Melissa Gutschall

A randomized behavioural trial targeting glycaemic index improves dietary, weight and metabolic outcomes in patients with type 2 diabetes.

OBJECTIVE Glycaemic index (GI) reflects the postprandial glucose response of carbohydrate-containing foods. A diet with lower GI may improve glycaemic control in people with diabetes. The purpose of the present study was to evaluate the change in outcomes following a behavioural intervention which promoted lower-GI foods among adults with diabetes. DESIGN A pre-test-post-test control group design was used with participants randomly assigned to an immediate (experimental) or delayed (control) treatment group. The intervention included a 9-week, group-based intervention about carbohydrate and the glycaemic index. Dietary, anthropometric and metabolic measures were obtained pre/post-intervention in both groups and at 18-week follow-up for the immediate group. SETTING The study was conducted in a rural community in the north-eastern USA. SUBJECTS Adults having type 2 diabetes mellitus for > or =1 year, aged 40-70 years and not requiring insulin therapy (n 109) were recruited. RESULTS Following the intervention, mean dietary GI (P < 0.001), percentage of energy from total fat (P < 0.01) and total dietary fibre (P < 0.01) improved in the immediate compared with the delayed group. Mean BMI (P < 0.0001), fasting plasma glucose (P = 0.03), postprandial glucose (P = 0.02), fructosamine (P = 0.02) and insulin sensitivity factor (P = 0.04) also improved in the immediate group compared with the delayed group. Mean waist circumference among males (P < 0.01) and body weight among males and females (P < 0.01) were significantly different between treatment groups. CONCLUSIONS Educating clients about carbohydrate and the glycaemic index can improve dietary intake and health outcomes among adults with type 2 diabetes.

Impact of 100% Fruit Juice Consumption on Diet and Weight Status of Children: An Evidence-based Review

Consumption of 100% fruit juice remains controversial for its potential adverse impact on weight and displacement of essential foods in the diets of children. A systematic review of the literature published from 1995–2013 was conducted using the PubMed database to evaluate associations between intake of 100% fruit juice and weight/adiposity and nutrient intake/adequacy among children of 1 to 18 years of age. Weight status outcome measures included body mass index (BMI), BMI z-score, ponderal index, obesity, weight gain, adiposity measures, and body composition. Nutrient outcome measures included intake and adequacy of shortfall nutrients. Data extraction and analysis was conducted according to the Academy of Nutrition and Dietetics Evidence Analysis Process. Twenty-two studies on weight status provided evidence that did not support an association between 100% fruit juice consumption and weight/adiposity in children after controlling for energy intake. Limited evidence from eight studies suggests that children consuming 100% fruit juice have higher intake and adequacy of dietary fiber, vitamin C, magnesium, and potassium. Differences in methodology and study designs preclude causal determination of 100% fruit juice as sole influencer of weight status or nutrient intake/adequacy of shortfall nutrients. In context of a healthy dietary pattern, evidence suggests that consumption of 100% fruit juice may provide beneficial nutrients without contributing to pediatric obesity.

The development of self-efficacy and outcome expectation measures regarding glycaemic load and the nutritional management of type 2 diabetes

OBJECTIVE Traditionally, carbohydrate has been the largest contributor to energy intake among people with diabetes, yet different carbohydrate foods produce different glycaemic responses. Glycaemic load represents the total glycaemic effect of the diet and influences glycaemic control. Adequate self-efficacy and outcome expectations are needed to change carbohydrate intake and to evaluate relevant interventions. The purpose of this research was to develop and test instruments regarding self-efficacy and outcome expectations for the adoption of a lower glycaemic load diet. DESIGN Participants completed each instrument at their convenience and mailed the instruments to the investigators. SETTING/SUBJECTS A community sample of individuals 21-75 years of age with type 2 diabetes for >or= 1 year (n = 108) was recruited. RESULTS Principal components analysis revealed three factors on the self-efficacy questionnaire: glycaemic index, negative food selection and self-regulation efficacy which accounted for 62% of the variance in these items. The outcome expectations instrument yielded three factors: barriers to dietary change and glycaemic control, and family support expectations which accounted for 48% of the variance. Coefficient alpha for each construct was >0.70 and coefficient H for each construct was >or= 0.80. CONCLUSIONS The two instruments developed for this study can provide important insights about the self-efficacy and outcome expectations regarding the quantity and quality of carbohydrate consumed and self-monitoring performed for diabetes management. Future research is needed to evaluate the relationship among these constructs, dietary intake and glycaemic control.

Self-monitoring predicts change in fiber intake and weight loss in adults with diabetes following an intervention regarding the glycemic index

OBJECTIVE Self-monitoring can facilitate behavioral change by providing feedback regarding goal attainment. Glycemic index (GI) quantifies the glycemic response to carbohydrate-containing foods. Low GI diets may improve weight and glycemic control. We examined the relation between self-monitoring and changes in diet and body weight following an intervention in which consumption of low GI foods was encouraged among adults aged 40-70 years with diabetes. METHODS Pre/post-intervention dietary intake was assessed with 24-h dietary recalls and weight was obtained. Mean number of days participants kept self-monitoring records was determined. The impact of self-monitoring on the change in GI, fiber intake, weight and body mass index (BMI) was evaluated using regression analyses. RESULTS Each additional day of self-monitoring was associated with a mean reduction in weight and BMI of -0.95 kg and -0.34 kg/m(2), respectively. The mean change in fiber intake increased in men but did not significantly change in women for each additional day of monitoring. CONCLUSION Self-monitoring was associated with weight loss in men and women and greater fiber intake in men. PRACTICE IMPLICATIONS Men can self-monitor to lose weight and increase fiber intake. Self-monitoring facilitates weight loss in women but other behavioral strategies are needed to improve fiber intake.

A Randomized Trial About Glycemic Index and Glycemic Load Improves Outcomes Among Adults With Type 2 Diabetes

Glycemic index (GI) represents the postprandial glucose response of carbohydrate foods, and glycemic load (GL) represents the quantity and quality of carbohydrate consumed. A diet lower in GI and GL may improve diabetes management. A 9-week intervention regarding GI and GL was evaluated among adults in the age range of 40-70 years who had had type 2 diabetes ≥1 year (n = 103). Randomized pre—post test design with immediate and delayed treatment groups was employed. Dietary intake, knowledge, outcome expectations, self-efficacy, and empowerment regarding GI and GL and glucose monitoring were assessed. Four components were identified for outcome expectations using principal components analysis (dietary barrier, glycemic control, family support, and glucose monitoring), and two components were identified for self-efficacy (GI and self-regulation). Significant improvements in GI, knowledge, empowerment, self-efficacy, and outcome expectations (all p < .05) were observed except for glucose monitoring expectations. Only self-regulation efficacy significantly declined (p < .05) at the follow-up assessment in the immediate group. Nutrition education regarding GI and GL can improve dietary intake, knowledge, outcome and efficacy expectations, and empowerment for diabetes management.

The Time Is Now: A Blueprint for Simulation in Dietetics Education

C LINICAL SIMULATION MODELS are increasingly used as tools for facilitating the education and training of health care professionals. Levett-Jones and Lapkin defined simulation as “a technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner.” Gaba stated that simulation, although sometimes delivered through technologic means, is not a technology. Rather, simulation is an instructional technique or methodology for imitating the real world by providing guided, participative experiences to students outside real-world settings. The increased complexity of the health care industry, higher patient acuity levels, severe financial penalties for provider errors, and reduction in the availability of clinical placements for students have been cited as reasons for the increasing amount of research focused on simulation in health care education. In 1999, the well-known Institute of Medicine report, To Err Is Human: Building a Safer Health System, suggested that the use of simulation in health professions education could promote enhanced interdisciplinary interactions resulting in improved patient safety. Patient safety may be enhanced by simulations that allow learners to rehearse clinical behaviors in a low-risk environment, thus permitting students to make mistakes and to learn from those mistakes without harming patients. Application of a rehearsal analogy to health care simulation reveals similarities to other fields of endeavor, including but not limited to sports, music, aviation, the military, and law enforcement, in which practice before immersion in real situations plays a vital role in the training of professionals. The purpose of this article is to describe a rationale for the incorporation of simulation methodology within dietetics education programs, and to propose a blueprint for the design, use, and evaluation of dietetics-focused simulations.

A Reduced-Carbohydrate Diet Improves Outcomes in Patients With Metabolic Syndrome: A Translational Study

Carbohydrate-restricted diets have been promoted for the management of central obesity, a feature of metabolic syndrome. This study evaluated the impact of a reduced-carbohydrate diet provided in a typical outpatient setting on outcomes associated with metabolic syndrome. Adults older than 21 years who met the criteria for metabolic syndrome were recruited (n = 21) and received 2 nutritional counseling sessions. Changes in body weight, blood pressure, and anthropometric, glucose, and lipid outcomes were assessed. Participants lost a mean (±SD) of 5.0 (±3.4) kg (P < .05). There was a significant reduction in waist circumference, body mass index, and systolic and diastolic blood pressure (all P < .01). No significant improvement in glucose or lipoprotein level was observed. Only 50% of participants met the criteria for metabolic syndrome at the end of the study. A reduced-carbohydrate diet can be effective in promoting weight loss and is accompanied by improvements in body composition and blood pressure over 3 months.

Addressing Health Disparities in Rural Nutrition Practice: A Qualitative Model from Rural Appalachia

ABSTRACT This study used a mixed methods design to explore factors that affect food choices and nutrition care in rural Appalachian people. Ten registered dietitians, 10 graduate dietetic interns, and 10 rural patients participated in an interview or focus group and completed a descriptive questionnaire. Identified themes and subthemes were incorporated into 4 components depicted by the rural health nutrition care model—(1) access and resources; (2) sociocultural characteristics; (3) traditional foods; and (4) health behaviors—and verified by participants. Understanding factors that affect nutrition care of rural Appalachian people can enhance cultural competence for dietetics practitioners. Future research should verify these findings within other pockets of Appalachia and further investigate successful strategies for overcoming barriers within each model component.