Validation of dietary intake data in black women with type 2 diabetes

Under-reporting of the energy intake in patients with type 2 diabetes

BACKGROUND

In patients with type 2 diabetes mellitus (DM), an accurate assessment of food intake is essential for clinical nutritional management. Tools such as the food frequency questionnaire (FFQ) and 24-h food record (24HR) identify dietary habits in support of dietary planning. However, it is possible that these tools have reporting errors with respect to assessing food intake, particularly energy intake (EI).

METHODS

A cross-sectional study was conducted in patients with type 2 DM. EI was assessed by the FFQ and 24HR tools. Resting energy expenditure (REE) was measured by indirect calorimetry. Data were analysed using a kappa test, t-test and Spearman's correlation coefficients. Under-reporting was assessed using the EI/REE ratio. Patients with values <1.18 and <1.10 for FFQ and 24HR, respectively, were considered as under-reporting.

RESULTS

We evaluated 55 patients [mean (SD) 62.7 (5.3) years old, duration of diabetes 11.2 (7.3) years, 52.7% female]. The mean (SD) EI assessed by FFQ was 1797.7 (641.3) and as assessed by 24HR was 1624 (484.8) kcal day^-1 . The mean (SD) REE was 1641.3 (322.3) kcal day^-1 . The mean (SD) ratios FFQ/REE and 24HR/REE were 1.11 (0.38) and 1.01 (0.30), respectively. The tools showed a moderate agreement for under-reporting of EI (kappa = 0.404; P = 0.003). Moderate and positive correlations between REE were observed with FFQ (r = 0.321; P = 0.017) and 24HR (r = 0.364; P = 0.006). According to the tools, the under-reporting was observed in approximately 65% of patients.

CONCLUSIONS

The majority of patients with type 2 DM under-reported their calorie intake, as assessed by FFQ and 24HR. REE showed a positive correlation with both tools.

Racial Differences in Weight Loss Mediated by Engagement and Behavior Change

Objective

We set out to determine if a primarily Internet-delivered behavioral weight loss intervention produced differential weight loss in African American and non-Hispanic White women, and to identify possible mediators.

Design

Data for this analysis were from a randomized controlled trial, collected at baseline and 4-months.

Setting

The intervention included monthly face-to-face group sessions and an Internet component that participants were recommended to use at least once weekly.

Participants

We included overweight or obese African American and non-Hispanic White women (n=170), with at least weekly Internet access, who were able to attend group sessions.

Intervention

Monthly face-to-face group sessions were delivered in large or small groups. The Internet component included automated tailored feedback, self-monitoring tools, written lessons, video resources, problem solving, exercise action planning tools, and social support through message boards.

Main Outcome Measure

Multiple linear regression was used to evaluate race group differences in weight change.

Results

Non-Hispanic White women lost more weight than African American women (-5.03% vs.-2.39%, P=.0002). Greater website log-ins and higher change in Eating Behavior Inventory score in non-Hispanic White women partially mediated the race-weight loss relationship.

Conclusions

The weight loss disparity may be addressed through improved website engagement and adoption of weight control behaviors.

Two-year follow-up study of a group-based diabetes medical nutrition therapy and motivational interviewing intervention among African American women

OBJECTIVES

To assess the 2-year efficacy of a combined medical nutrition therapy and motivational interviewing (MI) pilot study intervention and factors that influenced long-term dietary self-care.

RESEARCH DESIGN AND METHODS

Pilot study participants, African American women with type 2 diabetes, completed a 2-year follow-up study visit, including clinical assessments and completion of a dietary self-care questionnaire and a semi-structured interview. Wilcoxon signed-rank tests were used to evaluate differences between baseline and 2-year follow-up clinical and dietary self-care outcomes. Hierarchical coding was used to analyze semi-structured interviews and categorize facilitator and barrier themes into subthemes. Subthemes were quantified based on the number of subtheme-related comments.

RESULTS

Among the 12 participants (mean age 57.1±5.7 years), improvements were observed for HbA1c (baseline: 10.25%; interquartile range [IQR]: 8.10, 11.72 and follow-up: 8.8%; IQR: 7.48,10.22), systolic blood pressure (baseline: 142 mm Hg; IQR: 134.25, 157.25 and follow-up: 127 mm Hg; IQR: 113.5, 143.25), frequency of eating high-fat foods (baseline: 3.5 days; IQR: 2.75, 4.25 and follow-up: 3 days; IQR: 2.5, 4.5), and of spacing carbohydrates throughout the day (baseline: 3 days; IQR: 3.0, 4.0 and follow-up: 4 days; IQR: 1.5, 4.5). There was a statistically significant decrease (p=0.04) in the frequency of fruit and vegetable intake (baseline: 4 days; IQR: 3.75, 7.0 and follow-up: 3.5 days; IQR: 2.75, 4.0). Dietary self-care barriers and facilitators included internal (eg, motivation) and external factors (eg, social support). Motivation (70 comments) and lack of motivation (67 comments) were the most pervasive facilitator and barrier subthemes, respectively.

CONCLUSION

Overall, diabetes-related clinical and dietary self-care outcomes were improved following a combined medical nutritional therapy/MI intervention, and motivation played an important role in dietary self-care engagement. Future research is needed to assess the added benefit of MI in improving clinical and dietary self-care outcomes and to identify best strategies to support post-intervention dietary self-care engagement.

Preliminary efficacy of group medical nutrition therapy and motivational interviewing among obese African American women with type 2 diabetes: a pilot study

OBJECTIVE

To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). RESEARCH DESIGN & METHOD: African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention.

RESULTS

Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes.

CONCLUSION

The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.

Validation of an FFQ to assess dietary protein intake in type 2 diabetic subjects attending primary health-care services in Mali

OBJECTIVE

To validate a 53-item quantitative FFQ (QFFQ) for the assessment of dietary protein intake in type 2 diabetic outpatients in Bamako, Mali.

DESIGN

Consumption of protein-containing foods over the week preceding the interview was measured with a 7d QFFQ and compared with intakes measured with 48-h recalls.

SETTING

Centre National de Lutte contre le Diabète.

SUBJECTS

Seventeen male and forty female adults with type 2 diabetes.

RESULTS

Correlation between protein intakes estimated using the QFFQ and 48h recalls was 0.63 (P < 0.0001). There was no significant difference between the two methods concerning the total protein daily intakes and intakes per kilogram of body weight. The QFFQ indicated that foods of animal origin were a lesser source of protein. Animal protein intake did not differ between men and women but sources did. In men, the main sources were beef (54 % of total animal protein), fish (15 %) and milk powder (8 %). In women, the principal sources were fish (28 %), beef (20 %) and birds (13 %). In contrast, plant protein intake was significantly higher in men than in women (P = 0.01), but the same plant foods contributed in similar proportions for both genders, rice being by far the greatest source (47 % of plant protein in men, 53 % in women).

CONCLUSION

The QFFQ developed in this study is a valid tool to evaluate dietary protein intakes in Malian diabetic subjects. While the total protein intakes were low in both men and women, differences in choices and amounts of protein food sources were shown.

Underreporting of energy intake and associated factors in a Latino population at risk of developing type 2 diabetes

The objective of this study was to examine the extent of underreporting of total energy intake and associated factors in a low-income, low-literacy, predominantly Caribbean Latino community in Lawrence, MA. Two hundred fifteen Latinos participated in a diabetes prevention study, for which eligibility included a >or=30% risk of developing diabetes in 7.5 years. Dietary self-reported energy intake was assessed using three randomly selected days of 24-hour diet recalls. Basal metabolic rate (BMR) was estimated using the Mifflin-St Jeor equation. Underreporting was determined by computing a ratio of energy intake to BMR, with a ratio of 1.55 expected for sedentary populations. Linear regression analyses were used to identify factors associated with underreporting (energy intake:BMR ratio). The population was predominately women (77%), middle-aged (mean 52+/-11 years), obese (78% had a body mass index >or=30); low-literate (62% < high school education), unemployed (57% reported no job), married or living with partner (52%), and some had a family history of diabetes (37% had siblings with diabetes). Reported total daily energy intake was 1,540+/-599 kcal, whereas estimated BMR was 1,495.7+/-245.1 kcal/day. When multiplied by an activity factor (1.20 for sedentariness), expected energy intake was 1,794+/-294.0 per day, indicating underreporting by an average of 254 kcal/day. Mean energy intake:BMR was 1.03+/-0.37, and was lower for participants with higher body mass index, siblings with diabetes, sedentary lifestyle, and those who were unemployed. Energy intake underreporting is prevalent in this low-income, low-literacy Caribbean Latino population. Future studies are needed to develop dietary assessment measures that minimize underreporting in this population.