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Food intake of individuals with and without diabetes across different countries and ethnic groups

Abstract

Background/Objectives:

Given the importance of nutrition therapy in diabetes management, we hypothesized that food intake differs between individuals with and without diabetes. We investigated this hypothesis in two large prospective studies including different countries and ethnic groups.

Subjects/Methods:

Study populations were the European Prospective Investigation into Cancer and Nutrition Study (EPIC) and the Multiethnic Cohort Study (MEC). Dietary intake was assessed by food frequency questionnaires, and calibrated using 24h-recall information for the EPIC Study. Only confirmed self-reports of diabetes at cohort entry were included: 6192 diabetes patients in EPIC and 13 776 in the MEC. For the cross-sectional comparison of food intake and lifestyle variables at baseline, individuals with and without diabetes were matched 1:1 on sex, age in 5-year categories, body mass index in 2.5 kg/m2 categories and country.

Results:

Higher intake of soft drinks (by 13 and 44% in the EPIC and MEC), and lower consumption of sweets, juice, wine and beer (>10% difference) were observed in participants with diabetes compared with those without. Consumption of vegetables, fish and meat was slightly higher in individuals with diabetes in both studies, but the differences were <10%. Findings were more consistent across different ethnic groups than countries, but generally showed largely similar patterns.

Conclusions:

Although diabetes patients are expected to undergo nutritional education, we found only small differences in dietary behavior in comparison with cohort members without diabetes. These findings suggest that emphasis on education is needed to improve the current behaviors to assist in the prevention of complications.

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References

  • American Diabetes Association (1994). Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 17, 519–522.

    Article  Google Scholar 

  • American Diabetes Association (2007). Nutrition recommendations and interventions for diabetes: a position statement of the American diabetes association. Diabetes Care 30 (Suppl 1), S48–S65.

    Article  Google Scholar 

  • Bellizzi KM, Rowland JH, Jeffery DD, McNeel T (2005). Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 23, 8884–8893.

    Article  Google Scholar 

  • Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005). Life after cancer epidemiology (LACE) study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16, 545–556.

    Article  Google Scholar 

  • Coups EJ, Ostroff JS (2005). A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 40, 702–711.

    Article  Google Scholar 

  • Ferrari P, Slimani N, Ciampi A, Trichopoulou A, Naska A, Lauria C et al. (2002). Evaluation of under- and overreporting of energy intake in the 24-h diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5, 1329–1345.

    Article  CAS  Google Scholar 

  • Ferrari P, Kaaks R, Fahey MT, Slimani N, Day NE, Pera G et al. (2004). Within- and between-cohort variation in measured macronutrient intakes, taking account of measurement errors, in the European Prospective Investigation into Cancer and Nutrition study. Am J Epidemiol 160, 814–822.

    Article  Google Scholar 

  • Fitzgerald N, Damio G, Segura-Perez S, Perez-Escamilla R (2008). Nutrition knowledge, food label use, and food intake patterns among Latinas with and without type 2 diabetes. J Am Diet Assoc 108, 960–967.

    Article  Google Scholar 

  • Fox CS, Coady S, Sorlie PD, Levy D, Meigs JB, D’Agostino Sr RB et al. (2004). Trends in cardiovascular complications of diabetes. Jama 292, 2495–2499.

    Article  CAS  Google Scholar 

  • Fox CS, Coady S, Sorlie PD, D′Agostino Sr RB, Pencina MJ, Vasan RS et al. (2007). Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation 115, 1544–1550.

    Article  Google Scholar 

  • Gregg EW, Cheng YJ, Narayan KM, Thompson TJ, Williamson DF (2007). The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976–2004. Prev Med 45, 348–352.

    Article  Google Scholar 

  • Hu FB, Cho E, Rexrode KM, Albert CM, Manson JE (2003). Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Circulation 107, 1852–1857.

    Article  Google Scholar 

  • Iestra J, Knoops K, Kromhout D, de Groot L, Grobbee D, van Staveren W (2006). Lifestyle, mediterranean diet and survival in European post-myocardial infarction patients. Eur J Cardiovasc Prev Rehabil 13, 894–900.

    Article  Google Scholar 

  • King DE, Mainous III AG, Carnemolla M, Everett CJ (2009). Adherence to healthy lifestyle habits in US adults, 1988–2006. Am J Med 122, 528–534.

    Article  Google Scholar 

  • Kolonel LN, Henderson BE, Hankin JH, Nomura AM, Wilkens LR, Pike MC et al. (2000). A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am J Epidemiol 151, 346–357.

    Article  CAS  Google Scholar 

  • Krebs-Smith SM, Kris-Etherton P (2007). How does MyPyramid compare to other population-based recommendations for controlling chronic disease? J Am Diet Assoc 107, 830–837.

    Article  Google Scholar 

  • Li TY, Brennan AM, Wedick NM, Mantzoros C, Rifai N, Hu FB (2009). Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes. J Nutr 139, 1333–1338.

    Article  CAS  Google Scholar 

  • Lissner L, Troiano RP, Midthune D, Heitmann BL, Kipnis V, Subar AF et al. (2007). OPEN about obesity: recovery biomarkers, dietary reporting errors and BMI. Int J Obes (Lond) 31, 956–961.

    Article  CAS  Google Scholar 

  • Mann JI, De Leeuw I, Hermansen K, Karamanos B, Karlstrom B, Katsilambros N et al. (2004). Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 14, 373–394.

    Article  CAS  Google Scholar 

  • Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP (2001). The continuing epidemics of obesity and diabetes in the United States. Jama 286, 1195–1200.

    Article  CAS  Google Scholar 

  • Nöthlings U, Wilkens LR, Murphy SP, Hankin JH, Henderson BE, Kolonel LN (2005). Meat and fat intake as risk factors for pancreatic cancer: the multiethnic cohort study. J Natl Cancer Inst 97, 1458–1465.

    Article  Google Scholar 

  • Nöthlings U, Murphy SP, Wilkens LR, Boeing H, Schulze MB, Bueno-de-Mesquita HB et al. (2008a). A food pattern that is predictive of flavonol intake and risk of pancreatic cancer. Am J Clin Nutr 88, 1653–1662.

    Article  Google Scholar 

  • Nöthlings U, Schulze MB, Weikert C, Boeing H, van der Schouw YT, Bamia C et al. (2008b). Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population. J Nutr 138, 775–781.

    Article  Google Scholar 

  • Riboli E, Kaaks R (1997). The EPIC Project: rationale and study design. European prospective investigation into cancer and nutrition. Int J Epidemiol 26 (Suppl 1), S6–S14.

    Article  Google Scholar 

  • Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr 5, 1113–1124.

    Article  CAS  Google Scholar 

  • Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M et al. (2000). Standardization of the 24-h diet recall calibration method used in the European prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54, 900–917.

    Article  CAS  Google Scholar 

  • Slimani N, Kaaks R, Ferrari P, Casagrande C, Clavel-Chapelon F, Lotze G et al. (2002). European prospective investigation into cancer and nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5, 1125–1145.

    Article  CAS  Google Scholar 

  • Solomon CG, Hu FB, Stampfer MJ, Colditz GA, Speizer FE, Rimm EB et al. (2000). Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation 102, 494–499.

    Article  CAS  Google Scholar 

  • Stram DO, Hankin JH, Wilkens LR, Pike MC, Monroe KR, Park S et al. (2000). Calibration of the dietary questionnaire for a multiethnic cohort in Hawaii and Los Angeles. Am J Epidemiol 151, 358–370.

    Article  CAS  Google Scholar 

  • Stumvoll M, Goldstein BJ, van Haeften TW (2005). Type 2 diabetes: principles of pathogenesis and therapy. Lancet 365, 1333–1346.

    Article  CAS  Google Scholar 

  • Tanasescu M, Cho E, Manson JE, Hu FB (2004). Dietary fat and cholesterol and the risk of cardiovascular disease among women with type 2 diabetes. Am J Clin Nutr 79, 999–1005.

    Article  CAS  Google Scholar 

  • Trichopoulou A, Psaltopoulou T, Orfanos P, Trichopoulos D (2006). Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort. J Intern Med 259, 583–591.

    Article  CAS  Google Scholar 

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Acknowledgements

This study was supported by the German Research Foundation, the cluster of excellence ‘inflammation-at-interfaces’ and an EFSD/sanofi-aventis grant. The sponsor did not have any influence on the contents of the manuscript.

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Correspondence to U Nöthlings.

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Nöthlings, U., Boeing, H., Maskarinec, G. et al. Food intake of individuals with and without diabetes across different countries and ethnic groups. Eur J Clin Nutr 65, 635–641 (2011). https://doi.org/10.1038/ejcn.2011.11

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  • DOI: https://doi.org/10.1038/ejcn.2011.11

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