Association between Cardiometabolic Profile and Dietary Characteristics among Adults with Type 1 Diabetes Mellitus.

BACKGROUND: The Mediterranean-style dietary pattern has been associated with several cardiometabolic benefits, yet no study has assessed the potential benefits of this diet in adults with type 1 diabetes mellitus (T1DM). OBJECTIVE: The objective of the present study was to examine the association between cardiometabolic profile and alignment of the diet with 1) Canadian nutrient recommendations for T1DM in terms of fat, protein, carbohydrate, saturated fat, dietary fiber, and sodium and 2) a Mediterranean-style dietary pattern among adults with T1DM. DESIGN/PARTICIPANTS/SETTING: This is a cross-sectional analysis including 118 adults with T1DM recruited between 2011 and 2013 in Montreal, Canada. STATISTICAL ANALYSES: Body mass index (calculated as kg/m(2)), waist circumference, truncal fat percentage (dual-energy x-ray absorptiometry), blood pressure, and lipid profile values were measured. Insulin sensitivity was estimated (estimated glucose disposal rate). A 3-day food record was completed and physical activity was measured with a motion sensor. Differences for the cardiometabolic profile between groups with a diet meeting the Canadian nutrient recommendations for T1DM (percentage of energy from fat, protein, carbohydrate, saturated fat, as well as grams of dietary fiber and milligrams of sodium) or not were examined with general linear models. A Mediterranean diet score was calculated (range=0 to 44) and Pearson correlations between this score and cardiometabolic variables were computed. Significance was set at P≤0.05. RESULTS: Participants' mean ± standard deviation age was 44.3±12.3 years, glycated hemoglobin was 8.0%±1.1%, and Mediterranean diet score was 20.2±5.0. Having a diet that meets at least three nutritional recommendations was associated with a lower truncal fat percentage (28.0% vs 32.2%; P=0.01) only. In contrast, the Mediterranean diet score was inversely correlated with body mass index (r=-0.30, P=0.002), waist circumference (r=-0.31, P=0.002), truncal fat percentage (r=-0.38, P<0.001), systolic (r=-0.20, P=0.03) and diastolic blood pressure (r=-0.23, P=0.01), and was directly correlated with estimated glucose disposal rate (r=0.22, P=0.03), after adjustments for energy intake, sex, and age. The association with estimated glucose disposal rate was no longer significant (P=0.055) after adjustment for physical activity level. CONCLUSIONS: These results suggest that a higher Mediterranean diet score in the context of T1DM is associated with a favorable cardiometabolic profile. Further research is needed to confirm these findings.

Middle-aged women's decisions about body weight management: needs assessment and testing of a knowledge translation tool.

OBJECTIVE: This study aims to assess middle-aged women's needs when making body weight management decisions and to evaluate a knowledge translation tool for addressing their needs. METHODS: A mixed-methods study used an interview-guided theory-based survey of professional women aged 40 to 65 years. The tool summarized evidence to address their needs and enabled women to monitor actions taken. Acceptability and usability were reported descriptively. RESULTS: Sixty female participants had a mean body mass index of 28.0 kg/m(2) (range, 17.0-44.9 kg/m(2)), and half were premenopausal. Common options for losing (82%) or maintaining (18%) weight included increasing physical activity (60%), eating healthier (57%), and getting support (40%). Decision-making involved getting information on options (52%), soliciting others' decisions/advice (20%), and being self-motivated (20%). Preferred information sources included written information (97%), counseling (90%), and social networking websites (43%). Five professionals (dietitian, personal trainer, occupational therapist, and two physicians) had similar responses. Of 53 women sent the tool, 27 provided acceptability feedback. They rated it as good to excellent for information on menopause (96%), body weight changes (85%), and managing body weight (85%). Most would tell others about it (81%). After 4 weeks of use, 25 women reported that the wording made sense (96%) and that the tool had clear instructions (92%) and was easy to use across time (88%). The amount of information was rated as just right (64%), but the tool had limited space for responding (72%). CONCLUSIONS: When making decisions about body weight management, women's needs were "getting information" and "getting support." The knowledge translation tool was acceptable and usable, but further evaluation is required.

Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes.

AIMS: To describe (i) current bedtime nutritional practices and (ii) the association between post-dinner dietary intake and the occurrence of non-severe nocturnal hypoglycemia (NH) in real-life conditions among adult patients with type 1 diabetes using insulin analogs. METHODS: One hundred adults (median [interquartile range]: age 46.4 [36.0-55.8] years, HbA1c 7.9 [7.3-8.6] % (63 [56-70] mmol/mol)) using multiple daily injections (n=67) or insulin pump (n=33) wore a blinded continuous glucose monitoring system and completed a food diary for 72-h. RESULTS: NH occurred on 28% of 282 nights analyzed. (i) Patients reported post-dinner dietary intakes on 63% of the evenings. They injected rapid-acting insulin boluses on 64 occasions (23% of 282 evenings). These insulin boluses were mostly injected with (n=37) dietary intakes. (ii) Post-dinner dietary intake was not associated with NH occurrence in univariate analyses. In multivariate analyses, the injection of rapid-acting insulin modulated the association between post-dinner dietary intake and NH: with insulin, post-dinner carbohydrate intake was positively associated with NH (odds ratio (OR): 1.16 [95% confidence interval, CI: 1.04-1.29] per 5g increase, p=0.008); without insulin, post-dinner protein intake was inversely associated with NH occurrence (OR [95% CI]: 0.88 [0.78-1.00] per 2g increase, p=0.048). CONCLUSIONS: NH remains frequent in adults with type 1 diabetes. There is a complex relationship between post-dinner dietary intake and NH occurrence, including the significant role of nutrient content and rapid-acting insulin injection that requires further investigation.

Weight cycling and depressive symptoms in diabetes: a community-based study of adults with type 2 diabetes mellitus in Quebec.

OBJECTIVE: The problems of obesity and depression in type 2 diabetes mellitus are well documented, yet the role of weight cycling in relation to these 2 chronic conditions has not been examined. The study objective was to determine whether weight cycling predicts the development of depressive symptoms in the course of 1 year. METHODS: A cohort study of 1100 adults with type 2 diabetes participating in the Diabetes Health and Well-Being Study (telephone survey using the random-digit-dialling method) had complete data at the 1-year follow up on depressive symptoms (Patient Health Questionnaire 9) and weight cycling frequency (going on a diet and losing >10 kg). RESULTS: At baseline, 56.5% of subjects reported weight cycling on at least 1 occasion in their lifetime; it was found to be associated with baseline body mass index, depression, sex and age (p<0.05). Regression analyses indicated that severe weight cycling (≥4 times) was not associated with the development of major depressive symptoms; however, it was associated with maintaining major depressive symptoms (p=0.038) but significance disappeared after adjusting for body mass index, physical activity, smoking and sociodemographic characteristics. Development and maintenance of major depressive symptoms were associated with physical inactivity (p<0.05); maintenance of major depressive symptoms was also associated with higher body mass index values (p<0.05). CONCLUSIONS: Weight cycling is a widespread phenomenon in diabetes. It was associated with depression, but severe cycling was not an independent predictor of the development and maintenance of major depressive symptoms. Clinicians should consider physical inactivity when evaluating and addressing depression in patients with type 2 diabetes.

Lifestyle interventions targeting body weight changes during the menopause transition: a systematic review.

OBJECTIVE: To determine the effectiveness of exercise and/or nutrition interventions and to address body weight changes during the menopause transition. METHODS: A systematic review of the literature was conducted using electronic databases, grey literature, and hand searching. Two independent researchers screened for studies using experimental designs to evaluate the impact of exercise and/or nutrition interventions on body weight and/or central weight gain performed during the menopausal transition. Studies were quality appraised using Cochrane risk of bias. Included studies were analyzed descriptively. RESULTS: Of 3,564 unique citations screened, 3 studies were eligible (2 randomized controlled trials, and 1 pre/post study). Study quality ranged from low to high risk of bias. One randomized controlled trial with lower risk of bias concluded that participation in an exercise program combined with dietary interventions might mitigate body adiposity increases, which is normally observed during the menopause transition. The other two studies with higher risk of bias suggested that exercise might attenuate weight loss or weight gain and change abdominal adiposity patterns. CONCLUSIONS: High quality studies evaluating the effectiveness of interventions targeting body weight changes in women during their menopause transition are needed. Evidence from one higher quality study indicates an effective multifaceted intervention for women to minimize changes in body adiposity.

Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review.

Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established.

Recurrent subthreshold depression in type 2 diabetes: an important risk factor for poor health outcomes.

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health-related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health-related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

Longitudinal relationships between depression and functioning in people with type 2 diabetes.

BACKGROUND: The reciprocal relationship between depression and functioning in people with chronic conditions is poorly understood. PURPOSE: The aim of the present study was to analyze the dynamic relationship between depression and functioning in a community sample of people with diabetes. METHODS: Participants with diabetes were assessed at baseline and three yearly follow-up assessments (n = 1,403). Depression was assessed using the Patient Health Questionnaire. Global functioning was assessed using the World Health Organization Disability Assessment Schedule II. RESULTS: Path analysis suggested a reciprocal relationship between depression and functioning. Baseline depression was associated with functioning at 3 years follow-up through depression and functioning at 1 and 2 years follow-up assessments. CONCLUSIONS: Depression and functioning might interact with each other in a dynamic way: depression at one assessment point might predict poor functioning at the next assessment point, which in turn might predict depression at the next assessment point. This should be taken into account in both treatment and research programs.

Trajectories of self-rated health in people with diabetes: associations with functioning in a prospective community sample.

BACKGROUND: Self-rated health (SRH) is a single-item measure that is one of the most widely used measures of general health in population health research. Relatively little is known about changes and the trajectories of SRH in people with chronic medical conditions. The aims of the present study were to identify and describe longitudinal trajectories of self-rated health (SRH) status in people with diabetes. METHODS: A prospective community study was carried out between 2008 and 2011. SRH was assessed at baseline and yearly at follow-ups (n=1288). Analysis was carried out through trajectory modeling. The trajectory groups were subsequently compared at 4 years follow-up with respect to functioning. RESULTS: Four distinct trajectories of SRH were identified: 1) 72.2% of the participants were assigned to a persistently good SRH trajectory; 2) 10.1% were assigned to a persistently poor SRH trajectory; 3) mean SRH scores changed from good to poor for one group (7.3%); while 4) mean SRH scores changed from poor to medium/good for another group (10.4%). Those with a persistently poor perception of health status were at higher risk for poor functioning at 4 years follow-up than those whose SRH scores decreased from good to poor. CONCLUSIONS: SRH is an important predictor for poor functioning in diabetes, but the trajectory of SRH seems to be even more important. Health professionals should pay attention to not only SRH per se, but also changes in SRH over time.

Changes in depressive symptoms and changes in lifestyle-related indicators: a 1-year follow-up study among adults with type 2 diabetes in Quebec.

OBJECTIVE: The study purpose was to examine the association between changes in depressive symptoms and changes in lifestyle-related indicators among adults with type 2 diabetes. METHODS: A longitudinal survey was conducted among individuals with type 2 diabetes in Quebec. The sample consisted of 1183 subjects who responded to the baseline and 1-year follow-up telephone interviews, with complete data for depressive symptoms (Patient Health Questionnaire 9). Regression models were used to determine associations between changes in depressive symptoms and changes in lifestyle-related indicators (physical activity, body mass index (BMI)) and, perception-related indicators (control of body weight and of amount of food eaten). RESULTS: After 1 year, 136 subjects (11.5%) developed depression (major or minor), 118 (10%) remained depressed, 829 (70%) remained not depressed and 100 (8.5%) reverted to not depressed. Subjects who developed depression, compared with those who remained not depressed, were more likely to be inactive at baseline, remain inactive at 1 year, report a worsening of their perception of controlling body weight, report maintaining a poor perception of controlling amount of food eaten and report maintaining a poor perception of controlling body weight (p<0.05). The same factors were associated with maintenance of depression at 1 year (p<0.05). Changes in BMI were not associated with changes in depressive symptoms. CONCLUSIONS: Physical inactivity, perception of poor control of body weight and amount of food eaten have been found to be associated prospectively with the development and persistence of depression and, therefore, should be considered priority targets for diabetes treatment. Depression is related to the continuation of poor lifestyle and perception-related indicators.

The pattern of depressive symptoms in people with type 2 diabetes: a prospective community study.

OBJECTIVE: The aim of the present study was to identify and describe longitudinal patterns of depression in a community sample of people with type 2 diabetes in Quebec, Canada. METHODS: A prospective community based study in Quebec, Canada, was carried out between 2008 and 2011. Participants with diabetes were assessed at baseline and at 1, 2 and 3 years follow-up (n=1388). Depression was assessed using the patient health questionnaire (PHQ-9). RESULTS: Longitudinal latent class analysis yielded four clusters representing different longitudinal patterns of depression: cluster 1 ("no depression"; 67%): participants had neither minor nor major depression over time. Cluster 2 ("slowly increasing prevalence of minor and major depression over time"; 20%): participants had low levels of depression at baseline but increasing levels of minor and major depression over time; while most of the Cluster 3 ("increasing major depression"; 6%) participants had high and increasing levels of major depression over time. Participants in cluster 4 ("improved depression"; 7%) started with high levels of depression but progressed to low levels of depression. CONCLUSIONS: Our results provide important evidence of different longitudinal patterns of depression in people with type 2 diabetes. Identification of four distinct groups of participants might improve our understanding of the course of depression and may provide a basis of classification for intervention.

Impact of energy restriction with or without resistance training on energy metabolism in overweight and obese postmenopausal women: a Montreal Ottawa New Emerging Team group study.

OBJECTIVE: The present study measured the impact of adding resistance training to an energy-restricted diet on the components of energy expenditure in overweight or obese postmenopausal women. METHODS: Participants (n = 137) were randomly divided into two groups: (1) a diet and resistance training (DRT) group and (2) a diet-only (DO) group. Women followed a 6-month energy-restricted diet consisting of 2,100 to 3,360 kJ less than daily needs. The DRT group also followed a resistance training program (three times a week). Resting energy expenditure (REE) was measured by indirect calorimetry. Total energy expenditure was measured with doubly labeled water. Body composition was measured by dual-energy x-ray absorptiometry. RESULTS: Eighty nine women were included in the analyses for this study (DRT, n = 21; DO, n = 68). REE in both groups was significantly lower after the intervention (mean difference ± SD: DO, -0.26 ± 0.4 MJ d; DRT, -0.33 ± 0.4 MJ d; P ≤ 0.05). Relative REE, expressed per kilogram of lean body mass corrected for fat mass change, remained stable in both groups. Physical activity energy expenditure remained stable in both groups (mean difference ± SD: DO, 0.02 ± 1 MJ d, P = 0.91; DRT, -0.14 ± 1 MJ d, P = 0.64). CONCLUSIONS: Adding resistance training to an energy-restricted diet does not significantly alter any compartment of energy expenditure. REE is lower owing to reduction in body composition compartments, but relative REE is not significantly altered.

Self-rated health: a predictor for the three year incidence of major depression in individuals with Type II diabetes.

BACKGROUND: To determine whether self-rated health was a predictor for the three year incidence of major depression in people with Type II diabetes. METHODS: Data was collected as part a population-based telephone survey of adults with diabetes, in Québec, Canada (2008-2011). Adults with Type II diabetes who did not have major depression at baseline were assessed at three follow-up interviews conducted 12, 24 and 36 months after baseline. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Self-rated health status was determined by asking participants to rate their health on a scale from excellent to poor. RESULTS: The sample consisted of 1265 adults with Type II diabetes who did not have major depression at baseline. 36% of individuals who had developed major depression at follow up rated their health as fair or poor at baseline compared to 14.4% of those who had not developed major depression. Logistic regression analyses indicated fair or poor self-rated health at baseline to be predictive of a twofold increased risk for major depression at follow-up, even after adjusting for socio-demographic characteristics, lifestyle-related behaviors, disability and diabetes characteristics (OR=2.05, 95% CI 1.20-3.48). LIMITATIONS: We have focused on current depression (last two weeks) and we have used a questionnaire (PHQ-9) rather than a clinical interview for the assessment of depression. CONCLUSIONS: Self-rated health status might be a predictor for developing major depression in people with diabetes in addition to well established risk factors.

Synergistic associations of physical activity and diet quality on cardiometabolic risk factors in overweight and obese postmenopausal women.

Healthy diet and physical activity are associated with a lower cardiometabolic risk (CMR). Little is known about whether they interact to improve CMR. The purpose of the present study was to determine the synergistic associations of diet quality and physical activity energy expenditure (PAEE) on CMR factors. The present study was an a posteriori analysis of two cross-sectional studies on 124 inactive non-diabetic postmenopausal women with a BMI ≥ 27 kg/m². The following factors were measured: diet quality (assessed by the Canadian Healthy Eating Index (C-HEI) from a 3 d food record); PAEE (doubly labelled water); body composition (dual-energy X-ray absorptiometry, computed tomography scan); lipoprotein profile (total, HDL- and LDL-cholesterol (HDL-C and LDL-C), non-HDL-C, total cholesterol:HDL-C, TAG, apoA1, apoB, apoA1:apoB and LDL-C:apoB); insulin sensitivity (homeostasis model assessment of insulin resistance and hyperinsulinaemic-euglycaemic clamp); inflammatory markers (high-sensitivity C-reactive protein (hs-CRP), haptoglobin, orosomucoid, IL-6 and leucocyte count). The association of the interaction PAEE × C-HEI and CMR factors was evaluated by hierarchical regressions. Fat mass-adjusted ANCOVA determined the interaction between PAEE and the C-HEI. In hierarchical regressions, the interaction PAEE × C-HEI was a correlate of more favourable values of HDL-C, apoB, apoA1:apoB and LDL-C:apoB ratios, and hs-CRP, while only PAEE was a negative correlate of haptoglobin. Compared with those in the low-PAEE/low-C-HEI group, women in the high-PAEE/high-C-HEI group had 10 % higher HDL-C, 13 % lower apoB, 11 % larger LDL particles and 28 % lower hs-CRP concentrations (P< 0·05). PAEE and the C-HEI have a synergistic association with the CMR profile. These results support the integration of both diet quality and physical activity in the management of CMR.

The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal-Ottawa New Emerging Team group study.

OBJECTIVE: Cardiovascular disease is the first cause of mortality in women in North America. The risk of cardiovascular disease increases sharply after middle age in women, especially after menopause. The aim was to investigate changes in body composition and cardiometabolic profile throughout the menopausal transition. METHODS: This was a 5-year observational, longitudinal study on the menopausal transition. The study included 102 premenopausal women at baseline (age, 49.9 ± 1.9 y; body mass index, 23.3 ± 2.2 kg/m). Outcome measures include menopause status, body composition by dual-energy x-ray absorptiometry (total fat mass [FM], trunk FM, and total fat-free mass), waist circumference, visceral and abdominal subcutaneous fat, fasting glucose and insulin levels, homeostasis model assessment of insulin resistance, plasma lipid levels (triglycerides, total cholesterol, and high- and low-density lipoprotein cholesterol), and resting blood pressure. RESULTS: Repeated-measure analyses revealed significant increases for FM, percentage FM, trunk FM, visceral fat, plasma fasting glucose, and high-density lipoprotein cholesterol (0.05 > P < 0.01) and a significant decrease for plasma glucose levels after follow-up. Those who were in perimenopause or postmenopause by year 3 of the study showed a significant increase in visceral fat (P < 0.01) compared with baseline. Despite some significant changes in the metabolic profile among the menopause statuses, the women did not show any cardiometabolic deterioration by the end of the study. CONCLUSIONS: Our results suggest that changes in body composition and fat distribution can occur in nonobese women as they go through the menopausal transition. However, these changes were not accompanied by cardiometabolic deteriorations in the present study.

Relationship between the Bertin index to estimate visceral adipose tissue from dual-energy X-ray absorptiometry and cardiometabolic risk factors before and after weight loss.

The purpose of this study was to investigate the relationship between visceral adipose tissue (VAT), estimated with the Bertin index obtained from dual-energy X-ray absorptiometry (DXA), with cardiometabolic risk factors before and after a weight loss program and compare it with VAT measured with computed tomography (CT) scan. The study population for this analysis included 92 nondiabetic overweight and obese sedentary postmenopausal women (age: 58.1 ± 4.7 years, BMI: 31.8 ± 4.2 kg/m(2)) participating in a weight loss intervention that consisted of a caloric restricted diet with and without resistance training (RT). We measured (i) VAT using CT scan, (ii) body composition (using DXA) from which the Bertin index was calculated, (iii) cardiometabolic risk factors such as insulin sensitivity (using the hyperinsulinenic-euglycemic clamp technique), peak oxygen consumption, blood pressure, plasma lipids, C-reactive protein as well as fasting glucose and insulin. VAT levels for both methods significantly decreased after the weight loss intervention. Furthermore, no differences in VAT levels between both methods were observed before (88.0 ± 25.5 vs. 83.8 ± 22.0 cm(2)) and after (76.8 ± 27.8 vs. 73.6 ± 23.2 cm(2)) the weight loss intervention. In addition, the percent change in VAT levels after the weight loss intervention was similar between both methods (-13.0 ± 16.5 vs. -12.5 ± 12.6%). Moreover, similar relationships were observed between both measures of VAT with cardiometabolic risk factors before and after the weight loss intervention. Finally, results from the logistic regression analysis consistently showed that fat mass and lean body mass were independent predictors of pre- and post-VAT levels for both methods in our cohort. In conclusion, estimated visceral fat levels using the Bertin index may be able to trace variations of VAT after weight loss. This index also shows comparable relationships with cardiometabolic risk factors when compared to VAT measured using CT scan.

Factors associated with disability and depressive symptoms among individuals with diabetes: a community study in Quebec.

BACKGROUND: The prevalence of diabetes in Canada is increasing. Multiple factors have been identified in the development of disability in diabetic patients, but the interaction of those risk factors is not clear. OBJECTIVE: The purpose of this paper was to assess the association between diabetes severity, health behavior, socioeconomic status, social support, depression, and disability simultaneously in a population-based study of individuals with diabetes in Quebec, Canada. METHOD: Random digit dialing was used to select a sample of 2,003 adults with self-reported diabetes in Quebec. Health status was assessed by the World Health Organization Disability Assessment Schedule II and the CDC Healthy Days Measures. The Patient Health Questionnaire (PHQ-9) was used to assess depression. Potential risk factors included diabetes severity, social support, socioeconomic status, and health behavior factors. Structural equation models were used to identify risk factors that contributed to both depressive symptoms and disability. RESULTS: The prevalence of major and minor depression was 8.7% and 10.9%, respectively, while the prevalence of severe disability was 6.7%. Diabetes severity and health behavior factors were associated with both depression and disability. Social support was associated with depression for women but not for men. DISCUSSION: Our results suggest a complex interaction between health behavior factors, diabetes severity, social support, depression, and disability. Behavioral factors and diabetes-specific factors might have a direct effect on both depression and physical functioning.

Exploring adolescents' awareness of diabetes using the free association technique.

PURPOSE: Healthy adolescents' awareness of diabetes was explored, and gender and grade-level differences in understanding were determined. METHODS: Adolescents without diabetes in grades five, eight, and 10 (n=128) at four New Brunswick schools wrote down all words/expressions that came to mind when they heard the word "diabetes" (i.e., they used the free association technique). Answers were classified into categories using content analysis. RESULTS: Eighty-eight girls and 40 boys completed the activity (n=44, 52, and 32 in grades five, eight, and 10, respectively). Nine principal categories were identified: 66% of the adolescents cited sugar (e.g., eating too much sugar, not enough sugar), 48% treatment (e.g., needles, injections), 45% the nature of diabetes (e.g., a disease, types of diabetes, heredity), 41% nutrition (e.g., diet, sugar-containing foods, other foods), 38% blood (e.g., too much/not enough sugar in blood), 18% complications (e.g., death), 11% physiological manifestations/symptoms (e.g., fainting), 6% obesity, and 6% physical activity. No differences were found in category citation frequency between boys and girls and grade levels, except that grade 10 students more frequently cited the categories of treatment, blood, and obesity (p=0.05). CONCLUSIONS: Students thought of diabetes in terms of sugar and injections. Words related to obesity, prevention, and complications were cited infrequently.

French adaptation of the eating disorder recovery self-efficacy questionnaire (EDRSQ): psychometric properties and conceptual overview.

High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessment of EDs. Self-efficacy is a key motivational factor in the recovery from EDs. A self-report measure, the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthy eating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the EDRSQ to French (EDRSQ-F), (b) assess the psychometric properties of this French version, and (c) establish normative data for a non-clinical sample. Participants were 203 undergraduate women. They completed the EDRSQ-F and measures of ED symptoms, depression and self-esteem. A confirmatory factor analysis (CFA) revealed a bi-factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence of construct validity. Findings support the validity of the EDRSQ-F and suggest it is a useful instrument for the assessment of EDs.