Impact of food pattern on glycemic control among type 2 diabetic patients: a cross-sectional study in the United Arab Emirates

Amena Sadiya, Rama Mnla, Amena Sadiya, Rama Mnla

Abstract

Background: Optimum nutrition has an integral role in glycemic control of diabetic patients. In this study, we intend to explore the frequency of food group/item consumption and its association with the risk of poor glycemic control (HbA1c >7%) among type 2 diabetes (T2D) patients in the United Arab Emirates (UAE), since there are no data available in this region.

Methods: In this retrospective cross-sectional study, data on frequency of food group/item consumption of 843 T2D patients aged ≥18 years were collected from records documented by dietitians in a tertiary care center in the UAE.

Results: The trends of food consumption demonstrate that one-third of the participants consumed all five major food groups, and 10% adhered to the recommended "MyPlate" meal pattern with the optimum mix of food groups. Univariate analysis indicated that participants who adhered to the MyPlate meal pattern presented lower HbA1c (β=-0.78, 95% CI -1.22, -0.25; P<0.01). Daily intake of fresh fruit was shown to be protective (β=-0.64, 95% CI -1.26, -0.04; P=0.04) while fruit juice intake >1 time/day increased the risk of poor glycemic control (β=1.53, 95% CI 0.72, 2.35; P<0.001). Multiple logistic regression models (area under the receiver operating characteristics curve =0.67) showed consumption of fizzy drinks and fast food ≥1 time/week increased the odds of poor glycemic control by 2.05 (95% CI 1.16, 3.68; P=0.01) and 1.83 (95% CI 1.02, 3.3 P=0.04), respectively, while fresh fruit consumption indicated a clinically relevant protective effect (OR=0.65, 95% CI 0.23, 1.79; P=0.4).

Conclusion: Consuming food such as fizzy drinks and fast food ≥1 time/week could possibly serve as an independent predictor for poor glycemic control, while fresh fruit could have a protective effect on glycemic control among T2D patients.Clinical Trial Registry: ClinicalTrials.gov Identifier: NCT03388229.

Keywords: United Arab Emirates; diabetes; food consumption; food pattern; glycemic control.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Food group/item consumption frequency in patients with type 2 diabetes mellitus in the United Arab Emirates (n=843).

References

    1. International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Brussels: International Diabetes Federation; 2017.
    1. Nathan DM; DCCT/EDIC Research Group. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care. 2014;37(1):9–16. doi:10.2337/dc13-2112
    1. Papamichou D, Panagiotakos DB, Itsiopoulos C. Dietary patterns and management of type 2 diabetes: a systematic review of randomised clinical trials. Nutr Metab Cardiovasc. 2019. doi:10.1016/j.numecd.2019.02.004
    1. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–865. doi:10.1016/S0140-6736(98)07037-8
    1. Coppell KJ, Kataoka M, Williams SM, et al. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment–Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. Bmj. 2010;341:c3337. doi:10.1136/bmj.c3337
    1. Abdi S, Sadiya A, Ali S, Varghese S, Abusnana S. Behavioural Lifestyle Intervention Study (BLIS) in patients with type 2 diabetes in the United Arab Emirates: a randomized controlled trial. BMC Nutr. 2015;1:37. doi:10.1186/s40795-015-0028-4
    1. Sadiya A, Abdi S, Abusnana S. Lifestyle intervention for weight loss: a group-based program for Emiratis in Ajman, United Arab Emirates. Diabetes Metab Syndr Obes. 2016;18(9):101–108. doi:10.2147/DMSO.S103620
    1. Jones-McLean EM, Shatenstein B, Whiting SJ. Dietary patterns research and its applications to nutrition policy for the prevention of chronic disease among diverse North American populations. Appl Physiol Nutr Metab. 2010;35:195–198. doi:10.1139/H10-003
    1. Antonio JP, Sarmento RA, de Almeida JC. Diet quality and glycemic control in patients with type 2 diabetes. J Acad Nutr Diet. 2019;119(4):652–658. doi:10.1016/j.jand.2018.11.006
    1. Dis Rahati S, Shahraki M, Arjomand G, Shahraki T. Food pattern, lifestyle and diabetes mellitus. Int J High Risk Behav Addict. 2014;3(1):e8725. doi:10.5812/ijhrba.8725.
    1. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42(5):731–754. doi:10.2337/dci19-0014
    1. Juarez DT, Ma C, Kumasaka A, Shimada R, Davis J. Failure to reach target glycated a1c levels among patients with diabetes who are adherent to their antidiabetic medication. Popul Health Manag. 2014;17(4):218–223. doi:10.1089/pop.2013.0099
    1. Baynouna LM, Neglekerke NJ, Ali HE, et al. Audit of healthy lifestyle behaviors among patients with diabetes and hypertension attending ambulatory health care services in the United Arab Emirates. Glob Health Promot. 2017;21(4):44–51. doi:10.1177/1757975914528248
    1. Al-Kaabi J, Fatma Al-Maskari F, Saadi H, et al. Assessment of dietary practice among diabetic patients in the United Arab Emirates. Rev Diabet Stud Summer. 2008;5(2):110–115.
    1. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Suppl 1):S120–43. doi:10.2337/dc14-S120
    1. United Arab Emirates Population. April 2, 2019. Accessed June8, 2019 Available from:
    1. Razzak HA, Harbi A, Shelpai W, Qawas A. Epidemiology of diabetes mellitus in the United Arab Emirates. Curr Diabetes Rev. 2018;14(6):542–549. doi:10.2174/1573399813666170920152913.
    1. Thanopoulou A, Karamanos B, Angelico F, et al. Nutritional habits of subjects with type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD). Diabetologia. 2004;47:367. doi:10.1007/s00125-003-1316-0
    1. Schwingshackl L, Knüppel S, Michels N, et al. Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries. Eur J Epidemiol. 2019. doi:10.1007/s10654-019-00523-4
    1. Dave JM, An LC, Jeffery RW, Ahluwalia JS. Relationship of attitudes toward fast food and frequency of fast-food intake in adults. Obesity (Silver Spring). 2009;17(6):1164–1170. doi:10.1038/oby.2009.26
    1. Maryniuk MD. From pyramids to plates to patterns: perspectives on meal planning. Diabetes Spectr. 2017;30:67–70. doi:10.2337/ds16-0080
    1. Du H, Li L, Bennett D, et al. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: a 7-y prospective study of 0.5 million Chinese adults. PLoS Med. 2017;14:4. doi:10.1371/journal.pmed.1002230
    1. Silva FM, Kramer CK, de Almeida JC, Steemburgo T, Gross JL, Azevedo MJ. Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutr Rev. 2013;71:790–801. doi:10.1111/nure.2013.71.issue-12
    1. Kim Y, Keogh JB, Clifton PM. Polyphenols and glycemic control. Nutrients. 2016;8:E17. doi:10.3390/nu8010017
    1. Xu YJ, Tappia PS, Neki NS, et al. Prevention of diabetes-induced cardiovascular complications upon treatment with antioxidants. Heart Fail Rev. 2014;19:113–121. doi:10.1007/s10741-013-9379-6
    1. Chan HT, Yiu KH, Wong CY, et al. Increased dietary fruit intake was associated with lower burden of carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus. Diabet Med. 2013;30:100–108. doi:10.1111/dme.12142
    1. Wang B, Liu K, Mi M, Wang J. Effect of fruit juice on glucose control and insulin sensitivity in adults: a meta-analysis of 12 randomized controlled trial. PLoS One. 2014;9(4):e95323. doi:10.1371/journal.pone.0095323.
    1. Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Jama. 2004;292:927–934. doi:10.1001/jama.292.8.927
    1. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48(4):677–685. doi:10.1016/j.jacc.2006.03.052
    1. McKeown NM, Dashti HS, Ma J, et al. Sugar-sweetened beverage intake associations with fasting glucose and insulin concentrations are not modified by selected genetic variants in a ChREBP-FGF21 pathway: a meta-analysis. Diabetologia. 2018;61(2):317–330. doi:10.1007/s00125-017-4475-0
    1. Yuzbashian E, Asghari G, Mirmiran P, Zadeh-Vakili A, Azizi F. Sugar-sweetened beverage consumption and risk of incident chronic kidney disease: tehran lipid and glucose study. Nephrology (Carlton). 2016;21(7):608–616. doi:10.1111/nep.12646
    1. Fenwick EK, Gan AT, Man RE, et al. Diet soft drink is associated with increased odds of proliferative diabetic retinopathy. Clin Exp Ophthalmol. 2018. doi:10.1111/ceo.13154
    1. Bodicoat DH, Carter P, Comber A, et al. Is the number of fast-food outlets in the neighbourhood related to screen-detected type 2 diabetes mellitus and associated risk factors? Public Health Nutr. 2015;18(9):1698–1705. doi:10.1017/S1368980014002316
    1. Ceriello A, Quagliaro L, Piconi L, et al. Effect of postprandial hypertriglyceridemia and hyperglycemia on circulating adhesion molecules and oxidative stress generation and the possible role of simvastatin treatment. Diabetes. 2004;53:701–710. doi:10.2337/diabetes.53.6.1467
    1. Tyldum GA, Schjerve IE, Tjonna AE, et al. Endothelial dysfunction induced by post-prandial lipemia: complete protection afforded by high-intensity aerobic interval exercise. J Am Coll Cardiol. 2009;53:200–206. doi:10.1016/j.jacc.2008.09.033
    1. Hollekim-Strand SM, Malmo V, Follestad T, Wisløff U, Ingul CB. Fast food increases postprandial cardiac workload in type 2 diabetes independent of pre-exercise: a pilot study. Nutr J. 2015;14:p1–11. doi:10.1186/s12937-015-0069-1

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere