ABSTRACT
Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women. Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months. Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups. Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM.
ABSTRACT
Introduction: The aim of this study was to develop and validate a semiquantitative food frequency questionnaire (FFQ) for assessing habitual added sugar consumption of adults in the Klang Valley. Methods: In the development phase, a 24-hour dietary recall (24-hr DR) was used to determine food items to be included into the FFQ among adults from three major ethnicities (n=51). In the validation phase, the FFQ was further validated against a reference method which was a multiple-pass 24-hr DR among 125 adults in Klang Valley. The response rate for the latter phase was 96.1%. Results: The semi-quantitative FFQ consisting of 64 food items was categorised into 10 food groups. The mean added sugar intake determined by the reference method was 44.2 ± 20.2 g/day while that from the FFQ was 49.4 ± 21.4 g/day. The difference in mean intake between the two methods was 5.2 g (95% CI = 2.6-7.9; SD = 14.9, p<0.05) or 11.8%. Pearson correlation was r=0.74 (p<0.001) for the two methods while Spearman rank correlations for the various food groups ranged between 0.11 (cake and related foods) to 0.61 (self-prepared drinks), with most groups correlating significantly (p<0.05). Cross-classification of subjects into quintiles of intake showed 47.2% of the subjects correctly classifying into the same quintile, 34.4% into adjacent quintiles while none were grossly misclassified. The Bland-Altman plot was concentrated in the y-axis range (-24.14 g to 34.8 g) with a mean of 5.22 g. Conclusion: This semi-quantitative FFQ provides a validated tool for estimating habitual intake of added sugar in the adult population of the Klang Valley.