An in-depth study of diet and parental feeding in young kids with type 1 diabetes

描述（由申请人提供）：成功的饮食管理对于1型糖尿病（T1DM）幼儿实现接近正常的血糖控制至关重要。多吃水果和蔬菜、低脂肪饮食的儿童可以实现良好的血糖控制，降低肥胖和长期糖尿病相关并发症的风险，包括血脂异常和心血管疾病（CVD）。关注患有1型糖尿病的幼儿的饮食是很重要的，因为数据显示，7%的3-9岁儿童有2种或更多的心血管疾病风险因素，考虑到美国超重的总体趋势，这一比例现在可能更高。青少年T1DM患者快速接受胰岛素强化治疗已经彻底改变了糖尿病的管理，但数据显示，遵循这种治疗方案的青少年在饮食计划中强调碳水化合物的含量，而排除了其他宏量营养素。这导致许多患有糖尿病的青少年饮食中水果和蔬菜的摄入量较低，而脂肪的摄入量相对较高。这种饮食的结果是体重增加，血脂异常和心血管疾病的风险增加，除了有T1DM。候选人K23的初步数据表明，患有T1DM的幼儿饮食与青少年相似，但我们不知道幼儿的父母是否对低碳水化合物含量的食物有类似的偏见，或者他们是否认为健康饮食存在其他障碍。研究这些问题很重要，因为它们的答案将直接为T1DM幼儿的饮食干预提供信息，K候选人推测，如果不解决饮食问题，仅行为干预将无法成功改变幼儿的血糖控制。本研究的目的是：1)收集定性数据，研究父母对T1DM患者营养的理解及其饮食管理的原因；2)研究影响父母饮食管理的食物环境因素。这项研究具有重要意义，因为它将提供数据，揭示父母对T1DM营养的理解以及他们食物选择的潜在因素，这对于确定如何改变父母的饮食管理是必要的。核心假设是父母对T1DM的健康饮食习惯和儿童饮食环境因素的误解是饮食管理成功的障碍。研究方法将是一种混合方法的研究设计，使用结构化和半结构化访谈，对食品环境的有效评估，以及定量的父母问卷。拟议的研究将扩大K候选物目前的K23项目，并为未来的干预开发提供新的数据。这项研究的创新之处在于它对幼儿强化饮食方案的独家和深入关注，以及对饮食管理重要的两个新因素的研究：父母对健康糖尿病饮食的理解以及他们对健康饮食外部障碍的感知。这些目标与候选人在年幼T1DM儿童中的K23工作相一致，她的长期目标是开发干预措施，可以早期改变这些患者的健康结果，并预防糖尿病相关并发症的发展。

DESCRIPTION (provided by applicant): Success in dietary management is critical to achieving near normal glycemic control in young children with type 1 diabetes mellitus (T1DM). Children who eat a diet high in fruits and vegetables and low in fat can achieve good glycemic control and reduce their risk for obesity and long-term diabetes-related complications, including dyslipidemia and cardiovascular disease (CVD). It is important to focus on diet in young children with T1DM because data suggest 7% of 3-9 year olds have 2 or more risk factors for CVD and given the general trend toward overweight in the US, this percent could now be higher. The rapid uptake of intensive insulin therapy in youth with T1DM has revolutionized diabetes management, but data show that adolescents who follow this regimen emphasize carbohydrate content in meal planning to the exclusion of other macronutrients. This has led many adolescents with T1DM to consume a diet that is low in fruit and vegetable intake and relatively high in fat intake. The result of this diet is weight gain and increased risk for dyslipidemia and CVD in addition to having T1DM. Preliminary data from the candidate's K23 suggest that young children with T1DM consume a diet similar to adolescents, but we do not know if parents' of young children share a similar bias for foods low in carbohydrate content or if they perceive other barriers to healthy eating. It is important to research these questions because their answers would directly inform dietary interventions for young children with T1DM and the K candidate speculates that without also addressing diet, a behavior-only intervention would not be successful in changing glycemic control in young children. The aims are 1) to collect qualitative data examining parents' understanding of nutrition in T1DM and the reasons underlying their dietary management and 2) to examine factors of the food environment impacting parents' dietary management. The proposed study is significant because it will produce data revealing parents' understanding of nutrition in T1DM and the factors underlying their food choices, which are necessary to identify how to change parents' dietary management. The central hypothesis is that parents' misunderstanding of healthful eating practices for T1DM and elements of children's food environment are barriers to success in dietary management. The study approach will be a mixed-methods research design using structured and semi-structured interviews, validated assessments of the food environment, and quantitative parent questionnaires. The proposed study will expand the K candidate's current K23 program and provide new data to inform future intervention development. The study is innovative because of its exclusive and in-depth focus on young children on intensive regimens and its examination of two novel factors that are important to dietary management: parents' understanding of a healthful diabetes diet and their perception of external barriers to a healthful diet. The aims compliment the candidate's K23 work in young children with T1DM and her long-term goal to develop interventions that can change health outcomes early for these patients and forestall the development of diabetes-related complications.