Diabetes Nutrition and Complications Trial: adherence to the ADA nutritional recommendations, targets of metabolic control, and onset of diabetes complications. A 7-year, prospective, population-based, observational multicenter study.
OBJECTIVE
To know the adherence to the ADA nutritional recommendations and its relation to targets of metabolic control and onset of diabetic complications in a sample of diabetic people in Spain.


METHODS
The Diabetes Nutrition and Complications Trial (DNCT) is a prospective, population-based, observational multicenter study designed to know the nutritional pattern, based on the 7-day food diaries, of a population with long-standing diabetes mellitus (93/99 type 1/type 2 diabetic patients, 20/18 years of duration of diabetes, and 6.9%/6.4% HbA(1c) values) and its relation with the onset of microvascular and macrovascular diabetes complications between 1993 and 2000.


RESULTS
After a median follow-up period of 6.5 years, more than 55% of diabetic people complied with the recommendation of protein intake between 15% and 20%, but only 27% consumed less than 10% of saturated fatty acids (SFAs), the 13% achieved up 10% of polyunsaturated fatty acids (PUFAs) intake, the 39% consumed more than 60% from carbohydrate and monounsaturated fatty acids (MUFAs), and the 30% consumed <300 mg/day of cholesterol. In spite of these, more than 90% had an optimal HDL cholesterol and non-HDL cholesterol level, and triglycerides level, while less than 41% of diabetic people had an HbA(1c) value >7.5%. Moreover, more than 69% consumed a MUFAs-to-SFAs ratio >1.5 and the 46% a PUFAs-to-SFAs ratio >0.4. Nonadherence to nutritional recommendation, but MUFAs/SFAs ratio >1.5 and PUFAs/SFAs ratio >0.4, was associated with a reduction between 3.4- and 8.2-fold in the risk of onset of diabetic complications.


CONCLUSIONS
The adherence to ADA nutritional recommendations for people with diabetes in Spain is rather poor except for the protein consumption. Only PUFAs/SFAs >0.4 and MUFAs/SFAs>1.5 were associated to near-optimal targets of metabolic control and a reduction in the risk of the onset of diabetic complications. These data suggest that other nutritional recommendations should be taken in mind.
Department of Endocrinology and Nutrition, San Carlos University Hospital, E-28040 Madrid, Spain. acalle.hcsc@salud.madrid.org
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000178:diet therapy*; D003927:Diet, Diabetic / Q000592:standards*; D004041:Dietary Fats / Q000008:administration & dosage / Q000592:standards; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage / Q000592:standards; D004044:Dietary Proteins / Q000008:administration & dosage / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011153:Population; D013030:Spain; D014481:United States
D004041:Dietary Fats; D004042:Dietary Fats, Unsaturated; D004044:Dietary Proteins