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

1 型糖尿病幼儿饮食和父母喂养的深入研究

• 批准号: 8191480
• 负责人: Susana R Patton
• 金额: $ 7.5万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-26 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8191480
• 关键词: 7 year old; 9 year old; Address; Adolescent; Behavior; Behavioral; Blood Glucose; Carbohydrates; Cardiovascular Diseases; Child; Complement; Complications of Diabetes Mellitus; Data; Day Care; Development; Diabetes Mellitus; Diet; Dietary Factors; Dietary Intervention; Dyslipidemias; Eating; Economics; Elements; Environment; Exclusion; Fatty acid glycerol esters; Food; Future; Goals; Health; Insulin; Insulin-Dependent Diabetes Mellitus; Intake; Intervention; Interview; Knowledge; Lead; Life; Link; Macronutrients Nutrition; Measures; Mentored Patient-Oriented Research Career Development Award; Methods; Mission; Morbidity - disease rate; Motivation; Outcome; Overweight; Parenting behavior; Parents; Patient Self-Report; Patients; Perception; Price; Public Health; Questionnaires; Regimen; Research; Research Design; Risk; Risk Factors; Schools; Structure; Thinking; Weight Gain; Work; Youth; base; blood glucose regulation; burden of illness; cardiovascular risk factor; career; diabetes management; feeding; fruits and vegetables; glycemic control; health belief; innovation; insight; mortality; novel; nutrition; obesity risk; success; therapy development; trend; uptake

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. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because type 1 diabetes is common in children and sub- optimal diabetes management can lead to increased morbidity and mortality in patients. Healthy eating is key to better glycemic control and reduced risk for long-term diabetes-related complications. Thus, the proposed research is relevant to the part of NIH's mission that pertains to developing fundamental knowledge to extend healthy life and reduce the burden of illness.

描述(由申请人提供)：成功的饮食管理是实现1型糖尿病(T1 DM)儿童血糖控制接近正常的关键。饮食中水果和蔬菜含量高，脂肪含量低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)。重要的是要关注患有T1 DM的幼儿的饮食，因为数据表明，7%的3-9岁儿童有两个或更多的心血管疾病危险因素，考虑到美国超重的总体趋势，这个百分比现在可能更高。在患有T1 DM的年轻人中，胰岛素强化疗法的快速接受使糖尿病的管理发生了革命性的变化，但数据显示，遵循这种疗法的青少年在饮食计划中强调碳水化合物含量，而不是其他大量营养素。这导致许多患有T1 DM的青少年饮食中水果和蔬菜摄入量较低，脂肪摄入量相对较高。这种饮食的结果是体重增加，除了患有T1 DM外，还增加了患血脂异常和心血管疾病的风险。来自候选人的K23的初步数据表明，患有T1 DM的幼儿的饮食与青少年相似，但我们不知道幼儿的父母是否也有类似的低碳水化合物食物偏好，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T1 DM儿童的饮食干预提供信息，K候选人推测，如果不同时解决饮食问题，仅针对行为的干预将不会成功地改变幼儿的血糖控制。研究的目的是：1)收集定性数据，调查父母对T1 DM患者的营养知识的了解情况，以及他们饮食管理的原因；2)调查影响父母饮食管理的食物环境因素。这项拟议的研究意义重大，因为它将产生数据，揭示父母对T1 DM患者的营养知识的理解，以及他们选择食物的因素，这对于确定如何改变父母的饮食管理是必要的。中心假设是，父母对T1 DM的健康饮食习惯的误解以及儿童食物环境的因素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、对食物环境的有效评估和定量的父母问卷。这项拟议的研究将扩大K候选人目前的K23计划，并提供新的数据，为未来的干预发展提供信息。这项研究具有创新性，因为它专门和深入地关注幼儿强化养生法，并检查了对饮食管理很重要的两个新因素：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看法。这些目标是对候选人在T1 DM儿童中的K23工作和她的长期目标的赞扬，她的长期目标是开发能够早期改变这些患者的健康结果并预防糖尿病相关并发症发展的干预措施。 公共卫生相关性：拟议的研究与公共健康相关，因为1型糖尿病在儿童中很常见，而次优的糖尿病管理可能会导致患者发病率和死亡率的增加。健康饮食是更好地控制血糖和降低长期糖尿病相关并发症风险的关键。因此，拟议的研究与NIH使命的一部分有关，即发展基础知识以延长健康寿命和减轻疾病负担。