Diet in 45- to 74-Year-Old Individuals with Diagnosed Diabetes: Comparison to Counterparts without Diabetes in a Nationally Representative Survey (Etude Nationale Nutrition Santé 2006-2007)

A healthy diet has been shown to prevent diabetes complications. However, the eating habits of individuals with diabetes who are aware of their glycemic condition have been poorly studied. This study's objective was to assess the dietary behavior overall and according to dietary recommendations in adults diagnosed with diabetes compared with those of a general population of the same age (45 to 74 years) in a nationally representative survey carried out in France in 2006-2007 (Etude Nationale Nutrition Santé) (n=1,476 including 101 patients with diabetes). Trained dietitians assessed diet using three 24-hour recalls and diabetes was self-declared. After weighting and using multiple adjustments, mean food and nutrient intakes were compared according to diabetes status. Interactions with age and sex were sought. Adults with diabetes had lower intakes of sweetened foods (40 g/day vs 125 g/day), alcohol (1.45 g/day vs 1.64 g/day), energy (1,790 kcal/day vs 1,986 kcal/day), and simple sugar (63.1 g/day vs 89.8 g/day) and higher intakes of meat (126 g/day vs 109 g/day), complex carbohydrates (26.3% energy intake vs 23.6% energy intake), and vitamins B and E (628 μg/day vs 541 μg/day). In addition, 45- to 59-year-old individuals with diabetes ate more fruits and vegetables, fiber, beta carotene, folate, vitamin C, and potassium than adults of the same age who did not have diabetes. Overall, 45- to 74-year-old adults with diabetes had a higher-quality diet than individuals without diabetes. However, compared with recommendations, a healthy diet continues to represent a public health challenge in terms of preventing diabetes complications.     

Adherence to dietary recommendations for saturated fat, fiber, and sodium is low in American Indians and other U.S. adults with diabetes

The objective of this article was to evaluate how well American Indians with diabetes met dietary recommendations and to compare adherence to dietary recommendations with those of U.S. adults with diabetes in the NHANES. Dietary intake in both studies was assessed using a 24-h recall questionnaire. Dietary intakes were evaluated against American Diabetes Association (ADA) dietary recommendations. The analysis sample consisted of 1008 participants from the Strong Heart Study (SHS) examined from 1997 to 1999 and 373 participants from NHANES examined from 1999 to 2000, all with diabetes. In both samples, intake of protein, PUFA, monounsaturated fatty acids, and carbohydrates met the 1997 ADA dietary recommendations. However, intakes of SFA as well as sodium were higher and dietary fiber intake was lower than recommended. In the SHS and NHANES, only 4.6 and 8.5% of persons with diabetes met recommendations for both SFA and fiber (P = 0.02), respectively. However, only 8.3% of the NHANES sample met the 2006 recommendations for SFA and fiber and none of the SHS sample met those recommendations. This cross-sectional study shows low adherence to ADA dietary recommendations for saturated fat, fiber, and sodium by American Indians with diabetes and by the broader U.S. population of adults with diabetes and shows that for American Indians with diabetes, programs to decrease SFA and increase fiber intakes are warranted.     

Dietary adherence and associated glycemic control in families of young children with type 1 diabetes

OBJECTIVE: This study examined the dietary intake, dietary adherence, and associated daily glycemic control of young children (mean age 5.6+/-1.6 years) with type 1 diabetes in 33 families. DESIGN: This was a one-sample cross-sectional study. Children's nutrient and energy intakes were measured using 3-day diet diaries. Children's mean daily blood glucose levels were assessed prospectively for 2 weeks using the FreeStyle (TheraSense, Inc, Alameda, CA) home blood glucose meter. STATISTICAL ANALYSIS: Means, standard deviations, and frequencies described the sample. Associations between dietary adherence and glycemic control were examined by one-tailed Pearson correlations. RESULTS: Mean nutrient intakes were less than the Dietary Reference Intake for children's intake of vitamin B-12 and calcium. Children's dietary deviations revealed better-than-predicted adherence to the number and timing of feedings per day and number of carbohydrate units consumed per meal. In contrast, children's daily carbohydrate intake was approximately 80%+/-21% of the recommended levels based on their weight and age. In addition, children's energy intake was only 78%+/-18% of the recommended levels based on age. Correlations revealed a positive association between poor dietary adherence and higher blood glucose levels. CONCLUSIONS: Young children with type 1 diabetes are likely to have adequate dietary intake of most micronutrients. However, their adherence to specific carbohydrate and energy intake recommendations may be lower. Because the preschool years represent a period of rapid growth, diet plans for preschoolers with diabetes need to be revised often for optimal management of type 1 diabetes. Close adherence to dietary recommendations is one behavior that may improve blood glucose control in young children with diabetes.     

Do European people with type 1 diabetes consume a high atherogenic diet? 7-year follow-up of the EURODIAB Prospective Complications Study

Background/objectives

Individuals with type 1 diabetes have a high risk of developing cardiovascular diseases, and it has been reported that they consume a high atherogenic diet. We examined how nutrient intake and adherence to current European nutritional recommendations evolved in a large cohort of European individuals with type 1 diabetes over a period of 7 years.

Subjects/methods

We analysed data from the EURODIAB Prospective Complications Study, a European multicentre prospective cohort study. Standardized 3-day dietary records were employed in individuals with type 1 diabetes. One thousand one hundred and two patients (553 men, 549 women, baseline age 33 ± 10 years, duration 15 ± 9 years) had complete nutritional data available at baseline and after 7 years. We calculated mean differences in reported nutrients over time and adjusted these for age, gender, HbA_1c and BMI with ANOVA models.

Results

Compared to baseline, there were minor changes in nutrients. Reported protein (?0.35 % energy (en), fat (?1.07 % en), saturated fat (?0.25 % en) and cholesterol (?7.42 mg/1000 kcal) intakes were lower, whereas carbohydrate (+1.23 % en) and fibre (+0.46 g/1000 kcal) intakes were higher at the 7-year follow-up. European recommendations for adequate nutrient intakes were followed in individuals with type 1 diabetes for protein (76 % at baseline and 78 % at follow-up), moderately for fat (34, 40 %), carbohydrate (34, 41 %) and cholesterol (39, 47 %), but poorly for fibre (1.4, 2.4 %) and saturated fat (11, 13 %).

Conclusion

European individuals with type 1 diabetes consume a high atherogenic diet as few patients met recommendations for dietary fibre and saturated fat. This study showed minor changes in dietary nutrients and energy intakes over a period of 7 years. Nutrition education needs particular focus on strategies to increase dietary fibre and reduce saturated fat to exploit their potential benefit.     

Adherence to diet in youth with type 1 diabetes

This article reviewed current findings on dietary adherence in youth with type 1 diabetes mellitus (T1DM), discussed factors predicting dietary adherence, and presented directions for future research. The included studies involved youth with T1DM, presented dietary adherence data specifically, and/or described usual dietary patterns in youth. Articles that explored predictors had to focus exclusively on dietary adherence. The final sample was 23 articles. Adherence articles were organized into two categories: eating behaviors and macronutrients and dietary recommendations. Rates of adherence to eating behaviors ranged from 21% to 95%. Studies examining macronutrients and dietary recommendations revealed higher than recommended intakes of fat and saturated fat and lower than recommended intakes of fruits, vegetables, and whole grains. Six studies investigated factors predicting dietary adherence. These studies revealed associations with child behavior problems and knowledge deficits. The available literature identified many youth with T1DM struggling with adherence and not meeting dietary guidelines for their disease. Future research should examine diet in youth exclusively on intensive insulin regimens, community-based predictors of diet, and the influence of mood on dietary adherence.     

Sodium and Potassium Content of Foods Consumed in an Italian Population and the Impact of Adherence to a Mediterranean Diet on Their Intake

High sodium and low potassium intakes are associated with increased levels of blood pressure and risk of cardiovascular diseases. Assessment of habitual dietary habits are helpful to evaluate their intake and adherence to healthy dietary recommendations. In this study, we determined sodium and potassium food-specific content and intake in a Northern Italy community, focusing on the role and contribution of adherence to Mediterranean diet patterns. We collected a total of 908 food samples and measured sodium and potassium content using inductively coupled plasma mass spectrometry. Using a validated semi-quantitative food frequency questionnaire, we assessed habitual dietary intake of 719 adult individuals of the Emilia-Romagna region. We then estimated sodium and potassium daily intake for each food based on their relative contribution to the overall diet, and their link to Mediterranean diet patterns. The estimated mean sodium intake was 2.15 g/day, while potassium mean intake was 3.37 g/day. The foods contributing most to sodium intake were cereals (33.2%), meat products (24.5%, especially processed meat), and dairy products (13.6%), and for potassium they were meat (17.1%, especially red and white meat), fresh fruits (15.7%), and vegetables (15.1%). Adherence to a Mediterranean diet had little influence on sodium intake, whereas potassium intake was greatly increased in subjects with higher scores, resulting in a lower sodium/potassium ratio. Although we may have underestimated dietary sodium intake by not including discretionary salt use and there may be some degree of exposure misclassification as a result of changes in food sodium content and dietary habits over time, our study provides an overview of the contribution of a wide range of foods to the sodium and potassium intake in a Northern Italy community and of the impact of a Mediterranean diet on intake. The mean sodium intake was above the dietary recommendations for adults of 1.5–2 g/day, whilst potassium intake was only slightly lower than the recommended 3.5 g/day. Our findings suggest that higher adherence to Mediterranean diet patterns has limited effect on restricting sodium intake, but may facilitate a higher potassium intake, thereby aiding the achievement of healthy dietary recommendations.     

Dietary-fat intake in the US population.

OBJECTIVE: This article looks at the food group choices by individuals grouped based on fat intake, saturated fat intake, and use of lowfat foods. METHODS: Food consumption data from USDA's National Food Consumption Surveys (NFCS) and the Continuing Survey of Food Intakes by Individuals (CSFII) were used to look at changes in the mean energy, percent calories from fat and saturated-fat and total-fat intakes over time. USDA's 1995 CSFII data were used to evaluate the diets of individuals grouped based on percent calories from fat and use of low-fat foods. Individuals six to 50 years old who had complete food intake records were included and five age-gender classifications were used. RESULTS: The percent of calories from total fat and saturated fat have steadily declined over the last 30 years, and the amount of fat in the diet has increased from 1989 to 1995. Those whose diets met the Dietary Guidelines Recommendations for fat and saturated fat had lower fat intakes. Except for adult males, those with low-fat diets had higher intakes of total-food amount. Also, lower saturated-fat intakes were associated with lower energy intakes. In general, high-fruit-and-grain-products consumption were seen in groups with low-fat intake. For those who included low-fat foods in their diets and also had low-fat intakes, rice and pasta were the major foods of choice for calories. Fried potatoes were one of the main sources of calories for high-fat groups. CONCLUSION: The study showed individuals whose diets included low-fat foods are more likely to have a diet that meets the dietary guidelines recommendations for fat and saturated fat.     

Effect of low-glycemic-index dietary advice on dietary quality and food choice in children with type 1 diabetes

BACKGROUND: The practicality of diets with a low glycemic index (GI) is controversial. Theoretically, low-GI diets may limit food choice and increase dietary fat intake, but there is little objective evidence to support such a theory. OBJECTIVE: The objective was to determine the effect of low-GI dietary advice on dietary quality and food choice in children with diabetes. DESIGN: Children aged 8-13 y with type 1 diabetes (n = 104) were recruited to a prospective, randomized study comparing the effects of traditional carbohydrate-exchange dietary advice (CHOx) with those of more flexible low-GI dietary advice (LowGI). We determined the effect on long-term macronutrient intake and food choice with the use of 3-d food diaries. RESULTS: There were no differences in reported macronutrient intakes during any of the recording periods. After 12 mo, intakes of dietary fat (33.5 +/- 5.6% and 34.2 +/- 6.7% of energy, P = 0.65), carbohydrate (48.8 +/- 5.4% and 48.6 +/- 6.5% of energy, P = 0.86), protein (17.6 +/- 2.5% and 17.3 +/- 3.7% of energy, P = 0.61), total sugars, and fiber did not differ significantly between the CHOx and LowGI groups, respectively. The average number of different carbohydrate food choices per day also did not differ significantly. Subjects in the lowest-GI quartile consumed less carbohydrate as potato and white bread, but more carbohydrate as dairy-based foods and whole-grain breads than did subjects in the highest-GI quartile. CONCLUSION: Children with diabetes who receive low-GI dietary advice do not report more limited food choices or a diet with worse macronutrient composition than do children who consume a traditional carbohydrate-exchange diet.     

Systematic review and meta-analysis of energy and macronutrient intakes during pregnancy in developed countries

Research reporting diet during pregnancy in nationally representative samples is limited. This review summarizes the dietary intakes of pregnant women in developed countries and compares them with national recommendations. A systematic search without date limits was conducted. All studies reporting the macronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified the studies to be included and assessed the methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Energy and macronutrient intakes of pregnant women do not match national recommendations. Energy and fiber intakes were consistently below recommendations, while total fat and saturated fat intakes were generally above recommendations and carbohydrate and polyunsaturated fat intakes were below to borderline low compared with recommendations. A mismatch between dietary practices and macronutrient recommendations in pregnant women is widespread and not well quantified. The implications of these practices are unknown until further research compares maternal diet with short-term and long-term maternal and offspring health outcomes.     

Diet and diabetes, a brief overview: personal perspective

Over the past several years there has been renewed interest in the dietary management of persons with diabetes. Many of the older concepts are being questioned and dietary recommendations are being revised. A uniform concensus regarding the best diet for insulin-requiring diabetic persons is not available. In my opinion, the best diet, considering our state of knowledge and the limitations imposed by current treatment modalities, is a diet that is most acceptable to the patient as long as it is nutritionally adequate. Once a diet is decided upon, constancy of carbohydrate (CHO) content for each meal is emphasized. A diet low in fat and containing approximately 50-60% CHO is desirable but is not as important as patient compliance. A stable reduction in the plasma glucose concentration in these patients should be the overwhelming objective. Dietary management of non-insulin requiring diabetic persons remains uncertain and controversial. Much more scientific data are needed before dietary recommendations can be made. Nevertheless, one can educate patients regarding CHO containing foods which have a large effect on the postmeal glucose concentration (cooked potatoes and cereal products such as bread and breakfast cereals) and those which produce a smaller effect (milk and milk products, fruits, vegetables, table sugar, and honey). With the interest in the dietary management of diabetic patients at the present time, I look forward to rapid progress in this field and resolution of the current controversies.     

The effects of subject-selected high carbohydrate, low fat diets on glycemic control in insulin dependent diabetes mellitus

In the present study, six women with insulin dependent diabetes mellitus (IDDM) were assigned to begin either a control diet containing 45% of the calories as carbohydrate, 40% fat, and 15% protein for four weeks, or a high carbohydrate, low fat diet with 65% carbohydrate, 20% fat, and 15% protein for six weeks. All subjects completed both periods in a cross-over experimental design. Individual menus varied, and were subject-selected from a calculated exchange list consisting of conventional food items. Subjects selected an equal distribution of carbohydrate from simple and complex sources during both dietary periods, and dietary fiber intake was only modestly greater during the high carbohydrate diet (50 g) than in the control diet period (28 g). No significant changes occurred in any measures of glycemic control between the control and high carbohydrates diets; fasting serum glucose 215 vs 213 mg/100 ml; preprandial serum glucose 214 vs 200 mg/100 ml; 24 hour urine glucose 36 vs 31 g/day; and glycosylated hemoglobin 10.3 vs 10.5% Hb A1, respectively. Similarly, insulin dose was unchanged during the control (38 IU/day) and experimental (38 IU/day) periods. These findings indicate that the application of present dietary recommendations to persons with IDDM in a realistic clinical setting led to neither an improvement nor a deterioration of glycemic control.     

Diet and exercise habits of patients with diabetes,dyslipidemia, cardiovascular disease or hypertension

OBJECTIVE: The objective of this study was to determine whether free-living individuals diagnosed with diabetes, dyslipidemia, cardiovascular disease or hypertension follow standard dietary recommendations for treatment of these diet-modifiable disorders. METHODS: Data are from 1,782 adult men and women who completed an annual clinic visit as part of a large study of diet and health. Usual dietary intake over the previous month was assessed with a self-administered food frequency questionnaire. Trained staff obtained a detailed medical history and information on health and exercise habits, measured height and weight, and collected a fasting blood specimen to measure total serum cholesterol, triglycerides and carotenoids. Multivariate linear regression was used to test associations of diet-modifiable chronic diseases with diet and exercise habits. RESULTS: 42% of the study sample reported at least one diet-modifiable disease or risk factor for disease. These individuals had higher total serum cholesterol (p < 0.001) and triglycerides (p < 0.001) compared to those without these conditions. Diabetics consumed a greater percent of energy from fat (p < 0.01), and men with hypertension consumed a greater percent energy from saturated fat (p < 0.05) compared to those without these conditions. There were few other differences in dietary intake between diseased and healthy individuals, and on average, all participants had diets that were not consistent with recommended guidelines for prevention or treatment of these diet-modifiable disorders. Forty-six percent of all participants were overweight or obese, and BMI was significantly higher among participants with at least one diet-modifiable disorder (p < 0.001). Healthy and diseased participants exercised about 17 minutes per day, and compared to non-diabetics, persons with diabetes exercised with 25% less intensity (p < 0.05). CONCLUSION: Participants in this sample with diet-modifiable disorders reported that they are motivated to eat less fat, but most are still overweight or obese, consume a diet high in fat and low in fruits and vegetables and engage in very little physical exercise. New strategies are needed to help patients adopt and maintain healthful dietary practices that will reduce their risk.     

Sources of food affect dietary adequacy of Inuit women of childbearing age in Arctic Canada

Dietary transition in the Arctic is associated with decreased quality of diet, which is of particular concern for women of childbearing age due to the potential impact of maternal nutrition status on the next generation. The study assessed dietary intake and adequacy among Inuit women of childbearing age living in three communities in Nunavut, Canada. A culturally-appropriate quantitative food-frequency questionnaire was administered to 106 Inuit women aged 19-44 years. Sources of key foods, energy and nutrient intakes were determined; dietary adequacy was determined by comparing nutrient intakes with recommendations. The prevalence of overweight/obesity was >70%, and many consumed inadequate dietary fibre, folate, calcium, potassium, magnesium, and vitamin A, D, E, and K. Non-nutrient-dense foods were primary sources of fat, carbohydrate and sugar intakes and contributed >30% of energy. Traditional foods accounted for 21% of energy and >50% of protein and iron intakes. Strategies to improve weight status and nutrient intake are needed among Inuit women in this important life stage.     

Contemporary diet and body weight of Navajo women receiving food assistance: an ethnographic and nutritional investigation

Preceded by 6 months of ethnographic research, a survey of 107 Navajo women, primarily food assistance participants, was conducted to describe and evaluate the contemporary Navajo diet. On the basis of results of 1-day dietary recalls, mean nutrient intakes were found to be below the RDA for calcium, phosphorus, iron, vitamin A, and energy. Sixty-three percent of the women in the sample were overweight or obese. The overall percentages of energy from fat, carbohydrate, and protein were closer to those recommended in the Dietary Goals than those in the current U.S. diet. The fat in the diet appeared to be primarily saturated, however, and fiber intake was lower than the U.S. average. Traditional foods were infrequently consumed. Women with higher incomes tended to have better diets. Commodity foods supplied by USDA's Food Distribution Program provided 43% of caloric intake and 37% to 57% of the intakes of all other nutrients except fat and vitamin C for the 72% of the sample participating in that program. It is concluded that the Food Distribution Program provides an important nutritional contribution to the contemporary Navajo diet.     

The diet of 13-year-old students in the city of Saragossa

BACKGROUND: The importance of diet as a cause of different diseases and the possibility of educational involvement during the school-age years leads to it being advisable to ascertain the attitudes of young people with regard to nutrition and their eating habits. METHODS: Cross-section study. A self-test survey was conducted regarding the nutrition-related habits and knowledge on a sample randomly taken from among 543 students from the 1st level school-leaving certificate studies (age 13) in the city of Saragossa, including an assessment of the foods eaten by means of 24-hour recall and a questionnaire regarding how often different foods are eaten weekly. A pilot study was conducted on 50 individuals, with validation by means of personal interviews in 15 cases. RESULTS: A total of 516 questionnaires were analyzed. The subjects were found to possess an average degree of knowledge regarding nutrition-related matters. A total 41.5% of the sample acknowledged advertising having an impact on their diet. A greater diet-related impact was found to exist among the females analyzed. The eating survey revealed a diet consisting of normal calorie intakes, but excessive protein and low carbohydrate intakes, excess fat intake being noted among males. An excessive amount of Meat and meat products and Sweets and candies was noted, contrasting with the low Grain, Fish and Potato intake. CONCLUSIONS: Educational measures must be taken among school-age children with regard to informing them concerning the composition of foods and a correct diet, teaching them to take a critical stance with regard to food advertising. They must be counseled to lessen their intakes of Meats and Sweets and to increase the amount of complex carbohydrates and Fish.     

Adherence to Dietary Guidelines in Adults by Diabetes Status: Results From the 2012 Mexican National Health and Nutrition Survey

The aims of the present study were to compare the adherence to dietary guidelines and evaluate potential differences in nutrient profiles among adults by diabetes status. We used the Mexican Alternate Healthy Eating Index (MxAHEI) to evaluate adherence to dietary guidelines. We calculated the MxAHEI scores (total and by dietary component) with scales from 0 (non-adherence) to 100 (perfect adherence) based on a food frequency questionnaire. Mean daily intakes of macronutrients and micronutrients (g, mg, mcg/1000 kcal per day) were also estimated by diabetes status. Sex-specific, multivariable linear regression models were estimated to test whether MxAHEI scores as well as nutrient intakes were different by diabetes status. Mexican adults had low adherence to the dietary guidelines irrespective of their diabetes status (score < 50 points). Among men, the MxAHEI score was 2.6 points higher among those with diabetes than those without diabetes (46.9; 95% confidence intervals (CI): 44.6, 49.2 vs. 44.3; 95% CI: 44.2, 45.6, respectively). Among women, the total MxAHEI score was similar in individuals with diabetes compared to those without diabetes. Lower intakes of carbohydrates and added sugars and higher intakes of protein, calcium, and zinc were observed in individuals with diabetes. Our findings support the development of strategies focused on promoting dietary patterns that can help to prevent and control the disease.     

Dietary recommendations for children and adolescents with diabetes: an implementation paper

Summary and recommendations I General. 1. Children with diabetes mellitus have the same basic nutritional requirements as all other children. 2. Dietary recommendations should be based on good eating habits for the whole family. Radical changes in diet involving unusual foods or eating patterns for the child with diabetes alone are not appropriate. 3. Energy requirements of children vary widely and the energy content of the diet should be based on what the child usually eats. The diet should be reviewed regularly to meet the changing needs of growth and physical exercise without obesity. 4. The insulin regimen should, as far as is possible, be chosen to fit the child's daily life-style and preferred eating habits. Insulin type, dose and frequency should be reviewed with the diet as the child develops. 5. Regular distribution of meals and snacks throughout the day remains the most important way to avoid extremes of hyperglycaemia and hypoglycaemia. This distribution should be based on an exchange system, using handy measures and taking into account food and meal type, the particular insulin regimen and the child's exercise patterns and usual eating habits. Currently, this exchange system is based on carbohydrate foods but in the future the energy and fat contents will need further consideration. 6. Most special ‘diabetic foods’ are unnecessary. Low-calorie sweeteners, as used in low-calorie fruit squashes and fizzy drinks, are useful. 7. Children with diabetes from specific ethnic minority groups, or on vegan diets or living in deprived circumstances require special dietary attention for their diabetes. Those with coexisting chronic disorders such as cystic fibrosis or coeliac disease, should receive dietary advice from professionals with specialist knowledge. 8. Translating the principles of diabetic dietary management into a varied diet, arranged readily by the parents and eaten by the child, is demanding. It can best be met by a skilled dietitian working in close cooperation with child, parents, diabetes specialist nurse and doctor. n Infancy. 9. The diet should not differ from that of infants without diabetes. Breast feeding should be encouraged or a standard infant formula-feed used. Solids may be introduced from 3 to 6 months, but breast milk or a modified infant formula is encouraged as part of the increasingly mixed diet to at least the end of the first year. 10. Diabetes is rare in infancy so expert advice should be sought from dietitians experienced in paediatric diabetes. III Under-fives. 11. After 2 years of age the diet should slowly be changed to one relatively low in fats, with unrefined carbohydrate foods, fitting family customs and meeting energy needs. 12. Fully skimmed cows' milk contains insufficient vitamins A and D, too little fat and therefore energy for the under-fives. However, semiskimmed milk can safely be included in a nutritionally adequate diet from the age of 2 years. 13. Vitamin supplementation may be given to children aged from 1 month to 5 years according to needs and local practice for all children. There are no specific additional requirements for the under-fives with diabetes. IV Schoolchildren. 14. Reduction of fat intake, especially of saturated fats, is expected to reduce risk of coronary heart disease, and stroke in later life. After 5 years of age fat intake should be reduced to around 35–40% of total energy. 15. Replacing energy from fat by eating half or more of the daily food energy as carbohydrate, principally from unrefined, fibre-rich sources, may improve both short- and long-term health. Dietary carbohydrate for the child with diabetes should never be restricted below the usual family intake (usual range 45–50% of calories). 16. Schoolchildren should be encouraged to select their carbohydrate from sources which are rich in soluble fibre with physical structure intact (e.g. whole fruit, oats, porridge, peas, beans and lentils). These have been shown to improve glycaemic control. 17. Consumption of rapidly absorbed carbohydrate in the form of simple sugar such as fruit juice and sweets or refined starch such as mashed potato in isolation, should be discouraged. However, when used in conjunction with other nutrients within a meal, simple sugars and refined starch improve palatability without worsening metabolic control. 18. The use of sugars to prevent or treat hypoglycaemia should be established on an individual basis. 19. The proportion of energy taken as protein should not be increased among children with diabetes compared with their normal peers. 20. Supplements of minerals and vitamins are not required where a good balance of foods is taken. 21. Regular exercise should be encouraged, and insulin dose reduced or extra dietary energy provided as indicated by individual blood glucose monitoring.     

Dietary habits and health status of African‐Caribbean adults

Background: Although African‐Caribbeans in the UK are more likely to suffer from a number of diet‐related health conditions, including obesity, hypertension and type II diabetes, there have been few dietary studies on this group. The present study is based on a small survey of food and nutrient intakes and traditional dietary habits of African‐Caribbean adults living in Staffordshire. Methods: A questionnaire, designed to collect demographic data and information on medical status, physical activities, dietary, cooking and food shopping habits was administered to a convenience sample of 39 adults. Detailed information on food intakes was gathered using a modified existing Food Frequency Questionnaire with 169 items. Height and weight were measured for the calculation of body mass index. Results: The average age of the subjects was 47 years (range 19–65 years). The prevalence of obesity was 39% and one‐third of subjects reported having at least one health condition. Physical activities, outside of work, were undertaken by 95% of the sample. Traditional foods were used by 92% of respondents, including fruit and vegetables purchased at markets outside of their local area. A wide variety of foods were consumed and the percentages of energy provided by fats and carbohydrates (30% and 53%, respectively) appeared to be meeting government recommendations. However, absolute energy intakes were high and salt consumption, often in the form of commercial seasonings, exceeded government recommendations. Conclusions: The positive aspects of the diets of this population need to be encouraged. Interventions need to focus on ways of reducing total energy intakes, as well as levels of salt consumption.     

Diet and risk of diabetic retinopathy: a systematic review

Diabetic retinopathy is a microvascular complication of diabetes that threatens all individuals with diabetes, leading to vision loss or blindness if left untreated. It is frequently associated with diabetic macular edema, which can occur at any point during the development of diabetic retinopathy. The key factors known to lead to its development include hyperglycemia, hypertension, and the duration of diabetes. Though the diet is important in the development of diabetes, its role in diabetic retinopathy has not been clearly identified. In this systematic review, we aimed to identify, summarize and interpret the literature on the association between the diet and dietary intakes of specific foods, nutrients, and food groups, and the risk of diabetic retinopathy. We searched PubMed and Web of Science for English-language studies evaluating the association between the dietary intake of individual foods, macro or micronutrients, dietary supplements, and dietary patterns and their association with retinopathy or macular edema. After reviewing potentially relevant abstracts and, when necessary, full texts, we identified 27 relevant studies. Identified studies investigated intakes of fruit, vegetables, fish, milk, carbohydrates, fibre, fat, protein, salt, potassium, vitamins C, D, and E, carotenoids, dietary supplements, green tea and alcohol. Studies suggest that adherence to the Mediterranean diet and high fruit, vegetable and fish intake may protect against the development of diabetic retinopathy, although the evidence is limited. Studies concerning other aspects of the diet are not in agreement. The role of the diet in the development of diabetic retinopathy is an area that warrants more attention.     

Trends in nutrient and dietary intake among adults and the elderly: from NAHSIT 1993-1996 to 2005-2008

The aim of this study was to investigate trends in nutrients and sources of dietary intake for Taiwanese people from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 to 2005-2008. Twenty-four hour dietary recall data were obtained from the 2005-2008 NAHSIT. The results showed that intake of cereals and grains, and dietary fiber has decreased, whereas intake of carbohydrate rich convenience foods has increased. As a result, 10-20 g of dietary fat is now obtained from carbohydrate rich foods. A greater proportion of Taiwanese are choosing low-fat meat products, however, excessive intake of meat by men and women aged 19 to 64 years is resulting in excessive intakes of protein, cholesterol and saturated fat. Men and women aged 19 to 30 years had insufficient intakes of fruit and vegetables. Consumption of fruit, dairy/products, and nuts was low in all age groups. We recommend strengthening public nutrition education and changing diet related environment to improve dietary quality and food group distributions. Issues of concern include excessive intakes of energy and the soybean/fish/meat/eggs food group in all subjects, high amount of processed foods and refined-carbohydrate rich foods in men aged 19 to 64 years and women aged 19-30 years, as well as intakes below the DRI for a variety of nutrients in elderly persons.