Emphasis on Carbohydrates May Negatively Influence Dietary Patterns in Youth With Type 1 Diabetes

Joslin Diabetes Center, Section of Genetics and Epidemiology, Boston, Massachusetts, USA.
Diabetes care (Impact Factor: 8.42). 10/2009; 32(12):2174-6. DOI: 10.2337/dc09-1302
Source: PubMed


To assess perceptions of healthful eating and the influence of diabetes management on dietary behaviors among youth with type 1 diabetes and parents.
Youth with type 1 diabetes (n = 35), ages 8-21 years, and parents participated in focus groups. Focus group recordings were transcribed and coded into themes. Clinical data were abstracted from the electronic medical record.
Central topics were perceptions of healthful eating and the impact of diabetes management on diet. An emphasis on limiting postprandial glycemic excursions occasionally contradicted the traditional perception of healthful eating, which emphasized consumption of nutrient-dense whole foods in favor of prepackaged choices. Whereas fixed regimens required more rigid diets, basal-bolus regimens provided more opportunities for unhealthful eating. Most youth perceived "refined" grains as more healthful grains.
For youth with type 1 diabetes and parents, an emphasis on carbohydrate quantity over quality may distort beliefs and behaviors regarding healthful eating.

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Available from: Tonja Nansel, Oct 04, 2015
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    • "Both adolescents and adults generally understand fundamental principles of healthful eating, including which foods are more and less healthful [49,50]. Additionally, findings from focus groups among youth with type 1 diabetes [51,52] indicate that while youth widely perceive fruit and vegetable intake as relevant to healthful eating, they also understand the concept of healthful eating to encompass dietary behaviors such as fiber and whole grain intake, as well as limiting intake of nutrient-poor foods (e.g., snack foods, sweets). Such findings suggest the potential utility of examining social cognitive constructs as they relate to overall diet quality. "
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    ABSTRACT: Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents. Youth (n=252) ages 8--18 years with diabetes duration >=1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling. Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling beta^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) beta^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes beta^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling beta^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality. Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.
    International Journal of Behavioral Nutrition and Physical Activity 11/2013; 10(1):125. DOI:10.1186/1479-5868-10-125 · 4.11 Impact Factor
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    • "** p < 0.01. ulation, despite differential dietary considerations for diabetes management, such as ease of carbohydrate estimation or preference for foods requiring no insulin administration (Mehta, Haynie, et al., 2009). For the most part, food group preference and availability in this sample were unrelated to intake of non-corresponding food groups. "
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    ABSTRACT: The objective of this study was to examine associations of food preferences and availability with dietary intake in youth with type 1 diabetes, for whom dietary intake and quality are essential to disease management. Youth (n=252, age 13.2±2.8 y, diabetes duration 6.3±3.4 y) reported preferences and parents reported household availability for 61 food items categorized as fruit, vegetables, whole grains, refined grains and fats/sweets. Youth energy-adjusted daily servings of food groups, Healthy Eating Index-2005 and Nutrient Rich Foods 9.3 scores were calculated from 3-day diet records. Associations of dietary intake and quality variables with preference and availability of all food groups were evaluated by linear regressions adjusted for sociodemographic characteristics. Fruit and whole grain intake were positively related to corresponding preference and availability; whole grain intake and refined grain availability were inversely related. Vegetable, refined grain and fats/sweets intake were unrelated to preference and availability. Diet quality measures were related positively to fruit preference and whole grain availability and inversely to refined grains availability. Findings indicate associations of dietary intake with food preference and availability vary by food group in youth with type 1 diabetes. Measures of overall dietary quality were more consistently associated with food group availability than preferences.
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    ABSTRACT: The current standard of care for patients with type 1 diabetes (T1D) employs a system of intensive diabetes management aimed at near-normal glycemia, which reduces the risk of micro- and macrovascular complications. Optimal management is an ongoing process based on a patient-centered collaboration with a primary care clinician and a multidisciplinary diabetes team that provides diabetes management, including education and psychosocial support. Intensive diabetes therapy attempts to mimic physiologic insulin replacement. Over the past 15 years, there has been widespread use of multiple-dose insulin regimens using a variety of insulin analogs, administered either by injection or insulin pump therapy, together with medical nutrition therapy, frequent self-monitoring of blood glucose and, more recently, continuous logo glucose monitoring. It is now possible to achieve previously unattainable levels of glycemic control with less risk of severe hypoglycemia, and yet only a minority of patients achieves target hemoglobin A1c values. This review discusses contemporary management of T1D with a focus on health outcomes.
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