Enhancing Carbohydrate Quality in Diabetes Management

1型糖尿病的医学营养治疗侧重于将胰岛素方案和碳水化合物估计纳入家庭的生活方式，符合首选的膳食常规和食物选择。 1型糖尿病儿童的饮食中水果、蔬菜和全谷物含量低，饱和脂肪含量高。 由于与1型糖尿病相关的心血管疾病风险增加，饮食质量差尤其令人担忧。 然而，很少有研究探讨饮食摄入的个人和家庭决定因素，改善饮食摄入的干预措施的有效性，或改善饮食质量对1型糖尿病青年血糖控制的影响。 在其他临床人群中的干预研究表明，在促进健康饮食方面存在重大挑战，并提出了以家庭为基础的方法的重要性，这些方法可以增强动机，促进技能，并帮助家庭克服健康饮食的障碍。 CHEF是一项随机对照试验，旨在改善1型糖尿病青年家庭的饮食质量，饮食在疾病管理中起着关键作用。该试验证明了基于健康行为理论的家庭行为干预对改善整体饮食质量和全植物食品摄入量的有效性（Nansel et al. 2015，PMID：25952160）。我们没有发现治疗分配的差异报告偏倚的证据，如治疗组和对照组中血清类胡萝卜素（水果和蔬菜摄入的生物标志物）与24小时饮食回忆中报告的水果和蔬菜摄入量随时间的相似相关性所证明的（Sanjeevi et.在2019年，PMID：31101482），支持以下结论：观察到的对饮食质量的治疗效果是由于食物摄入量的真实的变化，而不是干预参与者报告错误的增加。干预措施不影响总体饮食成本，饮食成本与饮食质量无关（Nansel等人，2015 PMID：27597745），这表明家庭有意义地改善饮食而不产生额外成本的可行性。研究结果进一步表明，饮食质量在表现出挑食行为的儿童中得到了最大程度的改善，这些儿童被广泛认为对饮食摄入量的改善更有抵抗力（Nansel et al. 2018 PMID：29389510）。尽管人们担心增加对饮食的关注可能会增加饮食紊乱，但这些行为并没有因为干预而增加（Eisenberg et al. 2018，PMID：29371234）。本年度的工作重点是为公共数据共享准备数据。

Medical nutrition therapy in type 1 diabetes focuses on integrating the insulin regimen and carbohydrate estimation into the familys lifestyle, conforming to preferred meal routines and food choices. Diets of children with type 1 diabetes are low in fruits, vegetables, and whole grains, and high in saturated fat. Poor diet quality is particularly concerning due to the increased risk of cardiovascular disease associated with type 1 diabetes. However, scant research has examined individual and family determinants of dietary intake, the effectiveness of intervention to improve dietary intake, or the impact of improved diet quality on glycemic control in youth with type 1 diabetes. Intervention studies in other clinical populations demonstrate substantial challenges in promoting healthful eating, and suggest the importance of family-based approaches that enhance motivation, facilitate skills, and assist families in overcoming barriers to healthful eating. CHEF was a randomized controlled trial of a behavioral nutrition intervention targeting improved diet quality in families of youth with type 1 diabetes, for whom diet plays a critical role in disease management. The trial demonstrated the efficacy of a family-based behavioral intervention grounded in health behavior theories to improve overall diet quality and intake of whole plant foods (Nansel et al. 2015, PMID: 25952160). We found no evidence of differential reporting bias by treatment assignment, as evidenced by similar associations of serum carotenoids (a biomarker of fruit and vegetable intake) with reported fruit and vegetable intake from 24-hour diet recalls across time in both treatment and control group (Sanjeevi et. al 2019, PMID: 31101482), supporting the conclusion that the observed treatment effect on diet quality was due to real change in food intake, rather than increased reporting error in the intervention participants. The intervention did not affect overall diet cost, and diet cost was unassociated with diet quality (Nansel al. 2015 PMID: 27597745), suggesting the feasibility of families meaningfully improving diet without incurring additional cost. Findings further indicated that diet quality improved most in children demonstrating picky eating behaviors, widely considered as more resistant to improvements in dietary intake (Nansel et al. 2018 PMID: 29389510). Despite concerns that increased attention to diet may increase disordered eating, these behaviors did not increase due to the intervention (Eisenberg et al. 2018, PMID: 29371234). Work in the current year focused on preparing the data for public data-sharing.