The effectiveness of structured food pattern advice for achievement of macronutrient targets in nutrition intervention

Dietary advice to individuals in Medical Nutrition Therapy for the prevention and treatment of disease should be based on the best available evidence. A review of the evidence identifies appropriate nutrients on which to base advice. However, evidence to support the application of advice for the achievement of nutrient targets in free-living individuals has not been adequately determined. In this doctoral program the hypothesis tested was that structured advice based on the pattern of intake from food group sources of required nutrients will result in better achievement of dietary targets and thereby clinical outcomes than advice based on existing core food guides. In developing a more comprehensive food guidance system, nutritional therapy for diabetes treatment provides an appropriate example in which individual macronutrients and the type of fat are targets of advice. A cross-sectional survey of the food habits of a sample of women with Gestational Diabetes Mellitus was conducted to confirm the relevance of food patterns to specific clinical outcomes, in this case, glucose tolerance. Secondly, foods commonly consumed by these women enabled the identification of food groups likely to impact on macronutrient and fat profiles within the diet. Subsequent determination of a total diet model demonstrated that a structured approach to dietary advice relating to nine food groups (vegetables, starch, fruit, milk, soymilk, meat, oily fish/soybeans, monounsaturated and polyunsaturated fats) for the identification of sources of saturated and unsaturated fats would achieve nutritional adequacy and targets for energy and individual macronutrients with minimal variation. This then formed the basis of individualised advice in dietary intervention trials. Applying the newly developed advice system in an intervention trial demonstrated its feasibility in women with Gestational Diabetes Mellitus. Compared with a similar group receiving standardised low fat advice, 80% achieved saturated and polyunsaturated fat targets compared with nil in the standard intervention group, without detrimental changes to the overall macronutrient profile. The clinical effectiveness of the advice system was again demonstrated in a second trial. In this study men and women with Type 2 Diabetes Mellitus followed two alternative patterns of advice based on the newly developed food guidance system for six months. In these two groups respectively, 79% and 100% of subjects, achieved targeted proportions of total polyunsaturated fat compared to 25% in a control group (p(less than)0.05). In addition, greater improvements were achieved for HDL cholesterol (+18% and +21% compared to +13% control, p(less than)0.05) and triglyceride levels (-12% and -11% compared to -2% control). In summary, this thesis has outlined the development and evaluation of an advice system to support nutrition intervention in people with diabetes. Individualised advice based on a structured food pattern identifying food group sources of target nutrients was both feasible to implement and effective in practice. The application of this knowledge will help support nutrition intervention research as well as provide an evidence-based approach to Medical Nutrition Therapy

Journal of music therapy

Women with gestational diabetes mellitus (GDM) have a greater risk of developing type 2 diabetes mellitus (DM) and heart disease than pregnant women without GDM. Advice given during the GDM pregnancy provides an opportunity to develop protective dietary patterns for the long-term management of this risk. Dietary guidelines for the prevention and management of type 2 DM support the inclusion of unsaturated fats, but food advice needs to target this outcome. The aim of this study was to compare the dietary intakes of women with GDM given general low-fat advice (control group) to women with GDM given the same advice with additional targets for food sources of unsaturated fats (intervention group). After approximately 6 weeks, the intervention group reported more ideal dietary fatty acid intakes than the control group, with polyunsaturated: saturated fat ratios of 1:1 and 0.4:1, respectively (P<.001), assessed using repeated measures analysis of variance. These results confirm the need to include food sources of unsaturated fats in advice strategies to assure optimal protective eating habits in this at-risk group

Different approaches to dietary advice all produce weight loss but with differences in dietary fat profile

Obesity Reviews (Suppl2) Vol