of Medicine and Pharmacy, University of New England, Armidale, NSW 2351 Australia
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16
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Di Onofrio V, Gallé F, Di Dio M, Belfiore P, Liguori G. Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy. BMC Public Health 2018; 18:1181. [PMID: 30333012 PMCID: PMC6192365 DOI: 10.1186/s12889-018-6101-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/05/2018] [Indexed: 01/04/2023] Open
Abstract
Background Type 2 diabetes (T2D) is associated with a prion diminished quality of life, especially due to the severe complications that it implicates. Changing dietary habits is an absolute priority, as well as implementing nutritional motivational programs. The aim of this study was to verify the effectiveness of a nutritional intervention in improving the health of patients affected by T2D. Methods A total of 69 patients participated in a nine-months motivational program focused on the principles of the Mediterranean diet, the classes of nutrients, the distribution of the meals during the day and the dietary choices. During regular meetings, the patients were requested to fill out a questionnaire about their dietary habits and behaviours. Clinical and metabolic parameters were also analysed. Results At the end of the intervention the number of people who declared that they ate five meals a day (p = 0.006) and preferred to have fruit for snack (p = 0.004) increased, while there was a reduction in the use of sweeteners and an elimination of the use of fructose (p = 0.05). The total daily consumption of kilocalories (kcal) had been reduced and the percentages of carbohydrates, proteins and lipids, after the intervention, follow the guidelines. In relation to this, a significant improvement (p < 0.05) was registered in systolic and diastolic pressure, BMI and waist circumference, as well as in glycaemic values (p = 0.018). Conclusions A nutritional motivational intervention may be useful in improving dietary habits and health status of patients with T2D. We hope that a similar intervention will be applied in Campania and in other Italian regions. Trial registration Registration number is ISRCTN11067689; date of registration: 10/09/2018. Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-018-6101-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valeria Di Onofrio
- Department of Sciences and Technologies, University of Naples "Parthenope", Business District, Block C4, 80143, Naples, Italy.
| | - Francesca Gallé
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy
| | - Mirella Di Dio
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy
| | - Patrizia Belfiore
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy
| | - Giorgio Liguori
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy
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Vitale M, Masulli M, Calabrese I, Rivellese AA, Bonora E, Signorini S, Perriello G, Squatrito S, Buzzetti R, Sartore G, Babini AC, Gregori G, Giordano C, Clemente G, Grioni S, Dolce P, Riccardi G, Vaccaro O. Impact of a Mediterranean Dietary Pattern and Its Components on Cardiovascular Risk Factors, Glucose Control, and Body Weight in People with Type 2 Diabetes: A Real-Life Study. Nutrients 2018; 10:nu10081067. [PMID: 30103444 PMCID: PMC6115857 DOI: 10.3390/nu10081067] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
Abstract
This study evaluates the relation of a Mediterranean dietary pattern and its individual components with the cardiovascular risk factors profile, plasma glucose and body mass index (BMI) in people with type 2 diabetes. We studied 2568 participants at 57 diabetes clinics. Diet was assessed with the EPIC (European Prospective Investigation into Cancer and Nutrition) questionnaire, adherence to the Mediterranean diet was evaluated with the relative Mediterranean diet score (rMED). A high compared to a low score was associated with a better quality of diet and a greater adherence to the nutritional recommendations for diabetes. However, even in the group achieving a high score, only a small proportion of participants met the recommendations for fiber and saturated fat (respectively 17% and 30%). Nonetheless, a high score was associated with lower values of plasma lipids, blood pressure, glycated hemoglobin, and BMI. The relationship of the single food items components of the rMED score with the achievement of treatment targets for plasma lipids, blood pressure, glucose, and BMI were also explored. The study findings support the Mediterranean dietary model as a suitable model for type 2 diabetes and the concept that the beneficial health effects of the Mediterranean diet lie primarily in its synergy among various nutrients and foods rather than on any individual component.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | | | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, 37134 Verona, Italy.
| | - Stefano Signorini
- University Department Laboratory Medicine, Hospital of Desio, 20832 Monza, Italy.
| | - Gabriele Perriello
- Endocrinology and Metabolism, University of Perugia, 06126, Perugia, Italy.
| | - Sebastiano Squatrito
- Diabetes Unit, University Hospital Garibaldi-Nesima of Catania, 95122 Catania, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 04100 Rome, Italy.
| | - Giovanni Sartore
- Department of Medicine, University of Padua, 35100 Padova, Italy.
| | | | - Giovanna Gregori
- Diabetes Unit, Azienda Sanitaria Toscana Nord-Ovest, Massa Carrara, 54100 Massa Carrara, Italy.
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, 90127 Palermo, Italy.
| | - Gennaro Clemente
- Institute for Research on Population and Social Policies-National Research Council, 84084 Fisciano, Italy.
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy.
| | - Pasquale Dolce
- Department of Public Health, Federico II University of Naples, 80131 Naples, Italy.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
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18
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De Carli L, Gambino R, Lubrano C, Rosato R, Bongiovanni D, Lanfranco F, Broglio F, Ghigo E, Bo S. Impaired taste sensation in type 2 diabetic patients without chronic complications: a case-control study. J Endocrinol Invest 2018; 41:765-772. [PMID: 29185232 DOI: 10.1007/s40618-017-0798-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/17/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Few and contradictory data suggest changes in taste perception in type 2 diabetes (T2DM), potentially altering food choices. We, therefore, analyzed taste recognition thresholds in T2DM patients with good metabolic control and free of conditions potentially impacting on taste, compared with age-, body mass index-, and sex-matched normoglycemic controls. METHODS An ascending-concentration method was used, employing sucrose (sweet), sodium chloride (salty), citric acid (sour), and quinine hydrochloride (bitter), diluted in increasing concentration solutions. The recognition threshold was the lowest concentration of correct taste identification. RESULTS The recognition thresholds for the four tastes were higher in T2DM patients. In a multiple regression model, T2DM [β = 0.95; 95% CI 0.32-1.58; p = 0.004 (salty); β = 0.61; 0.19-1.03; p = 0.006 (sweet); β = 0.78; 0.15-1.40; p = 0.016 (sour); β = 0.74; 0.22-1.25; p = 0.006 (bitter)] and waist circumference [β = 0.05; 0.01-0.08; p = 0.012 (salty); β = 0.03; 0.01-0.05; p = 0.020 (sweet); β = 0.04; 0.01-0.08; p = 0.020 (sour); β = 0.04; 0.01-0.07; p = 0.007 (bitter)] were associated with the recognition thresholds. Age was associated with salty (β = 0.06; 0.01-0.12; p = 0.027) and BMI with sweet thresholds (β = 0.06; 0.01-0.11; p = 0.019). CONCLUSIONS Taste recognition thresholds were higher in uncomplicated T2DM, and central obesity was significantly associated with this impairment. Hypogeusia may be an early sign of diabetic neuropathy and be implicated in the poor compliance of these patients to dietary recommendations.
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Affiliation(s)
- L De Carli
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Gambino
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Lubrano
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - D Bongiovanni
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - F Lanfranco
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - F Broglio
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Bo
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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19
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Sarfati D, McLeod M, Stanley J, Signal V, Stairmand J, Krebs J, Dowell A, Leung W, Davies C, Grainger R. BetaMe: impact of a comprehensive digital health programme on HbA1c and weight at 12 months for people with diabetes and pre-diabetes: study protocol for a randomised controlled trial. Trials 2018; 19:161. [PMID: 29506562 PMCID: PMC5836439 DOI: 10.1186/s13063-018-2528-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/05/2018] [Indexed: 01/06/2023] Open
Abstract
Background Long-term conditions (LTCs) are the biggest contributor to health loss in New Zealand. The economic cost and burden on the health system is substantial and growing. Self-management strategies offer a potential way to reduce the pressure on health services. This study evaluates a comprehensive self-management programme (the BetaMe programme) delivered by mobile and web-based technologies for people with Type 2 diabetes (T2DM) and pre-diabetes. The primary aim of this study is to evaluate the effectiveness of the BetaMe programme versus usual care among primary care populations in improving the control of T2DM and pre-diabetes, as measured by change in HbA1c and weight over 12 months. Methods Participants will be recruited through two primary healthcare organisations and a Māori healthcare provider in New Zealand (n = 430). Eligible participants will be 18 to 75 years old, with T2DM or pre-diabetes, with an HbA1c of 41–70 mmol/mol up to 2 years prior to study commencement. Eligible participants who consent to participate will be individually randomised to the control arm (usual care) or intervention arm (usual care and BetaMe). The programme consists of a 16-week core followed by a maintenance period of 36 weeks. It incorporates (1) individualised health coaching, (2) goal setting and tracking, (3) peer support in an online forum and (4) educational resources and behaviour-change tools. The primary outcome measures are change in HbA1c and weight at 12 months. Secondary outcomes are changes in waist circumference, blood pressure, patient activation and diabetes-specific behaviours. All outcomes will be assessed at 4 and 12 months for the total study population and for Māori and Pacific participants specifically. All primary analyses will be based on intention-to-treat. Primary analysis will use linear mixed models comparing mean outcome levels adjusted for initial baseline characteristics at 12 months. Discussion This is a randomised controlled trial of a comprehensive self-management intervention for people with diabetes and pre-diabetes. If effective, this programme would allow healthcare providers to deliver an intervention that is person-centred and supports the self-care of people with T2DM, pre-diabetes and potentially other LTCs. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000549325. Registered on 19 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2528-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand.
| | - Melissa McLeod
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Virginia Signal
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Jeannine Stairmand
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - William Leung
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand.,Department of Medicine, University of Auckland, PO Box 1142, Auckland, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
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20
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Adherence to Diabetes Dietary Guidelines Assessed Using a Validated Questionnaire Predicts Glucose Control in Adults With Type 2 Diabetes. Can J Diabetes 2018. [DOI: 10.1016/j.jcjd.2017.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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22
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Asaad G, Chan CB. Food sources of sodium, saturated fat, and added sugar in the Physical Activity and Nutrition for Diabetes in Alberta (PANDA) trial. Appl Physiol Nutr Metab 2017; 42:1270-1276. [PMID: 28772082 DOI: 10.1139/apnm-2017-0266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diabetic patients may find it difficult to achieve recommended nutrient intakes embedded within dietary guidelines. The objective of this analysis was to document total sodium, saturated fat, and added sugar intake as well as the main food sources of these nutrients in Canadian adults with type 2 diabetes before and after an intervention focused on healthy eating. Participants were enrolled in a single-arm dietary intervention trial designed to improve glycemic control and adherence to dietary recommendations. A 4-week menu plan and recipes were provided for participants along with a 6-week educational curriculum. Three repeated 24-h dietary recalls were collected at baseline and 3 months. Food sources of sodium, saturated fat, and added sugar were a secondary outcome derived from the dietary recalls. After 3 months, there was a reduction (p < 0.05) in sodium intake of 561 mg/day, which was mainly due to reduced consumption of processed meats, soups, and condiments. Significantly lower intake of processed meat contributed to -2.9 g/day saturated fat intake (p < 0.1) while added sugar intake declined by 7 g/day (p < 0.1), which was due to lower consumption of baked goods/desserts and chocolate (both p < 0.05). The intervention was beneficial for type 2 diabetes patients in terms of changing dietary habits. However, the majority of the participants still exceeded the dietary guidelines for sodium and saturated fat. In addition to the efforts of individuals and their healthcare providers, strategies to increase the nutritional quality of prepared foods could provide widespread benefits.
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Affiliation(s)
- Ghada Asaad
- a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Catherine B Chan
- a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada.,b Department of Physiology, University of Alberta, Edmonton, AB T6G 2R3, Canada.,c Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Edmonton, AB T6G 2R3, Canada
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23
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Gallé F, Di Onofrio V, Cirella A, Di Dio M, Miele A, Spinosa T, Liguori G. Improving Self-Management of Type 2 Diabetes in Overweight and Inactive Patients Through an Educational and Motivational Intervention Addressing Diet and Physical Activity: A Prospective Study in Naples, South Italy. Diabetes Ther 2017; 8. [PMID: 28631241 PMCID: PMC5544619 DOI: 10.1007/s13300-017-0283-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Nutrition and physical activity are key elements in the prevention and management of type 2 diabetes. A community-based, multidisciplinary educational intervention aimed to improve quality of life and disease self-management in sedentary, overweight/obese type 2 diabetic patients was implemented in Naples, South Italy. METHODS The 9-month intervention included a motivational program, a nutrition program, and an exercise program. Satisfaction, worry, and embarrassment regarding their condition, together with disease-related behaviors and propensity towards physical activity, were evaluated through a validated questionnaire before and after the intervention; health status perception was evaluated through the short-form 12 questionnaire. Changes in HbA1c level and weight were also checked. RESULTS A significant improvement (p < 0.05) was registered in behaviors related to the management of hypoglycemic crisis and food choice; in nearly all the items related to living with the disease (p < 0.01); and in health status perception (p < 0.01). The adoption of healthy behavior was more common among women (OR 2.17, 95% CI 1.09, 3.02) and persons with higher educational levels (OR 1.26, 95% CI 0.83, 2.17; OR 1.54, 95% CI 0.56, 2.27). About 30% of participants did not modify their emotional status after the intervention. Although not significantly (p = 0.18), the trust of patients towards physical activity increased at the end of the study, together with their active lifestyle (p < 0.01) and with the decrease of perceived barriers (p < 0.01). A significant improvement was registered in glycemic control and weight status (p < 0.01). CONCLUSIONS The intervention was feasible and effective in addressing diet and physical activity among participants, giving consequent improvements in health status. Similar educational interventions including a training program for people with diabetes should be standardized and adopted by the Italian National Health System.
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Affiliation(s)
- Francesca Gallé
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy.
| | - Valeria Di Onofrio
- Department of Sciences and Technologies, University of Naples "Parthenope", Naples, Italy
| | - Assunta Cirella
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - Mirella Di Dio
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - Alessandra Miele
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | | | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
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24
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Ponzo V, Rosato R, Tarsia E, Goitre I, De Michieli F, Fadda M, Monge T, Pezzana A, Broglio F, Bo S. Self-reported adherence to diet and preferences towards type of meal plan in patient with type 2 diabetes mellitus. A cross-sectional study. Nutr Metab Cardiovasc Dis 2017; 27:642-650. [PMID: 28684081 DOI: 10.1016/j.numecd.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Few studies have evaluated the attitudes of patients with type 2 diabetes mellitus (T2DM) towards the given dietary plans. In this study, we aimed to evaluate: i) the self-reported adherence of T2DM patients to the prescribed diets; ii) the use of other types of diet schemes; iii) the patients' preferences towards the type of meal plans. METHODS AND RESULTS A 16 multiple-choice items questionnaire was administered to 500 T2DM patients; 71.2% (356/500) of them had the perception of having received a dietary plan; only 163/356 declared to be fully adherent. The latter had lower BMI (25.8 ± 4.5 vs 29.1 ± 4.5 kg/m2, p < 0.001) than patients who were partly adherent. Among patients not following the given diet, 61.8% was eating in accordance to a self-made diet and 20.9% did not follow any diet. Only a few patients (2.4%) had tried a popular diet/commercial program. Most patients preferred either a "sufficiently free" (201/500) or a "free" (218/500) scheme. The use of supplements attracted younger, obese individuals, with higher education, and most managers. In a multinomial regression model, age and diabetes duration were inversely associated with the choice of a "rigid" scheme, diabetes duration and glycated hemoglobin levels were inversely correlated with a "free" diet choice, obesity was associated with a "strategic" scheme choice, while lower education (inversely) and obesity (directly) correlated with the preference for "supplement use". CONCLUSIONS Socio-cultural/individual factors could affect attitudes and preferences of T2DM patients towards diet. These factors should be considered in order to draw an individually tailored dietary plan.
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Affiliation(s)
- V Ponzo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - R Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - E Tarsia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - I Goitre
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - F De Michieli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Fadda
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - T Monge
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - A Pezzana
- Unit of Clinical Nutrition, Department of Internal Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - F Broglio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Bo
- Department of Medical Sciences, University of Turin, Turin, Italy.
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25
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Adriouch S, Lelong H, Kesse-Guyot E, Baudry J, Lampuré A, Galan P, Hercberg S, Touvier M, Fezeu LK. Compliance with Nutritional and Lifestyle Recommendations in 13,000 Patients with a Cardiometabolic Disease from the Nutrinet-Santé Study. Nutrients 2017; 9:nu9060546. [PMID: 28587108 PMCID: PMC5490525 DOI: 10.3390/nu9060546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A healthy diet has been shown to prevent cardiovascular diseases complications. The objective of this study was to assess dietary intakes and compliance with nutritional and lifestyle recommendations in French adults diagnosed with hypertension, diabetes, dyslipidaemia or cardiovascular disease compared with healthy individuals. METHODS Data was collected from 26,570 subjects aged 35 to 70 years (13,285 patients and 13,285 controls matched by sex and age) of the French cohort NutriNet-Santé. Dietary intakes were assessed using three 24-h records. Mean food and nutrient intakes of patients were compared to those of healthy subjects using multivariable mixed logistic and linear regressions. RESULTS Compared to healthy controls, adults reporting cardiometabolic diseases had lower intakes of sweetened products, higher intakes of fish and seafood and a better compliance with dairy products. However, overall, they reported unhealthier lifestyles and dietary habits. Indeed, they were less often physically active and had similar habits regarding alcohol and tobacco consumption. They also had lower intakes of fruit, higher intakes of meat, processed meat and added fats. It is noteworthy that diabetic subjects tended to show the highest compliance with certain dietary recommendations (vegetables, pulses and whole grain products). CONCLUSION Our study brings into focus the fact that some nutritional aspects still need to be improved among individuals with a cardiometabolic disease. We should encourage higher intakes of fruits and vegetables, whole grain products, and lower intakes of meat and sodium, as well as healthy lifestyle (physical activity, no-smoking and limited intake of alcohol) in order to encourage a healthier management after being diagnosed.
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Affiliation(s)
- Solia Adriouch
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Hélène Lelong
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Emmanuelle Kesse-Guyot
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Julia Baudry
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Aurélie Lampuré
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Pilar Galan
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
- Département de Santé Publique, Hôpital Avicenne, F-93017 Bobigny, France.
| | - Serge Hercberg
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
- Département de Santé Publique, Hôpital Avicenne, F-93017 Bobigny, France.
| | - Mathilde Touvier
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
| | - Léopold K Fezeu
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, France.
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26
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Treatment Decisions and Adherence to Adjuvant Endocrine Therapy in Breast Cancer. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0248-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Matovu N, Matovu FK, Sseguya W, Tushemerirwe F. Association of dietary intake and BMI among newly diagnosed type 2 diabetes patients attending diabetic clinics in Kampala. BMC Nutr 2017; 3:21. [PMID: 32153803 PMCID: PMC7050777 DOI: 10.1186/s40795-017-0141-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/01/2017] [Indexed: 11/28/2022] Open
Abstract
Background Dietary intake is a known determinant of body mass index (BMI) among different populations and is therefore a useful component for BMI control. To our knowledge, no study has investigated the usual dietary intake and its association with BMI in type 2 diabetes patients among the Ugandan population. This study aimed to analyse the usual dietary intake of newly diagnosed type 2 diabetes patients and determine the association between the different dietary nutrients and BMI. Methods We conducted a cross sectional study among 200 newly diagnosed type 2 diabetes patients in two major diabetic clinics of Kampala district. Sociodemographic, lifestyle, clinical measurements and dietary intake data were collected using a pretested structured questionnaire and a 24-h dietary recall respectively. Patients were divided according to quintile of nutrient intake. The association between dietary intake and BMI was investigated using multiple linear regression. Results The average energy intake was 1960.2 ± 594.6 kilocalories/day. Carbohydrate, protein and fat contributed 73, 12.6 and 14.4% of the daily energy consumption respectively. We observed an inverse association between protein intake and BMI. Slopes (95% C.I) of average BMI for patients in the respective quintiles were: 0.0, -2.1 (-4.2, -0.06), -4.4 (-6.9, -1.9), -5.6 (-8.2, -3.0), and -7.3 (-10.6, -4.0); ptrend <0.001. In contrast, the findings showed a positive association between carbohydrate intake and BMI. Slopes (95% C.I) of average BMI for patients in the respective quintiles were: 0.0, 3.0 (0.6, 5.4), 3.5 (0.5, 6.4), 5.2 (1.9, 8.6) and 9.7 (5.3, 14.1); ptrend <0.001 after adjusting for sociodemographic, clinical and dietary intake variables. We found no significant association between the dietary intake of fibre, fat, saturated fat, polyunsaturated fat and monounsaturated fat with BMI in the final adjusted model. Conclusion Higher intake of carbohydrate was associated with higher BMI while higher intake of protein was associated with lower BMI.
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Affiliation(s)
- Nicholas Matovu
- 1Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Flavia K Matovu
- 2Department of Epidemiology and Biostatistics, School of Public Health, Makerere University and Makerere University - John Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Florence Tushemerirwe
- 1Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
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Giorgini M, Vitale M, Bozzetto L, Ciano O, Giacco A, Rivieccio A, Calabrese I, Riccardi G, Rivellese AA, Annuzzi G. Micronutrient Intake in a Cohort of Italian Adults with Type 1 Diabetes: Adherence to Dietary Recommendations. J Diabetes Res 2017; 2017:2682319. [PMID: 29109962 PMCID: PMC5646341 DOI: 10.1155/2017/2682319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/30/2017] [Accepted: 09/17/2017] [Indexed: 11/18/2022] Open
Abstract
Micronutrients are of fundamental importance in maintaining health status. However, data on their dietary intake are few particularly in persons with diabetes. The aim of this study was to evaluate in adults with type 1 diabetes (T1DM) attending a tertiary-level diabetes center in Southern Italy the intake of micronutrients (both vitamins and minerals) and the adherence to recommendations. Seven-day food records of 60 T1DM patients were analyzed. Micronutrient intake was evaluated based on the Italian food composition tables and expressed as amount per 1000 kcal of energy intake to adjust for possible underreporting. Adherence to recommendations for vitamins A, B6, B12, and C and niacin was acceptable in both sexes (ranging from 77% to 100%). Half of the patients did not adhere to folate recommendation, even less to vitamin E, and no patient reached the recommended intake for vitamin D. As for minerals, adherence was low for potassium and selenium (0-23%); intermediate for zinc, copper, and magnesium; low and intermediate for calcium in men and women, respectively; and low for iron in women. In conclusion, the diet followed by T1DM patients may not have a sufficient content of different micronutrients. Therefore, an adequate intake of low-fat dairy products, fish, legumes, and vegetables should be encouraged as components of a healthier dietary pattern.
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Affiliation(s)
- Marisa Giorgini
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ornella Ciano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Angela Giacco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Anna Rivieccio
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Angela A. Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Vitale M, Masulli M, Cocozza S, Anichini R, Babini AC, Boemi M, Bonora E, Buzzetti R, Carpinteri R, Caselli C, Ceccarelli E, Cignarelli M, Citro G, Clemente G, Consoli A, Corsi L, De Gregorio A, Di Bartolo P, Di Cianni G, Fontana L, Garofolo M, Giorda CB, Giordano C, Grioni S, Iovine C, Longhitano S, Mancastroppa G, Mazzucchelli C, Montani V, Mori M, Perriello G, Rinaldi ME, Ruffo MC, Salvi L, Sartore G, Scaranna C, Tonutti L, Zamboni C, Zogheri A, Krogh V, Cappellini F, Signorini S, Riccardi G, Vaccaro O. Sex differences in food choices, adherence to dietary recommendations and plasma lipid profile in type 2 diabetes - The TOSCA.IT study. Nutr Metab Cardiovasc Dis 2016; 26:879-885. [PMID: 27212622 DOI: 10.1016/j.numecd.2016.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/08/2016] [Accepted: 04/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Diabetic women have a more adverse plasma lipid profile than men. Sex differences in dietary habits may play a role, but are little investigated. The study evaluates the quality of diet, adherence to the nutritional recommendations of the Diabetes and Nutrition Study Group and their relation with plasma lipid in men and women with diabetes. METHODS AND RESULTS We studied 2573 people, aged 50-75, enrolled in the TOSCA.IT study (clinicaltrials.gov; NCT00700856). Plasma lipids were measured centrally. Diet was assessed with a semi-quantitative food frequency questionnaire. Women had a more adverse plasma lipid profile than men. Women consumed significantly more legumes, vegetables, fruits, eggs, milk, vegetable oils, and added sugar, whereas men consumed more starchy foods, soft drinks and alcoholic beverages. This stands for a higher proportion (%) of energy intake from saturated fat and added sugar (12.0 ± 2.4 vs 11.5 ± 2.5 and 3.4 ± 3.2 vs 2.3 ± 3.2, P < 0.04), and a higher intake of fiber (11.2 ± 2.8 vs 10.4 ± 2.6 g/1000 Kcal/day) in women. Adherence to the recommendations for saturated fat and fiber consumption was associated with significantly lower LDL-cholesterol regardless of sex. Adherence to the recommendations for added sugars was associated with significantly lower triglycerides and higher HDL-cholesterol in men and women. CONCLUSIONS Men and women with diabetes show significant differences in adherence to nutritional recommendations, but sex differences in plasma lipid profile are unlikely to be explained by nutritional factors. Adherence to the nutritional recommendations is associated with a better plasma lipid profile regardless of sex, thus reinforcing the importance of substituting saturated for unsaturated fat sources, increasing fiber and reducing added sugar intake.
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Affiliation(s)
- M Vitale
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - M Masulli
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - S Cocozza
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - R Anichini
- UO di Diabetologia, USL 3, Pistoia, Italy
| | - A C Babini
- Diabetologia, Ospedale Infermi, Rimini, Italy
| | - M Boemi
- UOC Malattie Metaboliche e Diabetologia, Istituto INRCA-IRCCS, Ancona, Italy
| | - E Bonora
- Dipartimento di Medicina, Divisione di Endocrinologia, Diabete e Metabolismo, Università di Verona, Italy
| | - R Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | - R Carpinteri
- UO di Malattie Metaboliche e Diabetologia, AO Treviglio, Italy
| | - C Caselli
- UOD Endocrinologia e Diabetologia, AUSL della Romagna, Cesena, Italy
| | - E Ceccarelli
- UOC Diabetologia, Dipartimento di Medicina, Chirurgia e Neuroscienze, Università di Siena, Italy
| | | | - G Citro
- UO Endocrinologia e Diabetologia, ASP, Potenza, Italy
| | - G Clemente
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - A Consoli
- DMSI e CeSI-Met, Università di Chieti-Pescara, Italy
| | - L Corsi
- SSD Diabetologia e Malattie Metaboliche, ASL 4 Chiavarese, Genova, Italy
| | - A De Gregorio
- UOSD Diabetologia, Ospedale San Salvatore, L'Aquila, Italy
| | - P Di Bartolo
- UO di Diabetologia Ravenna, A. Usl Romagna, Italy
| | | | - L Fontana
- UOC Diabetologia e Dietologia, Ospedale S. Pertini, Roma, Italy
| | - M Garofolo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | | | - C Giordano
- Endocrinologia e Malattie Metaboliche, Università di Palermo, Italy
| | - S Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - C Iovine
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - S Longhitano
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - G Mancastroppa
- Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy
| | | | - V Montani
- UOSD, Presidio Ospedaliero di Atri, Italy
| | - M Mori
- SSD Diabetologia, ASL 1, Massa Carrara, Italy
| | | | - M E Rinaldi
- Dipartimento di Medicina dei Sistemi, Università degli Studi di Roma "Tor Vergata", Italy
| | - M C Ruffo
- Dipartimento di Medicina Interna, Policlinico di Messina, Italy
| | - L Salvi
- Dipartimento di Medicina Clinica e Molecolare, Università "La Sapienza", Roma, Italy
| | - G Sartore
- DPT Medicina, Università degli Studi di Padova, Italy
| | - C Scaranna
- USC Malattie Endocrine e Diabetologia, AO Papa Giovanni XXIII, Bergamo, Italy
| | - L Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, Udine, Italy
| | - C Zamboni
- UO Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale S. Anna, Ferrara, Italy
| | - A Zogheri
- UO di Diabetologia, Ospedale di Prato, Italy
| | - V Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - F Cappellini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - S Signorini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - G Riccardi
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - O Vaccaro
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy.
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Changes in fruit, vegetable and juice consumption after the diagnosis of type 2 diabetes: a prospective study in men. Br J Nutr 2016; 117:712-719. [PMID: 27409648 DOI: 10.1017/s0007114516002257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given the importance of prevention of complications in type 2 diabetes (T2D), we aimed to examine changes over time in consumption of fruits, vegetables and juice among men who were diagnosed with T2D in comparison with men without diabetes. The prospective Cohort of Swedish Men, aged 45-79 years in 1997, was used to examine changes in diet after diagnosis of T2D. Dietary intake was assessed using FFQ in 1997 and 2009. In all, 23 953 men who were diabetes free at baseline (1997) and completed both FFQ were eligible to participate in the study. Diagnosis of T2D was reported by subjects and ascertained through registers. Multivariable linear mixed models were used to examine changes in mean servings/week over time. In total, 1741 men developed T2D during the study period. Increased consumption of vegetables and fruits was observed among those who developed T2D (equivalent to 1·6 servings/week, 95 % CI 1·08, 2·03) and men who remained diabetes free (0·7 servings/week, 95 % CI 0·54, 0·84). Consumption of juice decreased by 0·6 servings/week (95 % CI -0·71, -0·39) among those who developed T2D and increased by 0·1 servings/week (95 % CI 0·05, 0·15) in those who were diabetes free. Changes over time and between groups were statistically significant. Although improvements in diet were observed, only 36 % of those with T2D and 35 % of those without diabetes consumed ≥5 servings of fruits and vegetables/d in 2009.
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Giulia Falchi A, Grecchi I, Muggia C, Palladini G, Perlini S. Effects of a Bioavailable Arabinoxylan-enriched White Bread Flour on Postprandial Glucose Response in Normoglycemic Subjects. J Diet Suppl 2016; 13:626-33. [PMID: 27049812 DOI: 10.3109/19390211.2016.1156798] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The beneficial effects of soluble fibers on carbohydrate metabolism are well documented. In this regard, we tested an arabinoxylan-enriched white bread flour, obtained by a patented process by which the bran extracted from the milling process is enzymatically hydrolyzed in order to separate the soluble fraction fiber from the insoluble fiber. We recruited 24 healthy normoglycemic volunteers [Age 34-61 ± 12.5 y; Body Mass Index (BMI) 22.1 ± 2.5 kg/m(2); Waist circumference (WC) 84.43 ± 8.0 cm; Fat Mass (FM) 22.7 ± 8.0%] attending the Dietetics Outpatient Clinic of the Internal Medicine Department at IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy. Subjects acutely consumed arabinoxylan-enriched white bread (weight: 100 g) or isoenergetic control breads, in a double-blind crossover study design. Plasma glucose levels were measured just before bread administration and 30 minutes afterwards. The 30-minute peak postprandial glucose concentrations after arabinoxylan-enriched meals were significantly lower than after the control meal (107±4.6 mg/dL vs. 121 ± 5.2 mg/dL; p < 0.05). The here-reported results show how postprandial glucose responses were improved by ingestion of the arabinoxylan-enriched meal. Further studies are needed to clarify whether daily consumption of arabinoxylan-enriched bread will benefit patients with type 2 diabetes mellitus.
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Affiliation(s)
- Anna Giulia Falchi
- a Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation , University of Pavia , Pavia , Italy
| | - Ilaria Grecchi
- a Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation , University of Pavia , Pavia , Italy
| | - Chiara Muggia
- a Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation , University of Pavia , Pavia , Italy
| | - Giuseppina Palladini
- a Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation , University of Pavia , Pavia , Italy
| | - Stefano Perlini
- a Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation , University of Pavia , Pavia , Italy
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Marques-Vidal P, Vollenweider P, Grange M, Guessous I, Waeber G. Dietary intake of subjects with diabetes is inadequate in Switzerland: the CoLaus study. Eur J Nutr 2016; 56:981-989. [PMID: 26744301 DOI: 10.1007/s00394-015-1146-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize the dietary intake of subjects aged 40-80 years according to self-reported diabetes and presence of an anti-diabetic diet. METHODS Cross-sectional study conducted between 2009 and 2012 on 4289 participants (2274 women) living in Lausanne. RESULTS Of the 299 (7 %) participants with self-reported diabetes, only 151 (51 %) reported an anti-diabetic diet. Compared to participants not reporting diabetes, participants with self-reported diabetes (with or without a diet) had a higher consumption of artificial sweeteners (0.3 ± 0.7 vs. 0.4 ± 0.8 and 0.8 ± 1.0 times/day) and a lower consumption of honey/jam (mean ± standard deviation: 0.5 ± 0.5 vs. 0.4 ± 0.4 and 0.4 ± 0.4 times/day) or sugar (0.6 ± 0.9 vs. 0.4 ± 0.7 and 0.2 ± 0.5 times/day) for participants not reporting diabetes, participants with self-reported diabetes not on a diet and on a diet, respectively. Compared to participants not on a diet, participants on a diet had a higher consumption of vegetables (1.8 ± 1.3 vs. 1.4 ± 1.0 portions/day), while no differences were found regarding all other food groups and nutrients. Participants with self-reported diabetes on a diet had a higher consumption of meat (5.6 ± 3.6 vs. 4.8 ± 2.9 portions/week) and a lower consumption of simple carbohydrates (21.0 ± 7.9 vs. 23.5 ± 8.4 % total energy intake) than participants not reporting diabetes. CONCLUSION People with diabetes eat less simple carbohydrates, but do not comply with current advice on fish, nuts, fruits and vegetables. Improvement of the dietary intake in persons with diabetes in Switzerland is needed.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Peter Vollenweider
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Matthieu Grange
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Idris Guessous
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, 1010, Lausanne, Switzerland.,Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gérard Waeber
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Park K. Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients. Nutr Res Pract 2015; 9:658-66. [PMID: 26634056 PMCID: PMC4667208 DOI: 10.4162/nrp.2015.9.6.658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES The current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years. SUBJECTS/METHODS Data were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician's diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level ≥ 126 mg/dl. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design. RESULTS Among all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased. CONCLUSIONS Analysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is necessary and that provision and expansion of educational programs for T2DM patients is critical after diagnosis.
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Affiliation(s)
- Kyong Park
- Department of Food and Nutrition, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 712-749, Korea
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Aitaoto N, Campo SL, Snetselaar LG, Janz KF, Farris KB, Parker E, Belyeu-Camacho T, Jimenez FRP. Formative Research to Inform Nutrition Interventions in Chuuk and the US Pacific. J Acad Nutr Diet 2015; 115:947-53. [PMID: 25634092 PMCID: PMC4450123 DOI: 10.1016/j.jand.2014.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 11/19/2014] [Indexed: 11/23/2022]
Abstract
The type 2 diabetes epidemic is a global health issue, and it is especially severe in the US Pacific. Although there are nutrition interventions in Hawaii and the Pacific, success is limited, in part, because of the lack of tailoring for the Pacific context. The Pacific context is inclusive of environment, political, and economic situation; historical (precontact, colonial, and post colonial) background; cultural practices; and spiritual orientation. This study used Grounded Theory and Community-Based Participatory Research processes to identify influences that hinder or facilitate adherence to nutrition recommendations. Data were gathered through key informant interviews (faith leaders and health care providers) and focus-group discussions (individual with diabetes and care takers). Results showed barriers to nutrition recommendations adherence that were similar to other minority populations in the United States, such as cost of healthy foods, taste preference, low availability of healthy food choices, lack of ideas for healthy meals/cooking, and lack of culturally appropriate options for dietary modification. It also elucidated behaviors that influence adherence to nutrition recommendations, such as preparing and consuming meals for and with extended family and church members; patient and group motivation; and access to healthy, affordable, and palatable foods. Participants expressed the need for interventions that are tailored to the local culture and context and a holistic view of health, with a focus on motivation (spiritual and emotional support). These findings could be used to develop culturally and contextually appropriate programs. For example, adapting motivational interviewing techniques and materials by adding family members to motivational interviewing sessions vs patients only, as Pacific Islanders have a collectivistic culture and family members play an important role in adherence; conducting motivational interviewing in the community in addition to the clinical setting; utilizing church leaders as motivational interviewing counselors in addition to health care providers; and changing motivational interviewing narratives and tools (eg, a confidence scale of 1 to 10 will be unfamiliar to many Pacific Islanders); therefore, counselors need to develop another method to indicate levels of confidence, such as the color of the lagoon/ocean that goes from turquoise (the color of shallow water) to navy blue (the color of deep water).
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Affiliation(s)
- Nia Aitaoto
- Manu O Ku Project/Kokua Kalihi Valley, 2239 North School Street, Honolulu, Hawaii 96819, Phone: 808-222-8043, Fax: 808-222-8043,
| | - Shelly L. Campo
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, S161 CPHB, 105 River Street, Iowa City, IA 52242, Phone: 319-335-9097, Fax: 319-384-1490,
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, S425 CPHB, 105 River Street, Iowa City, IA 52242, Phone: 319-384-1553, Fax: 319-384-4955,
| | - Kathleen F. Janz
- Health and Human Physiology, College of Liberal Arts and Sciences, E130 Field House 52242, Iowa City, IA, Phone: 319-335-9345, Fax: 319-335-6669,
| | - Karen B. Farris
- Social & Administrative Sciences, College of Pharmacy, 3567B CC Little Building, 428 Church Street, Ann Arbor, Michigan 48109-1065, Phone: 734-763-5150, Fax: 734-764-7312,
| | - Edith Parker
- Department of Community and Behavioral Health, N432A CPHB, 105 River Street, Iowa City, IA 52242, Phone: 319-384-1472, Fax: 319-384-1490,
| | - Tayna Belyeu-Camacho
- Faith in Action Research and Resource Alliance, c/o Diocese of Chalan Kanoa, P.O Box 500745, Chalan Kanoa, MP 96950, Phone: (670) 234-3000, Fax: (670) 235-3002,
| | - Father Ryan P. Jimenez
- Diocese of Chalan Kanoa, P.O Box 500745, Chalan Kanoa, MP 96950, Phone: (670) 234-3000, Fax: (670) 235-3002,
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Soria-Contreras DC, Bell RC, McCargar LJ, Chan CB. Feasibility and efficacy of menu planning combined with individual counselling to improve health outcomes and dietary adherence in people with type 2 diabetes: a pilot study. Can J Diabetes 2014; 38:320-5. [PMID: 25175312 DOI: 10.1016/j.jcjd.2014.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 01/21/2014] [Accepted: 03/26/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to test the feasibility and efficacy of implementing a 4-week menu plan combined with individual counselling among people with type 2 diabetes. METHODS A 12-week pilot study with a pretest and post-test design was conducted among 15 participants with type 2 diabetes. The menu plan incorporated the overall recommendations of the Canadian Diabetes Association nutrition therapy guidelines and considered factors such as the accessibility, availability and acceptability of foods. Change in glycated hemoglobin (A1C) was the primary outcome, and secondary outcomes were changes in serum lipid, anthropometric and dietary measures. RESULTS Mean (±SD) age of the participants was 59.3±9.9 years, and duration of diabetes was 8.1±8.3 years. After the program, A1C decreased by 1.0%±0.86% (p<0.05). There were significant reductions (p<0.05) in weight, body mass index, waist circumference and fat mass and increased high-density lipoprotein cholesterol. No significant changes were observed in dietary measures except for perceived dietary adherence score, which increased significantly (p<0.05). Participants reported using the menu plan an average of 5.0±1.9 days a week and attended, on average, 4 of 6 counselling sessions. CONCLUSIONS Menu planning and individual counselling were demonstrated to be feasible and effective for diabetes management, and they represent a simple and practical approach to implement the nutritional recommendations for diabetes in Canada.
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Affiliation(s)
- Diana C Soria-Contreras
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Linda J McCargar
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada.
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Breen C, Ryan M, McNulty B, Gibney MJ, Canavan R, O'Shea D. High saturated-fat and low-fibre intake: a comparative analysis of nutrient intake in individuals with and without type 2 diabetes. Nutr Diabetes 2014; 4:e104. [PMID: 24492470 PMCID: PMC3940826 DOI: 10.1038/nutd.2014.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The aim of dietary modification, as a cornerstone of type 2 diabetes (T2DM) management, is to optimise metabolic control and overall health. This study describes food and nutrient intake in a sample of adults with T2DM, and compares this to recommendations, and to intake in age, sex, body mass index (BMI) and social-class matched adults without T2DM. DESIGN A cross-sectional analysis of food and nutrient intake in 124 T2DM individuals (64% male; age 57.4±5.6 years, BMI 32.5±5.8 kg m(-2)) and 124 adults (age 57.4±7.0 years, BMI 31.2±5.0 kg m(-2)) with no diabetes (ND) was undertaken using a 4-day semiweighed food diary. Biochemical and anthropometric variables were also measured. RESULTS While reported energy intake was similar in T2DM vs ND (1954 vs 2004 kcal per day, P=0.99), T2DM subjects consumed more total-fat (38.8% vs 35%, P0.001), monounsaturated-fat (13.3% vs 12.2%; P=0.004), polyunsaturated-fat (6.7% vs 5.9%; P<0.001) and protein (18.6% vs 17.5%, P0.01). Both groups exceeded saturated-fat recommendations (14.0% vs 13.8%). T2DM intakes of carbohydrate (39.5% vs 42.9%), non-milk sugar (10.4% vs 15.0%) and fibre (14.4 vs 18.9 g) were significantly lower (P<0.001). Dietary glycaemic load (GL) was also lower in T2DM (120.8 vs 129.2; P=0.02), despite a similar glycaemic index (59.7 vs 60.1; P=0.48). T2DM individuals reported consuming significantly more wholemeal/brown/wholegrain breads, eggs, oils, vegetables, meat/meat products, savoury snacks and soups/sauces and less white breads, breakfast cereals, cakes/buns, full-fat dairy, chocolate, fruit juices, oily fish and alcohol than ND controls. CONCLUSION Adults with T2DM made different food choices to ND adults. This resulted in a high saturated-fat diet, with a higher total-fat, monounsaturated-fat, polyunsaturated-fat and protein content and a lower GL, carbohydrate, fibre and non-milk sugar content. Dietary education should emphasise and reinforce the importance of higher fibre, fruit, vegetable and wholegrain intake and the substitution of monounsaturated for saturated-fat sources, in energy balanced conditions.
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Affiliation(s)
- C Breen
- Diabetes and Endocrine Units, St Columcille's and St Vincent's University Hospitals, Dublin, UK
| | - M Ryan
- Institute of Food and Health, University College Dublin, Dublin, UK
| | - B McNulty
- Institute of Food and Health, University College Dublin, Dublin, UK
| | - M J Gibney
- Institute of Food and Health, University College Dublin, Dublin, UK
| | - R Canavan
- Diabetes and Endocrine Units, St Columcille's and St Vincent's University Hospitals, Dublin, UK
| | - D O'Shea
- Diabetes and Endocrine Units, St Columcille's and St Vincent's University Hospitals, Dublin, UK
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Castetbon K, Bonaldi C, Deschamps V, Vernay M, Malon A, Salanave B, Druet C. Diet in 45- to 74-year-old individuals with diagnosed diabetes: comparison to counterparts without diabetes in a nationally representative survey (Etude Nationale Nutrition Santé 2006-2007). J Acad Nutr Diet 2013; 114:918-925. [PMID: 24183995 DOI: 10.1016/j.jand.2013.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
A healthy diet has been shown to prevent diabetes complications. However, the eating habits of individuals with diabetes who are aware of their glycemic condition have been poorly studied. This study's objective was to assess the dietary behavior overall and according to dietary recommendations in adults diagnosed with diabetes compared with those of a general population of the same age (45 to 74 years) in a nationally representative survey carried out in France in 2006-2007 (Etude Nationale Nutrition Santé) (n=1,476 including 101 patients with diabetes). Trained dietitians assessed diet using three 24-hour recalls and diabetes was self-declared. After weighting and using multiple adjustments, mean food and nutrient intakes were compared according to diabetes status. Interactions with age and sex were sought. Adults with diabetes had lower intakes of sweetened foods (40 g/day vs 125 g/day), alcohol (1.45 g/day vs 1.64 g/day), energy (1,790 kcal/day vs 1,986 kcal/day), and simple sugar (63.1 g/day vs 89.8 g/day) and higher intakes of meat (126 g/day vs 109 g/day), complex carbohydrates (26.3% energy intake vs 23.6% energy intake), and vitamins B and E (628 μg/day vs 541 μg/day). In addition, 45- to 59-year-old individuals with diabetes ate more fruits and vegetables, fiber, beta carotene, folate, vitamin C, and potassium than adults of the same age who did not have diabetes. Overall, 45- to 74-year-old adults with diabetes had a higher-quality diet than individuals without diabetes. However, compared with recommendations, a healthy diet continues to represent a public health challenge in terms of preventing diabetes complications.
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Lim JH, Paik HY, Lee YS, Song Y. Adherence to lifestyle recommendations is associated with improved glycemic control and improved blood lipid levels in Korean adults with type 2 diabetes. Diabetes Res Clin Pract 2013; 101:e21-4. [PMID: 23891154 DOI: 10.1016/j.diabres.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/10/2013] [Indexed: 12/01/2022]
Abstract
We explored the association between the degree of adherence to recommendations and diabetes management in Korean adults who had type 2 diabetes for an average of 8 years. Subjects who met five or more lifestyle recommendations showed significantly lower blood lipid parameters and glycated hemoglobin than those who did not.
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Affiliation(s)
- Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Republic of Korea
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Franzini L, Ardigò D, Cavalot F, Miccoli R, Rivellese AA, Trovati M, Zavaroni I, Vaccaro O. Women show worse control of type 2 diabetes and cardiovascular disease risk factors than men: results from the MIND.IT Study Group of the Italian Society of Diabetology. Nutr Metab Cardiovasc Dis 2013; 23:235-241. [PMID: 22397873 DOI: 10.1016/j.numecd.2011.12.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND AIMS The study explores the degree of control of hyperglycaemia and cardiovascular (CV) disease risk factors in men and women with type 2 diabetes and the impact thereon of obesity, central adiposity, age and use of medications. METHODS AND RESULTS A cross-sectional survey was conducted at 10 hospital-based outpatients diabetes clinics. 1297 men and 1168 women with no previous CV events were studied. Women were slightly (only one year) older and more obese than men: average BMI was respectively 30.7 ± 5.7 vs 28.6 ± 4.1 kg/m(2) (p < 0.001), and prevalence of abdominal obesity was 86% vs 44% (p < 0.001). Women smoked less, but had higher HbA1c, LDL cholesterol, non-HDL cholesterol, systolic blood pressure and serum fibrinogen than men. Accordingly optimal targets for HbA1c (<7%), LDL cholesterol (<100 mg/dL), HDL cholesterol (>40 for men, >50 for women, mg/dL), and systolic blood pressure (<130 mmHg) were less frequently achieved by women than men (respectively 33.8% vs 40.2%; 14.6% vs 19.2%; 34.1% vs 44.5%; 68.8% vs 72%; p < 0.05 for all). Findings were confirmed after stratification for waist circumference (< or ≥ 88 cm for women; < or ≥ 102 cm for men), BMI (< or ≥ 25 kg/m(2)) or age (< or ≥ 65 years). As for treatment, women were more likely than men to take insulin, alone or in combination with oral hypoglycaemic drugs, to be under anti-hypertensive treatment, whereas the use of lipid lowering drugs was similar in men and women. CONCLUSIONS Control of hyperglycaemia and major CVD risk factors is less satisfactory in women than men. The gender disparities are not fully explained by the higher prevalence of total and central obesity in women; or by a less intensive medical management in women.
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Affiliation(s)
- L Franzini
- Department of Internal Medicine and Biomedical Sciences, University of Parma, via Gramsci 14, Parma, Italy.
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Kozica SL, Deeks AA, Gibson-Helm ME, Teede HJ, Moran LJ. Health-related behaviors in women with lifestyle-related diseases. Behav Med 2013; 38:65-73. [PMID: 22873731 DOI: 10.1080/08964289.2012.685498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Lifestyle related diseases associated with physical inactivity and poor diet quality, represent a major health burden. This study assessed negative and positive health habits and health care utilization in healthy women (n = 50) and women with lifestyle related diseases such as polycystic ovary syndrome (PCOS) (n = 50), gestational diabetes mellitus (GDM) (n = 44) and type 2 diabetes (DM2) (n = 43). A significant difference existed across groups for negative health habits (P = .012) with a trend for positive health habits (P = .06) elevated in women with PCOS. Women with DM2 had the highest amount of health care utilization including doctors office visits (P < .001), overnight hospital treatments (P < .001) and emergency room treatments (P = .01). Health practitioners would benefit from both encouraging positive health habits and addressing negative health habits. Furthermore, self-management and emphasizing the pivotal role patients' have in managing their illness is important for optimizing health outcomes. Elevated health care utilization rates were observed in women with DM2 but there were no differences in positive health habits across sub-groups. Encouraging lifestyle modification in women with precursor diseases such as GDM and PCOS is vital in order to prevent progression to DM2.
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Soedamah-Muthu SS, Chaturvedi N, Fuller JH, Toeller M. Do European people with type 1 diabetes consume a high atherogenic diet? 7-year follow-up of the EURODIAB Prospective Complications Study. Eur J Nutr 2012; 52:1701-10. [DOI: 10.1007/s00394-012-0473-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 11/22/2012] [Indexed: 12/18/2022]
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Carvalho FS, Pimazoni Netto A, Zach P, Sachs A, Zanella MT. [Importance of nutritional counseling and dietary fiber content on glycemic control in type 2 diabetic patients under intensive educational intervention]. ACTA ACUST UNITED AC 2012; 56:110-9. [PMID: 22584564 DOI: 10.1590/s0004-27302012000200004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 02/17/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the importance of nutritional counseling within a set of multidisciplinary interventions. SUBJECTS AND METHODS Forty-seven patients with type 2 diabetes and hyperglycemia (A1C ≥ 8%), treated conventionally (n = 19, GC) or intensively in six weekly visits (n = 28, GI) were analyzed. We evaluated mean weekly blood glucose (MWG) at baseline and after 6 weeks in both groups. RESULTS GI reduced caloric (p = 0.001), carbohydrate (p = 0.004), and fat (p = 0.001) intake, and increased fiber consumption, while GC reduced fiber intake (p = 0.018). Glycemic control (MWG ≤ 150 mg/dL) occurred in 75% of GI patients and in 31.6% of CG patients (p = 0.003), with negative correlation between changes in fiber intake and MWG values (r =-0.309; P = 0.035). Results were maintained after 12 weeks. CONCLUSION Educational short-term intensive intervention was more effective than conventional treatment to achieve glycemic control. Our results also indicate that a more appropriate fiber content in the diet contributes for better blood glucose control in these patients.
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Kim SH, Hong SB, Suh YJ, Choi YJ, Nam M, Lee HW, Park IB, Chon S, Woo JT, Baik SH, Park Y, Kim DJ, Lee KW, Kim YS. Association between nutrient intake and obesity in type 2 diabetic patients from the Korean National Diabetes Program: a cross-sectional study. J Korean Med Sci 2012; 27:1188-95. [PMID: 23091316 PMCID: PMC3468755 DOI: 10.3346/jkms.2012.27.10.1188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/25/2012] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to assess the association between usual dietary nutrient intake and obesity in Korean type 2 diabetic patients. We examined 2,832 type 2 diabetic patients from the Korean National Diabetes Program cohort who completed dietary assessment and clinical evaluation in this cross-sectional study. In men, higher dietary fiber intake was associated with a lower odds of being obese (P(trend) = 0.003) and in women, higher protein intake was associated with a lower odds of being obese (P(trend) = 0.03) after adjustment for age, diabetes duration, HbA1c, alcohol drinking, income, education level, and calorie intake. In men, higher fiber intake was associated with lower odds of obesity after further adjustment for diastolic blood pressure, physical activity, and possible confounding nutritional intake and medication. The multivariable adjusted odds ratio for the highest quintile of fiber intake was 0.37 (P(trend) < 0.001). In women, protein intake was not associated with obesity after further adjustment. In conclusion, higher intake of dietary fiber is associated with lower odds of being obese in type 2 diabetic men, suggesting a role for dietary fiber in the management and prevention of obesity in type 2 diabetes (ClinicalTrials.gov: NCT 01212198).
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Affiliation(s)
- So Hun Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seong Bin Hong
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Young Ju Suh
- Institute for Clinical Research, Inha University School of Medicine, Incheon, Korea
| | - Yun Jin Choi
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moonsuk Nam
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
- Center for Advanced Medical Education (BK 21 Project), Inha University School of Medicine, Incheon, Korea
| | - Hyoung Woo Lee
- Department of Internal Medicine, Yeungnam Univeristy College of Medicine, Daegu, Korea
| | - Ie Byung Park
- Department of Endocrinology and Metabolism, Gachon University of Science and Medicine, Incheon, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong-Taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yongsoo Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Kwan Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Young Seol Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
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Muñoz-Pareja M, León-Muñoz LM, Guallar-Castillón P, Graciani A, López-García E, Banegas JR, Rodríguez-Artalejo F. The diet of diabetic patients in Spain in 2008-2010: accordance with the main dietary recommendations--a cross-sectional study. PLoS One 2012; 7:e39454. [PMID: 22745757 PMCID: PMC3382177 DOI: 10.1371/journal.pone.0039454] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/21/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND No previous study has assessed the diet of the diabetic patients in the general population of an entire country in Europe. This study evaluates accordance of the diet of diabetic adults in Spain with nutritional recommendations of the European Association for the Study of Diabetes (EASD), American Diabetes Association (ADA), and the Mediterranean diet (MD). METHODS AND FINDINGS Cross-sectional study conducted in 2008-2010 among 12,948 persons representative of the population aged ≥18 years in Spain. Usual food consumption was assessed with a dietary history. EASD accordance was defined as ≥6 points on a score of 12 nutritional goals, ADA accordance as ≥3 points on a score of 6 goals, and MD accordance as ≥7 points on the Mediterranean Diet Adherence Screener. In the 609 diagnosed diabetic individuals, the diet was rich in saturated fat (11.2% of total energy), but trans fat intake was relatively low (1.1% energy) and monounsaturated fat intake was high (16.1% energy). Carbohydrate intake was relatively low (41.1% energy), but sugar intake was high (16.9% energy). Intake of cholesterol (322 mg/day) and sodium (3.1 g/day) was also high, while fiber intake was insufficient (23.8 g/day). EASD accordance was observed in 48.7% diabetic patients, ADA accordance in 46.3%, and MD accordance in 57.4%. The frequency of EASD, ADA and MD accordance was not statistically different between diagnosed and undiagnosed diabetic individuals. CONCLUSIONS Only about half of diabetic patients in Spain have a diet that is consistent with the major dietary recommendations. The lack of dietary differences between diagnosed and undiagnosed diabetic individuals reflects deficiencies in diabetes management.
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Affiliation(s)
- Maritza Muñoz-Pareja
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
| | - Luz M. León-Muñoz
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
| | - Pilar Guallar-Castillón
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
| | - Auxiliadora Graciani
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
| | - Esther López-García
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
| | - José R. Banegas
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Departamento Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz; CIBERESP, Madrid, Spain
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Klein GA, Stefanuto A, Boaventura BCB, de Morais EC, Cavalcante LDS, de Andrade F, Wazlawik E, Di Pietro PF, Maraschin M, da Silva EL. Mate tea (Ilex paraguariensis) improves glycemic and lipid profiles of type 2 diabetes and pre-diabetes individuals: a pilot study. J Am Coll Nutr 2012; 30:320-32. [PMID: 22081618 DOI: 10.1080/07315724.2011.10719975] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Yerba mate (Ilex paraguariensis) infusions have been shown to reduce plasma glucose in animals and serum lipids in humans. The aim of this study was to evaluate the effects of roasted mate tea consumption, with or without dietary counseling, on the glycemic and lipid profiles of individuals with type 2 diabetes mellitus (T2DM) or pre-diabetes. METHODS Twenty-nine T2DM and 29 pre-diabetes subjects were divided into 3 groups: mate tea, dietary intervention, and mate tea and dietary intervention. Individuals drank 330 mL of roasted mate tea 3 times a day and/or received nutritional counseling over 60 days. Blood samples were collected and food intake was assessed at baseline and after 20, 40, and 60 days of treatments. RESULTS Mate tea consumption decreased significantly the levels of fasting glucose (25.0 mg/dL), glycated hemoglobin A(1c) (HbA(1c)) (0.85%), and low-density lipoprotein cholesterol (LDL-c) (13.5 mg/dL) of T2DM subjects (p < 0.05); however, it did not change the intake of total energy, protein, carbohydrate, cholesterol, and fiber. In pre-diabetes individuals, mate tea consumption combined with nutritional counseling diminished significantly the levels of LDL-c (11 mg/dL), non-high-density lipoprotein cholesterol (HDL-c) (21.5 mg/dL), and triglycerides (53.0 mg/dL) (p < 0.05). Individuals of this group decreased significantly their consumption of total fat (14%), cholesterol (28%), and saturated (23.8%) and monounsaturated (28.0%) fatty acids, and increased their fiber intake by 35% (p < 0.05). CONCLUSIONS Mate tea consumption improved the glycemic control and lipid profile of T2DM subjects, and mate tea consumption combined with nutritional intervention was highly effective in decreasing serum lipid parameters of pre-diabetes individuals, which may reduce their risk of developing coronary disease.
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Affiliation(s)
- Graziela A Klein
- Department of Clinical Analysis, CCS, Federal University of Santa Catarina, Campus Universitario s/n, Trindade, Brazil
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Beta-glucan- or rice bran-enriched foods: a comparative crossover clinical trial on lipidic pattern in mildly hypercholesterolemic men. Eur J Clin Nutr 2011; 65:864-71. [PMID: 21505506 DOI: 10.1038/ejcn.2011.48] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES There has been growing interest in using dietary intervention to improve the lipid profile. This work aims at analyzing the effects and the comparison of the enrichment of a diet with beta-glucans or rice bran in mildly hypercholesterolemic men. SUBJECTS/METHODS The subjects initially consumed a 3-week Step 1 American Heart Association diet with rice bran-enriched foods. After this adaptation period, volunteers were randomly assigned to follow a crossover, controlled trial that consisted of two treatment with beta-glucan- or rice bran-enriched foods, each of 4 weeks, with a 3-week wash-out, like the adaptation period, between periods. Fasted blood samples were collected on days 0, 21, 49, 70 and 98 in both study arms for measuring low-density lipoprotein (LDL)-cholesterol (primary outcome), total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, apolipoprotein (apo) A-I, apo B and glucose levels. RESULTS Twenty-four men (mean age: 50.3±5.3, mean body mass index: 24.9±1.9) completed the 14-week trial. Subjects in the 3-week adaptation period experienced significant reductions in the mean level of LDL cholesterol, total cholesterol, total cholesterol/HDL cholesterol, LDL cholesterol/HDL cholesterol, apo A-I, apo A-I/apo B and glucose. During the intervention diet periods, a difference was found between treatment groups for the mean change in LDL (0.21 (95% confidence interval (CI): 0.02-0.40), P=0.033) and total cholesterol (0.34 (95% CI: 0.20-0.47), P<0.001). Other parameters evaluated were not significantly affected by the diet consumed. CONCLUSIONS The results of the present crossover clinical trial showed that beta-glucan-enriched foods are more effective in lowering serum LDL levels, compared with rice bran-enriched foods.
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Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment--Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ 2010; 341:c3337. [PMID: 20647285 PMCID: PMC2907481 DOI: 10.1136/bmj.c3337] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the extent to which intensive dietary intervention can influence glycaemic control and risk factors for cardiovascular disease in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment. DESIGN Randomised controlled trial. SETTING Dunedin, New Zealand. PARTICIPANTS 93 participants aged less than 70 years with type 2 diabetes and a glycated haemoglobin (HbA(1c)) of more than 7% despite optimised drug treatments plus at least two of overweight or obesity, hypertension, and dyslipidaemia. INTERVENTION Intensive individualised dietary advice (according to the nutritional recommendations of the European Association for the Study of Diabetes) for six months; both the intervention and control participants continued with their usual medical surveillance. MAIN OUTCOME MEASURES HbA(1c) was the primary outcome. Secondary outcomes included measures of adiposity, blood pressure, and lipid profile. RESULTS After adjustment for age, sex, and baseline measurements, the difference in HbA(1c) between the intervention and control groups at six months (-0.4%, 95% confidence interval -0.7% to -0.1%) was highly statistically significant (P=0.007), as were the decreases in weight (-1.3 kg, -2.4 to -0.1 kg; P=0.032), body mass index (-0.5, -0.9 to -0.1; P=0.026), and waist circumference (-1.6 cm, -2.7 to -0.5 cm; P=0.005). A decrease in saturated fat (-1.9% total energy, -3.3% to -0.6%; P=0.006) and an increase in protein (1.6% total energy, 0.04% to 3.1%; P=0.045) in the intervention group were the most striking differences in nutritional intake between the two groups. CONCLUSIONS Intensive dietary advice has the potential to appreciably improve glycaemic control and anthropometric measures in patients with type 2 diabetes and unsatisfactory HbA(1c) despite optimised hypoglycaemic drug treatment. TRIAL REGISTRATION Clinical trials NCT00124553.
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Affiliation(s)
- Kirsten J Coppell
- Edgar National Centre for Diabetes and Obesity Research, Department of Medical and Surgical Sciences, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
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Effects of the PRo-active Interdisciplinary Self-MAnagement (PRISMA, Dutch DESMOND) program on dietary intake in type 2 diabetes outpatients: A pilot study. Clin Nutr 2010; 29:199-205. [DOI: 10.1016/j.clnu.2009.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 08/04/2009] [Accepted: 08/13/2009] [Indexed: 11/24/2022]
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Bonomo K, De Salve A, Fiora E, Mularoni E, Massucco P, Poy P, Pomero A, Cavalot F, Anfossi G, Trovati M. Evaluation of a simple policy for pre- and post-prandial blood glucose self-monitoring in people with type 2 diabetes not on insulin. Diabetes Res Clin Pract 2010; 87:246-51. [PMID: 19954855 DOI: 10.1016/j.diabres.2009.10.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 10/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Since there is no agreement on regimens of self-monitoring of blood glucose (SMBG) in type 2 diabetes not on insulin, we evaluated the effects of a simple SMBG policy taking into account compliance. METHODS AND RESULTS 273 type 2 diabetic patients not on insulin with HbA1c >7% attending our Diabetes Clinic and already using SMBG were randomized as follows: Group A, one BG profile/month with fasting and post-prandial values; Group B, one BG profile every 2 weeks with pre- and post-prandial values. Patients were followed-up by the same team every 3 months with the same education and treatment policies. At 3 and 6 months, SMBG profiles were evaluated and HbA1c measured. SMBG was carried out as recommended by 73% of Group A and 44% of Group B patients. In compliant patients, HbA1c and BG were unchanged in Group A whereas in Group B fasting, pre-prandial and two out of three post-prandial BG values were reduced and HbA1c decreased from 8.09+/-0.84% to 7.60+/-0.73% (p<0.001). The influence on BG control was similar for the two policies when compliance was not considered. CONCLUSIONS The more intensive SMBG policy considered is associated with improvements in glycaemic control in compliant subjects.
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Affiliation(s)
- Katia Bonomo
- San Luigi Gonzaga Faculty of Medicine of the Turin University, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Italy
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