What helps and what hinders primary care treatment for women with type 2 diabetes and binge eating disorder? A qualitative study

AIM

Although binge-eating disorder (BED) is a common comorbidity of type 2 diabetes, little is known about the treatment experiences for persons with both conditions. Our aim was to explore perceptions of Primary Care Providers' (PCPs') treatment among adult women with both diagnoses.

METHODS

In this qualitative descriptive study, we conducted semi-structured interviews with a sample of 21 women (90% non-Hispanic white; mean age 49 ± 14.8 years, mean body mass index [BMI] 43.8 ± 8.4; 48% had type 2 diabetes, mean HbA_1c 68 mmol/mol, 8.4%) who had previously participated in a secondary care specialized eating disorder treatment programme. Interviews were audio-recorded, transcribed and analysed using thematic analysis and NVivo 12.

RESULTS

Participants described PCPs' helpful and unhelpful attitudes and behaviours during type 2 diabetes and BED treatment experiences. Helpful treatment was experienced when PCPs demonstrated a person-centred approach by providing adequate diabetes education, individualized care and non-judgmental attitudes from which participants reported increased understanding of diabetes and BED, improved diabetes self-care and fewer negative self-perceptions. Unhelpful treatment occurred when PCPs did not provide sufficient diabetes education and manifested deficient understanding of BED characterized by simplistic advice or judgmental attitudes, from which participants reported having limited knowledge and understanding of diabetes and BED, low self-efficacy, diminished trust and feelings of guilt, shame and failure.

CONCLUSIONS

We propose a preliminary pathways treatment model derived from our findings, which utilizes integrated type 2 diabetes and BED education and person-centred collaboration. This preliminary model needs to be tested in quantitative research with a larger sample.

A qualitative analysis of factors related to eating disorder onset in female collegiate athletes and non-athletes

Female athletes are at risk for clinical eating disorders, yet their onset experiences have rarely been studied with qualitative methods. This study, which included interviews with 12 collegiate female athletes and 17 non-athletes, identified factors that contributed to eating disorder onset for both subgroups. Inductive content analysis revealed that low self-worth, peer issues, and comorbid psychological disorders were common in both groups. However, athletes reported sport-specific factors including performance pressure, team weigh-ins, and injuries, whereas family dysfunction, bullying, and puberty were more commonly reported triggers for non-athletes. Findings support prevention and treatment programs customized for unique vulnerabilities for each subgroup.

Trends in dietary carbohydrate consumption from 1991 to 2008 in the Framingham Heart Study Offspring Cohort

The intake of carbohydrates has been evaluated cross-sectionally, but not longitudinally in an ageing American adult population. The aim of the present study was to examine trends in the intake of dietary carbohydrates and their major food sources among the Framingham Heart Study Offspring (FOS) cohort, which had been uniquely tracked for 17 years in the study. The FOS cohort was recruited in 1971-1975. Follow-up examinations were conducted, on average, every 4 years. Dietary data collection began in 1991 (examination 5) using a validated semi-quantitative FFQ. The study included 2894 adults aged ≥ 25 years with complete dietary data in at least three examinations from 1991 to 2008. Descriptive statistics were generated using SAS version 9.3, and a repeated-measures model was used to examine trends in the intake of carbohydrates and their food sources in the whole sample, and by sex and BMI category. Over 17 years of follow-up, the percentage of energy from total carbohydrates (51·0-46·8 %; P for trend < 0·001) and total sugars (18·2-16·6 %; P for trend < 0·001) decreased. There was a decrease in the percentage of energy from fructose (5·4-4·7 %; P for trend < 0·001) and sucrose (9·8-8·8 %; P for trend < 0·001). Dietary fibre intake increased (18·0-19·2 g/d; P for trend < 0·001). The number of weekly servings of yeast bread, soft drinks/soda, cakes/cookies/quick breads/doughnuts, potatoes, milk, pasta, rice and cooked grains, fruit juice/drinks, potato chips/maize chips/popcorn, and lunch foods (e.g. pizzas and burgers) decreased significantly (P for trend < 0·001), while the intake of ready-to-eat cereals, legumes, fruits, dairy products, candy and ice cream/sherbet/frozen yogurt increased significantly (P for trend<0·04). Similar trends were observed when the analyses were stratified by sex and BMI. The present results suggest favourable trends in dietary carbohydrate consumption, but dietary guidelines for fruits, vegetables and fibre were not met in this cohort.

Trends in dietary fat and high-fat food intakes from 1991 to 2008 in the Framingham Heart Study participants

Few longitudinal studies carried out in US adults have evaluated long-term dietary fat intakes and compared them with the national recommendations during the two-decade period when the prevalence of obesity and insulin resistance increased substantively. In the present study, we examined trends in the intakes of dietary fats and rich dietary sources of fats in the Framingham Heart Study Offspring Cohort over a 17-year period. The cohort was established in 1971-75 with follow-up examinations being conducted approximately every 4 years. Dietary data were collected using a semi-quantitative FFQ beginning in 1991 (exam 5). We included 2732 adults aged ≥ 25 years with complete dietary data in at least three examinations from 1991 to 2008. Descriptive statistics were generated using SAS version 9.3, and a repeated-measures model was used to examine trends in macronutrient and food intakes using R. Over the 17 years of follow-up, the percentage of energy derived from total fat and protein increased (27·3-29·8% of energy and 16·8-18·0% of energy, respectively) and that derived from carbohydrate decreased (51·0-46·8% of energy; P-trend < 0·001). Increases in the percentage of energy derived from all fat subtypes were observed, except for that derived from trans-fats, which decreased over time (P-trend < 0·001). Trends were similar between the sexes, although women exhibited a greater increase in the percentage of energy derived from saturated fat and less reduction in the percentage of energy derived from trans-fats (P interaction < 0·05). Trends in fat intake were similar across the BMI categories. The number of weekly servings of cheese, eggs, ice cream desserts, nuts, butter and sausages/processed meats increased, whereas the intake of milk, margarine, poultry, confectioneries, chips and breads decreased (P-trend < 0·001). In this cohort of predominantly Caucasian older adults, the percentage of energy derived from dietary fats increased over time, but it remained within the national recommendations of less than 35 % of total energy, on average.

Dietary Patterns and the Metabolic Syndrome in Obese and Non-obese Framingham Women**

OBJECTIVES

To examine the relationship between habitual dietary patterns and the metabolic syndrome (MetS) in women and to identify foci for preventive nutrition interventions.

RESEARCH METHODS AND PROCEDURES

Dietary patterns, nutrient intake, cardiovascular disease (CVD), and MetS risk factors were characterized in 1615 Framingham Offspring-Spouse Study (FOS) women. Dietary pattern subgroups were compared for MetS prevalence and CVD risk factor status using logistic regression and analysis of covariance. Analyses were performed overall in women and stratified on obesity status; multivariate models controlled for age, apolipoprotein E (APOE) genotypes, and CVD risk factors.

RESULTS

Food and nutrient profiles and overall nutritional risk of five non-overlapping habitual dietary patterns of women were identified including Heart Healthier, Lighter Eating, Wine and Moderate Eating, Higher Fat, and Empty Calories. Rates of hypertension and low high-density lipoprotein levels were high in non-obese women, but individual MetS risk factor levels were substantially increased in obese women. Overall MetS risk varied by dietary pattern and obesity status, independently of APOE and CVD risk factors. Compared with obese or non-obese women and women overall with other dietary patterns, MetS was highest in those with the Empty Calorie pattern (contrast p value: p<0.05).

DISCUSSION

This research shows the independent relationship between habitual dietary patterns and MetS risk in FOS women and the influence of obesity status. High overall MetS risk and the varying prevalence of individual MetS risk factors in female subgroups emphasize the importance of preventive nutrition interventions and suggest potential benefits of targeted behavior change in both obese and non-obese women by dietary pattern.

Health status and practices of urban Caribbean Latinos with diabetes mellitus

Although Caribbean Latinos are more likely than non-Hispanic whites to develop diabetes, their health status has been poorly characterized. Information on diabetes management, metabolic control, dietary habits, and diabetes knowledge was gathered from a group of urban Caribbean Latinos with diabetes in order to characterize the nutritional behaviors, diabetes attitudes, health perceptions, and metabolic control of this high risk group. Interviews and medical record reviews were conducted among seventy low-income urban Caribbean Latinos with type 2 diabetes mellitus. Patients attending outpatient clinics were interviewed by bilingual interviewers. Medical records were reviewed to ascertain prevalence of diabetes-related complications, medications, and metabolic parameters. Participants were primarily Spanish-speaking and of Puerto Rican origin. Eighty-one percent were unemployed, and only 27% had completed high school or higher educational levels. Average hemoglobin A1c was 10.6%. Among those with hypertension and hyperlipidemia, many were not receiving treatment. Participants' estimation of their own degree of metabolic control was poor, as was their understanding of desirable blood glucose and weight goals. A second evening meal was common. Diets were higher in fat and sugar content than currently recommended. More effective treatment strategies for both patients and providers are needed to improve glycemic control and cardiovascular risk factors among indigent urban Caribbean Latinos. Essential features of such strategies for patient programs include culturally appropriate dietary counseling and low literacy materials to better communicate glycemic and weight goals and dietary guidelines. Provider education is needed regarding established guidelines and cultural influences on diabetes-related practices.

Nutrition and the global risk for chronic diseases: the INTERHEALTH nutrition initiative. The INTERHEALTH Steering Committee

As chronic, noncommunicable diseases (NCDs) have emerged as leading causes of morbidity and mortality worldwide, the World Health Organization's INTERHEALTH Programme, an international collaboration currently involving 15 countries, has focused its attention on population-based NCD prevention. Participating nations include Australia, Chile, China, Cuba, Cyprus, Finland, Japan, Lithuania, Malta, Mauritius, Russia, Sri Lanka, Tanzania, Thailand, and the United States. This paper will review and assess global trends in food and nutrient intake among INTERHEALTH countries between 1954 and 1986.

High fiber diets slow bone turnover in young men but have no effect on efficiency of intestinal calcium absorption

Dietary fiber reduces the absorption of dietary calcium from a meal, but its impact on calcium kinetics is unknown. We therefore evaluated the effects of a high fiber diet on calcium balance and kinetics and on calcium-regulating hormones. Seven young men each participated in two 23-d experiments. In the low fiber period the controlled diet provided 6.5 g fiber/d and 530 mg calcium/d. In the high fiber period fiber was increased to 31.3 g/d and calcium to 586 mg/d by substituting high fiber cereal. Measured between d 7 and 12 of each period, the high fiber diet significantly lowered the apparent absorption of calcium (from 60.6 +/- 23.8% to 37.1 +/- 26.5%) and reduced calcium balance, although balance remained positive overall. Fiber had no effect on serum total or ultrafiltrable calcium, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D or parathyroid hormone concentrations measured on d 1, 7, 12 and 20. Calcium kinetics was studied between d 17 and 23 by administering oral 44Ca and intravenous 42Ca to fasting subjects. Fractional absorption of calcium in the fasting state was unaffected by fiber. However, during the high fiber period, subjects had significantly lower bone accretion, resorption and turnover rates, and calcium flow to bone from the exchangeable pool than during the low fiber period. We conclude that the fiber-induced reduction in calcium absorption slowed down bone calcium turnover but did not increase the efficiency of intestinal absorption.