Sleep, diet and physical activity among adults living with type 1 and type 2 diabetes

Objective: To document sleep/insomnia, fruit and vegetables (FV) consumption and physical activity (PA) according to diabetes presence and type and biological sex, as these three lifestyle habits may influence glycemic control and prevention of diabetes-related complications. Method: Adults between 18-64 years of age were invited to complete validated Web-based self-reported questionnaires assessing sleep, insomnia, FV consumption and PA. Pregnant women and shift workers were excluded from the study. Results: A total of 151 adults (80.1% women), of which 54 had diabetes (type 1 [T1D]: 30 and type 2 [T2D]: 24), completed the questionnaires. Sleep quality scores were significantly higher, indicating poorer sleep quality, according to diabetes presence (diabetes: 7.2±3.5 vs. no diabetes: 5.4±3.5, p=0.0024) and type (T1D: 6.1±2.9 vs. T2D: 8.7±3.8, p=0.0072). Sleep duration was significantly shorter among adults living with diabetes (diabetes: 7.0±1.7 hours/night vs. no diabetes: 7.8±1.3 hours/night, p=0.0019), regardless of type. More adults living with diabetes had moderate to severe clinical insomnia (diabetes: 25.9% vs. no diabetes: 10.4%, p=0.0129), especially those with T2D (T1D: 13.3% vs. T2D: 41.7%, p = 0.0182). FV consumption and PA did not significantly vary according to diabetes presence and type. Only PA differed by biological sex with lower PA among women. Discussion: The results suggest that adults living with diabetes, especially those with T2D, are at higher risk for short and poor sleep quality, and clinical insomnia. Conclusions: Adults living with diabetes, especially those with T2D, should have access to effective sleep interventions to prevent complications associated with elevated glucose levels.Objectifs L’objectif de nos travaux était de documenter le sommeil et l’insomnie, la consommation de fruits et de légumes (FL) et l’activité physique (AP) en fonction de la présence et du type de diabète, et du sexe biologique, puisque ces 3 habitudes de vie peuvent influencer la régulation de la glycémie et la prévention des complications liées au diabète. Méthodes Nous avons invité des adultes âgés de 18 à 64 ans à remplir des questionnaires valides d’autoévaluation en ligne qui portaient sur le sommeil, l’insomnie, la consommation de FL et l’AP. Nous avons exclu de l’étude les femmes enceintes et les travailleurs de quart. Résultats Un total de 151 adultes (80,1 % de femmes), parmi lesquels 54 avaient le diabète (type 1 [DT1], n = 30; type 2 [DT2], n = 24), ont rempli les questionnaires. Les scores sur la qualité du sommeil étaient significativement plus élevés, c’est-à-dire qu’ils indiquaient une moins bonne qualité de sommeil, en fonction de la présence de diabète (diabète, 7,2 ± 3,5; aucun diabète, 5,4 ± 3,5; p = 0,0024) et du type de diabète (DT1, 6,1 ± 2,9; DT2, 8,7 ± 3,8; p = 0,0072). La durée du sommeil était significativement plus courte chez les adultes qui vivaient avec le diabète (diabète, 7,0 ± 1,7 heures/nuit; aucun diabète, 7,8 ± 1,3 heures/nuit; p = 0,0019), indépendamment du type. Davantage d’adultes qui vivaient avec le diabète avaient une insomnie clinique modérée à importante (diabète, 25,9 %; aucun diabète, 10,4 %; p = 0,0129), particulièrement ceux atteints du DT2 (DT1, 13,3 %; DT2, 41,7 %; p = 0,0182). La consommation de FL et l’AP ne variaient pas de façon significative en fonction de la présence et du type de diabète. Seule l’AP différait selon le sexe biologique, c’est-à-dire une AP moindre chez les femmes. Conclusions Les résultats montrent que les adultes qui vivent avec le diabète, particulièrement le DT2, sont exposés à un risque plus élevé de courte durée de sommeil et de mauvaise qualité de sommeil, et d’insomnie clinique. Les adultes qui vivent avec le diabète, particulièrement ceux qui vivent avec le DT2, devraient avoir accès à des interventions efficaces sur le sommeil pour prévenir les complications associées à une glycémie élevée

Education Matters: Certified health professionals have higher credibility than non health professionals on Instagram

Social media serves as an accessible source of health information and nutrition information. Instagram, an internationally known social media platform with an average of more than 1 billion monthly active users, allows its users to create and share content. However, the credibility of the nutrition content created by users with unknown qualifications may be questionable. The objective of this study is to assess the credibility of content created by nutrition influencers on Instagram by comparing health professionals with non-health professionals.  For this study, “influencer” is defined as an Instagram user with at least 15,000 followers who promotes products, services, or ideas and who creates nutrition- or health-related content. For each influencer (n=29), two posts were selected every month from August 2018 to July 2019. Using the “Credible Information Factsheet” from the Dietitians of Canada, a credibility score based on four dichotomous criteria was created. Looking at the 24 posts of each influencer holistically, a credibility score out of 4 was calculated, with 0 being the least credible and 4 being the most credible.  Without exception, a greater proportion of health professionals compared to non-health professionals met each criterion from the “Credible Information Factsheet”. 92% of the health professionals met criteria 1 (Miracle Cure) compared to only 31% of non-health professionals. This demonstrates how the vast majority of health professionals would not promise a miracle cure, while most non-health professionals would readily promise a miracle cure. Additionally, 46% of health professionals met criteria 4 (Research-based) compared to only 19% of non-health professionals, which demonstrates how non-health professionals do not support claims with research. When looking at the total credibility scores for health professionals and non-health professionals, not a single health professional scored a total of 0, while not a single non-health professional scored a total of 4. Most importantly, health professionals had an average credibility score of 2.4, which is twice as high as that of non-health professionals (1.2).  Overall, health professionals appeared to be more credible than non-health professionals. By viewing nutrition information posted on Instagram by non-health professionals, followers potentially expose themselves to misinformation. Further research should be undertaken to validate the credibility score based on the “Credible Information Factsheet” by determining how adept the factsheet is at differentiating credibility for Instagram content

Facilitators and barriers experienced by federal cross-sector partners during the implementation of a healthy eating campaign

To identify facilitators and barriers that Health Canada’s (HC) cross-sector partners experienced while implementing the Eat Well Campaign: Food Skills (EWC; 2013–2014) and describe how these experiences might differ according to distinct partner types. A qualitative study using hour-long semi-structured telephone interviews conducted with HC partners that were transcribed verbatim. Facilitators and barriers were identified inductively and analysed according partner types. Implementation of a national mass-media health education campaign. Twenty-one of HC’s cross-sector partners (food retailers, media and health organizations) engaged in the EWC. Facilitators and barriers were grouped into seven major themes: operational elements, intervention factors, resources, collaborator traits, developer traits, partnership factors and target population factors. Four of these themes had dual roles as both facilitators and barriers (intervention factors, resources, collaborator traits and developer traits). Sub-themes identified as both facilitators and barriers illustrate the extent to which a facilitator can easily become a barrier. Partnership factors were unique facilitators, while operational and target population factors were unique barriers. Time was a barrier that was common to almost all partners regardless of partnership type. There appeared to be a greater degree of uniformity among facilitators, whereas barriers were more diverse and unique to the realities of specific types of partner. Collaborative planning will help public health organizations anticipate barriers unique to the realities of specific types of organizations. It will also prevent facilitators from becoming barriers. Advanced planning will help organizations manage time constraints and integrate activities, facilitating implementation

Effect of an isoenergetic traditional Mediterranean diet on apolipoprotein A-I kinetic in men with metabolic syndrome

BACKGROUND: The impact of the Mediterranean diet (MedDiet) on high-density lipoprotein (HDL) kinetics has not been studied to date. The objective of this study was therefore to investigate the effect of the MedDiet in the absence of changes in body weight on apolipoprotein (apo) A-I kinetic in men with metabolic syndrome (MetS). METHODS: Twenty-six men with MetS (NCEP-ATP III) were recruited from the general community. In this fixed sequence study, participants’ diet was first standardized to a control diet reflecting current averages in macronutrient intake in North American men, with all foods and beverages provided under isoenergetic conditions for 5 weeks. Participants were then fed an isoenergetic MedDiet over a subsequent period of 5 weeks to maintain their weight constant. During the last week of each diet, participants received a single bolus dose of [5,5,5-(2)H(3)] (L)-leucine and fasting blood samples were collected at predetermined time points. ApoA-I kinetic was determined by multicompartmental modeling using isotopic enrichment data over time. Data were analyses using MIXED models. RESULTS: The response of HDL-cholesterol (C) to MedDiet was heterogeneous, such that there was no mean change compared with the control diet. Plasma apoA-I concentration (−3.9%) and pool size (−5.3%, both P < 0.05) were significantly lower after MedDiet and apoA-I production rate tended to be reduced (−5.7%, P = 0.07) with no change in apoA-I fractional catabolic rate (FCR, -1.6%, P = 0.64). Participants among whom HDL-C concentrations were increased with MedDiet (responders: mean ∆HDL-C: +9.9 ± 3.2%, N = 11) showed significantly greater reductions in apoA-I FCR and in apoB and very-low-density lipoprotein-triglycerides (VLDL-TG) concentrations (all P < 0.04) than those among whom HDL-C levels were reduced after the MedDiet (non-responders: mean ∆HDL-C: -12.0 ± 3.9%, N = 8). Correlation analysis revealed that only variations in apoA-I FCR (r = -0.48, P = 0.01) and in plasma VLDL-TG (r = −0.45, P = 0.03) concentrations were correlated with the individual HDL-C response to the MedDiet. CONCLUSIONS: Data from this controlled feeding study suggest that the heterogeneous response of HDL-C to MedDiet, in the absence of important weight loss, is primarily related to individual variations in apoA-I FCR and in plasma VLDL-TG concentrations. TRIAL REGISTRATION: ClinicalTrial.gov registration number: NCT0098865

Full-time employment, diet quality and food skills of Canadian parents

Purpose : To explore the associations between full-time employment status, food skills, and diet quality of Canadian parents. Methods : A sample of Canadian parents (n = 767) were invited to complete a web-based survey that included sociodemographic variables, questions about food skills, and a validated food frequency questionnaire. Results were analyzed with linear and logistic regression models, controlling for sociodemographic variables and multiple testing. Results : After controlling for covariates and multiple testing, there were no statistically significant differences in foods skills between parents’ employment status. Time was the most reported barrier for meal preparation, regardless of work status, but was significantly greater for full-time compared with other employment status (P < 0.0001). Additionally, parents who worked full-time had lower odds of reporting food preferences or dietary restrictions (P = 0.0001) and health issues or allergies (P = 0.0003) as barriers to food preparation, compared with parents with other employment status. These results remained statistically significant even after controlling for covariates and multiple testing. Conclusions : Overall, food skills did not differ significantly between parents’ employment status. Time, however, was an important barrier for most parents, especially those working full time. To promote home-based food preparation among parents, strategies to manage time scarcity are needed.Objectif : Explorer les associations entre une situation d’emploi à temps plein, les compétences alimentaires et la qualité de l’alimentation des parents canadiens. Méthodes : Un échantillon de parents canadiens (n = 767) a été invité à répondre à un sondage Web comprenant des variables sociodémographiques, des questions sur les compétences alimentaires et un questionnaire de fréquence alimentaire validé. Les résultats ont été analysés au moyen de modèles de régression linéaire et logistique en tenant compte des variables sociodémographiques et des tests multiples. Résultats : Après avoir tenu compte des covariables et des tests multiples, aucune différence statistiquement significative n’a été observée quant aux compétences alimentaires des parents en fonction de leur situation d’emploi. Le temps était l’obstacle à la préparation des repas le plus souvent mentionné, quelle que soit la situation d’emploi, mais il était considérablement plus important chez les personnes travaillant à temps plein comparativement aux personnes ayant une autre situation d’emploi (P < 0,0001). De plus, les parents qui travaillaient à temps plein avaient moins de chances d’indiquer que leurs préférences ou restrictions alimentaires (P = 0,0001) et leurs problèmes de santé ou leurs allergies (P = 0,0003) étaient des obstacles à la préparation des aliments, comparativement aux parents se trouvant dans une autre situation d’emploi. Ces résultats sont demeurés statistiquement significatifs même après avoir tenu compte des covariables et des tests multiples. Conclusions : Dans l’ensemble, les compétences alimentaires des parents ne différaient pas de façon significative en fonction de leur situation d’emploi. Le temps était cependant un obstacle important pour la plupart des parents, surtout pour ceux qui travaillent à temps plein. Afin de favoriser la préparation des aliments à la maison par les parents, des stratégies pour les aider à gérer le manque de temps sont nécessaires

Current knowledge and interest of French Canadians regarding nutrigenetics

Objective: The purpose of this study was to draw a global portrait of the current knowledge and interest regarding nutrigenetics in a population of French Canadians from the province of Quebec (Canada). Methods: A total of 2238 residents from the province of Quebec, Canada, were recruited via social networks and from the Laval University employees/students lists to participate to a 37-question online survey on nutrigenetics. Results: Most participants were not familiar with the term “nutrigenetics” (82.7%). Participants with good genetic literacy (26.8%) were less interested in nutrigenetic testing (p<0.0001). The vast majority of participants (90.7%) reported to be willing to follow a personalized diet based on nutrigenetic testing, especially if they came to know themselves as carriers of a polymorphism increasing the risk of certain diseases. Participants had higher interest in testing related to metabolic response to macronutrients (types of sugars, fats and proteins) than to micronutrients or other nutrients related to food intolerance. Conclusions: The attitude of French Canadians about nutrigenetics are very consistent with results from other survey published in the literature. Although few individuals are familiar with nutrigenetics, public’s attitude towards nutrigenetics is globally favourable

Nutrigenetic testing for personalized nutrition : an evaluation of public perceptions, attitudes, and concerns in a population of French Canadians

Background/aims: This study aimed to evaluate attitudes, perceptions and concerns about nutrigenetic testing for personalized nutrition in the general population of the province of Quebec, in Canada. Methods: A total of 1425 individuals from the province of Quebec fully completed a 37 question online survey on nutrigenetics and were included in analyses. Chi-square tests were used to test for associations between categorical variables. Results: The majority of participants (93.3%) considered dietitians as the best professionals to give personalized dietary advice based on nutrigenetic testing. The main reported advantage for nutrigenetic testing was “health” (23.5%), followed by “disease prevention” (22.2%). Among disadvantages, “no disadvantage” (24.4%), followed by “diet restriction” (12.9%) were mostly reported. The two major concerns raised were the accessibility to genetic testing by telemarketing companies and spammers (51.8%), and solicitation by companies using the personal genetic data to sell products (48.6%). Conclusions: French Canadians generally have a positive attitude towards nutrigenetics and find many benefits to its use. They rose up possible confidentiality issues associated with the management or property of genetic test results. However education about confidentiality issues is still considerably needed. These findings overall suggest that the population is interested by a more extensive use of nutrigenetics in health management

Exploration of shared decision‐making processes among dieticians and patients during a consultation for the nutritional treatment of dyslipidaemia

Background: Shared decision making (SDM) holds great potential for improving the therapeutic efficiency and quality of nutritional treatment of dyslipidaemia by promoting patient involvement in decision making. Adoption of specific behaviours fostering SDM during consultations has yet to be studied in routine dietetic practice. Objective: Using a cross-sectional study design, we aimed to explore both dieticians’ and patients’ adoption of SDM behaviours in dietetic consultations regarding the nutritional treatment of dyslipidaemia. Methods: Twenty-six dieticians working in local health clinics in the Quebec City metropolitan area were each asked to identify one dyslipidaemic patient they would see in an upcoming consultation. Based on the Theory of Planned Behaviour (TPB), questionnaires were designed to study two targeted SDM behaviours: ‘to discuss nutritional treatment options for dyslipidaemia’ and ‘to discuss patients’ values and preferences about nutritional treatment options for dyslipidaemia’. These questionnaires were administered to the dietician–patient dyad individually before the consultation. Associations between TPB constructs (attitude, subjective norm and perceived behavioural control) towards behavioural intentions were analysed using Spearman’s partial correlations. Results: Thirteen unique patient-dietician dyads completed the study. Perceived behavioural control was the only TPB construct significantly associated with both dieticians’ and patients’ intentions to adopt the targeted SDM behaviours (P < 0.05). Conclusions: As perceived behavioural control seems to determine dieticians’ and patients’ adoption of SDM behaviours, interventions addressing barriers and reinforcing enablers of these behaviours are indicated. This exploratory study highlights issues that could be addressed in future research endeavours to expand the knowledge base relating to SDM adoption in dietetic practice

Assessments of the Extent to which Health‐Care Providers Involve Patients in Decision Making: A Systematic Review of Studies Using the OPTION Instrument

Background: We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. Objective: To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking

Are French Canadians able to accurately self-rate the quality of their diet? Insights from the PREDISE study

Cette étude se propose principalement de comparer l’autoévaluation de la qualité du régime alimentaire à un score de qualité nutritionnelle globale et à évaluer la prédictibilité de l’autoévaluation concernant l’adhésion aux recommandations de saine alimentation. Cette étude examine aussi la possible influence des caractéristiques individuelles sur l’association entre l’autoévaluation du régime alimentaire et le score de qualité nutritionnelle globale. Dans le cadre du projet PRédicteurs Individuels, Sociaux et Environnementaux (PREDISE), 1045 participants (51 % femmes) du Québec (Canada) ont autoévalué la qualité de leur régime alimentaire (« En général, diriez-vous que vos habitudes alimentaires sont : excellentes, très bonnes, bonnes, passables ou mauvaises? »). Les données de trois rappels alimentaires de 24 h via Internet ont permis le calcul du Healthy Eating Index (C-HEI), un indicateur de qualité nutritionnelle globale. Les participants percevaient leurs habitudes alimentaires comme étant excellentes (2,4 %), très bonnes (22,7 %), bonnes (49,5 %), passables (20,3 %) ou mauvaises (5,1 %). Le C-HEI variait significativement entre les catégories d’autoévaluation dans la direction attendue (p 68) de saine alimentation en présentant une sensibilité de 44,5 % et une spécificité de 81,5 % (statistique C = 0,63). L’association entre l’autoévaluation et le C-HEI était modifiée significativement par le sexe (p interaction = 0,0131); les femmes avaient un C-HEI plus élevé que les hommes dans les catégories « bonnes » et « passables ». L’autoévaluation du régime alimentaire permet de donner un aperçu de la qualité du régime alimentaire d’une population. Cependant, les résultats de cette étude suggèrent d’utiliser ces données avec prudence compte tenu de leur faible prédictibilité concernant l’adhésion aux recommandations de saine alimentation. Des caractéristiques individuelles sont susceptibles d’influencer l’aptitude à autoévaluer adéquatement la qualité du régime alimentaire.The main objective of this study was to compare self-rated diet quality to a more comprehensive score of diet quality and to assess the ability of self-rated diet quality to predict adherence to healthy eating guidelines. This study also aimed at evaluating the influence of individual characteristics on the association between self-rated diet quality and the overall diet quality score. As part of the PREDISE study, 1045 participants (51% women) from the Province of Québec, Canada, self-rated their diet quality (“In general, would you say that your dietary habits are: excellent, very good, good, fair, or poor?”). Three web-based 24-hour food recalls were completed, generating data for the calculation of the Canadian Healthy Eating Index (C-HEI), an overall diet quality indicator. Participants rated their diet quality as excellent (2.4%), very good (22.7%), good (49.5%), fair (20.3%) or poor (5.1%). The C-HEI significantly differed between diet ratings, in the expected direction (p<0.0001). Self-rated diet quality predicted adherence to healthy eating guidelines (i.e. C-HEI>68) with a sensitivity of 44.5% and a specificity of 81.5% (c-statistic=0.63). Sex significantly modified the association between self-rated diet quality and C-HEI (p interaction=0.0131); women had higher C-HEI than men in the “good” and “fair” ratings. Self-rated diet quality can be useful to obtain an overview of the diet quality of a population. Results of this study suggest that such data should be used with caution given its poor ability to predict adherence to healthy eating guidelines. Individual characteristics may influence one’s ability to appropriately self-evaluate diet quality