Effect of protein and carbohydrate distribution among meals on quality of life, sleep quality, inflammation, and oxidative stress in patients with type 2 diabetes: A single-blinded randomized controlled trial

The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs.

METHODS

Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis.

RESULTS

Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence.

CONCLUSION

The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.

Dietary and Sleep Quality Association in Hemodialysis Patients

Background

Poor sleep quality is a common issue among patients with end-stage renal disease (ESRD) who undergo dialysis. Nutritional habits are associated with sleep hygiene in patients undergoing dialysis. The objective of this study was to examine the potential correlation between nutritional status and sleep quality in individuals receiving hemodialysis treatment.

Materials and Methods

This cross-sectional study included 160 hemodialysis patients. A food frequency questionnaire (FFQ) was used to measure food intake in participants. The Persian-validated version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Patients were classified as poor or good sleepers with a PSQI score of <5 and >5, respectively.

Results

Eighty-four percent of hemodialysis patients had bad sleep hygiene. There was a significant association between sleep quality and educational status and age (P < 0.001). Poor sleepers were older (61.65 years versus 51.12) and less educated (31.1% versus 4%). However, there was no significant difference in the intake of micro- and macronutrients between poor and good sleepers (P > 0.05).

Conclusion

The results of this study suggest that sleep quality has no significant relationship with nutrient intake in hemodialysis patients. Demographic factors, such as age and educational status, have played a more effective role than nutritional factors in patients' sleep quality.

Interactions between nutrient intake and comorbidities for quality of life in premenopausal and postmenopausal women

OBJECTIVE

This study aimed to identify the associations between nutrient intake and health-related quality of life (HRQOL) in premenopausal and postmenopausal women.

METHODS

Using data from Korean National Health and Nutrition Examination Surveys (2019-2020), EQ-5D-3L, and multivariate logistic and linear regression models, we analyzed the association and interaction between nutrient intake, comorbidities, and HRQOL among 4,027 Korean women.

RESULTS

Nutrient intake levels were lower in postmenopausal women than in premenopausal women. Interactions were observed between numerous nutrient intakes and comorbidities for HRQOL among premenopausal and postmenopausal women. Higher intakes of various nutrients (particularly, folic acid and vitamin A) were related to higher HRQOL scores in premenopausal women with comorbidities (log of inverse HRQOL scores, β = -0.31 [95% confidence interval [CI], -0.58 to -0.05] and β = -0.19 [95% CI, -0.37 to -0.001]) and postmenopausal women with comorbidities (log of inverse HRQOL scores, β = -0.34 [95% CI, -0.61 to -0.07] and β = -0.19 [95% CI, -0.38 to -0.01]), respectively. Regular exercise was associated with a lower risk of mobility problems (odds ratio [OR], 0.59; 95% CI, 0.44-0.81), self-care problems (OR, 0.53; 95% CI, 0.28-0.99), usual activity problems (OR, 0.42; 95% CI, 0.26-0.67), and any problem (OR, 0.71; 95% CI, 0.56-0.90), as well as an increase in HRQOL score (log of inverse HRQOL scores, β = -0.42; 95% CI, -0.68 to -0.16) in postmenopausal women. Smoking was related to a higher prevalence of depression and anxiety problems (OR, 2.51; 95% CI, 1.53-4.13) and any problem (OR, 1.67; 95% CI, 1.11-2.52), as well as a decrease in HRQOL scores (log of inverse HRQOL scores, β = 0.51; 95% CI, 0.14-0.88) in premenopausal women.

CONCLUSIONS

Given the lower nutrient intake levels in postmenopausal women, it is critical to establish HRQOL-improving approaches for this population, including regular exercise, nutrient intake, and smoking cessation.