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A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study.
Zazpe, I, Sanchez-Tainta, A, Estruch, R, Lamuela-Raventos, RM, Schröder, H, Salas-Salvado, J, Corella, D, Fiol, M, Gomez-Gracia, E, Aros, F, et al
Journal of the American Dietetic Association. 2008;(7):1134-44; discussion 1145
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Abstract
OBJECTIVE To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet. DESIGN A 12-month assessment of a randomized primary prevention trial. SUBJECTS/SETTINGS One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or > or =3 cardiovascular risk factors. INTERVENTION Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1 L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines. MAIN OUTCOME MEASURES Changes in food and nutrient intake after 12 months. STATISTICAL ANALYSES Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted. RESULTS Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits (P<0.05 for all within- and between-group differences). Participants in all three groups decreased their intake of meat and pastries, cakes, and sweets (P<0.05 for all). Fiber, monounsaturated fatty acid, and polyunsaturated fatty acid intake increased in the Mediterranean diet groups (P<0.005 for all). Favorable, although nonsignificant, changes in intake of other nutrients occurred only in the Mediterranean diet groups. CONCLUSIONS A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual's overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.
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A randomised controlled trial investigating the effect of an intensive lifestyle intervention v. standard care in adults with type 2 diabetes immediately after initiating insulin therapy.
Barratt, R, Frost, G, Millward, DJ, Truby, H
The British journal of nutrition. 2008;(5):1025-31
Abstract
Obesity and type 2 diabetes are inextricably linked. It is therefore unfortunate that insulin, the ultimate treatment to improve glycaemic control in type 2 diabetes, is associated with significant weight gain. The aim of the present investigation was to ascertain whether a dietitian-led intensive lifestyle intervention could attenuate weight gain associated with commencing insulin therapy. Subjects (n 50) with type 2 diabetes, within 4 weeks of starting insulin therapy, were randomly allocated to a control or intervention group. The control group continued with standard care whilst the intervention group followed a dietitian-led intensive lifestyle intervention. Over 6 months the control group gained 4.9 (sd 3.6) kg (P < 0.001), whilst the intervention group maintained their weight ( - 0.6 (sd 5.1) kg (NS). The difference in weight change between the groups was 5.5 kg (P < 0.001). The control group had significant increases whilst the intervention group had slight decreases in: BMI (+1.7 (sd 1.3) kg/m2 (P < 0.001) v. - 0.3 (sd 2.0) kg/m2 (NS)), waist circumference (+5.3 (sd 5.0) cm (P < 0.001) v. - 0.4 (sd 5.2) cm (NS)) and percentage body fat (+1.5 (sd 2.0) % (P < 0.001) v. - 0.4 (sd 2.8) % (NS)). Differences between the groups for these parameters were significant (P < 0.01). Throughout the study, both groups experienced significant reductions in HbA1c, but only minor changes in blood lipids. The present study demonstrates that weight gain is not an inevitable consequence of starting insulin therapy, but attenuation of the weight gain requires a high level of intervention. The first 6 months to 1 year after initiating insulin therapy provides the ideal 'window of opportunity'.
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Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes.
Reader, D, Splett, P, Gunderson, EP, ,
Journal of the American Dietetic Association. 2006;(9):1426-33
Abstract
Nutrition practice guidelines were developed for gestational diabetes mellitus by registered dietitians from the Diabetes Care and Education and the Women's Health and Reproductive Nutrition dietetic practice groups. To validate the guidelines, a clinical trial was designed with clinic sites randomly assigned to either nutrition practice guidelines care (12 sites) or usual nutrition care (13 sites), with diabetes, obstetric, and other clinic types represented in both groups. Volunteer dietitians served as study coordinators and recruited women diagnosed with gestational diabetes mellitus. The nutrition practice guidelines define medical nutrition therapy (MNT) for gestational diabetes and emphasize three areas-definition of MNT clinical goals with indexes to modify or advance MNT and criteria to start insulin; use of self-monitoring tools; and provision of three nutrition visits. Usual care sites provided prenatal nutrition care according to usual practice. The effect of nutrition care (sites following the nutrition care guidelines) and type of clinic site on changes in glycated hemoglobin and infant birth weight, adjusted for other covariates, were evaluated using linear regression. Differences in insulin use and other infant outcomes between treatment groups were evaluated using logistic regression. Generalized estimating equations were used to accommodate nonindependence within randomized clusters of patients within clinic sites. Data from 215 women indicated less insulin use at diabetes clinic sites in the nutrition practice guidelines groups and improved glycated hemoglobin control during the treatment period in diabetes clinics compared with obstetric or other clinics. A higher proportion of women in the usual care group had glycated hemoglobin levels that exceeded 6% at follow-up compared with women in the nutrition practice guidelines group (13.6% vs 8.1%), although not statistically significant (P=0.26). A significant clinic type and treatment group effect was found for birth weight. Nutrition practice guidelines for gestational diabetes mellitus reflected nutrition care already being provided by registered dietitians in diabetes clinics prior to this study because outcomes at these clinics were not impacted. Use of the guidelines by dietitians at obstetric and other clinics tended to improve outcomes at these sites.