ABSTRACT
INTRODUCTION: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. OBJECTIVE: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. METHODS: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m2, and time since the diagnosis 1 (0-5) years were included in the study. RESULTS: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05). CONCLUSIONS: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes.
Subject(s)
Diabetes Mellitus, Type 2/diet therapy , Patient Compliance/statistics & numerical data , Body Mass Index , Body Weights and Measures , Diabetes Mellitus, Type 2/blood , Diet, Diabetic , Female , Follow-Up Studies , Glycated Hemoglobin/analysis , Humans , Information Literacy , Male , Mexico , Middle Aged , Patient Compliance/psychology , Patient Education as Topic , Prospective Studies , Surveys and Questionnaires , Time Factors , Triglycerides/bloodABSTRACT
ABSTRACT: The aim of this study was to evaluate the carcass characteristics and the physicochemical parameters, centesimal composition, and fatty acid profile of the longissimus lumborum muscle of crossbred steers on a Brachiaria (Syn. Uruchloa) brizantha cv. Marandu pasture during the growing and finishing phases. Twenty-two uncastrated steers ½ Holstein/Zebu, with an average initial weight of 210 kg ± 8.2 kg and eight months of age, were distributed in a completely randomized design, in which the experimental period was fractionated in to three seasons associated with two nutritional plans (NP1 and NP2) and 11 animals by treatment: NP1- mineral mixture ad libitum in rainy seasons + nitrogen/energy supplement at 1 g.kg-1 body weight (BW) in the dry season; and NP2 - nitrogen/energy supplement at 2 g.kg-1 BW in rainy season 1 and in the dry season + nitrogen/energy supplement at 1 g.kg-1 BW in rainy season 2, provided daily at 1000 h. Of the carcass measurements, differences were only observed (p>0.05) between the nutritional plans for loin-eye area corrected for 100 kg of hot carcass weight. Among the physicochemical parameters, only shear force was influenced (p>0.05) by the treatments, with higher values obtained in Nutritional Plan 1. The centesimal composition and fatty acid profile were not influenced (P<0.05) by supplementation. Nutritional plans used in the growing and finishing phases involving low levels of protein-energy supplementation do not lead to changes significant in carcass characteristics and meat. Nutritional Plan 1 is the most appropriate because it presents a lower cost.
RESUMO: Objetivou-se avaliar as características da carcaça, parâmetros físico-químicos, composição centesimal e perfil de ácidos graxos do músculo Longissimus lomborum de novilhos mestiços em pastagem de Brachiaria (Syn. Uruchloa) brizantha cv. Marandu, durante as fases de recria e terminação. Foram utilizados 22 novilhos (½ Holandês e ½ Zebu) não castrados, com peso inicial médio 210 kg ± 8,2 kg e oito meses de idade, distribuídos em delineamento inteiramente casualisado, com período experimental dividido em três estações, associada com 2 planos nutricionais (PN1 e PN2) e 11 animais por tratamento: PN1 (mistura mineral ad libitum nas estações chuvosas (EC) e suplemento nitrogenado/energético na quantidade de 1 g.kg-1 do peso corporal (PC) na estação seca) e PN2 (suplemento nitrogenado/energético de 2 g.kg-1 PC nas EC 1 e na seca, e suplemento nitrogenado/energético na quantidade de 1 g.kg-1 PC na EC 2) fornecidos diariamente às 10:00h. Para as características de carcaça foi observado diferença (p>0,05) entre os planos nutricionais, apenas para área de olho de lombo corrigida para 100 kg de peso de carcaça quente. Para os parâmetros físico-químicos apenas a força de cisalhamento foi influenciada pelos tratamentos (P>0,05) e foi maior para o plano nutricional 1. A composição centesimal e o perfil de ácidos graxos, não foram influenciados (p<0,05) pela suplementação. Planos nutricionais de recria e terminação com baixos níveis de suplementação proteico-energética não promove alterações significativas nas características da carcaça e da carne. O plano nutricional 1 é o mais indicado porque apresenta menor custo.
ABSTRACT
The aim of this study was to evaluate the carcass characteristics and the physicochemical parameters, centesimal composition, and fatty acid profile of the longissimus lumborum muscle of crossbred steers on a Brachiaria (Syn. Uruchloa) brizantha cv. Marandu pasture during the growing and finishing phases. Twenty-two uncastrated steers ½ Holstein/Zebu, with an average initial weight of 210 kg ± 8.2 kg and eight months of age, were distributed in a completely randomized design, in which the experimental period was fractionated in to three seasons associated with two nutritional plans (NP1 and NP2) and 11 animals by treatment: NP1- mineral mixture ad libitum in rainy seasons + nitrogen/energy supplement at 1 g.kg-1 body weight (BW) in the dry season; and NP2 - nitrogen/energy supplement at 2 g.kg-1 BW in rainy season 1 and in the dry season + nitrogen/energy supplement at 1 g.kg-1 BW in rainy season 2, provided daily at 1000 h. Of the carcass measurements, differences were only observed (p>0.05) between the nutritional plans for loin-eye area corrected for 100 kg of hot carcass weight. Among the physicochemical parameters, only shear force was influenced (p>0.05) by the treatments, with higher values obtained in Nutritional Plan 1. The centesimal composition and fatty acid profile were not influenced (P 0.05) by supplementation. Nutritional plans used in the growing and finishing phases involving low levels of protein-energy supplementation do not lead to changes significant in carcass characteristics and meat. Nutritional Plan 1 is the most appropriate because it presents a lower cost.(AU)
Objetivou-se avaliar as características da carcaça, parâmetros físico-químicos, composição centesimal e perfil de ácidos graxos do músculo Longissimus lomborum de novilhos mestiços em pastagem de Brachiaria (Syn. Uruchloa) brizantha cv. Marandu, durante as fases de recria e terminação. Foram utilizados 22 novilhos (½ Holandês e ½ Zebu) não castrados, com peso inicial médio 210 kg ± 8,2 kg e oito meses de idade, distribuídos em delineamento inteiramente casualisado, com período experimental dividido em três estações, associada com 2 planos nutricionais (PN1 e PN2) e 11 animais por tratamento: PN1 (mistura mineral ad libitum nas estações chuvosas (EC) e suplemento nitrogenado/energético na quantidade de 1 g.kg-1 do peso corporal (PC) na estação seca) e PN2 (suplemento nitrogenado/energético de 2 g.kg-1 PC nas EC 1 e na seca, e suplemento nitrogenado/energético na quantidade de 1 g.kg-1 PC na EC 2) fornecidos diariamente às 10:00h. Para as características de carcaça foi observado diferença (p>0,05) entre os planos nutricionais, apenas para área de olho de lombo corrigida para 100 kg de peso de carcaça quente. Para os parâmetros físico-químicos apenas a força de cisalhamento foi influenciada pelos tratamentos (P>0,05) e foi maior para o plano nutricional 1. A composição centesimal e o perfil de ácidos graxos, não foram influenciados (p 0,05) pela suplementação. Planos nutricionais de recria e terminação com baixos níveis de suplementação proteico-energética não promove alterações significativas nas características da carcaça e da carne. O plano nutricional 1 é o mais indicado porque apresenta menor custo.(AU)