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Goon S, Chapman-Novakofski K. Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:905-913. [PMID: 37943229 DOI: 10.1016/j.jneb.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/31/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.
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Affiliation(s)
- Shatabdi Goon
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
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Wan CS, Rawat P, Gulyani P, Elmi Y, Ng AH. Dietary management of type 2 diabetes mellitus among South Asian immigrants: A mixed-methods study. Nutr Diet 2023; 80:413-424. [PMID: 37271927 DOI: 10.1111/1747-0080.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
AIMS There is a high prevalence of South Asian immigrants in Australia living with type 2 diabetes mellitus, with the dietary management of the condition presenting as a key challenge. However, their current dietary patterns and barriers to diabetes self-management are unclear. Therefore, this study aims to (i) investigate current dietary patterns and (ii) explore barriers and facilitators to dietary management in this population. METHODS A concurrent mixed-methods study comprising three 24-h dietary recalls and a semi-structured interview for each self-identified South Asian immigrant adult with diabetes recruited across Victorian primary care clinics and social media to address the aforementioned two aims. Dietary recall data were converted into food groups using Foodworks, and data analysed in SPSS. Qualitative data were thematically analysed using NVivo. RESULTS Among 18 participants recruited, 14, 16 and 17 participants had grain, fruit and dairy intake lower than daily Australian recommendations, respectively. These findings echoed qualitative data that participants viewed diabetes management as reducing carbohydrate intake. Participants reported difficulties incorporating diabetes-related dietary and lifestyle recommendations into their routine and a lack of knowledge about available organisational support. They mentioned challenges in receiving social support from families and friends and relied on support from health professionals. Facilitators included proficiency in nutrition information label reading and self-blood glucose monitoring skills. CONCLUSION Enhancing the accessibility to organisational support, facilitating the adaption of dietary recommendations into individuals' routines, and strengthening support from health professionals are essential components in intervention development to improve diabetes management for South Asians.
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Affiliation(s)
- Ching Shan Wan
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Victoria, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | | | - Purva Gulyani
- Diet Yumm, Craigieburn, Victoria, Australia
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Yusra Elmi
- Diet Yumm, Craigieburn, Victoria, Australia
| | - Ashley H Ng
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Melbourne, Victoria, Australia
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Farzaei M, Shahbazi S, Gilani N, Ostadrahimi A, Gholizadeh L. Nurses' knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus. BMC MEDICAL EDUCATION 2023; 23:192. [PMID: 36978041 PMCID: PMC10053032 DOI: 10.1186/s12909-023-04178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes. METHODS This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis. RESULTS The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008). CONCLUSION Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.
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Affiliation(s)
- Mahsa Farzaei
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, P.O. Box 51745347, Tabriz, Iran
| | - Shahla Shahbazi
- Department of Medical- Surgical Nursing, Faculty of Nursing and Midwifery& Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, P.O. Box 51745347, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Postal code: 166614711 Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Postal code: 5166614711 Iran
| | - Leila Gholizadeh
- Faculty of Health, University of Technology, PO Box 123, Broadway, Sydney, NSW 2007 Australia
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de Sequeira S, Halperin I, Lipscombe LL. Culturally Tailored Resources for South Asian Immigrant Women With Gestational Diabetes: Do They Work and What's Missing? A Qualitative Study. Can J Diabetes 2019; 43:573-579. [PMID: 31787243 DOI: 10.1016/j.jcjd.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) increases the risk of pregnancy complications. South Asian immigrant women have among the highest rates of GDM in Canada and they also have the highest lifelong risk of developing type 2 diabetes after a GDM pregnancy. Diabetes Canada has been developing diabetes education material that accounts for the cultural preferences of South Asians. However, there is uncertainty to whether South Asian immigrants are aware of these resources or trust them, or if other factors influence their uptake of advice. METHODS In this study, we conducted qualitative interviews to explore, among South Asian immigrant women with GDM: 1) their awareness of diabetes education resources, 2) their attitudes toward information from different resources and varying health-care providers and 3) their barriers and facilitators for GDM management recommendations. Gender theory is embedded in this study, as culturally specific gender roles regarding motherhood have been shown to be important to South Asian immigrant women and their perceptions of health. RESULTS There was an emergence of 3 main themes. First, awareness of culturally tailored educational resources is low. Second, there is an overabundance of GDM management information, which leads to variability among participants of how they rank accuracy of informational sources. Finally, there is a gender role reversal present, where women are being taken care of by their families instead of being the providers of care. CONCLUSIONS These results indicate that better dissemination strategies for GDM educational material are needed for health-care providers and patients, and may require additional consideration of family involvement during GDM education sessions.
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Affiliation(s)
- Stephanie de Sequeira
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Ilana Halperin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Plasencia J, Hoerr S, Carolan M, Weatherspoon L. Acculturation and Self-Management Perceptions Among Mexican American Adults With Type 2 Diabetes. FAMILY & COMMUNITY HEALTH 2017; 40:121-131. [PMID: 28207675 DOI: 10.1097/fch.0000000000000139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Because type 2 diabetes (T2DM) is disproportionately high among Mexican Americans in the United States, this study examined how acculturation influences T2DM self-management, a critical component for disease outcome. Qualitative interviews of 24 low-income Mexican American patients with T2DM were matched to their biomedical and dietary data and degree of acculturation. Greater acculturation to the United States was associated with less favorable diabetes control, fiber density, leisure-time physical activity, and more physical disability. Health care professionals can improve their cultural competence by learning culturally appropriate foods and fostering a warm, caring manner with Mexican Americans to enhance their sense of well-being and compliance with T2DM recommendations.
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Affiliation(s)
- Julie Plasencia
- Department of Food Science and Human Nutrition (Ms Plasencia, and Drs Hoerr, and Weatherspoon) and Human Development and Family Studies (Dr Carolan), Michigan State University, East Lansing
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Hempler NF, Nicic S, Ewers B, Willaing I. Dietary education must fit into everyday life: a qualitative study of people with a Pakistani background and type 2 diabetes. Patient Prefer Adherence 2015; 9:347-54. [PMID: 25750523 PMCID: PMC4348137 DOI: 10.2147/ppa.s77380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The high prevalence of diabetes among South Asian populations in European countries partially derives from unhealthy changes in dietary patterns. Limited studies address perspectives of South Asian populations with respect to utility of diabetes education in everyday life. This study explores perspectives on dietary diabetes education and healthy food choices of people living in Denmark who have a Pakistani background and type 2 diabetes. METHODS In-depth interviews were conducted between October 2012 and December 2013 with 12 participants with type 2 diabetes who had received dietary diabetes education. Data analysis was systematic and was based on grounded theory principles. RESULTS Participants described the process of integrating and utilizing dietary education in everyday life as challenging. Perceived barriers of the integration and utilization included a lack of a connection between the content of the education and life conditions, a lack of support from their social networks for dietary change, difficulty integrating the education into everyday life, and failure to include the participants' taste preferences in the educational setting. CONCLUSION Dietary education that is sensitive to the attitudes, wishes, and preferences of the participants and that aims at establishing a connection to the everyday life of the participants might facilitate successful changes in dietary practices among people with a Pakistani background and type 2 diabetes. The findings suggest that more focus should be placed on collaborative processes in the dietary educational setting in order to achieve appropriate education and to improve communication between this population and health care professionals.
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Affiliation(s)
- Nana F Hempler
- Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark
- Correspondence: Nana F Hempler, Health Promotion Research, Steno Diabetes Center, Niels Steensens Vej 8, 2820 Gentofte, Denmark, Tel +45 4073 2591, Fax +45 4443 8235, Email
| | - Sara Nicic
- Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark
| | - Bettina Ewers
- Nutrition and Food Services Department, Steno Diabetes Center, Gentofte, Denmark
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center, Gentofte, Denmark
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Hempler NF, Ewers B. Development of culturally sensitive dialog tools in diabetes education. Indian J Endocrinol Metab 2015; 19:178-181. [PMID: 25593850 PMCID: PMC4287768 DOI: 10.4103/2230-8210.146880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Person-centeredness is a goal in diabetes education, and cultural influences are important to consider in this regard. This report describes the use of a design-based research approach to develop culturally sensitive dialog tools to support person-centered dietary education targeting Pakistani immigrants in Denmark with type 2 diabetes. The approach appears to be a promising method to develop dialog tools for patient education that are culturally sensitive, thereby increasing their acceptability among ethnic minority groups. The process also emphasizes the importance of adequate training and competencies in the application of dialog tools and of alignment between researchers and health care professionals with regards to the educational philosophy underlying their use.
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Affiliation(s)
| | - Bettina Ewers
- Department of Nutrition and Food Services, Steno Diabetes Center, Gentofte, Denmark
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Van Son CR. Developing Culturally Targeted Diabetes Educational Materials for Older Russian-Speaking Immigrants. DIABETES EDUCATOR 2014; 40:418-426. [PMID: 24667951 DOI: 10.1177/0145721714528247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Older adults who immigrate late in life face many challenges adapting to a new country. Immigrants bring their cultural beliefs and behaviors with them, which can influence their ability to make dietary changes required when they have type 2 diabetes. Culturally targeted patient education materials are needed to improve immigrants' health literacy and abilities to self-manage diabetes. Currently, there is a scarcity of diabetes patient education materials to meet the educational needs of the Russian-speaking immigrant group. The purpose of this article is to describe a project in which culturally targeted diabetes education materials for older Russian-speaking immigrants were designed and developed. CONCLUSIONS Culturally targeted patient education materials are essential if they are to be accepted and used by clients from different ethnic minority populations. The creation of culturally relevant materials requires a team effort and community stakeholder input. The availability of materials on the internet facilitates access and use by health care providers. Culturally targeted education materials are an important component in addressing health literacy in ethnic minority populations. Next steps require that these materials be evaluated to test their impact on diabetes self-management behaviors and clinical outcomes such as adherence, amount of physical activity, and blood glucose levels.
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Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37 Suppl 1:S120-43. [PMID: 24357208 DOI: 10.2337/dc14-s120] [Citation(s) in RCA: 421] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Gougeon R, Sievenpiper JL, Jenkins D, Yale JF, Bell R, Després JP, Ransom TPP, Camelon K, Dupre J, Kendall C, Hegazi RA, Marchetti A, Hamdy O, Mechanick JI. The transcultural diabetes nutrition algorithm: a canadian perspective. Int J Endocrinol 2014; 2014:151068. [PMID: 24550982 PMCID: PMC3914410 DOI: 10.1155/2014/151068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/08/2013] [Indexed: 01/02/2023] Open
Abstract
The Transcultural Diabetes Nutrition Algorithm (tDNA) is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG) recommendations is essential to address varied patient populations within and among diverse regions worldwide. The Canadian version of tDNA supports and targets behavioural changes to improve nutritional quality and to promote regular daily physical activity consistent with Canadian Diabetes Association CPG, as well as channelling the concomitant management of obesity, hypertension, dyslipidemia, and dysglycaemia in primary care. Assessing glycaemic index (GI) (the ranking of foods by effects on postprandial blood glucose levels) and glycaemic load (GL) (the product of mean GI and the total carbohydrate content of a meal) will be a central part of the Canadian tDNA and complement nutrition therapy by facilitating glycaemic control using specific food selections. This component can also enhance other metabolic interventions, such as reducing the need for antihyperglycaemic medication and improving the effectiveness of weight loss programs. This tDNA strategy will be adapted to the cultural specificities of the Canadian population and incorporated into the tDNA validation methodology.
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Affiliation(s)
- Réjeanne Gougeon
- Crabtree Nutrition Laboratories, McGill University Health Centre/Royal Victoria Hospital, Montreal, QC, Canada H3H 1A1
- Crabtree Nutrition Laboratories, McGill University Health Centre/Royal Victoria Hospital H6.90, 687 Pine Avenue West, Montreal, QC, Canada H3A 1A1
- *Réjeanne Gougeon:
| | - John L. Sievenpiper
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada L8N 3Z5
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada M5C 2T2
| | - David Jenkins
- Department of Nutritional Sciences and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3E2
- Clinical Nutrition and Risk Factor Modification Center, Division of Endocrinology and Metabolism, and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada M5C 2T2
| | - Jean-François Yale
- McGill University Health Centre/Royal Victoria Hospital, Montreal, QC, Canada H3A 1A1
| | - Rhonda Bell
- Division of Human Nutrition, Division of Agriculture, Food and Nutritional Science, and the Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada T6G 2E1
| | - Jean-Pierre Després
- Centre de Recherche de L'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada G1V 4G5
| | - Thomas P. P. Ransom
- Division of Endocrinology and Metabolism, Capital Health, Halifax, NS, Canada B3H 2Y9
- Dalhousie University, Canada
| | - Kathryn Camelon
- Department of Allied Health, Clinical Nutrition, University Health Network, Toronto, ON, Canada M5G 2C4
| | - John Dupre
- Robarts Research, University of Western Ontario, London, ON, Canada N6A 5B7
| | - Cyril Kendall
- Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada M5S 3E2
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Albert Marchetti
- Medical Education and Research Alliance (Med-ERA), New York, NY 10019, USA
- Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA
| | - Osama Hamdy
- Joslin Diabetes Center, Harvard University, Boston, MA 02215, USA
| | - Jeffrey I. Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013; 36:3821-42. [PMID: 24107659 PMCID: PMC3816916 DOI: 10.2337/dc13-2042] [Citation(s) in RCA: 356] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is no standard meal plan or eating pattern that works universally for all people with diabetes. In order to be effective, nutrition therapy should be individualized for each patient/client based on his or her individual health goals; personal and cultural preferences; health literacy and numeracy; access to healthful choices; and readiness, willingness, and ability to change. Nutrition interventions should emphasize a variety of minimally processed nutrient dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term.
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Abstract
Larger portion sizes (PS) may be inciting over-eating and contributing to obesity rates. Currently, there is a paucity of data on the effectiveness of serving size (SS) guidance. The aims of the present review are to evaluate SS guidance; the understanding, usability and acceptability of such guidance, its impact on consumers and potential barriers to its uptake. A sample of worldwide SS guidance schemes (n 87) were identified using targeted and untargeted searches, overall these were found to communicate various inconsistent and often conflicting messages about PS selection. The available data suggest that consumers have difficulty in understanding terms such as 'portion size' and 'serving size', as these tend to be used interchangeably. In addition, discrepancies between recommended SS and those present on food labels add to the confusion. Consumers generally understand and visualise SS best when expressed in terms of household measures rather than actual weights. Only a limited number of studies have examined the direct impact of SS guidance on consumer behaviour with equivocal results. Although consumers recognise that guidance on selecting SS would be helpful, they are often unwilling to act on such guidance. The challenge of achieving consumer adherence to SS guidance is formidable due to several barriers including chronic exposure to larger PS, distorted consumption norms and perceptions, the habit of 'cleaning one's plate' and language barriers for ethnic minorities. In conclusion, the impact of SS guidance on consumers merits further investigation to ensure that future guidance resonates with consumers by being more understandable, usable and acceptable.
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