The 3C Nutrition Ancillary Study: describing the integration of diet and disease self-management among adolescents and adults with type 1 diabetes in China Public Deposited

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  • March 19, 2019
Creator
  • Jaacks, Lindsay
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
Abstract
  • The incidence of type 1 diabetes (T1D) is increasing in China and morbidity and mortality may be substantially higher there than in the U.S. While results of clinical trials support intensive disease self-management to reduce the risk of complications, our knowledge of self-management practices in China is limited in scope and outdated. In order to address this gap, a cross-sectional study was conducted in Beijing from January-August 2013. Data collection entailed a fasting blood draw, a questionnaire, and three 24-hour dietary recalls. Telephone administration of the 24-hour recalls was validated against in-person administration in a pilot study. Data on individuals without diabetes were from the China Health and Nutrition Survey. The aims were three-fold: among individuals with T1D in Beijing, 1) to describe the contribution of nutrition education to disease self-management and diet, 2) to compare their dietary intake to individuals without diabetes in Beijing, and 3) to use reduced rank regression to identify dietary pattern(s) that maximize the explained variation in key cardiometabolic risk factors. Participants (n=100) averaged 41.7 ±16.3 years old, diabetes duration, 11.8 ±9.7 years. Fewer than half of participants had "ever" met with a dietitian and only 18% had attended a diabetes education session that covered nutrition in the past 12 months. Nutrition therapy for T1D typically involved matching fixed insulin doses to a diet that was rigid with respect to amount and timing, rather than an individualized, flexible approach recommended by international Diabetes Associations. One effect of this was that participants with T1D had a significantly lower mean percentage of energy from carbohydrates and higher mean percentages of energy from fat and protein compared to a cohort of individuals without diabetes in Beijing. Finally, we identified a dietary pattern characterized by high intakes of wheat products and low-sugar cakes, and low intakes of beans and pickled vegetables that was significantly associated with lower HbA1c and LDL cholesterol. Together, these results highlight an important need for nutrition counseling for individuals with T1D in China that is consistent with current clinical practice guidelines to promote health and reduce risk for complications of diabetes.
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  • In Copyright
Advisor
  • Popkin, Barry
  • Crandell, Jamie
  • Mayer-Davis, Elizabeth
  • Rosamond, Wayne D.
  • Mendez, Michelle
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2014
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  • Chapel Hill, NC
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  • This item is restricted from public view for 1 year after publication.
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