Eating behavior among type 2 diabetic patients: a poorly recognized aspect in a poorly controlled disease

Understanding the Interplay of Dietary Intake and Eating Behavior in Type 2 Diabetes

Diet and eating behavior both play a crucial role in the prevention and management of type 2 diabetes mellitus (T2DM). The main objective of this study was to investigate the relationship between dietary intake and eating behavior in a population of patients with T2DM. A cross-sectional study was performed using 416 patients with T2DM and their dietary intake and eating behavior were assessed with validated questionnaires. Women scored significantly higher than men for emotional and restrained eating (p < 0.001). Correlation analyses showed that emotional eaters consumed significantly more calories (r = 0.120, p = 0.014) and fat (r = 0.101, p = 0.039), as well as non-alcoholic beverages for women (r = 0.193, p = 0.003) and alcohol for men (r = 0.154, p = 0.038). Also, individuals who ate based on external cues consumed significantly more calories (r = 0.188, p < 0.001) and fat (r = 0.139, p = 0.005). These results demonstrate that eating behavior influences dietary intake. Understanding this relationship could optimize diabetes management and allow for more individualized nutritional guidance.

Dietary practice and associated factors among type 2 diabetic patients attending chronic follow-up in public hospitals, central Ethiopia, 2022

BACKGROUND

Diabetes Mellitus (DM) is affecting numerous Ethiopian populations regardless of environmental and social status. Diabetic people all over the world are commonly urged to acquire a healthy eating habit, which necessitates lifelong changes in food habits, beliefs, and meal patterns. Dietary management is considered one of the cornerstones of diabetes care, as it is an important component of the overall treatment plan. Choosing and following a healthy diet is important for everyone, especially people with diabetes.

OBJECTIVE

This study aims to assess dietary practices and associated factors among type 2 diabetes patients in the west Shewa Zone, Oromia Regional State, Ethiopia, in 2022.

METHODS

A hospital-based cross-sectional study design was conducted in West Shewa Zone public hospitals among 421 randomly selected type 2 diabetic patients from February 1 to March 30, 2022. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Descriptive, bivariate, and multivariate binary logistic regression analyses were done using SPSS.

RESULTS

In this study, about 35.6% (95% CI: 30.9-39.9) of type 2 diabetes patients had good dietary practices. Diabetes knowledge (AOR 9 2; 95% CI 4.4-19.4), food-secured households (AOR 3.3; 95% CI 1.6-6.9), high self-efficacy (AOR 6.6; 95% CI 3.2-13.9), diabetes diet information from healthcare professionals (AOR 2.9; 95% CI 1.3-6.4), complete dietary change (AOR = 2.3; 95% CI 1.1-4.8), and female gender (AOR 3.6; 95% CI 1.6-8.1) were independent predictors of good dietary practice.

CONCLUSION

The proportion of patients with type 2 diabetes, who attended follow-up at West Shawa Public Hospitals and practiced good dietary habits, was low. Patients' household food insecurity, diabetes knowledge, self-efficacy, source of information on the diabetic diet, complete dietary change after diabetes diagnosis, and gender were all significantly associated with type 2 diabetic patients' dietary practices. Thus, promoting the provision of continuous, modified, and comprehensive education and advice on the importance of diabetes self-management, particularly adherence to dietary recommendations, is fundamental to decreasing the burden of diabetes complications and massive health expenses among diabetic patients.

Effect of using mobile phone communication on dietary management of Type 2 Diabetes Mellitus patients in Kenya

Purpose

Advancements in management of non-communicable diseases using regular reminders on lifestyle and dietary behaviors have been effectively achieved using mobile phones. This study evaluates the effects of regular communication using a mobile phone on dietary management of Type 2 Diabetes Mellitus (T2DM) among patients attending Kitui County Referral Hospital (KCRH) in Kenya.

Methods

Pre/post-study design among eligible and consenting T2DM patients visiting KCRH was used for this study. One hundred and thirty-eight T2DM patients were enrolled; 67 in the intervention group (IG) and 71 in the control group (CG). The IG received regular reminders on key dietary practices through their mobile phones for six months while the CG did not. The Net Effect of Intervention (NEI) and bivariate logistic regression were used to determine the impact of mobile phone communication intervention at p < 0.05. SPSS version 24 was used to analyze the data.

Results

The results revealed an increase of respondents who adhered to the meal plan in the IG from 47.8% to 59.7% compared to a decrease from 49.3% to 45.1% in CG with corresponding NEI increasing (16.1%) significantly (p < 0.05). The proportion of respondents with an increased frequency of meals increased from 41.8 to 47.8% in the IG compared to a reduction from 52.1% to 45.1% in the CG with corresponding NEI increasing (13.0%) significantly (p < 0.05).

Conclusion

Regular reminders on lifestyle and dietary behaviors using mobile phone communication improved adherence to dietary practices such as meal planning and frequency of meals in the management of T2DM.

Factors associated with added sugar consumption of older adults from the region of Campinas-SP, Brazil

Adequate nutrition has a profound impact on older adults' health. Therefore, special attention should be given to the dietetic intake of added sugars, which in excess is associated with poorer control of chronic diseases in this phase. The aim of the study was to evaluate the prevalence of consumption of added sugars in older adults in the Campinas-SP region, its associated factors, and its main dietary sources. A cross-sectional study was conducted in the region of Campinas-SP, with a convenience sample of 586 older individuals. Intake was obtained using two 24-hour food recalls, and values >5% of total energy consumption were considered inadequate. The contribution of the groups and foods in relation to the total content of sugars was also calculated. A critical level of p<0.05 was considered. The average intake of added sugars was higher than recommended (7.0%), and this inadequacy was observed in more than half of the sample, being table sugar and honey the main dietary sources. The prevalence of inadequate consumption was higher among women (69.8%; p=0.004) and individuals with low weight (83.7%; p=0.014), and lower in those with diabetes (47.8%; p<0.001). Results indicate that health and nutrition actions should be developed to ensure adequate sugar intake at this stage.

Alias SR. Age and fasting blood sugar levels are associated factors for mindful eating among Type 2 diabetes mellitus patients during COVID-19 pandemic confinement

The COVID-19 pandemic has impacted the eating behaviours of many people, especially Type 2 Diabetes Mellitus (T2DM) patients. This study aimed to determine the level of mindful eating and its associated factors among T2DM patients at a primary care clinic near Kuala Lumpur. A cross-sectional study was conducted from 18th December 2020 to 5th March 2021 during the movement control order in Malaysia. Respondents were recruited using systematic random sampling via an electronic appointment system. They completed a questionnaire consisting of sociodemographic, clinical profiles, and a Malay-translated Mindful Eating Questionnaire (MEQ-M). Their blood pressure and body mass index were taken during the appointment day while the remaining clinical profiles such as fasting blood sugar (FBS) were obtained from the medical record. Two hundred respondents were recruited with a mean (SD) age of 57.0 (10.90) years. More than half of them were female (54%). Two-thirds of them had uncontrolled diabetes based on elevated FBS of >7 mmol/L (61.5%) and glycated haemoglobin (HbA1c) of >7% (67%), respectively. The mean (SD) score for mindful eating was 2.9 (0.25). Multiple logistic regression revealed that older respondents had a higher level of mindful eating [(AOR = 1.05, p-value 0.01, 95% CI = 1.01–1.09)]. In addition, elevated FBS level was also associated with a greater level of mindful eating [(AOR = 2.55, p-value 0.01, 95% CI = 1.28–5.07)]. Therefore, healthcare providers should promote mindful eating during the consultation, especially among younger patients. Blood glucose monitoring is also recommended to instil awareness of the importance of healthy eating habits.

The relationship between intuitive eating and eating attitude and glycemic control in patients with type 2 diabetes mellitus

Amaç: Bu çalışma, Tip 2 Diabetes Mellitus (T2DM) hastalarında sezgisel yemenin yeme tutumu ve glisemik kontrol ile ilişkisini belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Araştırmanın örneklemini; 18 Kasım 2019 – 12 Mart 2020 tarihleri arasında Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı Polikliniği’ne gelen T2DM tanılı ve dahil edilme kriterlerini karşılayan 385 birey oluşturmuştur. Çalışma verileri; bireylerin demografik bilgilerine, sağlık bilgilerine ve biyokimyasal verilerine yönelik sorular ile Sezgisel Yeme Ölçeği (IES-2) ve Yeme Tutum Testinin (EAT-26) yer aldığı bir form kullanılarak yüz yüze görüşme yöntemi ile elde edilmiştir. Bulgular: Çalışmaya katılan bireylerin yaş ortalaması 59,12±9,78 olup %62,6’sı kadındı. Sezgisel yeme ile bireylerin vücut ağırlığı, BKİ değeri, bel çevresi ve trigliserit değeri arasında istatistiksel olarak negatif yönde ve zayıf düzeyde anlamlı bir ilişki saptandı (p&lt;0,05). EAT-26 puanı ile IES-2 alt ölçeklerinden olan “duygusal sebeplerden ziyade fiziksel sebeplerle yeme” alt ölçeği arasında istatistiksel olarak negatif yönde ve zayıf düzeyde anlamlı bir ilişki belirlendi (p&lt;0,05). Ayrıca EAT-26 puanı ile “açlık ve tokluk işaretlerine güven” alt ölçeği arasında istatistiksel olarak pozitif yönde ve zayıf düzeyde anlamlı bir ilişki bulundu (p&lt;0.05). Sonuç: Çalışma sonucunda; sezgisel yeme ile T2DM’li bireylerin antropometrik ölçümleri, trigliserit değerleri ve yeme tutumları arasında zayıf düzeyde anlamlı ilişki olduğu belirlenmiştir. Sezgisel yemenin yeme tutumu ve glisemik kontrol ile arasındaki nedensellik ilişkisini daha iyi belirleyebilmek için ileri çalışmalara ihtiyaç vardır.

Effects of nucleus accumbens insulin inactivation on microstructure of licking for glucose and saccharin in male and female rats

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.

Food insecurity, type 2 diabetes, and hyperglycaemia: A systematic review and meta-analysis

AIMS

Food insecurity (FIS) is a major public health issue with possible implications for type 2 diabetes mellitus (T2DM) risk. We conducted a systematic review and meta-analysis to explore the association between FIS and T2DM.

METHODS

We performed a systematic search in PubMed, Embase, Scopus, and Web of Science. All cross-sectional, peer-reviewed studies investigating the link between FIS and T2DM were included. Population characteristics, study sizes, covariates, T2DM diagnoses, and diabetes-related clinical measures such as fasting blood glucose (FBG) and HbA1c were extracted from each study. Outcomes were compared between food insecure and food secure individuals. Effect sizes were combined across studies using the random effect model.

RESULTS

Forty-nine peer-reviewed studies investigating the link between FIS and T2DM were identified (n = 258,250). Results of meta-analyses showed no association between FIS and clinically determined T2DM either through FBG or HbA1c: OR = 1.22 [95%CI: 0.96, 1.55], Q(df = 5) = 12.5, I2  = 60% and OR = 1.21 [95%CI: 0.95, 1.54], Q(df = 5) = 14; I2  = 71% respectively. Standardized mean difference (SMD) meta-analyses yielded no association between FIS and FBG or HbA1c: g = 0.06 [95%CI: -0.06, 0.17], Q(df = 5) = 15.8, I2  = 68%; g = 0.11 [95% CI: -0.02, 0.25], Q(df = 7) = 26.8, I2  = 74% respectively. For children, no association was found between FIS and HbA1c: g = 0.06 [95%CI: 0.00, 0.17], Q(df = 2) = 5.7, I2  = 65%.

CONCLUSIONS

Despite multiple proposed mechanisms linking FIS to T2DM, integration of the available literature suggests FIS is not associated with clinically determined T2DM or increases in FBG or HbA1c among adult patients.

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Barriers to Healthy Eating and Diabetes Diet Education: Divergent Perspectives of Patients and Their Providers

Patients report that adhering to diet is the most challenging aspect of diabetes management. Provision of diet education is often delegated to health care providers, despite a lack of nutrition education and training and limited awareness of environmental and cultural challenges faced by patients. Aim. We examined perceived barriers to diet self-management among low-income minority patients with type 2 diabetes and their health care providers within a single ecosystem, to test whether providers understood patient barriers. Method. We surveyed 149 members of a safety-net clinic (99 patients, 50 providers), using barriers derived from the literature. Binomial logistic regression was applied to investigate relationships between barriers and patients' sociodemographic variables and Pearson's χ² was used to compare differences in perceived barriers between patients and providers. Results. Providers expressed divergent perceptions of patients' barriers to healthy eating, including more total barriers and little agreement with patients on their relative importance. Largest differences in providers' perceptions of patient barriers included poor motivation, high use of fast food, inadequate family support, and lack of cooking skills-all suggesting patient inadequacy. In contrast, patients showed evidence of high motivation-in rate of blood glucose measurement and desire for diet education. Patients identified primary care providers as a main source of nutrition education, yet providers indicated lack of time for diet discussion and preferred other staff do the teaching. Conclusion. The findings from this study strongly suggest that health systems need to consider patient, provider, and system barriers when implementing nutrition education and management programs.

Effectiveness of an adapted diabetes nutrition education program on clinical status, dietary behaviors and behavior mediators in adults with type 2 diabetes: a randomized controlled trial

PURPOSE

This study evaluated the effectiveness of an adapted social-cognitive theory underpinned diabetes nutrition education program (NEP) on: clinical (HbA1c, BMI, blood lipids, blood pressure) and selected dietary behaviors (starchy foods and energy intake, vegetables and fruit intake) and behavior mediators (knowledge and diabetes management self-efficacy) in patients with type 2 diabetes mellitus (T2DM).

METHODS

A tertiary hospital outpatient adults (40-70 years) with poorly controlled (HbA1c ≥ 8 %) T2DM were randomized to either intervention group (n = 39: NEP, 7-monthly group education sessions, bi-monthly follow-up sessions, 15-minute individual session, workbook + education materials) or control group (n = 38: education materials only). NEP aimed to improve clinical status through improved dietary behaviors and behavior mediators. Outcomes and changes in diabetes medication were assessed at six and 12 months. Intention-to-treat analysis was conducted. ANCOVA compared the groups (baseline values, age, sex adjustments).

RESULTS

Forty-eight (62.3 %) participants completed the study. Intervention group compared to the control group had lower (-0.53 %), clinically meaningful HbA1c (primary outcome) at 6 months, albeit not sustained at 12 months. Compared to the control group, the intervention group had significantly lower: (i) systolic blood pressure at six and 12 months (ii) diastolic pressure at 12 months, (iii) energy intake at six-months, (iv) up-titration of insulin at six and 12 months and higher diabetes knowledge scores at six months.

CONCLUSIONS

NEP had limited effects on HbA1c, targeted dietary behaviors and behavior mediators but showed positive effects on blood pressure. The NEP health cost savings potential supports the need for improving program participation.

TRIAL REGISTRATION

ClinicalTrials.gov. number NCT03334773; 7 November 2017 retrospectively registered.

Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study

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.

Short-term effectiveness of a theory-based intervention to promote diabetes management behaviours among adults with type 2 diabetes in Iran: A randomised control trial

BACKGROUND

Diet and physical activity are recommended for diabetes management. Evidence suggests theory-based interventions are more efficacious than non-theory approaches. This study aimed to test the short-term effectiveness of an integrated theoretical model-based intervention to encourage compliance for low-fat food consumption, carbohydrate counting and physical activity in adults with type 2 diabetes.

METHODS

A 4-week parallel randomised control trial was conducted in Iran. Data were collected using a self-report questionnaire at baseline and 8-weeks post-intervention. This survey assessed the theory of planned behaviour (TPB) constructs of attitude, subjective norm (others' approval) and perceived behavioural control (PBC). We also assessed risk perceptions (motivational) and planning (volitional) from the health action process approach (HAPA). Furthermore, weight, body mass index, triglyceride (TG) and LDL-cholesterol were measured, with a sub-sample of participants providing haemoglobin A1c (HbA1c) assessments.

RESULTS

For both low-fat food consumption and physical activity, only planning revealed a significant improvement over time for intervention rather than control participants (F = 8.78, P ≤ .001 for low-fat vs F = 11.26, P ≤ .001 for physical activity). For carbohydrate counting, significant effects were found for behaviour (F = 4.37, P = .03), intention (F = 8.14, P ≤ .001), PBC (F = 7.52, P ≤ .001) and planning (F = 4.54, P = .03), reflecting improvements over time in the intervention participants compared to controls. Furthermore, the effects of the intervention on behaviour were partially mediated via participants' degree of planning (B = 0.10, SE = 0.06, CI = 0.01 to 0.26). The serum TG level was significantly reduced from pre to post-intervention for intervention rather than for control participants (F = 18.69, P ≤ .001) as did Hb1Ac in a sub-sample of study participants.

CONCLUSIONS

This intervention showed promising short-term effects for carbohydrate counting but did not show improvements for low-fat diet nor physical activity. Given the improvement in psychological measures and self-reported behaviour for carbohydrate counting, coupled with the findings for TG, future research is needed to demonstrate longer-term improvements.

The Nutritional and Health Effects of the COVID-19 Pandemic on Patients with Diabetes Mellitus

COVID-19 related restrictions aimed at curbing the spread of the coronavirus result in changes in daily routines and physical activity which can have a negative effect on eating and health habits. The aim of the study was to assess the impact of the COVID-19 pandemic on patients with diabetes and their nutrition and health behaviours. A survey conducted in July 2020 included 124 individuals with type 1 (n = 90) and 2 (n = 34) diabetes mellitus from Poland. To assess nutritional and health behaviours, an online questionnaire covering basic information, anthropometric data, and details regarding physical activity, eating, and hygiene habits was used. Almost 40% of all respondents with type 1 and 2 diabetes mellitus (DM) stated that their disease self-management had significantly improved. Over 60% of all participants declared that they had started eating more nutritious and regular meals during the COVID-19 pandemic. Enhanced hygiene, in particular, during the period, a statistically significant increase in hand sanitiser use was reported by respondents (18% vs. 82%, p < 0.001). The study demonstrated that the pandemic had a significant impact on the behaviour of patients with DM. Improved disease self-management and making healthy, informed food and hygiene choices were observed.

Gut microbiota of obese and diabetic Thai subjects and interplay with dietary habits and blood profiles

Obesity and type 2 diabetes mellitus (T2DM) have become major public health issues globally. Recent research indicates that intestinal microbiota play roles in metabolic disorders. Though there are numerous studies focusing on gut microbiota of health and obesity states, those are primarily focused on Western countries. Comparatively, only a few investigations exist on gut microbiota of people from Asian countries. In this study, the fecal microbiota of 30 adult volunteers living in Chiang Rai Province, Thailand were examined using next-generation sequencing (NGS) in association with blood profiles and dietary habits. Subjects were categorized by body mass index (BMI) and health status as follows; lean (L) = 8, overweight (OV) = 8, obese (OB) = 7 and diagnosed T2DM = 7. Members of T2DM group showed differences in dietary consumption and fasting glucose level compared to BMI groups. A low level of high-density cholesterol (HDL) was observed in the OB group. Principal coordinate analysis (PCoA) revealed that microbial communities of T2DM subjects were clearly distinct from those of OB. An analogous pattern was additionally illustrated by multiple factor analysis (MFA) based on dietary habits, blood profiles, and fecal gut microbiota in BMI and T2DM groups. In all four groups, Bacteroidetes and Firmicutes were the predominant phyla. Abundance of Faecalibacterium prausnitzii, a butyrate-producing bacterium, was significantly higher in OB than that in other groups. This study is the first to examine the gut microbiota of adult Thais in association with dietary intake and blood profiles and will provide the platform for future investigations.

Salutogenic model of health to identify turning points and coping styles for eating practices in type 2 diabetes mellitus

BACKGROUND

It is important for people with Type 2 Diabetes Mellitus (T2DM) to eat healthily. However, implementing dietary advice in everyday life is difficult, because eating is not a distinguishable action, but a chain of activities, embedded in social practices and influenced by previous life experiences. This research aims to understand why and how eating practices are developed over the life-course by investigating influential life experiences - turning points - and coping strategies for eating practices of people with T2DM.

METHODS

The Salutogenic Model of Health guided the study's objective, study design and analysis. Seventeen interviews were performed and analysed based on the principles of interpretative phenomenological analysis. Narrative inquiry and the creation of timelines and food boxes were used as tools to facilitate reflection on turning points and eating practices.

RESULTS

Turning points for unhealthier eating were experiences that strongly disturbed the participants' emotional stability. These experiences included psychosocial trauma, physical health disorders, job loss, and smoking cessation. Turning points for healthier eating were experiences that significantly changed participants views on life and made participants reflective about the effects of current eating practices on future health and life goals. These turning points included confrontation with ill-health, becoming a parent, psychosocial therapy, and getting married. Notably, turning points for healthier eating seemed only to happen when life was relatively stress-free. All participants experienced turning points for healthier eating, yet, not all participants succeeded in improving their diets. Two coping styles were distinguished: active and passive coping. Active coping individuals were able to act in line with their personal intentions, whereas passive coping individuals could not. Differences between active and passive coping styles seemed to be explained by differences in available resources important for adapting and maintaining a healthy diet.

CONCLUSION

Disadvantaged childhood and later life adversities together with the inability to manage the mental stress explained the development unhealthier eating practices. All participants experienced turning points for healthier eating that caused eating to become a priority in their life. Yet, the fact that not all were able to eat as they intended, advocates for nutritional guidance for people with T2DM, with a greater emphasis on reflexivity, psycho-social well-being and social support.

Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications

AIM

Motivation to take up and maintain a healthy lifestyle is key to diabetes prevention and management. Motivations are driven by factors on the psychological, biological and environmental levels, which have each been studied extensively in various lines of research over the past 25 years. Here, we analyse and reflect on current and emerging knowledge on motivation in relation to lifestyle behaviours, with a focus on people with diabetes or obesity. Structured according to psychological, (neuro-)biological and broader environmental levels, we provide a scoping review of the literature and highlight frameworks used to structure motivational concepts. Results are then put in perspective of applicability in (clinical) practice.

RESULTS

Over the past 25 years, research focusing on motivation has grown exponentially. Social-cognitive and self-determination theories have driven research on the key motivational concepts 'self-efficacy' and 'self-determination'. Neuro-cognitive research has provided insights in the processes that are involved across various layers of a complex cortical network of motivation, reward and cognitive control. On an environmental - more upstream - level, motivations are influenced by characteristics in the built, social, economic and policy environments at various scales, which have provided entry points for environmental approaches influencing behaviour.

CONCLUSIONS

Current evidence shows that motivation is strongly related to a person's self-efficacy and capability to initiate and maintain healthy choices, and to a health climate that supports autonomous choices. Some approaches targeting motivations have been shown to be promising, but more research is warranted to sustainably reduce the burden of diabetes in individuals and populations.

Goat Milk Consumption Ameliorates Abnormalities in Glucose Metabolism and Enhances Hepatic and Skeletal Muscle AMP-Activated Protein Kinase Activation in Rats Fed with High-Fat Diets

SCOPE

Diabetes endangers health and causes serious economic impediment. The aim of this study is to identify the effects of goat milk consumption on glucose metabolism of rats with high-fat (HF) diet.

METHODS AND RESULTS

Sixty male Sprague Dawley rats are divided into five groups and fed with different diets for 24 weeks: goat-milk-based HF diet (GHF group; goat milk powder+HF diet), cow-milk-based HF diet (CHF group; cow milk powder+HF diet), HF diet, HF diet plus acarbose (HF+A group; acarbose+HF diet), and chow diet (CD group). Fasting glucose in GHF-fed rats are lower than HF-fed rats on weeks 16 and 20. GHF-fed rats display improved insulin sensitivity in oral glucose and insulin tolerance tests. Compared with HF-fed rats, glycated hemoglobin and triglycerides in GHF-fed rats are lower and high-density lipoprotein level is higher. AMP-activated protein kinase activation (AMPK) in the liver and skeletal muscle is higher in GHF rats than HF rats. Phosphoenolpyruvate carboxykinase and glucose 6-phosphatase protein levels in the liver are lower and hexokinase 2 protein level in the skeletal muscle is higher in GHF rats compared with HF rats.

CONCLUSION

Goat milk consumption can ameliorate abnormalities in glucose metabolism, and AMPK pathway in the liver and skeletal muscle plays an important role in the process.

The effect of enterolactone on sphingolipid pathway and hepatic insulin resistance development in HepG2 cells

AIMS

Obesity and type 2 diabetes mellitus, correlate with increased tissue concentration of sphingolipids, which directly interfere with insulin signaling pathway. Phytoestrogens are a group of plant-derived compounds that have been studied in the case of metabolic disorders treatment. Therefore, the aim of this study was to ascertain whether enterolactone (ENL), a commonly known phytoestrogen, may affect sphingolipid metabolism and decrease hepatic insulin resistance development in a lipid overload state.

MAIN METHODS

The study was conducted on HepG2 cells incubated with ENL and/or palmitic acid (PA) for 16 h. Intra- and extracellular sphingolipid concentrations were assessed by high performance liquid chromatography. The expression of sphingolipid pathway enzymes, apoptosis and insulin signaling pathway proteins and glucose metabolism regulators were evaluated by Western Blot.

KEY FINDINGS

In HepG2 cells, a considerable augmentation of intracellular ceramide and sphingosine concentration in ENL with PA group were indicated with simultaneous increase in extracellular ceramide concentration. The ENL treatment increased expression of selected enzymes from de novo ceramide synthesis pathway with lower expression of ceramide transfer protein. We also observed a decreased expression of insulin-stimulated phosphorylation of AKT and AMPK after exposure to ENL with PA. Our research demonstrated that ENL with PA resulted in an increased expression of caspase-3.

SIGNIFICANCE

Enterolactone, in a higher fatty acids availability, led to the development of hepatic IR in HepG2 cells. This phenomenon may be the result of elevated intracellular ceramide accumulation caused by increased de novo synthesis pathway what led to enhanced apoptosis of HepG2 cells.

The effect of meals on bone turnover - a systematic review with focus on diabetic bone disease

INTRODUCTION

Type 2 diabetes is associated with an increased risk of bone fractures. Bone mineral density (BMD) is increased and bone turnover is low in type 2 diabetes and the increased BMD does not explain the increased fracture risk. However, the low bone turnover may lead to insufficient bone renewal with unrepaired micro-cracks and thus increase fracture risk. Ingestion of food acutely decreases bone resorption markers and the macronutrient composition of meals and meal frequency may influence bone metabolism adversely in subjects with unhealthy eating patterns, e.g., patients with type 2 diabetes.

AREAS COVERED

The treatment strategy of bone disease in type 2 diabetics is covered in this review. The current management of diabetic bone disease consists of anti-osteoporotic treatment. However, anti-resorptives may further reduce an already low bone turnover with uncertain effects. Furthermore, the acute and long-term effects of meal ingestion, weight loss alone and in combination with exercise as well as the possible underlying mechanisms are covered in this systematic review.

EXPERT COMMENTARY

Current management of diabetic bone disease is based on principles of anti-osteoporotic treatment in non-diabetic subjects. However, studies are urged to investigate whether anti-resorptives are equally beneficial in type 2 diabetes as in non-diabetic individuals.

Development of a marmalade for patients with type 2 diabetes: Sensory characteristics and acceptability

Type 2 diabetes is one of the most common noncommunicable diseases worldwide. The quality of life of people with this metabolic disorder is highly related to nutrition, given that products for glycemic control are of great importance for them. In this study, we have developed marmalades for glycemic control with the aims to investigate the most important sensory characteristics, to study the impact of the sensory properties on the acceptability of these marmalades, and to evaluate a difference in the acceptability of the marmalade samples between healthy people and people with type 2 diabetes. The main objects of the investigation were agar-, gelatin-, and pectin-based marmalades with maltitol, dried fruits, and berries for glycemic control. By means of descriptive sensory analysis, we have shown that major factors of the sensory differentiation of marmalade samples are the type of gelling agent and presence of nonsoluble components such as apple puree, which influencing the perception of “off-flavor,” “gumminess,” and “springiness” sensory attributes. Results of this research show that even with significant differences in sensory attributes it is possible to develop marmalade for glycemic control that will have no differences in the total liking score for the perception of both healthy people and patients with type 2 diabetes.

Eating disoders in type 2 diabetic people: Brief review

BACKGROUND

Relationship between type 1 diabetes and Eating disorders is well-known, less information exists on the relationship between type 2 diabetes (T2DM) people and eating disorders.

AIM

Review information on the prevalence and impact of type 2 diabetes and eating disorders comorbidity.

METHODS

Search in Medline and PubMed relevant articles on the aforementioned co-morbidity. Review includes articles on epidemiological, clinical and therapeutics aspects.

CONCLUSIONS

Disordered eating behaviours may affect around 40% of T2DM people, being the predominant clinical forms: Eating Disorders Non otherwise specified (EDNOS), Night Eating Syndrome (NES) and Binge Eating Disorder (BED), however, population-based estimates of T2DM and ED comorbidity are mandatory to determine the prevalence of ED in T2DM people. The association between both entities has a consequence which is an impairment of metabolic control, associated to increase risk of vascular complications and difficult body weight loss, basis of T2DM treatment.

Pragmatic dietary advice for diabetes during Navratris

Navratri is one of the most common religious fasts observed among Hindus. A large number of people with diabetes follow Navratris fast irrespective of its health implications, often without proper education and medical advice. The quest for the scientific research on dietary advices for Hindu fasts including Navratris shows paucity of literature comparative to the dietary advices advocated during Ramadan. The eating and physical activity patterns during different fasts vary a lot depending up on social and cultural factors. Even eating pattern is not uniform among all persons following Navratris and is modified as per their region, local culture, and religious beliefs. Dietary advice during Navratris depends upon pattern of fasting, religious beliefs, and local sociocultural factors. In this review, efforts are made to provide pragmatic dietary advice for people with diabetes, modifications in the menus and cooking practices, and timings of the meals for successful blood glucose management during Navratris. This review will also help plan diet and physical activity advice for persons observing other fasts as well.

Psychometric Properties of the Modified Personal Diabetes Questionnaire Among Chinese Patients With Type 2 Diabetes

This study examined the psychometric properties of the Chinese version of the Personal Diabetes Questionnaire (C-PDQ). The PDQ was translated into Chinese using a forward and backward translation approach. After being reviewed by an expert panel, the C-PDQ was administered to a convenience sample of 346 adults with Type 2 diabetes. The Chinese version of the Summary of Diabetes Self-Care Activities (C-SDSCA) was also administered. The results of the exploratory factor analysis revealed a one-factor structure for the Diet Knowledge, Decision-Making, and Eating Problems subscales and a two-factor structure for the barriers-related subscales. The criterion and convergent validity were supported by significant correlations of the subscales of the C-PDQ with the glycated hemoglobin values and the parallel subscales in the C-SDSCA, respectively. The C-PDQ subscales also showed acceptable internal consistency (α = .61-.89) and excellent test-retest reliability (intraclass correlation coefficients: .73-.96). The results provide preliminary support for the reliability and validity of the C-PDQ. This comprehensive, patient-centered instrument could be useful to identify the needs, concerns, and priorities of Chinese patients with type 2 diabetes.

Development of a brief, reliable and valid diet assessment tool for impaired glucose tolerance and diabetes: the UK Diabetes and Diet Questionnaire

Objective

Dietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual’s diet. The present study examined the UKDDQ’s repeatability and relative validity compared with 4 d food diaries.

Design

The UKDDQ was completed twice with a median 3 d gap (interquartile range=1–7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen’s weighted kappa (κ_w).

Setting

South West of England.

Subjects

Adults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m²; participants were 91 % White British.

Results

The UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κ_w ranged from 0·43 (‘savoury pastries’) to 0·87 (‘vegetables’). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for ‘alcohol’ (κ_w=0·71) and ‘breakfast cereals’ (κ_w=0·70), with no agreement for ‘vegetables’ (κ_w=0·08) or ‘savoury pastries’ (κ_w=0·09).

Conclusions

The UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management.

Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran

OBJECTIVE

To identify barriers to recommended dietary adherence in patients with type 2 diabetes.

DESIGN

Observational cross-sectional study.

SAMPLE

One hundred-forty six overweight/obese volunteers with type 2 diabetes, who had previously received dietary advice for at least one year, were recruited from two diabetes clinics in Tabriz, north-west of Iran.

MEASUREMENTS

A 24-item questionnaire was designed to assess dietary barriers. The validity and reliability of the questionnaire were assessed by Content Validity Index, Content Validity Ratio and Cronbach's alpha, respectively. An exploratory factor analysis with principal component analysis extraction and varimax rotation was utilized in order to extract the underlying factors of dietary nonadherence.

RESULTS

Factor analysis yielded seven barrier factors including: situational barriers/difficulty resisting temptation [percent variance=11.64%], stress-related eating disorder/cost [percent variance=9.11%], difficulty with meal and snack plans [percent variance=8.76%], confusion [percent variance=8.45%], work-related issues [percent variance=7.72%], small portion size [percent variance=6.87%] and lack of palatability/family support [percent variance=6.78%]. These factors explained about 59.4% of the total variance.

CONCLUSIONS

Overall, patients with type 2 diabetes perceived some barriers to recommended dietary adherence. In dietary counseling, considering and addressing these barriers will likely be effective in increasing the dietary adherence for patients with type 2 diabetes in Iran.

Experiences of food abstinence in patients with type 2 diabetes: a qualitative study

OBJECTIVE

People with type 2 diabetes often report pressure to abstain from many of life's pleasures. We tried to reconstruct these patients' sense of pressure to better understand how people with diabetes make sense of, and integrate, these feelings into their life.

DESIGN, SETTING AND PARTICIPANTS

A secondary analysis of narrative interviews with 14 patients with type 2 diabetes who are part of a website project.

MAIN OUTCOME MEASURES

Grounded theory-based analysis of narrative interviews, consisting of open, axial and selective coding.

RESULTS

People with type 2 diabetes felt obliged to give up many pleasures and live a life of abstinence. They perceived a pressure to display a modest culinary lifestyle via improved laboratory test results and weight. Their verbal efforts to reassure and distance themselves from excessiveness indicate a high moral pressure. With regard to the question of how to abstain, food and behaviour were classified into healthy and unhealthy. Personal rules sometimes led to surprising experiences of freedom.

CONCLUSIONS

People with diabetes have internalised that their behaviour is a barrier to successful treatment. They experience an intensive pressure to show abstinence and feel misjudged when their efforts have no visible effect. Taking into account this moral pressure, and listening to patients' personal efforts and strategies to establish healthy behaviours, might help to build a trusting relationship with healthcare providers.

Factors associated with diet barriers in patients with poorly controlled type 2 diabetes

BACKGROUND

The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables.

METHODS

Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers.

RESULTS

Diet barriers were moderately evident (2.23±0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24±1.98), followed by "eating away from home" (2.79±1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (β=-0.282, P<0.001) and empowerment (β=-0.190, P=0.015), and more negative appraisal (β=0.225, P=0.003).

CONCLUSION

Culturally tailored, patient-centered intervention programs that acknowledge individuals' preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes.

Knowledge and perceptions about diet and physical activity among Sri Lankan adults with diabetes mellitus: a qualitative study

Background

Diabetes mellitus (DM) is a rapidly growing health concern in Sri Lanka. Diet and physical activity are important modifiable risk factors affecting the incidence, severity and management of DM. The present study aims to evaluate the knowledge and perceptions about dietary patterns and physical activity among a group of adults with DM in Sri Lanka using qualitative research methods.

Methods

Fifty adults from a cohort of diabetic patients attending the medical clinics at the National Hospital of Sri Lanka were invited for the study. Data were collected via 10 Focus Group Discussions. Verbatim recording and documenting emotional responses were conducted by two independent observers. Directed content analysis of qualitative data was done with the help of NVIVO v10.0.

Results

Mean age was 61.2 ± 9.9 years and 46 % were males. Mean duration of diabetes was 10.4 ± 7.5 years. All were aware of the importance of diet in the management of DM. But most had difficulty in incorporating this knowledge into their lives mostly due to social circumstances. The majority described a list of ‘good foods’ and ‘bad foods’ for DM. They believed that ‘good’ foods can be consumed at all times, irrespective of quantity and ‘bad’ foods should be completely avoided. Many believed that fruits were bad for diabetes, while vegetables were considered as a healthy food choice. The majority thought that there were ‘special’ foods that help to control blood glucose, the most common being curry leaves and bitter-gourd. Most study participants were aware of the importance of being physical active. However, there was lack of consensus and clarity with regards to type, duration, timing and frequency of physical activity.

Conclusions

Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to practices were poor, mainly due to lack of clarity of information provided. There were many myths with regards to diet, some of which have originated from health care professionals. More evidence is needed to support or refute the claims about ‘special’ foods that the participants believe as being good for diabetes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2518-3) contains supplementary material, which is available to authorized users.

Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial

Objective

To evaluate the effect of a participant-customised nutrition education programme on glycated Hb (HbA1c), blood lipids, blood pressure, BMI and dietary behaviours in patients with type 2 diabetes mellitus.

Design

A randomised controlled trial. The control group (n 41) received education materials. The intervention group (n 41) received the same education materials and participated in eight weekly (2–2·5 h) group nutrition education sessions and follow-up sessions. Outcomes were assessed at 6 and 12 months. An intention-to-treat analysis was conducted. ANCOVA compared the groups (adjustments for baseline values, age, sex and clinic).

Setting

Two community health centres, Moretele sub-district (North West Province), South Africa.

Subjects

Adults (aged 40–70 years) with type 2 diabetes, HbA1c ≥8 %.

Results

Differences in HbA1c (primary outcome) were −0·64 % (P=0·15) at 6 months and −0·63 % (P=0·16) at 12 months in favour of the intervention group. Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P=0·005) at 6 months and 9·9 v. 11·9 servings/d (P=0·017) at 12 months. Median energy intake was significantly lower in the intervention group at 12 months (5988 v. 6946 kJ/d, P=0·017). No significant group differences in BMI, lipid profile, blood pressure and intakes of macronutrients, vegetables and fruits were observed.

Conclusions

Nutrition education was not efficacious on HbA1c; however, it improved specific dietary behaviours. Group education and hands-on activities appeared to contribute to the improvement. Optimal goal setting and self-efficacy training/assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in resource-limited settings.

Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients

OBJECTIVE

It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control.

METHOD

One hundred fifty-two T2DM patients aged between 18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores.

RESULTS

Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (P<.05). A positive correlation was found between EAT scores and depression scores (r = +0.196, P<.05). No significant difference was found in HbA1c levels between patients with BED and those without (P<.05).

CONCLUSIONS

T2DM patients should be examined in terms of the presence of BED and disordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression.

Dietary practice and associated factors among type 2 diabetic patients: a cross sectional hospital based study, Addis Ababa, Ethiopia

Background

Dietary management which is considered to be one of the cornerstones of diabetes care is based on the principle of healthy eating in the context of social, cultural and psychological influences on food choice. In Ethiopia, there is lack of data on the dietary practice of diabetic patients which underestimates its role in the management of diabetes. Hence, this study assesses the level of dietary practices and their associated factors among Type 2 diabetic patients in Addis Ababa, Ethiopia.

Methods

Institution-based cross-sectional quantitative study design was employed. A total of 403 study subjects were included in the study. A pretested questionnaire was used to collect data. The collected data were entered into Epi Info version 3.5.3 and exported to SPSS version 20.0 software packages for further statistical analysis. The data were analyzed using bivariate and multivariate logistic regression. The degree of association between dependent and independent variables was assessed using the odds ratio with a 95% confidence interval and variables with p-value ≤0.05 were considered significant.

Results

About 46.4% of the patients were overweight and obese. More than half of the respondents (58.8%) had FBG level ≥ 126 mg/dl. The level of dietary practice among 207 (51.4%) type 2 diabetic patients was poor. Not getting nutrition education in hospitals [AOR = 4.47, 95% CI: (1.92,10.40)], despondency [AOR = 2.15, 95% CI: (1.14,4.02)], facing difficulty to choose foods [AOR = 9.66, 95% CI: (5.12,18.24)], non- availability of fruits and vegetables [AOR = 2.78, 95% CI: (1.03,7.54)], thinking about the high cost of foods [AOR = 2.36,95% CI: (1.18, 4.70)] were the factors significantly associated with the poor dietary practice.

Conclusion

Findings of this study indicated that the majority of the patients had poor dietary practice. Therefore, the integration of diabetic based nutrition education with motivation and home gardening is highly recommended.

Lifestyle factors associated with type 2 diabetes and use of different glucose-lowering drugs: cross-sectional study

Aims

To examine the lifestyle profile among persons with and without Type 2 diabetes mellitus (DM) and among users of different glucose-lowering drugs.

Methods

We used questionnaire data from a Danish health survey and identified presence of Type 2 DM and use of medications through medical databases. We calculated age- and gender-standardized prevalence ratios (PRs) of lifestyle factors according to Type 2 DM and different glucose-lowering drugs.

Results

Of 21,637 survey participants aged 25–79 years, 680 (3%) had Type 2 DM (median age 63 years) with a median diabetes duration of 5 years. Participants with Type 2 DM had a substantially higher prevalence of obesity (36% vs. 13%, PR: 3.1, 95% confidence interval (CI): 2.8–3.6), yet more reported to eat a very healthy diet (25% vs. 21%, PR: 1.2, 95% CI: 1.0–1.4) and to exercise regularly (67% vs. 53%, PR: 1.3, 95% CI: 1.2–1.4). Also, fewer were current smokers or had high alcohol intake. When compared with metformin users, obesity was substantially less prevalent in users of sulfonylurea (PR: 0.5, 95% CI: 0.4–0-8), and insulin and analogues (PR: 0.4, 95% CI: 0.3–0.7). Tobacco smoking was more prevalent in sulfonylurea users (PR: 1.4, 95% CI: 0.9–2.1) compared with metformin users. We found no material differences in physical exercise, diet or alcohol intake according to type of glucose-lowering drug.

Conclusions

Type 2 DM patients are substantially more obese than other individuals, but otherwise report to have a healthier lifestyle. Metformin use is strongly associated with obesity, whereas sulfonylurea use tends to be associated with tobacco smoking.

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria

BACKGROUND

Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which undermines the benefits of current medical care.

OBJECTIVES

To evaluate the pattern of treatment non-adherence among ambulatory patients with poorly controlled type 2 diabetes in southwestern Nigeria, and to determine the possible factor(s) that accounted for such non-adherence with a view to identifying areas of future intervention to improve outcome.

METHODS

A prospective cross-sectional interview using the concept of RIM (Recognize, Identify and Manage) model was used to evaluate adherence to treatment recommendations among 176 consented patients recruited from the endocrinology out-patient clinics of two teaching hospitals in southwestern Nigeria between November, 2010 and January, 2011.

RESULTS

Overlaps of non-adherence behavior were obtained. More than three-quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factorsidentified as possible barriers to medication adherence include practical (145; 40.1%), knowledge (103; 28.5%), and attitudinal (114; 31.5%) barriers. Dietary non-adherence was mostly due to inappropriate guidance (62; 33.7%).

CONCLUSIONS

The arrays of non-adherence behavior among the cohort further emphasize the need for patient-centered approach as a reasonable strategy in resolving non-adherence problems in routine clinical practice.

Difference in weight loss based on ethnicity, age and comorbidity status in a publicly funded adult weight management centre: 1-year results

Limited evidence is available on the effectiveness of publicly funded weight loss (WL) clinics. We examined the 1-year WL outcomes and investigated predictors of WL and discontinuation of 1566 overweight and obese adults, who attended the Wharton Medical Clinic (WMC) weight management centre for at least 6 months. Overall, 42.7% (n = 669) of the entire sample achieved a ≥5%WL over the entire follow-up period from July 2008 to February 2012. On average, patients lost 5.6 ± 7.2 kg (5.0 ± 6.3%) of initial body weight (BW), while a subsample of patients attending the clinic for at least 1 year had a mean weight reduction of 6.6 ± 7.9 kg (5.9 ± 7.2%) of BW. Older patients were more likely to achieve a greater WL in comparison with young patients while White patients and those without type 2 diabetes (T2D) lost almost twice as much weight and %BW in comparison with Asian patients and patients with T2D, respectively (P < 0.05). Discontinuing patients did not differ in terms of sex, body mass index, education and smoking status from those who continued treatment (P > 0.05). Results of this study demonstrate that the WMC provides a practical model for clinically effective lifestyle-based treatment, accessible to a wide range of demographically diverse adults.

Promoting only the consumption of healthy foods may be an alternative stategy for treating patients with the metabolic syndrome

OBJECTIVE

To evaluate the effectiveness of two lifestyle, interventional approaches on metabolic abnormalities and eating habits of patients with metabolic syndrome.

MATERIALS/METHODS

This is a randomized controlled trial, involving a 6-month lifestyle intervention. Eighty-eight metabolic syndrome patients were randomized to one of the three groups: (i) "Increase - Decrease" group, (ii) "Increase" group, and (iii) "Minimum intervention" group. All patients received dietary and physical activity advice at baseline; patients in the first two groups also participated in individual counseling sessions. In the "Increase - Decrease" group, all recommended dietary and physical activity goals were targeted, whereas in the "Increase" group, only goals proposing an increase in dietary intake or physical activity were included. Patients received nutrition counseling through seven, one-to-one sessions, conducted every two weeks for the first 2 months, every month for the following 4 months. All participants underwent a full medical and nutritional assessment at baseline and at the end of the intervention.

RESULTS

At 6 months, BMI and waist circumference were improved in the "Increase" and the "Increase - Decrease" groups, compared to the "Minimum Intervention" group. Additionally, "Increase - Decrease" group reduced blood systolic (p=0.017), diastolic pressure (p=0.005) and glucose concentrations (p=0.015). Forty eight percent, 32%, and 19% of the patients in the "Increase - Decrease", "Increase" and "Minimum Intervention" groups, respectively, ceased to fulfill the criteria for the metabolic syndrome (p=0.031).

CONCLUSIONS

Promoting only the increase of the intake of healthy foods did not result in better outcome values compared to a conventional all-food approach.

Case-control study of disturbed eating behaviors and related psychographic characteristics in young adults with and without diet-related chronic health conditions

Young adults with diet-related chronic health conditions (DRCHCs; i.e., type 1 diabetes, celiac disease, cystic fibrosis, inflammatory bowel diseases, irritable bowel syndrome) face challenges complying with dietary restrictions required to effectively manage their health condition. These restrictions could put them at risk for disturbed eating. The purpose of this study was to determine if young adults with and without DRCHCs differed with regard to disturbed eating behaviors and related psychographics characteristics (i.e., body image attributes, mental disorders, intrapersonal characteristics and sociocultural environment [i.e., media and family]). Each DRCHC participant (cases=166) was matched to 4 healthy participants (controls=664) based on gender and BMI (±0.50 BMI units). Conditional logistic regression analyses indicate cases were twice as likely to have been diagnosed by a healthcare provider with an eating disorder (p=0.08, OR=1.99, CI(90) [1.03-3.83]). Cases were significantly more likely to use Inappropriate Compensatory Behaviors to manage their weight, i.e., excessive exercise (p=0.04, OR=1.41, CI(95) [1.02-1.94]) and misuse medication (p=0.04, OR=1.14, CI(95) [1.00-1.29]) than controls. Depression and anxiety were significantly higher, and health status was significantly poorer in cases compared with controls. DRCHC participants were less likely to report feeling body image pressures from the media, placed a greater value on their health, used social diversion, and recalled a greater emphasis being placed on their mothers' weights and mealtimes being less structured than control participants. Findings indicate that nutrition and other healthcare professionals should incorporate screening DRCHC patients for disturbed eating behaviors and eating disorders in their standards of care.

Detection of food intake from swallowing sequences by supervised and unsupervised methods

Studies of food intake and ingestive behavior in free-living conditions most often rely on self-reporting-based methods that can be highly inaccurate. Methods of Monitoring of Ingestive Behavior (MIB) rely on objective measures derived from chewing and swallowing sequences and thus can be used for unbiased study of food intake with free-living conditions. Our previous study demonstrated accurate detection of food intake in simple models relying on observation of both chewing and swallowing. This article investigates methods that achieve comparable accuracy of food intake detection using only the time series of swallows and thus eliminating the need for the chewing sensor. The classification is performed for each individual swallow rather than for previously used time slices and thus will lead to higher accuracy in mass prediction models relying on counts of swallows. Performance of a group model based on a supervised method (SVM) is compared to performance of individual models based on an unsupervised method (K-means) with results indicating better performance of the unsupervised, self-adapting method. Overall, the results demonstrate that highly accurate detection of intake of foods with substantially different physical properties is possible by an unsupervised system that relies on the information provided by the swallowing alone.

Diabetes dietary management alters responses to food pictures in brain regions associated with motivation and emotion: a functional magnetic resonance imaging study

AIMS/HYPOTHESIS

We hypothesised that living with type 2 diabetes would enhance responses to pictures of foods in brain regions known to be involved in learnt food sensory motivation and that these stronger activations would relate to scores for dietary adherence in diabetes and to measures of potential difficulties in adherence.

METHODS

We compared brain responses to food images of 11 people with type 2 diabetes and 12 healthy control participants, matched for age and weight, using functional magnetic resonance imaging (fMRI).

RESULTS

Having type 2 diabetes increased responses to pictured foods in the insula, orbitofrontal cortex (OFC) and basal ganglia and, within these regions, the effect of the fat content of the foods was larger in participants with type 2 diabetes than in healthy controls. Furthermore, increased activation to food within the insula and OFC positively correlated with external eating, dietary self-efficacy and dietary self-care. In contrast, responses within subcortical structures (amygdala and basal ganglia) were positively correlated with emotional eating and rated appetite for the food stimuli and negatively correlated with dietary self-care.

CONCLUSIONS/INTERPRETATION

Type 2 diabetes is associated with changes in brain responses to food that are modulated by dietary self-care. We propose that this is linked to the need to follow a life-long restrictive diet.

Five-year incidence of obesity and its determinants: the ATTICA Study

Objectives

To evaluate the 5-year incidence of obesity in a sample of CVD-free adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals.

Methods

Men (n 1514) and women (n 1528) (>18 years) without any clinical evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multistage and included information about various sociodemographic, lifestyle (diet, exercise and smoking), biochemical and clinical characteristics. In 2006, the 5-year follow-up was performed through telephone calls or personal visits. Data from the 1364 participants are analysed in the present work.

Results

The 5-year incidence of obesity was 21·8 % in men and 11·9 % in women. The ratio of men to women revealed that more men than women developed obesity, while more women than men became overweight during the follow-up period. It was found that men were 1·6 times more likely to develop obesity compared with women; abnormal waist circumference, smoking habits and the presence of hypercholesterolaemia increased the risk for developing obesity, irrespective of age and baseline lifestyle characteristics of the participants. In the multivariate analysis, no association was detected between adherence to a Mediterranean diet and incidence of obesity in initially normal-weight individuals.

Conclusions

Obesity remains a serious health problem for the Greek population; the alarming rates of excess body weight continue to increase. Preventive measures should be urgently addressed, targeting particularly those with metabolic risk factors.

Management of the metabolic syndrome and type 2 diabetes through lifestyle modification

Sustainable lifestyle modifications in diet and physical activity are the initial, and often the primary, component in the management of diabetes and the metabolic syndrome. An energy-prudent diet, coupled with moderate levels of physical activity, favorably affects several parameters of the metabolic syndrome and delays the onset of diabetic complications. Weight loss, albeit not an absolute prerequisite for improvement, is a major determinant and maximizes effectiveness. Adopting a healthy lifestyle pattern requires a series of long-term behavioral changes, but evidence to date indicates low long-term adherence to diet and physical activity recommendations. This calls for greater research and public health efforts focusing on strategies to facilitate behavior modification.

Effectiveness of an intensive nutritional intervention in patients with type 2 diabetes mellitus: results from a pilot study

The aim of this pilot study was to compare the effects of an intensive nutritional intervention with usual care conditions on dropout rate, body weight, lifestyle changes and glycemic control in patients with type 2 diabetes mellitus (T2DM). Thirty outpatients with T2DM but without insulin treatment (mean age: 57 +/- 9 yr) were randomly assigned to one of the two intervention groups: intensive care (IC) or usual care (UC). Patients in the UC group were given advice about dietary and physical activity goals in one consultation session at baseline, while patients in the IC group attended five goal-oriented consultation sessions held approximately every two weeks from baseline onwards. Changes in body weight, T2DM knowledge, dietary intake, physical activity, HbA1c, and percentage of dropouts were evaluated at 1-year follow-up post-intervention. Fifty percent of patients quitted the program and were classified as "dropouts". Program completers were older and included a lower percentage of newly diagnosed T2DM compared with dropouts. A tendency to a negative association between attendance of the IC group and the likelihood of dropping out was found (p = 0.08). No difference was detected between UC and IC groups regarding changes in body weight, HbA1c or other outcome measures, at post-intervention or 1-year follow-up. This pilot study did not confirm advantages of intensive nutritional intervention in T2DM patients in terms of glycemic control, body weight, diet and physical activity. However, the high dropout rate may have hampered its effectiveness.

Low energy reporting related to lifestyle, clinical, and psychosocial factors in a randomly selected population sample of Greek adults: the ATTICA Study

OBJECTIVE

Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample.

METHODS

Following a random multistage sampling, 1514 men (46+/-13 years old) and 1528 women (45+/-13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs.

RESULTS

LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 +/- 8.2, 95%CI 30.2-31.04 vs. 26.9 +/- 6.3, 95%CI 26.05-27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men.

CONCLUSION

Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures.