Primary Barriers of Adherence to a Structured Nutritional Intervention in Patients with Dyslipidemia.

PURPOSE: To describe the primary barriers to adequately adhering to a structured nutritional intervention. PATIENTS AND METHODS: A total of 106 participants diagnosed with dyslipidemia and without a medical nutrition therapeutic plan were included in this two-year study conducted at the INCMNSZ dyslipidemia clinic in Mexico City. All patients were treated with the same structured strategies, including three face-to-face visits and two telephone follow-up visits. Diet plan adherence was evaluated at each site visit through a 3-day or 24-h food recall. RESULTS: Barriers to adhere to the nutritional intervention were: lack of time to prepare their meals (23%), eating outside the home (19%), unwillingness to change dietary patterns (14%), and lack of information about a correct diet for dyslipidemias (14%). All barriers decreased significantly at the end of the intervention. Female gender, current smoking, and following a plan of more than 1500 kcal (R2 = 0.18 and p-value = 0.004) were associated with good diet adherence. Participants showed good levels of adherence to total caloric intake at visit 2 and 3, reporting 104.7% and 95.4%, respectively. Adherence to macronutrient intake varied from 65.1% to 126%, with difficulties in adhering to recommended carbohydrate and fat consumption being more notable. CONCLUSION: The study findings confirm that a structured nutritional intervention is effective in reducing barriers and improving dietary adherence and metabolic control in patients with dyslipidemias. Health providers must identify barriers to adherence early on to design interventions that reduce these barriers and improve adherence.

Barriers to adherence to a nutritional plan and strategies to overcome them in patients with type 2 diabetes mellitus; results after two years of follow-up.

INTRODUCTION: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. OBJECTIVE: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. METHODS: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m2, and time since the diagnosis 1 (0-5) years were included in the study. RESULTS: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05). CONCLUSIONS: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes.

Development and validation of a tool for predicting type 2 diabetes in Mexican women of reproductive age.

INTRODUCTION: Diabetes is a worldwide problem with a greater impact in developing countries, where many people are unaware of their risk. In Mexico, women show the greatest risk for T2D. Current risk scores have been developed and validated in predominantly older European cohorts. They are not the best option in Mexican women. The development of a risk model/score in this population would be useful. OBJECTIVE: To develop and validate a risk model and score that incorporates the most relevant risk factors for T2D in Mexican women of reproductive age. METHODS: The study was carried out in two phases, with the first phase being the development of the predictive model and the second phase the validation of the model in a separate independent population. A cohort of Mexican patients of reproductive age ("Derivation Cohort") was used to create the predictive model. It included data on 3161 women. Risk factors for identification were assessed using Cox proportional hazards regression. Finally a score with a range of 0 to 19 points was developed to identify the 2.4 year probability of developing DM2 in Mexican women of reproductive age. RESULTS: 147 new cases of T2D (4.6%) were identified in the Derivation Cohort model, 97 of 925 participants (10.48%) in the validation cohort. The risk factor predictors of T2D were: history of gestational diabetes (HR 2.69, 95% CI 1.10-6.58), BMI (HR 1.03, 95% CI 1.01-1.06), hypertriglyceridemia (HR 1.54, 95% CI 1.11-2.14) and fasting blood glucose (HR 1.06, 95% CI 1.05-1.08), with an AUC of 0.75. The AUC in the validation cohort was 0.91 (95% CI 0.87-0.94). The score had a sensitivity of 73% and specificity of 67% at a cutoff of ≥15. CONCLUSIONS: A predictive model and risk score was developed to detect cases at risk for incident T2D. It was generated using the characteristics of Mexican women of reproductive age. This risk score is a step forward in attempting to address the generational legacy that diabetes in pregnancy could have on women and their children.