title: Effects of Changing the Amount and Source of Dietary Carbohydrates on Symptoms and Dietary Satisfaction Over a 1-Year Period in Subjects with Type 2 Diabetes: Canadian Trial of Carbohydrates in Diabetes (CCD).
abstract: OBJECTIVE
  To determine the long-term effects of changing the amount or source of dietary carbohydrate on quality of life (QOL), symptoms and dietary satisfaction in people with type 2 diabetes.
  
  
  METHODS
  Subjects with diabetes treated by diet alone (n=162) were randomly assigned to high-carbohydrate/high-glycemic-index (HGI) diets; high-carbohydrate/low-glycemic-index (LGI) diets; or lower-carbohydrate/high-monounsaturated-fat (LC) diets for 1 year. We measured QOL at baseline and at study's end, and we measured symptoms and dietary satisfaction quarterly.
  
  
  RESULTS
  The HGI, LGI and LC diets contained, respectively, 47±1, 52±1 and 40±1% energy carbohydrate; 30±1, 27±1 and 40±1% fat with GI 64±0.4, 55±0.4 and 59±0.4. Significantly more participants reported increased flatulence on LGI than on LC and HGI diets at 3 months (41%, 19%, 14%; p<0.05), but not at 12 months (29%, 17%, 17%; ns). Abdominal distension was more severe (46% vs. 14%, 19%; p<0.05), and headache less severe (8% vs. 22%, 23%; p<0.05) on LGI than on both other diets. Increased appetite was more severe on LC (33%) than on HGI diets (14%, p<0.05). Joint/limb pains were less severe on LGI (16%) than HGI (28%) diets. LC elicited more severe gloomy thoughts (23%) than LGI (4%; p<0.05) but greater dietary-satisfaction (70%; p<0.05) than LGI (40%) and HGI (48%) diets. For all diets, glycated hemoglobin (A1C) levels increased less in those who gained less weight, had less increased appetite and were more satisfied with the enjoyment obtained from eating.
  
  
  CONCLUSIONS
  Each diet elicited increased severity of 1 or more symptoms than the other diets. Although overall dietary satisfaction was greater on the 40% carbohydrate diet than on the 50% carbohydrate diet, the LGI diet was no less satisfying than the HGI diet. Changes in appetite and dietary satisfaction may influence body weight and glycemic control, or vice-versa.
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: thomas.wolever@utoronto.ca.
authors.forename: Thomas M S
authors.initials: TM
authors.lastname: Wolever
authors.affiliation: Research Center (CHUM) Hôtel-Dieu de Montréal, University of Montréal, Montréal, Québec, Canada.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Chiasson
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Department of Medicine, University of Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Maheux
authors.affiliation: IRCM (Institut de Recherches Cliniques de Montréal), Montréal, Québec, Canada.
authors.forename: Rémi
authors.initials: R
authors.lastname: Rabasa-Lhoret
authors.affiliation: Department of Medicine, St. Joseph's Health Centre, Western University, London, Ontario, Canada.
authors.forename: N Wilson
authors.initials: NW
authors.lastname: Rodger
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Edmond A
authors.initials: EA
authors.lastname: Ryan
mesh_terms: D001066:Appetite; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy*; D004035:Diet Therapy / Q000009:adverse effects / Q000379:methods; D004040:Dietary Carbohydrates / Q000494:pharmacology*; D005260:Female; D005414:Flatulence; D038321:Glycemic Index; D006606:Hiccup; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
chemical_list: D004040:Dietary Carbohydrates
keywords: diet; dietary satisfaction; essai clinique à répartition aléatoire; glycemic index; indice glycémique; quality of life; qualité de vie; randomized controlled clinical trial; régime alimentaire; satisfaction alimentaire; symptoms; symptômes