title: Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study.
abstract: OBJECTIVE
  Diet and lifestyle advice for type 1 diabetes (T1DM) patients is based on little evidence and putative effects on glycaemic control. Therefore, we investigated the longitudinal relation between dietary and lifestyle variables and HbA1c levels in patients with type 1 diabetes.
  
  
  METHODS
  A 7-year prospective cohort analysis was performed in 1659 T1DM patients (52% males, mean age 32.5 years) participating in the EURODIAB Prospective Complications Study. Baseline dietary intake was assessed by 3- day records and physical activity, smoking status and alcohol intake by questionnaires. HbA1c during follow-up was centrally assessed by immunoassay. Analysis of variance (ANOVA) and restricted cubic spline regression analyses were performed to assess dose-response associations between diet and lifestyle variables and HbA1c levels, adjusted for age, sex, lifestyle and body composition measures, baseline HbA1c, medication use and severe hypoglycaemic attacks.
  
  
  RESULTS
  Mean follow-up of our study population was 6.8 (s.d. 0.6) years. Mean HbA1c level was 8.25% (s.d. 1.85) (or 66.6 mmol/mol) at baseline and 8.27% (s.d. 1.44) at follow-up. Physical activity, smoking status and alcohol intake were not associated with HbA1c at follow-up in multivariable ANOVA models. Baseline intake below the median of vegetable protein (<29 g/day) and dietary fibre (<18 g/day) was associated with higher HbA1c levels. Restricted cubic splines showed nonlinear associations with HbA1c levels for vegetable protein (P (nonlinear)=0.008) and total dietary fibre (P (nonlinear)=0.0009).
  
  
  CONCLUSIONS
  This study suggests that low intake of vegetable protein and dietary fibre are associated with worse glycaemic control in type 1 diabetes.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: S N
authors.initials: SN
authors.lastname: Balk
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: D A J M
authors.initials: DA
authors.lastname: Schoenaker
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: G D
authors.initials: GD
authors.lastname: Mishra
authors.affiliation: Diabetes Research Institute, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Toeller
authors.affiliation: Department of Epidemiology and Public-Health, University College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Chaturvedi
authors.affiliation: Department of Epidemiology and Public-Health, University College London, London, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Fuller
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: S S
authors.initials: SS
authors.lastname: Soedamah-Muthu
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D004032:Diet / Q000009:adverse effects*; D015930:Diet Records; D004043:Dietary Fiber / Q000009:adverse effects; D004044:Dietary Proteins / Q000009:adverse effects; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012907:Smoking; D011795:Surveys and Questionnaires; D014675:Vegetables; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D004043:Dietary Fiber; D004044:Dietary Proteins; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human