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治疗方案和碳水化合物评估纳入家庭生活方式，符合首选的饮食习惯和食物选择。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的风险增加，不良的饮食质量尤其令人担忧。然而，很少有研究调查饮食摄入的个人和家庭决定因素，改善饮食摄入的干预效果，或改善饮食质量对1型糖尿病青少年血糖控制的影响。在其他临床人群中进行的干预研究表明，在促进健康饮食方面存在重大挑战，并建议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。

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.