People with type 2 diabetes not meeting important nutritional recommendations

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"The most important thing about controlling diabetes, especially type 2 diabetes, is being able to manage energy in and energy out, and the best way to do that is through the diet," said Mara Z. Vitolins, Dr.P.H., M.P.H., R.D., lead author on the study and an associate professor in the department of epidemiology and prevention, part of the School of Medicine's Division of Public Health Sciences.

The study was done to see what people with type 2 diabetes were eating to make them overweight, Vitolins said. The results were surprising, she added, because researchers found that a majority of the group was not meeting food intake recommendations outlined in national dietary guidelines.

"I thought we were going to find people who, because they have a chronic disease, were more educated about and more motivated than the average American to eat healthy, but that's not the case," she said.

For the study, researchers used a detailed survey to assess the regular food consumption of 2,757 people with type 2 diabetes as they entered into a national study evaluating the effects of a lifestyle intervention, involving weight loss and physical activity, on cardiovascular disease. The goal was to find out what the participants were eating on a regular basis that led them to being overweight before any intervention.

The study showed that 93 percent of participants exceeded the recommended percentage of daily calories from fat, 85 percent exceeded the saturated fat recommendation and 92 percent consumed too much sodium in their regular diets. Additionally, less than half of the participants met the minimum recommended daily servings of fruits, vegetables, dairy products and grains based on the year 2000 version of the Food Guide Pyramid recommendations. Intake of diets rich in fruits and vegetables have been shown to prevent heart disease, the leading cause of death in people with type 2 diabetes.

"The way that the 2000 food guide pyramid was set up is really clever," Vitolins said. "It was meant to be a visual reminder that if you take out one of the blocks, or food groups - if you're missing any of the bricks - the pyramid collapses. It just crumbles. It's important that people with type 2 diabetes follow the recommendations. They can't afford to let their pyramids fall."

Only a limited number of participants met nutrient intake recommendations for total fat, saturated fat, sodium and fiber. Overall, the participants consumed a diet that provided approximately 44 percent of calories from carbohydrates, 40 percent from fat and 17 percent from protein.

Optimizing control of blood sugar, lipids, blood pressure and weight in people with type 2 diabetes is essential to reduce the risk for long-term complications and chronic disease, including cardiovascular disease. Consuming a low-saturated fat, high-fiber diet that includes high quality, nutrient-dense foods can aid in achieving and maintaining that type of metabolic control. Evidence-based nutrition principles and recommendations, as well as national guidelines, have been established to help inform and educate the public on healthy eating practices. Still, the study showed that these participants fell short of consuming foods that would help them meet those guidelines.

"It would seem likely that participants who had managed diabetes over a greater length of time would be more likely to understand the importance of consuming a healthful diet, but this was not supported by the data," the researchers wrote.

"The findings clearly illustrate a need to provide ongoing nutrition education for people with diabetes regardless of the amount of time they've had the disease," Vitolins said. "We can't continue to assume that people know how to follow an eating pattern that is healthy if they have type 2 diabetes. These people have, within their cupboards and refrigerators, the potential to really manage their diabetes well. Day to day, the foods they are eating should be considered a vital part of their treatment."

Additionally, Vitolins added, research efforts are needed to better understand the types of barriers that overweight people with type 2 diabetes face in their attempts to consume a healthy diet.

Wake Forest University Baptist Medical Center