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.

Development and validation of a tool for predicting type 2 diabetes in Mexican women of reproductive age / Desarrollo y validación de una herramienta de predicción de diabetes tipo 2 en mujeres mexicanas en edad reproductiva

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

INTRODUCCIÓN: La diabetes es un problema mundial con mayor impacto en los países en desarrollo, donde muchas personas desconocen su riesgo. En México las mujeres muestran un mayor riesgo de diabetes tipo 2 (DT2). Las escalas de riesgo actuales se han desarrollado y validado principalmente en cohortes europeas de edad avanzada y no representan la mejor opción para las mujeres mexicanas. El desarrollo de un modelo/puntaje de riesgo en esta población sería útil. OBJETIVO: Desarrollar y validar un modelo y escala de riesgo que incorpore los factores de riesgo de la DT2 más relevantes en las mujeres mexicanas en edad reproductiva. MÉTODOS: El estudio se realizó en 2 fases, en la primera se desarrolló el modelo predictivo en una cohorte de 3.161 mujeres mexicanas en edad reproductiva (cohorte de derivación) y en la segunda se validó en una población independiente. Se utilizó una regresión de riesgos proporcionales de Cox. Finalmente se desarrolló una escala de riesgo de 0 a 19, para identificar la probabilidad de desarrollar DT2 en 2,4 años en las mujeres mexicanas en edad reproductiva. El punto de corte fue ≥15, con una sensibilidad del 73% y una especificidad del 67%. RESULTADOS: Se identificaron 147 (4,6%) casos nuevos de DT2 en la cohorte de derivación del modelo y 97 de 925 (10,48%) en la cohorte de validación. Los factores de riesgo predictivos de DT2 fueron: historia de diabetes gestacional (HR: 2,69; IC 95%: 1,10-6,58), IMC (HR: 1,03; IC 95%: 1,01-1,06), hipertrigliceridemia (HR: 1,54; IC 95%: 1,11-2,14) y glucosa de ayuno (HR: 1,06; IC 95%: 1,05-1,08), con AUC de 0,75 y 0,91 (IC 95%: 0,87-0,95) en la cohorte de validación. CONCLUSIONES: Se desarrolló un modelo y score de riesgo para detectar casos en riesgo de diabetes incidente. Esta herramienta fue generada empleando las características de las mujeres mexicanas en edad reproductiva. El score de riesgo es un paso adelante al tratar de abordar el legado generacional que la diabetes en el embarazo podría tener sobre las mujeres y sus hijos

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.

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 / Barreras para la adherencia a un plan nutricional y estrategias para solventarlas en pacientes con diabetes tipo 2; resultados tras 2 años de seguimiento

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 ± 4.4 kg/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 >150 mg/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

Introducción: Los cambios en el estilo de vida en la terapia médica nutricional (TMN), se asocian con una disminución en la hemoglobina glucosilada A1c (HbA1c) del 0,3–2%. La evidencia muestra que las personas con barreras tienen menos probabilidades de adherirse a un plan nutricional a largo plazo. Hay información limitada sobre las barreras que impiden la implementación de un plan nutricional saludable y sobre las estrategias utilizadas para superarlas. Objetivo: Describir los cambios longitudinales en las percepciones de las barreras para la adherencia a un plan nutricional con diabetes tipo 2 (T2D). Métodos: Estudio prospectivo de cohorte con intervención, se evaluó el seguimiento a 2 años, todos los pacientes recibieron atención integral de acuerdo con el estudio CAIPaDi. Se utilizó un cuestionario para detectar las barreras más comunes para realizar un plan nutricional al inicio del estudio a los 3 meses, uno y 2 años de seguimiento. El análisis incluyó datos de 320 pacientes que tenían evaluaciones completas desde el basal hasta 2 años. Se incluyeron pacientes con T2D de 53,8 ± 9,1 años, 55,9% mujeres, IMC 29,2 ± 4,4 kg/m2 y tiempo desde el diagnóstico de 1 (0-5) año. Resultados: Al inicio del estudio, el 78,4% de los pacientes refirieron alguna barrera que limita la adherencia a un plan nutricional. Las barreras más frecuentes fueron «Falta de información sobre una dieta correcta» (24,7%), «Como fuera de casa la mayor parte del tiempo» (19,7%) y «Negación o rechazo a hacer cambios en mi dieta» (14,4%). Después de una intervención nutricional estructurada, que incluyó estrategias para reducir cada barrera, observamos un porcentaje de reducción del 37% (p < 0,001). Los sujetos que presentaban barreras persistentes a los 2 años de seguimiento, muestran una mayor proporción fuera del rango de control para la HbA1c el 24,7% (>7%) y triglicéridos el 27,5% (>150 mg/dl) en comparación con aquellos sin barreras (11,6 y 14,4%, respectivamente) p < 0,05. Conclusiones: La identificación de las barreras para la adherencia a un plan de alimentación puede permitir a los profesionales de la salud diseñar intervenciones con los componentes de comportamiento específicos necesarios para superar dicha barrera, mejorando la adherencia al plan de alimentación con cambios sostenidos a largo plazo

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.