Potential Effectiveness of Registered Dietitian Nutritionists in Healthy Behavior Interventions for Managing Type 2 Diabetes in Older Adults: A Systematic Review.

PURPOSE: A systematic review was conducted to assess how the involvement of a registered dietitian nutritionist (RDN) in healthy behavior interventions (HBIs) potentially affects outcomes in older adults with type 2 diabetes (T2D). METHODS: Literature was searched for primary research published between 2016 and 2020 on HBI involving a RDN affecting outcomes in older adults with T2D. Evaluations of hemoglobin A1c (HbA1c), blood glucose, blood pressure, cholesterol, anthropometry, body composition, medication usage, healthcare cost, and self-efficacy and/or adherence to healthy behaviors outcomes were selected for inclusion. All the literature included were summarized, evaluated for certainty of evidence criteria, and assessed for bias. RESULTS: A total of 12 studies were included for assessment. Involvement of a RDN in HBI was shown to reduce HbA1c, fasting blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure and improve lean body mass, body mass index (BMI), and self-efficacy in populations of older adults with T2D. Compared to older adults with T2D receiving HBI involving RDNs, patients receiving usual care may incur higher healthcare costs or longer hospital stays. There was a high certainty of evidence for a RDN involvement in HBI with regard to reduction in HbA1c. There was a moderate certainty of evidence for a RDN involvement in HBI with regard to favorable changes in weight or body composition and cardiometabolic health outcomes. Statistically significant improvements in outcomes were usually sustained in follow-up after conclusion of HBI. CONCLUSION: RDNs may play an integral role in HBIs resulting in improved glycemic control, weight management, cardiovascular outcomes, and presumably comorbidity management. RDNs are important facilitators of diet education and nutrition assessment, which are essential in T2D management and should, therefore, be considered for routine inclusion in interprofessional teams for improved outcomes in older adults with T2D.

Beyond Meat: A Comparison of the Dietary Intakes of Vegetarian and Non-vegetarian Adolescents.

Dietary intake of adult vegetarians from large prospective studies has been well-characterized but is rarely reported in vegetarian adolescents. Our objective was to describe and compare the dietary intake of vegetarian adolescents with their non-vegetarian counterparts in a population known to espouse healthy living. Adolescents (n = 534) aged 12-18 years old from middle and high schools near major Adventist universities in Michigan and Southern California provided dietary, demographic, and anthropometric data. Dietary intake was measured with a validated 151-item self-administered web-based food frequency questionnaire; weight and height were measured during school visits. Vegetarian was defined as the combined intake of meat, meat derivatives, poultry, and fish of <1 serving per week. Descriptive statistics and ANCOVA were used to compare the intake of vegetarians and non-vegetarians. Vegetarians significantly ate more fruits, vegetables, and other plant-based foods, but significantly less foods of animal origin, sugar-sweetened beverages, and coffee/tea compared to non-vegetarians. Vegetarians had significantly higher intakes of carbohydrates and total protein but lower intakes of fats, animal protein, and zinc compared to their counterparts. A majority (75% or more) of both groups met the 2015 Dietary Guidelines' age-and-gender-specific recommendations for most nutrients but only 16-18% of vegetarians/non-vegetarians did not exceed the upper limit for sodium. More vegetarians (49%) than non-vegetarians (25%) had <10% of their caloric intake from SFA. More than 90% of both groups met dairy recommendations, but greater proportions of vegetarians met recommendations for vegetables, fruits, nuts/soy products, and legumes than non-vegetarians. Of the non-vegetarians, only 7% and 44% met the fish and meats/poultry/eggs recommendation, respectively, which none of the vegetarians met. Compared to the general US adolescent population, both diet groups ate more fruits, vegetables, dairy and protein foods, and also consumed more micronutrients but less macronutrients. Overall, vegetarian adolescents have a more favorable dietary intake profile than non-vegetarians, but both vegetarians and non-vegetarians in this study population have a more adequate diet than the general US adolescent population. The influence of the Adventist plant-based diet culture that is translated both at home and at school is evident in our findings.

Unscrambling the relations of egg and meat consumption with type 2 diabetes risk.

Background: Meat intake is associated with increased risk of type 2 diabetes (T2D). It is not clear if egg intake is associated with T2D risk because purported associations may be due to concurrent consumption of eggs with meat. Objective: Our aim was to differentiate any associations between meat and egg consumption and the risk of T2D. Design: In this longitudinal study, 55,851 participants of the Adventist Health Study 2 who were free of diabetes provided demographic, anthropometric, and dietary data at baseline. Meat and egg intakes were assessed with a validated quantitative food-frequency questionnaire. Responses to 2 follow-up questionnaires determined incident T2D cases. Multivariate-adjusted logistic regression was used to determine relations between meat and egg intake and incident T2D. Results: T2D cases identified during a mean 5.3 y of follow-up totaled 2772. Meat intake of >0 to <25 g/d, ≥25 to <70 g/d, and ≥70 g/d significantly increased the risk of T2D compared with no meat intake (OR: 1.29; 95% CI: 1.16, 1.44; OR: 1.42; 95% CI: 1.25, 1.61; and OR: 1.65; 95% CI: 1.39, 1.96, respectively; P-trend < 0.0001). Egg intake compared with no egg intake was not associated with T2D risk. A significant meat-egg interaction (P = 0.019) showed that within every category of egg intake, there was an incremental rise in T2D risk as meat intake increased. However, within categories of meat intake, increasing egg intake did not increase the risk of T2D except among nonmeat-eaters consuming ≥5 eggs/wk (OR: 1.52; 95% CI: 1.09, 2.12). Conclusions: Meat consumption, but not egg consumption, is independently associated with T2D risk. Egg intake seems not to increase T2D risk further with meat intake. Our findings suggest that the purported egg-T2D risk relation in US populations may be biased due to failure to investigate egg-meat interactions. Further investigations are needed to ascertain T2D risk among nonmeat-eaters with high egg intakes.

Validating polyphenol intake estimates from a food-frequency questionnaire by using repeated 24-h dietary recalls and a unique method-of-triads approach with 2 biomarkers.

Background: The assessment of polyphenol intake in free-living subjects is challenging, mostly because of the difficulty in accurately measuring phenolic content and the wide presence of phenolics in foods.Objective: The aims of this study were to evaluate the validity of polyphenol intake estimated from food-frequency questionnaires (FFQs) by using the mean of 6 measurements of a 24-h dietary recall (24-HR) as a reference and to apply a unique method-of-triads approach to assess validity coefficients (VCs) between latent "true" dietary estimates, total urinary polyphenol (TUP) excretion, and a surrogate biomarker (plasma carotenoids).Design: Dietary intake data from 899 adults of the Adventist Health Study 2 (AHS-2; 43% blacks and 67% women) were obtained. Pearson correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated between 24-HRs and FFQs and between 24-HRs and TUPs. VCs and 95% CIs between true intake and polyphenol intakes from FFQs, 24-HRs, and the biomarkers TUPs and plasma carotenoids were calculated.Results: Mean ± SD polyphenol intakes were 717 ± 646 mg/d from FFQs and 402 ± 345 mg/d from 24-HRs. The total polyphenol intake from 24-HRs was correlated with FFQs in crude (r = 0.51, P < 0.001) and deattenuated (r = 0.63; 95% CI: 0.61, 0.69) models. In the triad model, the VC between the FFQs and theoretical true intake was 0.46 (95% CI: 0.20, 0.93) and between 24-HRs and true intake was 0.61 (95% CI: 0.38, 1.00).Conclusions: The AHS-2 FFQ is a reasonable indicator of total polyphenol intake in the AHS-2 cohort. Urinary polyphenol excretion is limited by genetic variance, metabolism, and bioavailability and should be used in addition to rather than as a replacement for dietary intake assessment.

Comparison of polyphenol intakes according to distinct dietary patterns and food sources in the Adventist Health Study-2 cohort.

Evidence suggests a relationship between polyphenol intake and health benefits. Polyphenol intake among a large US cohort with diverse dietary practices ranging from meatless to omnivorous diets has not been previously evaluated. The primary aim of this study was to compare polyphenol intakes of several vegetarian and non-vegetarian dietary patterns and to assess phenolic intake by food source. To characterise dietary intake, a FFQ was administered to 77 441 participants of the Adventist Health Study-2. Dietary patterns were defined based on the absence of animal food consumption as vegan, lacto-ovo-vegetarian, pesco-vegetarian, semi-vegetarian and non-vegetarian. Polyphenol intakes were calculated based on chromatography-derived polyphenol content data of foods from Phenol-Explorer, US Department of Agriculture databases and relevant literature. Results revealed a mean unadjusted total polyphenol intake of 801 (sd 356) mg/d, and the main foods contributing to polyphenol intakes were coffee, fruits and fruit juices. Total polyphenol intake differed significantly between dietary patterns, with phenolic acids from coffee contributing the greatest variation. The dominant classes and sources of dietary polyphenols differed between vegetarian and non-vegetarian diets. Flavonoid intake was the highest among pesco-vegetarians, and phenolic acid intake was the highest among non-vegetarians. In addition, coffee consumers appeared to have a different dietary profile than non-coffee consumers, including greatly reduced contribution of fruits, vegetables and legumes to total phenolic intake. Coffee drinkers were more likely to be non-vegetarians, which explained several of these observations. Further evaluating these differences may be important in identifying relationships between plant-based diets and health outcomes.