Evaluation and Comparison of Daily Total Energy Intake and Macronutrient Proportion Consumption Between Poor vs Good Glycemic Control Type 2 Diabetes Mellitus Patients: A cross-sectional study at Family Medicine OPD, Maharaj Nakorn Chiang Mai Hospital, Thailand
Keywords:
DM, nutrition, diet, calories, glycemic control, consumptionAbstract
OBJECTIVE To evaluate and compare daily total energy intake and macronutrient proportion consumption between poor and good glycemic control type 2 diabetic patients.
METHODS A cross-sectional study was conducted from December 2021 to March 2022 at Maharaj Nakorn Chiang Mai Hospital. Patient data was collected using a questionnaire. Dietary intake data was collected using 24-hour dietary recall and was analyzed by a dietitian. Factors and their association with poor glycemic control were analyzed.
RESULTS Of the 127 participants, 40.16% had poor glycemic control. The mean HbA1c level in the poor and the good glycemic control group was 7.67±0.61% and 6.39±0.44% respectively (p < 0.001). Among all patients, the mean total energy intake was 1,640.21±495.92 kcal/day, with mean proportions of 51.25% for carbohydrate, 16.56% for protein, and 32.12% for fat. There were no significant differences between the poor and good glycemic control groups in total energy intake (1702.63 ±503.48 kcal/day vs. 1598.32±489.65 kcal/day, p = 0.247), carbohydrate
intake (222.78±89.98 g/day vs. 203.72±79.36 g/day, p = 0.211), protein intake (70.12±21.50 g/day vs. 65.44±21.38 g/day, p = 0.230), or fat intake (58.94±19.26 g/day vs. 57.86±24.33 g/day, p = 0.790).
CONCLUSIONS The poor glycemic control group was more likely to consume more total energy and a higher proportion of carbohydrate and fat, which suggests that proper individualized dietary energy intake and diet proportions may enhance nutritional status and glycemic control.
References
Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. Avicenna J Med. 2020;10:174-88.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. PubMed PMID: 31518657
International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels, Belgium: International Diabetes Federation; 2021. p. 5-6.
Sakboonyarat B, Pima W, Chokbumrungsuk C, Pimpak T, Khunsri S, Ukritchon S, et al. National trends in the prevalence of glycemic control
among patients with type 2 diabetes receiving continuous care in Thailand from 2011 to 2018. Sci Rep. 2021;11:14260. PubMed PMID: 34253809
Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition Therapy Recommendations for the management of adults with diabetes. Diabetes Care. 2013;37(Supplement_1):S120-S43.
Kang HM, Kim DJ. Total energy intake may be more associated with glycemic control compared to each proportion of macronutrients in
the korean diabetic population. Diabetes Metab J. 2012;36:300-6.
Rivellese AA, Boemi M, Cavalot F, Costagliola L, De Feo P, Miccoli R, et al. Dietary habits in type II diabetes mellitus: how is adherence to dietary recommendations? Euro J Clin Nutr. 2008;62:660-4.
Singh P, Kesharwani RK, Keservani RK. 6 - protein, carbohydrates, and fats: energy metabolism. In:Bagchi D, editor. Sustained energy for enhanced human functions and activity. Massachusett: Academic Press; 2017. p. 103-15.
Franz MJ. Protein: metabolism and effect on blood glucose levels. Diabetes Educ. 1997;23:643-51.
Ahn HJ, Han KA, Kwon HR, Min KW. The small rice bowl-based meal plan was effective at reducing dietary energy intake, body weight, and blood glucose levels in Korean women with type 2 diabetes mellitus. Korean Diabetes J. 2010;34:340-9.
Jia SS, Liu Q, Allman-Farinelli M, Partridge SR, Pratten A, Yates L, et al. The use of portion control plates to promote healthy eating and diet-related outcomes: a scoping review. Nutrients. 2022;14:892. PubMed PMID: 35215542
Farvid MS, Homayouni F, Shokoohi M, Fallah A, Farvid MS. Glycemic index, glycemic load and their association with glycemic control among patients with type 2 diabetes. Eur J Clin Nutr. 2014;68:459-63.
Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E, et al. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association. Diabetes Care. 2004;27:2266-71.
Sato J, Kanazawa A, Makita S, Hatae C, Komiya K, Shimizu T, et al. A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control. Clin Nutr. 2017;36:992-1000.
Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. Nutrition therapy. Can J Diabetes. 2018;42(Supplement_1):S64-S79.
Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: The National Academies Press; 2005. p. 1358.
Duangsanjun W, Panuthai S, Suwankruhasn N, Kosachunhanun N. Carbohydrate intake and hemoglobin A1C in older adults with type 2 diabetes mellitus. Nursing Journal CMU. 2022;49:122-33.
Daniel WW. Biostatistics: a foundation of analysis in the health sciences. New York: John Wiley&Sons. 1995. p. 180.
Gouda M, Matsukawa M, Iijima H. Associations between eating habits and glycemic control and obesity in Japanese workers with type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2018;11:647-58.
Trongsakul S, Lambert R, Clark A, Wongpakaran N, Cross J. Development of the Thai version of Mini-Cog, a brief cognitive screening test. Geriatr Gerontol Int. 2015;15:594-600.
Jaturapatporn D, Hathirat S, Manataweewat B, Dellow AC, Leelaharattanarak S, Sirimothya S, et al. Reliability and validity of a Thai version of the General Practice Assessment Questionnaire (GPAQ). J Med Assoc Thai. 2006;89:1491-6.
World Health Organization. Global Physical Activity Questionnaire (GPAQ) Analysis Guide Switzerland: World Health Organization [Internet].2019 [cited 2022 Apirl 8]. Available from:https://www.who.int/docs/default-source/ncds/ncd-surveillance/gpaq-analysis-guide.pdf?sfvrsn=1e83d571_2
Ravussin E, Bogardus C. Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. Am J Clin Nutr. 1989;49(Supplement_5):968-75.
United Nations University, World Health Organization.Human Energy Requirements: Report of a Joint FAO/WHO/UNU Expert Consultation: Rome,17-24 October 2001. Rome, IT: FAO; 2004. p. 35-50.
Frankenfield DC. Bias and accuracy of resting metabolic rate equations in non-obese and obese adults. Clin Nutr. 2013;32:976-82.
Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:241-7.
Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, et al. Obesity in South and Southeast Asia-A new consensus on
care and management. Obes Rev. 2023;24:e13520.PubMed PMID: 36453081
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 13. older adults:standards of care in diabetes—2023. Diabetes
Care. 2022;46(Supplement_1):S216-S29.
Diabetes Association of Thailand. Carbohydrate counting for health and diabetes control. 3rd ed. Bangkok: Diabetes Association of Thailand under The Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn; 2019.
Puwastien P, Judprasong K, Sridonpai P, Saiwan T. Thai food composition tables 2015. 2nd ed. Nakhon Pathom: Institute of Nutrition, Mahidol University (INMU); 2015. p. 312.
Heilbronn LK, Noakes M, Clifton PM. Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Diabetes Care. 1999;22:889-95.
Romieu I, Dossus L, Barquera S, Blottière HM, Franks PW, Gunter M, et al. Energy balance and obesity: what are the main drivers? Cancer Causes Control. 2017;28:247-58.
Thewjitcharoen Y, Chotwanvirat P, Jantawan A, Siwasaranond N, Saetung S, Nimitphong H, et al. Evaluation of dietary intakes and nutritional knowledge in Thai patients with type 2 diabetes mellitus. J Diabetes Res. 2018;2018:9152910. PubMed PMID: 30671482
Westman EC. Type 2 diabetes mellitus: a pathophysiologic perspective. Front Nutr. 2021;8:707371. PubMed PMID: 34447776
Riccardi G, Giacco R, Rivellese AA. Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr. 2004;23:447-56.
Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: A review. Int J Health Sci (Qassim). 2017;11:65-71.
Sainsbury E, Kizirian NV, Partridge SR, Gill T, Colagiuri S, Gibson AA. Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;139:239-52.
Layman DK, Baum JI. Dietary protein impact on glycemic control during weight loss. J Nutr. 2004; 134:968S-73S.
Yamaoka T, Araki A, Tamura Y, Tanaka S, Fujihara K, Horikawa C, et al. Association between low protein intake and mortality in patients with type 2 diabetes. Nutrients. 2020;12:1629. PubMed PMID:32492838
Huh Y, Son KY. Association between total protein intake and low muscle mass in Korean adults. BMC Geriatr. 2022;22:319. PubMed PMID: 35410179
