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Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study

Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study
Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study

BACKGROUND/OBJECTIVES: Diet and lifestyle advice for type 1 diabetes (T1DM) patients is based on little evidence and putative effects on glycaemic control. Therefore, we investigated the longitudinal relation between dietary and lifestyle variables and HbA1c levels in patients with type 1 diabetes.

SUBJECTS/METHODS: A 7-year prospective cohort analysis was performed in 1659 T1DM patients (52% males, mean age 32.5 years) participating in the EURODIAB Prospective Complications Study. Baseline dietary intake was assessed by 3- day records and physical activity, smoking status and alcohol intake by questionnaires. HbA1c during follow-up was centrally assessed by immunoassay. Analysis of variance (ANOVA) and restricted cubic spline regression analyses were performed to assess dose-response associations between diet and lifestyle variables and HbA1c levels, adjusted for age, sex, lifestyle and body composition measures, baseline HbA1c, medication use and severe hypoglycaemic attacks.

RESULTS: Mean follow-up of our study population was 6.8 (s.d. 0.6) years. Mean HbA1c level was 8.25% (s.d. 1.85) (or 66.6 mmol/mol) at baseline and 8.27% (s.d. 1.44) at follow-up. Physical activity, smoking status and alcohol intake were not associated with HbA1c at follow-up in multivariable ANOVA models. Baseline intake below the median of vegetable protein (<29 g/day) and dietary fibre (<18 g/day) was associated with higher HbA1c levels. Restricted cubic splines showed nonlinear associations with HbA1c levels for vegetable protein (P (nonlinear)=0.008) and total dietary fibre (P (nonlinear)=0.0009).

CONCLUSIONS: This study suggests that low intake of vegetable protein and dietary fibre are associated with worse glycaemic control in type 1 diabetes.

Adolescent, Adult, Analysis of Variance, Blood Glucose/metabolism, Diabetes Mellitus, Type 1/blood, Diet/adverse effects, Diet Records, Dietary Fiber/adverse effects, Dietary Proteins/adverse effects, Exercise, Feeding Behavior, Female, Follow-Up Studies, Glycated Hemoglobin A/analysis, Humans, Life Style, Male, Middle Aged, Prospective Studies, Regression Analysis, Smoking, Surveys and Questionnaires, Vegetables, Young Adult
0954-3007
229-236
Balk, S.N.
66152542-8f5c-4ba7-9123-1938e83fce31
Schoenaker, D.A.J.M.
84b96b87-4070-45a5-9777-5a1e4e45e818
Mishra, G.D.
02143b82-e536-4915-9b30-3c86cbe1a1fe
Toeller, M.
34db8b67-0eea-40b4-9ee5-fedcc7f58d02
Chaturvedi, N.
2ca58292-9784-4321-9e5a-c59c50a2d574
Fuller, J.H.
1cc7f516-492a-4cd4-ad6b-854045ad81fe
Soedamah-Muthu, S.S.
a92e78f0-b28c-44f3-be86-e744fd004ff4
EURODIAB Prospective Complications Study Group
Balk, S.N.
66152542-8f5c-4ba7-9123-1938e83fce31
Schoenaker, D.A.J.M.
84b96b87-4070-45a5-9777-5a1e4e45e818
Mishra, G.D.
02143b82-e536-4915-9b30-3c86cbe1a1fe
Toeller, M.
34db8b67-0eea-40b4-9ee5-fedcc7f58d02
Chaturvedi, N.
2ca58292-9784-4321-9e5a-c59c50a2d574
Fuller, J.H.
1cc7f516-492a-4cd4-ad6b-854045ad81fe
Soedamah-Muthu, S.S.
a92e78f0-b28c-44f3-be86-e744fd004ff4

Balk, S.N., Schoenaker, D.A.J.M., Mishra, G.D., Toeller, M., Chaturvedi, N., Fuller, J.H. and Soedamah-Muthu, S.S. , EURODIAB Prospective Complications Study Group (2015) Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study. European Journal of Clinical Nutrition, 70 (2), 229-236. (doi:10.1038/ejcn.2015.110).

Record type: Article

Abstract

BACKGROUND/OBJECTIVES: Diet and lifestyle advice for type 1 diabetes (T1DM) patients is based on little evidence and putative effects on glycaemic control. Therefore, we investigated the longitudinal relation between dietary and lifestyle variables and HbA1c levels in patients with type 1 diabetes.

SUBJECTS/METHODS: A 7-year prospective cohort analysis was performed in 1659 T1DM patients (52% males, mean age 32.5 years) participating in the EURODIAB Prospective Complications Study. Baseline dietary intake was assessed by 3- day records and physical activity, smoking status and alcohol intake by questionnaires. HbA1c during follow-up was centrally assessed by immunoassay. Analysis of variance (ANOVA) and restricted cubic spline regression analyses were performed to assess dose-response associations between diet and lifestyle variables and HbA1c levels, adjusted for age, sex, lifestyle and body composition measures, baseline HbA1c, medication use and severe hypoglycaemic attacks.

RESULTS: Mean follow-up of our study population was 6.8 (s.d. 0.6) years. Mean HbA1c level was 8.25% (s.d. 1.85) (or 66.6 mmol/mol) at baseline and 8.27% (s.d. 1.44) at follow-up. Physical activity, smoking status and alcohol intake were not associated with HbA1c at follow-up in multivariable ANOVA models. Baseline intake below the median of vegetable protein (<29 g/day) and dietary fibre (<18 g/day) was associated with higher HbA1c levels. Restricted cubic splines showed nonlinear associations with HbA1c levels for vegetable protein (P (nonlinear)=0.008) and total dietary fibre (P (nonlinear)=0.0009).

CONCLUSIONS: This study suggests that low intake of vegetable protein and dietary fibre are associated with worse glycaemic control in type 1 diabetes.

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More information

Published date: 15 July 2015
Keywords: Adolescent, Adult, Analysis of Variance, Blood Glucose/metabolism, Diabetes Mellitus, Type 1/blood, Diet/adverse effects, Diet Records, Dietary Fiber/adverse effects, Dietary Proteins/adverse effects, Exercise, Feeding Behavior, Female, Follow-Up Studies, Glycated Hemoglobin A/analysis, Humans, Life Style, Male, Middle Aged, Prospective Studies, Regression Analysis, Smoking, Surveys and Questionnaires, Vegetables, Young Adult

Identifiers

Local EPrints ID: 441989
URI: http://eprints.soton.ac.uk/id/eprint/441989
ISSN: 0954-3007
PURE UUID: 4fc6da51-f452-425d-89fd-10c5717e6787
ORCID for D.A.J.M. Schoenaker: ORCID iD orcid.org/0000-0002-7652-990X

Catalogue record

Date deposited: 03 Jul 2020 16:31
Last modified: 10 Jan 2022 03:21

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Contributors

Author: S.N. Balk
Author: G.D. Mishra
Author: M. Toeller
Author: N. Chaturvedi
Author: J.H. Fuller
Author: S.S. Soedamah-Muthu
Corporate Author: EURODIAB Prospective Complications Study Group

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