The importance of the cultural dimension of food in understanding the lack of adherence to diet regimens among Mayan people with diabetes

Views, perceptions, and experiences of type 2 diabetes or weight management programs among minoritized ethnic groups living in high-income countries: A systematic review of qualitative evidence

BACKGROUND

Prevalence of both obesity and type 2 diabetes can be higher in patients from certain ethnic groups, yet uptake and adherence to current support within these groups is lower, leading to widening health inequalities in high-income countries.

OBJECTIVES

The main objective of this study is to understand the views, perceptions, and experiences of and barriers and facilitators in relation to the uptake and adherence to weight management and type 2 diabetes programs in minoritized ethnic groups in high-income countries.

METHODS

CINAHL, MEDLINE, PsycINFO, Scopus, Academic Search Complete, and PubMed were searched for English language studies undertaken in community-dwelling adults residing in high-income countries, who are from a minoritized ethnic group within the country of study.

RESULTS

Seventeen studies were synthesized using the JBI System for the Unified Management of the Assessment and Review of Information. From these studies, 115 findings were retrieved, and seven key themes were identified: (1) family health status and program education, (2) social support, (3) challenges, (4) cultural beliefs, (5) increased awareness and dietary changes, (6) impact of psychological evaluations, and (7) considerations for future.

CONCLUSIONS

Nutritional considerations for type 2 diabetes mellitus and weight management programs in high-income countries should include social, habitual, economic, and conceptual components, which should include consideration of local ethnic and cultural norms and building community relationships while creating culturally tailored programs.

Impact on Glycemic Variation Caused by a Change in the Dietary Intake Sequence

This work presents an analysis of the effect on glycemic variation caused by modifying the macronutrient intake sequence in a person without a diagnosis of diabetes. In this work, three types of nutritional studies were developed: (1) glucose variation under conditions of daily intake (food mixture); (2) glucose variation under conditions of daily intake modifying the macronutrient intake sequence; (3) glucose variation after a modification in the diet and macronutrient intake sequence. The focus of this research is to obtain preliminary results on the effectiveness of a nutritional intervention based on the modification of the sequence of macronutrient intake in a healthy person during 14-day periods. The results obtained corroborate the positive effect on the glucose of consuming vegetables, fiber, or proteins before carbohydrates, decreasing the peaks in the postprandial glucose curves (vegetables: 113-117 mg/dL; proteins: 107-112 mg/dL; carbohydrates: 115-125 mg/dL) and reducing the average levels of blood glucose concentrations (vegetables: 87-95 mg/dL; proteins: 82-99 mg/dL; carbohydrates: 90-98 mg/dL). The present work demonstrates the preliminary potential of the sequence in the macronutrient intake for the generation of alternatives of prevention and solution of chronic degenerative diseases, improving the management of glucose in the organism and permeating in the reduction of weight and the state of health of the individuals.

A WHO key informant language survey of people with lived experiences of diabetes: Media misconceptions, values-based messaging, stigma, framings and communications considerations

AIMS

This study aimed to learn from people with lived experiences of diabetes to raise the quality of diabetes communications.

METHODS

An online key informant survey for people (18+) with a direct and/or adjacent (caregiver, friend, family-member etc.,) lived experience of diabetes. Through thematic analysis, we gathered insights on perceptions of media reporting on diabetes and communicating with accuracy, impact and without stigma. Descriptive analysis also investigated effective values for WHO to communicate diabetes with key audiences of policy-makers, funding partners and the general public.

RESULTS

918 respondents in 58 WHO Member States were analysed. Participants identified five key themes requiring more appropriate consideration in the media: accurately defining diabetes types, over-emphasis on sugar and lifestyle, negative impacts of diabetes stigma, burden of costs (financial, personal and interpersonal) and mental health. Irrespective of audience, key values-based messages identified as important for WHO to convey included: 'urgency', 'preventing suffering', 'improving wellbeing' and 'meaningful engagement' of people with lived experience.

CONCLUSION

Learning from people with lived experience of diabetes identifies key diabetes communication considerations. Continued meaningful engagement of this group, including in WHO's work and the multistakeholder diffusion of this methodology to local contexts, could improve public discourse on diabetes and related policies.

"Food Doesn't Have Power Over Me Anymore!" Self-Efficacy as a Driver for Dietary Adherence Among African American Adults Participating in Plant-Based and Meat-Reduced Dietary Interventions: A Qualitative Study

BACKGROUND

African American (AA) adults are disproportionately affected by cardiovascular disease risk factors. Many nutrition interventions aim to promote healthier eating to reduce cardiovascular disease incidences among participants. However, little is known about what influences individuals' nutrition self-efficacy while participating in these interventions.

OBJECTIVE

The objective of this study is to explore the drivers and barriers of nutrition self-efficacy among Nutritious Eating With Soul (NEW Soul) participants. The NEW Soul study was funded from the National Heart, Lung, and Blood Institute.

DESIGN

A purposive-current study sampling was used to conduct 4 audio-recorded focus groups for this qualitative study. Bandura's self-efficacy theory of behavior change guided the framework. This theory asserts that individual self-efficacy is influenced by 4 factors: (1) mastery experiences, (2) vicarious experiences, (3) social persuasion, and (4) somatic and emotional states.

PARTICIPANTS/SETTING

Inclusion criteria for the NEW Soul program included being an AA, being between 18 and 65 years old, and having a body mass index between 25 and 49.9. Participants in cohort 2 (n = 84) of the NEW Soul program were asked to participate in focus groups. In total, 28 individuals (16 vegan, 12 omnivorous participants) took part in 4 in-person focus groups, which contained 3 to 13 participants. Focus groups took place in the southeastern United States.

MAIN OUTCOME MEASURE

Perception of drivers and barriers of following the diet.

STATISTICAL ANALYSIS

Responses were analyzed qualitatively using principles of content analysis.

RESULTS

Nine themes influenced participants' confidence in their ability to follow their diet: food preference, planning and preparation, identity and tradition, mindfulness, representation, social support, social influence, accountability, and state of mind.

CONCLUSION

In this study, self-efficacy played a prominent role in participants' motivations toward following the diet. Mastery experiences, vicarious experiences, social persuasion, and positive psychological arousal were all common themes in participant-reported sources of motivation. Nutrition interventions are likely to elicit positive behavioral outcomes if these 4 factors that enhance self-efficacy are incorporated into program development.

Intuitive eating is associated with glycemic control in type 2 diabetes

PURPOSE

The intuitive eating approach has shown promise, but studies on its association with diabetics are scarce. The aim of this study is to identify the association between intuitive eating and glycemic control in individuals with type 2 diabetes mellitus.

METHODS

This is an observational cross-sectional analytical study in patients at the endocrinology service of a university hospital in Vitória/ES, Brazil. For data collection, a semi-structured questionnaire was used and intuitive eating was assessed by Intuitive Eating Scale-2.

RESULTS

A total of 179 individuals, mostly female and elderly, and predominantly taking oral antidiabetic drugs without association with insulin were evaluated. In adjusting for the total scale score, the most intuitive eating was associated with lower chances of patients presenting inadequate glycemic control by 89% (OR = 0.114; CI 0.024-0.540; p = 0.006), and a higher score on the Body-Food-Choice Congruence subscale was associated with lower chances of participants presenting this inadequacy by almost 66% (OR = 0.341; CI 0.131-0.891; p = 0.028), regardless of their body mass index.

CONCLUSION

Eating intuitively, especially in accordance with body needs may be associated with lower chances of type 2 diabetics having inadequate glycemic control.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Protein Intake and Frailty: A Matter of Quantity, Quality, and Timing

Frailty is a geriatric syndrome that refers to a state of reduced resiliency to stressful events that occurs in response to physiological and/or psychosocial detriments. Frailty is a predictor of poor prognosis, given that frail older adults are at higher risk of many adverse health-related events. Hence, the identification of potential strategies to prevent the development and progression of frailty is of extreme importance for avoiding its negative outcomes. An adequate protein consumption is advocated as a possible intervention for the management of frailty in older adults due to its effects on muscle mass and physical function. However, empirical evidence is still needed to support this proposition. On the other hand, substantial evidence from observational studies has provided important information on the association between frailty and dietary protein-related parameters. Here, we provide a narrative review of the current literature regarding the association between protein intake (amount (how much?), quality (what type?), and distribution across meals (when?)) and frailty-related parameters. The ultimate aim of this work is to offer practical, evidence-based indications to healthcare professionals responsible for the care of frail older adults.

State Regulations to Support Children's Cultural and Religious Food Preferences in Early Care and Education

Objective

In July 2018 the Academy of Nutrition and Dietetics released a benchmark encouraging early care and education (ECE) programs, including child care centers and family child care homes, to incorporate cultural and religious food preferences of children into meals. We examined the extent to which states were already doing so through their ECE licensing and administrative regulations prior to the release of the benchmark. This review may serve as a baseline to assess future updates, if more states incorporate the benchmark into their regulations.

Methods

For this cross-sectional study, we reviewed ECE regulations for all 50 states and the District of Columbia (hereafter states) through June 2018. We assessed consistency with the benchmark for centers and homes. We conducted Spearman correlations to estimate associations between the year the regulations were updated and consistency with the benchmark.

Results

Among centers, eight states fully met the benchmark, 11 partially met the benchmark, and 32 did not meet the benchmark. Similarly for homes, four states fully met the benchmark, 13 partially met the benchmark, and 34 did not meet the benchmark. Meeting the benchmark was not correlated with the year of last update for centers (P = 0.54) or homes (P = 0.31).

Conclusions

Most states lacked regulations consistent with the benchmark. Health professionals can help encourage ECE programs to consider cultural and religious food preferences of children in meal planning. And, if feasible, states may consider additional regulations supporting cultural and religious preferences of children in future updates to regulations.

Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review

BACKGROUND

Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders.

METHODS

We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies.

FINDINGS

We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to "social influences" (40 studies) and "social/professional role and identity" (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians' paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients' trust in the effectiveness of the medication and/or the doctor's advice, or preferences for alternative therapies.

CONCLUSIONS

Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.

Association between Dietary Habits and Physical Function in Brazilian and Italian Older Women

The present study investigated and compared the patterns of dietary protein intake and physical function in Brazilian and Italian older women. Seventy-five Brazilian older women were recruited in a community senior center. Fifty-three age-matched Italian older women were selected from participants of the Longevity check-up (Lookup) 7+ study. In both samples, physical performance was evaluated by isometric handgrip strength (IHG) and five-time sit-to-stand (5 × STS) tests, while diet was assessed through 24-h recall. Results indicated that Brazilian women had a higher intake of plant-based protein (52.7% vs. 30.5% kcal), while Italian women consumed greater amounts of animal-derived protein (29.7% vs. 41.5% kcal). In Brazilian women, the binary logistic regression analysis indicated that body weight-adjusted protein consumption was associated with IHG adjusted by body mass index and with 5 × STS performance. In the Italian sample, the intake of isoleucine, leucine, and valine was significantly associated with 5 × STS performance. Our findings indicate that Brazilian and Italian community-dwelling older women show different patterns of protein intake, with higher consumption of plant-based protein in the Brazilian sample and higher ingestion of animal-derived protein in the Italian subgroup. These dietary patterns may differentially impact the relationship between physical function and protein intake observed in Brazilian and Italian older women.