Food frequency questionnaire results correlate with metabolic control in insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study.
OBJECTIVE
To validate food frequency analysis as a predictor of metabolic status in persons with type 2 diabetes and to identify psychosocial factors affecting dietary adherence.


METHODS
Three hundred forty-seven subjects with stable, insulin-treated type 2 diabetes completed a food frequency questionnaire and six instruments measuring different psychosocial attributes. Eight metabolic parameters were used as principal endpoints. Data from the food frequency questionnaires were used to estimate daily energy intake and determine each subject's adherence to seven dietary standards derived from the 2003 Dietary Recommendations of the American Diabetes Association. We excluded 105 subjects reporting daily energy intake <1,000 kcal because these results were considered unreliable. Subjects were then categorized into three groups depending on their adherence rates to American Diabetes Association dietary standards.


RESULTS
Subjects with the lowest dietary adherence had the poorest metabolic control. Adherence to dietary standards was particularly poor among subjects with metabolic syndrome (2.1%) and/or obesity (4.1%). The most important determinants of following recommended dietary practices were positive attitudes, fewer social barriers, and a conviction that diet could control diabetes.


CONCLUSIONS
For subjects with type 2 diabetes reporting a dietary intake of >1,000 kcal/day, food frequency questionnaire data could identify those with poor metabolic control. Nutrition interventions to improve metabolic control should focus on reducing fat intake and emphasizing the importance of diet. Multidisciplinary efforts should be directed at overcoming social barriers to recommended dietary practices and to treating depression.
Murata
Glen H
GH
New Mexico Veterans' Affairs Health Care System (111GIM), 1501 San Pedro Drive SE, Albuquerque, NM 87108, USA. glen.murata@med.va.gov
Shah
Jayendra H
JH
Duckworth
William C
WC
Wendel
Christopher S
CS
Mohler
M Jane
MJ
Hoffman
Richard M
RM
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D004034:Diet Surveys; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome
D004041:Dietary Fats; D007328:Insulin