Dietary recommendations for people with diabetes: an update for the 1990s Nutrition Subcommittee of the British Diabetic Association's Professional Advisory Committee

The Role of Diet in Patients with Metabolic Syndrome

Metabolic syndrome is a frequent metabolic disorder characterized by obesity and insulin resistance seems to be the main pathophysiological alteration. The goal of treating metabolic syndrome is to reduce the risk of coronary heart disease and the development of type 2 diabetes. The lifestyle modification therapy combines specific recommendations on diet alone or combined with other strategies. In this review, we address the following topics: 1) the importance of the high prevalence of metabolic syndrome and obesity, and 2) the role of lifestyle modification focusing on dietary fat intake in the management of MS.

Patient education and quality assurance in nursing

Changes in healthcare provision introduced in the early 1990s raised awareness of the issue of quality in health care. Quality, currently a fashionable topic, is an abstract concept and attempts to define and measure its properties have proved controversial and challenging. An equally challenging aspect of nursing care is the satisfactory delivery of health education to patients. This paper focuses on patient education and quality assurance in nursing. The results of a study concerning 20 young adults with insulin-dependent diabetes mellitus (IDDM) are reported. The findings indicate deficiencies in their experiences of patient education at initial diagnosis, discharge home after first hospital admission and when needing further information. It is contended that patient education is an area which requires qualitative as well as quantitative measurements of quality in order to capture the unique experience of information needs.

Arabinoxylan fibre improves metabolic control in people with Type II diabetes

OBJECTIVE

To determine whether diet supplementation with arabinoxylan-rich (AX)-fibre from wheat improves glycaemic control in Type II diabetes.

DESIGN

Randomized, crossover intervention trial.

SETTING

Monash Medical Centre.

SUBJECTS

A total of 15 subjects with Type II diabetes.

INTERVENTIONS

Over two 5-week periods, subjects supplemented their usual diet with control bread and muffins (50% whole wheat, 50% white flour) (control diet) or with AX-bread and muffins (50% whole wheat, 36% white flour, 14% AX fibre) (AX diet). Subjects completed a 7-day food diary. At 0 and 5 weeks, venous blood was collected for determination of fasting and 2 h glucose, insulin, fructosamine and blood lipids. Blood pressure, body weight and body fat were also determined. A 24 h faecal sample, from 12 subjects, was weighed and analysed for faecal polysaccharide as a marker for dietary compliance.

RESULTS

Control and AX diets were similar except the AX diet supplied an additional 15.1 (12.0-18.5) (mean (95% confidence intervals)) g/day dietary fibre (P=0.000). Consumption of the AX diet increased faecal output by 61.5 (0.2-122.8) g/day (P=0.05) on a wet weight basis and significantly lowered fasting and 2 h plasma glucose, 2 h insulin and serum fructosamine (P=0.002, 0.000, 0.015, and 0.02, respectively). Blood lipids, body weight, fat mass and blood pressure remained unchanged.

CONCLUSION

A supplement of 15 g/day of AX-rich fibre can significantly improve glycaemic control in people with Type II diabetes.

Effect of high levels of intense sweetener intake in insulin dependent diabetics on the ratio of dietary sugar to fat: a case–control study

OBJECTIVE

To examine the influence of intense sweetener consumption on nutrient intakes in insulin dependent diabetics compared to controls.

DESIGN

Case-control food consumption survey.

SETTING

Dietary data were collected from individuals in Ireland between 1998 and 1999.

SUBJECTS

Diabetics were recruited through diabetic outpatient departments of St. James's Hospital Dublin. Controls were friends of the patients or staff/students of Trinity College and University College Dublin. Of the 171 diabetics contacted, 122 agreed to participate (70% response rate) and 119 completed the study.

INTERVENTIONS

In all, 3-day food diaries were used to collect the food consumption data.

MAIN OUTCOME MEASURES

Fat--sugar seesaw, intense sweetness.

RESULTS

Patients had significantly higher % energy from starch, lower % energy from sugars and a high intake of fibre compared to controls. In both groups, there was an inverse relationship between % energy from fat and % en from sugar, with the diabetics at the lower level of sugar intake. A score of intense sweetness intakes was computed and across tertiles of this score, there were no significant effects on macronutrient intakes.

CONCLUSION

The fat-sugar seesaw present in the diabetic group was at a lower level compared to the control group. A high intake of intense sweeteners does not have a detrimental effect on macronutrient and micronutrient intakes.

Nutrition and lung health

There is an increasing interest in the relationship between nutrition and lung health. Epidemiological studies suggest that dietary habits may have an influence on lung function and the tendency to common lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. In particular, a diet rich in fresh fruit and fish has been associated with a salutary effect on lung health. End-stage COPD is associated with a state of nutritional depletion which is refractory to conventional nutritional supplementation. In contrast, malnutrition associated with cystic fibrosis is amenable to nutritional therapy, which has been shown to improve prognosis in this disease.

The Plate Model: a visual method of teaching meal planning. DAIS Project Group. Diabetes Atherosclerosis Intervention Study

Dietitians from Canada, Finland, France, and Sweden have explored methods of teaching meal planning to persons with diabetes and dyslipidemia in the Diabetes Atherosclerosis Intervention Study. The Plate Model, a method commonly used in Europe, is a simple alternative to the traditional exchange-based method for teaching meal planning. In this visual method, a dinner plate serves as a pie chart to show proportions of the plate that should be covered by various food groups. Portions of foods and appropriate food choices can be depicted for meals and snacks in assorted forms of the model. Methods of presenting the model range from professional photography to hand-drawn sketches and displays of food replicas. Benefits of the model for adult learners include enhancement of the connection between dietary theory and practice, promotion of memory retention and understanding through visual messages, and experience of a positive approach to nutrition counseling. Various cuisines and festive foods can be incorporated into the model. The Plate Model offers a meal planning approach that is simple and versatile. The effectiveness of the model and its applications to other populations need to be evaluated.

The Fasting Hyperglycaemia Study: II. Randomized controlled trial of reinforced healthy-living advice in subjects with increased but not diabetic fasting plasma glucose

Self-referred subjects (N = 227) thought to be at risk of developing non-insulin-dependent diabetes mellitus (NIDDM) and with fasting plasma glucose (FPG) in the range of 5.5 to 7.7 mmol.L-1 on two consecutive tests 2 weeks apart were randomized to reinforced or basic healthy-living advice. They were simultaneously allocated either to a sulfonylurea group or a control group in a two-by-two factorial design. A total of 201 subjects in three English and two French centers completed 1 year's follow-up study. Reinforced advice recommending dietary modification and increased exercise was given every 3 months, and basic advice was given once at the initial visit. Glycemia was monitored by FPG, dietary compliance by body weight and food diaries, and fitness compliance by bicycle ergometer assessment and exercise diaries. Both reinforced and basic advice groups had a significant mean reduction in body weight (1.5 kg) at 3 months, although the weight subsequently returned to baseline. After 1 year, subjects allocated to reinforced advice versus basic advice (1) reported a lower fat intake (34.1% v 35.8%, P = .04) with no difference in lipid profiles, (2) had improved fitness as shown by increased calculated maximal oxygen uptake ([Vo2max] 2.39 v 2.18 L.min-1, P = .007) with no change in insulin sensitivity, (3) showed no change in FPG, glucose tolerance, or hemoglobin A1c (HbA1c), and (4) showed a greater tendency to withdraw from the study (16% v 7%, P = .03). In conclusion, reinforced healthy-living advice given to self-referred subjects with increased FPG did not encourage sufficiently pronounced life-style changes for significantly greater effects on body weight and glycemia in a 1-year study than basic healthy-living advice.

Dietary advice in the management of diabetes mellitus--history and current practice

Diet has been recognised for over three thousand years as being vital to the overall management of diabetes mellitus (DM). Today dietary advice for the person with diabetes continues to play just as an important role, not just as regards the day to day control but also in respect of the prevention of complications. The history of dietary advice for diabetes is examined as well as current dietary advice.

Glycaemic responses in type 2 diabetic patients to various mixed meals taken at home

Eight Type 2 diabetic patients ate and prepared five different meals at home, taking each meal on two separate occasions. They measured their blood glucose just before eating and 30, 60, 120, and 180 min after the meal. The meals varied in energy and dietary fibre content and in the ratio (by energy) of carbohydrate to fat. Total energy content of the meals had little effect on the postprandial glycaemic responses nor were the responses reduced by meals with high dietary fibre content. The ratio of carbohydrate to fat did not significantly affect postprandial glycaemic responses when meals were low in fibre. However, postprandial glycaemic responses were significantly greater in the meal with a high ratio of carbohydrate to fat, high in fibre and low in energy compared with those after the equicaloric meal low in carbohydrate to fat ratio and low in fibre (area under the curve 683 +/- 131 vs 306 +/- 55 mmol l-1 min-1, p < 0.05). Fat intake of 35% of energy may be compatible with improved postprandial blood glucose concentrations. Many meal combinations need to be studied in order to provide reliable information for diabetic patients. The method outlined proved producible (within patient coefficient of variation 13%), easy to perform and inexpensive.

The degree of day-to-day variation in food intake in diabetic patients

A prospective study of food intake using 7 day food diaries was undertaken in 92 diabetic men and women aged 17-81 years. The median individual day-to-day coefficients of variation for energy intake were: in insulin treated patients 12.0%, in non-insulin treated patients 13.7%; for carbohydrate intake 14.5% and 13.8% and for fat 20.7% and 20.8%, respectively. The median individual differences between the minimum and maximum daily intake of energy in insulin treated patients was 787 kcal, in non-insulin treated patients 649 kcal, for carbohydrate intake 89g and 77g and fat 50g and 43g, respectively. Only 39% patients ate within 20% of their prescribed carbohydrate diet. In non-insulin treated patients on prescribed calorie controlled diets, calorie consumption was on average 46% in excess of that prescribed. Although the variation in dietary intake in diabetic patients is large, it is smaller than that reported in non-diabetic subjects in the UK. This variation is likely to make the manipulation of other antidiabetic therapy both difficult and somewhat arbitrary.