Enhancing Carbohydrate Quality in Diabetes Management

Eunice Kennedy Shriver National Institute Of Child Health & Human Development

Investigators

Linked publications, trials & patents

Abstract

Medical nutrition therapy in type 1 diabetes focuses on integrating the insulin regimen and carbohydrate estimation into the familys lifestyle, conforming to preferred meal routines and food choices. Diets of children with type 1 diabetes are low in fruits, vegetables, and whole grains, and high in saturated fat. Poor diet quality is particularly concerning due to the increased risk of cardiovascular disease associated with type 1 diabetes. However, scant research has examined individual and family determinants of dietary intake, the effectiveness of intervention to improve dietary intake, or the impact of improved diet quality on glycemic control in youth with type 1 diabetes. Intervention studies in other clinical populations demonstrate substantial challenges in promoting healthful eating, and suggest the importance of family-based approaches that enhance motivation, facilitate skills, and assist families in overcoming barriers to healthful eating. CHEF was a randomized controlled trial of a behavioral nutrition intervention targeting improved diet quality in families of youth with type 1 diabetes, for whom diet plays a critical role in disease management. The trial demonstrated the efficacy of a family-based behavioral intervention grounded in health behavior theories to improve overall diet quality and intake of whole plant foods (Nansel et al. 2015, PMID: 25952160). We found no evidence of differential reporting bias by treatment assignment, as evidenced by similar associations of serum carotenoids (a biomarker of fruit and vegetable intake) with reported fruit and vegetable intake from 24-hour diet recalls across time in both treatment and control group (Sanjeevi et. al 2019, PMID: 31101482), supporting the conclusion that the observed treatment effect on diet quality was due to real change in food intake, rather than increased reporting error in the intervention participants. The intervention did not affect overall diet cost, and diet cost was unassociated with diet quality (Nansel al. 2015 PMID: 27597745), suggesting the feasibility of families meaningfully improving diet without incurring additional cost. Findings further indicated that diet quality improved most in children demonstrating picky eating behaviors, widely considered as more resistant to improvements in dietary intake (Nansel et al. 2018 PMID: 29389510). Despite concerns that increased attention to diet may increase disordered eating, these behaviors did not increase due to the intervention (Eisenberg et al. 2018, PMID: 29371234). Work in the current year focused on preparing the data for public data-sharing.