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

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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

Development of food groupings to guide dietary advice for people with diabetes

Objective: To describe the development and characteristics of a food categorisation system and its application to guide advice for diabetes treatment. Design and methods: Foods commonly consumed by 16 adults with diabetes were grouped by macronutrient content and type of fat to form a set of reference food groups for dietary advice. Means for energy and macronutrients from individual food groups were then used to construct an overall intake pattern targeting 8000 kJ and relative amounts of carbohydrate, protein and fat (saturated fatty acids (SFA) Results: To differentiate between sources of fat, 13 food groups emerged and 10 were deemed acceptable to nutritional guidelines for diabetes treatment. The food group pattern was judged adequate for the achievement of dietary recommendations with low-potential variation in total energy (5%) and macronutrient proportions (protein 6%, fat 6%, carbohydrate 3%), but higher for fat types (SFA 22%, (monounsaturated fatty acids) MUFA 11%, PUFA 12%). Targeted proportions for fat types were achieved only when daily servings of PUFA-rich, oils, nuts and oily fish or soy were included in an ideal intake pattern. Conclusions: In theory, a dietary pattern constructed from food group sources of macronutrients and individual fat types results in low-potential variation from recommended nutrient targets and, therefore, is appropriate to guide advice for the treatment of diabetes

Walnuts and dietary approaches to the prevention and management of abnormal lipid profiles in Type 2 diabetes mellitus

Type 2 diabetes mellitus is associated with an increased risk of coronary heart disease, reflected in the presence of abnormal lipid profiles. Increasing the intake of polyunsaturated fat at the same time as reducing saturated fat can alleviate these risk factors. Including walnuts in a ‘whole of diet’ approach to managing fat consumption can help to ensure that the desired fatty acid profile is achieved. This comes via a food matrix that also delivers anti-oxidants, fibre and protein that may provide additional nutritional benefits. Thus there is good reason to include walnuts in dietary advice for patients with Type 2 diabetes mellitus

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

Obesity Reviews (Suppl2) Vol