Glycaemic control and awareness among diabetic patients of nutrition recommendations in diabetes

Wprowadzenie. Zapadalność na cukrzycę szybko wzrasta, szczególnie w krajach zurbanizowanych. Szacuje się, że w skali całego świata do 2035 r. liczba chorych na cukrzycę osiągnie poziom 600 milionów. Jest coraz więcej dowodów na to, że odpowiednia edukacja pacjentów jest jednym z najskuteczniejszych sposobów na opóźnienie rozwoju powikłań. Cel. Celem badań była ocena częstości wykonywania przez pacjentów pomiarów glikemii oraz ich wiedzy na temat zaleceń żywieniowych w cukrzycy. Materiał i metody. Badanie objęło grupę 303 pacjentów z cukrzycą typu 1 i 2. Narzędziem badawczym była autorska ankieta wzorowana na kwestionariuszu KomPAN, która składała się z testu wiedzy oraz pytań dotyczących samokontroli glikemii. Analizy statystycznej dokonano za pomocą programu PS IMAGO PRO 5 (IBM SPSS Statistics 25). Wyniki. Większość pacjentów wykazała się średnim poziomem wiedzy żywieniowej – 62% z nich uzyskało >50% poprawnych odpowiedzi. Jedynie 8% respondentów uzyskało wynik >80% punktów. Lepsze wyniki z testu uzyskiwali pacjenci z cukrzycą typu 1. Najwyższy odsetek poprawnych odpowiedzi uzyskano w pytaniach o konieczność eliminowania słodyczy i wprowadzenia do diety bogatych w błonnik pełnoziarnistych produktów zbożowych (>90% poprawnych odpowiedzi), a najniższy odsetek zaobserwowano w pytaniach wymagających oszacowania węglowodanów prostych i indeksu glikemicznego konkretnych produktów (<30% poprawnych odpowiedzi). Większość pacjentów wykonywała pomiar glikemii przynajmniej raz dziennie, jednak 6% zaniechało pomiarów domowych. Prawie połowa respondentów nie miała wykonywanego testu hemoglobiny glikowanej - większość tej grupy stanowili pacjenci z cukrzycą typu 2. Wnioski. Poziom wiedzy badanych pacjentów był niezadowalający i różnił się w zależności od typu cukrzycy. Potrzebna jest dalsza edukacja pacjentów w zakresie żywienia i samokontroli glikemii.Background. The incidence of diabetes has been rising rapidly, especially in urbanized countries. It is estimated that by 2035 the number of diabetics will have increased to almost 600 million around the world. There is a substantial amount of evidence which points to proper education as one of the most effective ways of delaying the diabetes-related development of complications. Objective. The aim of the study was to investigate the frequency of monitoring blood sugar by diabetic patients and their awareness of nutrition recommendations in diabetes. Materials and methods. The study included 303 patients with type 1 and 2 diabetes. The research tool was a questionnaire based on the KomPAN questionnaire that consisted of a nutrition knowledge test and several questions concerning glycaemic control. The statistical analysis was carried out using the PS IMAGO PRO 5 (IBM SPSS Statistics 25) software. Results. Most of the patients demonstrated a medium level of knowledge – 62% of them provided >50% of the correct answers. Only 8% of the respondents scored >80% of the correct answers. Better test results were achieved by patients with type 1 diabetes. The highest percentage of correct answers was observed in the questions regarding the need to limit sweets or introduce fibre-rich whole-grain products (>90%), the smallest percentage in the questions related to the assessment of carbohydrates and the glycaemic index of selected products (<30%). The majority of the patients checked their blood sugar levels every day, but 6% of them gave up glucose measurements at home. About half of the respondents did not take the HbA1c test - the majority of them were patients with type 2 diabetes. Conclusions. The level of knowledge of the examined patients was unsatisfactory and varied with the type of diabetes. Further education of patients about nutrition and glycaemic control is recommended

Phenotypic factors influencing the variation in response of circulating cholesterol level to personalised dietary advice in the Food4Me study

Individual response to dietary interventions can be highly variable. The phenotypic characteristics of those who will respond positively to personalised dietary advice are largely unknown. The objective of this study was to compare the phenotypic profiles of differential responders to personalised dietary intervention, with a focus on total circulating cholesterol. Subjects from the Food4Me multi-centre study were classified as responders or non-responders to dietary advice on the basis of the change in cholesterol level from baseline to month 6, with lower and upper quartiles defined as responder and non-responder groups, respectively. There were no significant differences between demographic and anthropometric profiles of the groups. Furthermore, with the exception of alcohol, there was no significant difference in reported dietary intake, at baseline. However, there were marked differences in baseline fatty acid profiles. The responder group had significantly higher levels of stearic acid (18 : 0, P=0·034) and lower levels of palmitic acid (16 : 0, P=0·009). Total MUFA (P=0·016) and total PUFA (P=0·008) also differed between the groups. In a step-wise logistic regression model, age, baseline total cholesterol, glucose, five fatty acids and alcohol intakes were selected as factors that successfully discriminated responders from non-responders, with sensitivity of 82 % and specificity of 83 %. The successful delivery of personalised dietary advice may depend on our ability to identify phenotypes that are responsive. The results demonstrate the potential use of metabolic profiles in identifying response to an intervention and could play an important role in the development of precision nutrition

Characteristics of European adults who dropped out from the Food4Me Internet-based personalised nutrition intervention

Objective To characterise participants who dropped out of the Food4Me Proof-of-Principle study. Design The Food4Me study was an Internet-based, 6-month, four-arm, randomised controlled trial. The control group received generalised dietary and lifestyle recommendations, whereas participants randomised to three different levels of personalised nutrition (PN) received advice based on dietary, phenotypic and/or genotypic data, respectively (with either more or less frequent feedback). Setting Seven recruitment sites: UK, Ireland, The Netherlands, Germany, Spain, Poland and Greece. Subjects Adults aged 18–79 years (n 1607). Results A total of 337 (21 %) participants dropped out during the intervention. At baseline, dropouts had higher BMI (0·5 kg/m2; P<0·001). Attrition did not differ significantly between individuals receiving generalised dietary guidelines (Control) and those randomised to PN. Participants were more likely to drop out (OR; 95 % CI) if they received more frequent feedback (1·81; 1·36, 2·41; P<0·001), were female (1·38; 1·06, 1·78; P=0·015), less than 45 years old (2·57; 1·95, 3·39; P<0·001) and obese (2·25; 1·47, 3·43; P<0·001). Attrition was more likely in participants who reported an interest in losing weight (1·53; 1·19, 1·97; P<0·001) or skipping meals (1·75; 1·16, 2·65; P=0·008), and less likely if participants claimed to eat healthily frequently (0·62; 0·45, 0·86; P=0·003). Conclusions Attrition did not differ between participants receiving generalised or PN advice but more frequent feedback was related to attrition for those randomised to PN interventions. Better strategies are required to minimise dropouts among younger and obese individuals participating in PN interventions and more frequent feedback may be an unnecessary burden

Iodine-deficiency prophylaxis and the restriction of salt consumption - a 21st century challenge

The World Health Organization (WHO) issued a recommendation (Technical Consultation: Paris 2006, Luxembourg 2007) that salt consumption, as a risk factor for hypertension, atherosclerosis, myocardial infarction, stroke, and select cancers, should be restricted. The European Commission looked to adhere to this recommendation by creating the High Level Group on Nutrition and Physical Activity. According to WHO recommendations, a daily allowance of 5 g NaCl (i.e., 2 g Na) for individual salt consumption should not be exceeded. At present, mean individual salt consumption in Poland totals 13.5 g, of which salt used in household constitutes 8.8 g. In some regions of Poland, this number reaches upwards of 15.0 g/person. The Position Paper on Initiatives Aimed at Decreasing Salt Consumption in Poland, developed by an expert group at the National Food and Nutrition Institute, set the course for intervention, including changing recipes for massproduced food products and large-scale catering, improving oversight by food control agencies, and continuing legislative changes. These interventions should also include education directed towards consumers, food producers, public health professionals, healthcare workers, and media representatives. The Position Paper of the Polish Hypertension Society also sets the course for promoting restricted salt consumption and controlling hypertension on a population level. However, household salt is the main carrier of iodine in the Polish model of iodine prophylaxis. Thus, any interventions also require synchronized action with the Polish Council for Control of Iodine Deficiency Disorders. Current efforts aimed at preventing iodine-deficiency look to increase consumption of other iodine-rich products (e.g., milk, mineral water) with standardized levels of iodine. Once they achieve an iodine concentration of 0.1-0.2 mg, these products can easily supplement any decrease in physiological iodine levels resulting from reduced salt consumption. Also required are wide-ranging educational campaigns which will be coordinated by the new designated WHO Collaborating Centre for Nutrition at the Chair of Endocrinology at Jagiellonian University, Collegium Medicum in Kraków. (Pol J Endocrinol 2010; 61 (1): 135-140)Światowa Organizacja Zdrowia (WHO, World Health Organization) wystosowała rekomendacje (Techniczne Konsultacje : Paryż 2006, Luksemburg 2007) dotyczące konieczności ograniczenia spożycia soli jako czynnika ryzyka nadciśnienia tętniczego, miażdżycy, zawałów serca, udarów oraz niektórych chorób nowotworowych. Wyzwanie to podjęła Komisja Europejska i utworzona przez nią Grupa Wysokiego Szczebla ds. Żywienia i Aktywności Fizycznej. Zgodnie z zaleceniami WHO dzienne spożyci soli nie powinno przekraczać 5 gr NaCl (2 g sodu)/osobę. Średnie dzienne spożycie soli w Polsce wynosi 13,5 g/osobę, w tym 8,8 g soli kuchennej, a w niektórych regionach kraju dochodzi do 15,0 g/osobę. Opracowane przez grono ekspertów Instytutu Żywności i Żywienia "Stanowisko w sprawie podjęcia inicjatywy zmniejszenia spożycia soli w Polsce" określa kierunki działania obejmujące: zmiany receptur przetworów spożywczych w przemyśle spożywczym i placówkach żywienia zbiorowego, wzmożenie nadzoru organów urzędowej kontroli żywności, kontynuacje odpowiednich działań legislacyjnych. Dotyczą one również działań edukacyjnych, kierowanych do konsumentów, producentów żywności, pracowników ochrony zdrowia i instytucji zdrowia publicznego, oraz przedstawicieli mediów. Stanowisko Polskiego Towarzystwa Nadciśnienia Tętniczego podejmuje akcję promocji ograniczania spożycia soli i kontroli nadciśnienia tętniczego na poziomie populacyjnym. Program taki wymaga synchronizacji działań z Polską Komisją ds. Kontroli Zaburzeń z Niedoboru Jodu w zakresie niezbędnych modyfikacji systemu profilaktyki jodowej. Ograniczenie spożycia soli zmniejszy bowiem dzienną dawkę jodu. Aktualne modyfikacje systemu profilaktyki jodowej idą w kierunku zwiększenia spożycia innych nośników jodu: mleka i wód mineralnych ze sprawdzoną zawartością jodu. W obu wypadkach stężenie jodu osiąga wartość 0,1-0,2 mg jodków i nośniki te mogą uzupełnić niedobór jodu spowodowany ograniczeniem spożycia soli. Wymaga to szerokiej akcji edukacyjnej, która jest częścią programu nowopowołanego Ośrodka Współpracującego z WHO w zakresie żywienia przy Klinice Endokrynologii UJCM w Krakowie. (Endokrynol Pol 2010; 61 (1): 135-140

Effects of a web-based personalized intervention on physical activity in European adults: a randomized controlled trial

Background: The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity (PA). There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults. Objective: It is hypothesized that providing personalized advice based on PA measured objectively alongside diet, phenotype, or genotype information would lead to larger and more sustained changes in PA, compared with nonpersonalized advice. Methods: A total of 1607 adults in seven European countries were randomized to either a control group (nonpersonalized advice, Level 0, L0) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet (Level 1, L1), PA plus diet and phenotype (Level 2, L2), or PA plus diet, phenotype, and genotype (Level 3, L3). PA was measured for 6 months using triaxial accelerometers, and self-reported using the Baecke questionnaire. Outcomes were objective and self-reported PA after 3 and 6 months. Results: While 1270 participants (85.81% of 1480 actual starters) completed the 6-month trial, 1233 (83.31%) self-reported PA at both baseline and month 6, but only 730 (49.32%) had sufficient objective PA data at both time points. For the total cohort after 6 months, a greater improvement in self-reported total PA (P=.02) and PA during leisure (nonsport) (P=.03) was observed in personalized groups compared with the control group. For individuals advised to increase PA, we also observed greater improvements in those two self-reported indices (P=.006 and P=.008, respectively) with increased personalization of the advice (L2 and L3 vs L1). However, there were no significant differences in accelerometer results between personalized and control groups, and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6. After 6 months, there were small but significant improvements in the objectively measured physical activity level (P<.05), moderate PA (P<.01), and sedentary time (P<.001) for individuals advised to increase PA, but these changes were similar across all groups. Conclusions: Different levels of personalization produced similar small changes in objective PA. We found no evidence that personalized advice is more effective than conventional “one size fits all” guidelines to promote changes in PA in our Web-based intervention when PA was measured objectively. Based on self-reports, PA increased to a greater extent with more personalized advice. Thus, it is crucial to measure PA objectively in any PA intervention study

Proposed guidelines to evaluate scientific validity and evidence for genotype-based dietary advice

Nutrigenetic research examines the effects of inter-individual differences in genotype on responses to nutrients and other food components, in the context of health and of nutrient requirements. A practical application of nutrigenetics is the use of personal genetic information to guide recommendations for dietary choices that are more efficacious at the individual or genetic subgroup level relative to generic dietary advice. Nutrigenetics is unregulated, with no defined standards, beyond some commercially adopted codes of practice. Only a few official nutrition-related professional bodies have embraced the subject, and, consequently, there is a lack of educational resources or guidance for implementation of the outcomes of nutrigenetic research. To avoid misuse and to protect the public, personalised nutrigenetic advice and information should be based on clear evidence of validity grounded in a careful and defensible interpretation of outcomes from nutrigenetic research studies. Evidence requirements are clearly stated and assessed within the context of state-of-the-art ‘evidence-based nutrition’. We have developed and present here a draft framework that can be used to assess the strength of the evidence for scientific validity of nutrigenetic knowledge and whether ‘actionable’. In addition, we propose that this framework be used as the basis for developing transparent and scientifically sound advice to the public based on nutrigenetic tests. We feel that although this area is still in its infancy, minimal guidelines are required. Though these guidelines are based on semiquantitative data, they should stimulate debate on their utility. This framework will be revised biennially, as knowledge on the subject increases

Profile of European adults interested in internet-based personalized nutrition: The Food4Me Study

Purpose Personalised intervention may have greater potential for reducing the global burden of non-communicable diseases and for promoting better health and wellbeing across the life-span than the conventional “one size fits all” approach. However, the characteristics of individuals interested in personalised nutrition (PN) are unclear. Therefore, the aim of this study was to describe the characteristics of European adults interested in taking part in an internet-based PN study. Methods Individuals from seven European countries (UK, Ireland, Germany, the Netherlands, Spain, Greece and Poland) were invited to participate in the study via the Food4Me website (http://www.food4me.org). Two screening questionnaires were used to collect data on socio-demographic, anthropometric and health characteristics as well as dietary intakes. Results A total of 5662 individuals expressed an interest in the study (mean age 40 ± 12.7; range 15-87 years). Of these 64.6% were female and 96.9% were Caucasian. Overall, 12.9% were smokers and 46.8% reported the presence of a clinically diagnosed disease. Furthermore, 46.9% were overweight or obese and 34.9% were sedentary during leisure time. Assessment of dietary intakes showed that 54.3% of individuals reported consuming at least 5 portions of fruit and vegetables per day, 45.9% consumed more than 3 servings of wholegrains and 37.2% limited their salt intake to less than 5.75g per day. Conclusions Our data indicate that individuals volunteering to participate in an internet-based PN study are broadly representative of the European adult population, most of whom had adequate nutrient intakes but who could benefit from improved dietary choices and greater physical activity. Future use of internet-based PN approaches is thus relevant to a wide target audience

The impact of MTHFR 677C → T risk knowledge on changes in folate intake: findings from the Food4Me study

Background It is hypothesised that individuals with knowledge of their genetic risk are more likely to make health-promoting dietary and lifestyle changes. The present study aims to test this hypothesis using data from the Food4Me study. This was a 6-month Internet-based randomised controlled trial conducted across seven centres in Europe where individuals received either general healthy eating advice or varying levels of personalised nutrition advice. Participants who received genotype-based personalised advice were informed whether they had the risk (CT/TT) (n = 178) or non-risk (CC) (n = 141) alleles of the methylenetetrahydrofolate reductase (MTHFR) gene in relation to cardiovascular health and the importance of a sufficient intake of folate. General linear model analysis was used to assess changes in folate intake between the MTHFR risk, MTHFR non-risk and control groups from baseline to month 6 of the intervention. Results There were no differences between the groups for age, gender or BMI. However, there was a significant difference in country distribution between the groups (p = 0.010). Baseline folate intakes were 412 ± 172, 391 ± 190 and 410 ± 186 μg per 10 MJ for the risk, non-risk and control groups, respectively. There were no significant differences between the three groups in terms of changes in folate intakes from baseline to month 6. Similarly, there were no changes in reported intake of food groups high in folate. Conclusions These results suggest that knowledge of MTHFR 677C → T genotype did not improve folate intake in participants with the risk variant compared with those with the non-risk variant

Effect of an internet-based, personalized nutrition randomized trial on dietary changes associated with the Mediterranean diet: the Food4Me Study

Background: Little is known about the efficacy of personalized nutrition (PN) interventions for improving consumption of a Mediterranean diet (MedDiet). Objective: The objective was to evaluate the effect of a PN intervention on dietary changes associated with the MedDiet. Design: Participants (n = 1607) were recruited into a 6-mo, Internet-based, PN randomized controlled trial (Food4Me) designed to evaluate the effect of PN on dietary change. Participants were randomly assigned to receive conventional dietary advice [control; level 0 (L0)] or PN advice on the basis of current diet [level 1 (L1)], diet and phenotype [level 2 (L2)], or diet, phenotype, and genotype [level 3 (L3)]. Dietary intakes from food-frequency questionnaires at baseline and at 6 mo were converted to a MedDiet score. Linear regression compared participant characteristics between high (>5) and low (≤5) MedDiet scores. Differences in MedDiet scores between treatment arms at month 6 were evaluated by using contrast analyses. Results: At baseline, high MedDiet scorers had a 0.5 lower body mass index (in kg/m2; P = 0.007) and a 0.03 higher physical activity level (P = 0.003) than did low scorers. MedDiet scores at month 6 were greater in individuals randomly assigned to receive PN (L1, L2, and L3) than in controls (PN compared with controls: 5.20 ± 0.05 and 5.48 ± 0.07, respectively; P = 0.002). There was no significant difference in MedDiet scores at month 6 between PN advice on the basis of L1 compared with L2 and L3. However, differences in MedDiet scores at month 6 were greater in L3 than in L2 (L3 compared with L2: 5.63 ± 0.10 and 5.38 ± 0.10, respectively; P = 0.029). Conclusions: Higher MedDiet scores at baseline were associated with healthier lifestyles and lower adiposity. After the intervention, MedDiet scores were greater in individuals randomly assigned to receive PN than in controls, with the addition of DNA-based dietary advice resulting in the largest differences in MedDiet scores. Although differences were significant, their clinical relevance is modest. This trial was registered at clinicaltrials.gov as NCT01530139