The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults.

This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.

Role of food and nutrition professionals in stemming the diabetes epidemic.

Food and nutrition professionals can play a major role in reversing the diabetes epidemic by helping patients reduce their risk for diabetes and prevent its onset. The Diabetes Prevention Program (DPP) clinical trial, spearheaded by the National Institutes of Health, has provided the research-based evidence needed to demonstrate that type 2 diabetes can be delayed or prevented through a 5% to 7% weight loss and regular physical activity, such as 150 minutes a week of brisk walking. The National Diabetes Education Program, through its "Small Steps. Big Rewards. Prevent Type 2 Diabetes" initiative, has translated the lifestyle intervention used in the DPP for health care professionals. The initiative includes a health care professional toolkit, user-friendly weight-loss materials for patients, and a mass media campaign to increase awareness that diabetes can be delayed or prevented. Food and nutrition professionals can access these materials free of charge online or through the National Diabetes Education Program clearinghouse. By applying the lessons learned from the DPP to patients at risk for diabetes, food and nutrition professionals can make a substantial contribution to reversing the diabetes epidemic.

Diabetes prevention. A GAMEPLAN for success.

Diabetes prevalence is growing at epidemic proportions, and the greatest increase in number of cases is anticipated to be among older adults. The Diabetes Prevention Program (DPP) showed that diabetes can be prevented or delayed among people with pre-diabetes (impaired glucose tolerance, impaired fasting glucose, or both). The National Diabetes Education Program has developed tools adapted from the DPP that primary care providers can use to counsel middle-age and older patients on diabetes prevention.

Implementing the American Diabetes Association's nutrition recommendations.

Evidence-based "Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications" outline the goals of medical nutrition therapy for type 1 and type 2 diabetes mellitus. Those goals are (1) to attain and maintain optimal metabolic outcomes, (2) to prevent and treat the chronic complications of diabetes, (3) to improve health through healthy food choices and through physical activity, and (4) to address individual patient nutritional needs. Discussion focuses on moderate caloric restriction and an increase in physical activity. Carbohydrate counting is offered as an option for all patients with diabetes. Working with other health care professionals can be a benefit to both the primary health care provider and the patient.

Usefulness of the food habits questionnaire in a worksite setting.

OBJECTIVE: To examine the validity and reliability of the 24-item Food Habits Questionnaire (FHQ) in a worksite setting. DESIGN: In a longitudinal design, subjects in a 9-month worksite intervention program completed the FHQ pre- and postintervention. A randomly selected subsample also completed 2 sets of 4-day food records. SETTING: Three locations within a multisite industrial equipment company. PARTICIPANTS: Subjects (N = 178) self-selected to participate in the program and completed the FHQ. Mean age was 40.7+/-10.6, 60% were male, and 82% were white, and there were 15 occupational categories. Thirty-two subjects completed 2 sets of 4-day food records. MAIN OUTCOME MEASURES: To examine the validity and reliability of the FHQ total scale and subscales in a worksite setting with both men and women from varying socioeconomic levels. ANALYSIS: Cronbach a coefficient to estimate internal consistency for the total scale and the subscales, Pearson correlation coefficients to estimate test-retest reliabilities and criterion validity. RESULTS: For the 5 subscales, findings showed generally low internal consistency, moderate test-retest reliability, and low to moderate correlations with food record results. Psychometric properties for the total score of the FHQ included satisfactory internal consistency, test-retest reliability, and criterion validity. CONCLUSIONS AND IMPLICATIONS: The FHQ subscales did not perform well and need to be more fully developed. Therefore, the FHQ may best be used as a total scale score to indicate fat-related behaviors.