Assessment of the effectiveness of the Physical Activity and Nutrition for Diabetes in Alberta (PANDA) nutrition intervention for type 2 diabetes patients

  • Author / Creator
    Asaad, G A
  • Type 2 diabetes patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) nutrition intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition therapy guidelines into their daily lives. The overall objective of this thesis was to evaluate the effectiveness of the PANDA nutrition intervention on glycated hemoglobin (A1c) and dietary adherence to guidelines. We conducted a single-arm trial in 73 participants with type 2 diabetes that measured outcomes at baseline, three and six months and allowed us to address the following aims: (1) To measure the reliability of the Perceived Dietary Adherence Questionnaire (PDAQ) and its validity relative to three repeated 24-h dietary recalls; (2) To evaluate the effectiveness of the intervention (menu plan plus education sessions) to improve glycemic control and diet quality and adherence; and (3) To identify the main food sources of sodium, saturated fat and added sugars and the influence of the PANDA intervention on food choices affecting intake of those nutrients. The intervention curriculum was based on Social Cognitive Theory and included 5 weekly group sessions, a grocery store tour, a four-week menu plan that incorporated the overall recommendations of the CDA nutrition therapy guidelines and hands-on activities. To measure validity of the PDAQ, individual sub-scores were correlated with specific information derived from the three 24-h dietary recalls (i.e., mean servings of food groups, nutrient intakes, glycemic index) using data from 64 trial participants for whom complete dietary data were available. The correlation coefficients for PDAQ items versus 24-h recalls ranged from 0.11 to 0.46. The correlation coefficient for the entire questionnaire was acceptable (r = 0.76). Reliability was determined using a test-retest protocol in 20 type 2 diabetes participants recruited for this purpose. The intra-class correlation (0.78) was acceptable, indicating good reliability. Three months after initiating the PANDA nutrition intervention in 73 participants, assessments were conducted in 64 program completers (88%). There were statistically significant reductions in A1c (-0.7% (95% CI ,-1.0, -0.4)), body mass index (BMI, -0.6 kg/m2 (95% CI,-0.8, -0.4)), systolic blood pressure (-4 mm Hg (95% CI,-6.8, -1.3)), total cholesterol (TC, -63 mg/dL (95% CI, -80.1, -46.9)), high density lipoprotein (HDL)- (+28 mg/dL (95% CI, 20.2, 34.8)) and low density lipoprotein (LDL)-cholesterol (-89 mg/dL (95% CI, -105.3, -72.5)). Significant improvements were maintained at 6 months in A1c, BMI, total-C, LDL-C and HDL-C. At 3 months, significant increases were observed in Healthy Eating Index (HEI, +2.1 score (95% CI, 0.2, 4.1)) and PDAQ (+8.5 score (95% CI, 6.1, 10.8)). After controlling for baseline A1c, BMI, age, and gender, a change in HDL-C of 10 mg/dL predicted -0.22% (95% CI, -0.041, -0.001) change in A1c, whereas -1 kg/m2 in BMI predicted -0.114% (95% CI, -0.33, -0.019) change in A1c. Because saturated fat, added sugar and sodium intakes were significantly decreased, and because there are specific recommendations for reducing intake of these nutrients, the main food sources of these nutrients was determined pre- and post-intervention. After 3 months, there was a reduction in sodium intake of 561 (95% CI (-891, -230)) mg/day, mainly due to reduced consumption of processed foods including meats and soups. Significantly lower intake of fat-containing milk and processed meat contributed to -2.9 (95% CI (-6.1, -0.1)) g/day saturated fat intake while added sugar intake declined by 7.0 (95% CI (-13.9, 1.8)) g/day, due to lower consumption of baked desserts/pastries and chocolate. The results suggest that PDAQ is a valid and reliable measure of adherence to Canadian diabetes nutrition recommendations in individuals with type 2 diabetes. The PANDA menu plan intervention was effective in improving glycemic control, anthropometric measures and dietary adherence in the short term. Changes in dietary intake of specific foods resulted in lower intakes of saturated fat, sodium and added sugar. These results suggest that a dietary intervention incorporating education sessions focused on menu planning and hands-on activities may be effective for diabetes management and behavioral changes, thereby providing support for a larger trial.

  • Subjects / Keywords
  • Graduation date
    Spring 2016
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
  • Specialization
    • Nutrition and metabolism
  • Supervisor / co-supervisor and their department(s)
  • Examining committee members and their departments
    • Dr.Rhonda Bell (Agricultural, Food, and Nutritional Science)
    • Dr.Andrea Haqq (Pediatrics)
    • Kaberi Dasgupta (Medicine)
    • Dr. Paula Robson (Agricultural, Food, and Nutritional Science)