Diabetic Diets in South Asia: Recommendations, Adherence, and Outcomes Público

Abstract

Introduction: Dietary modification is an important aspect of diabetes management that could reduce the burden of diabetes in South Asia by slowing disease progression and lowering the risk of complications. Our study aims to determine how frequently diets are recommended, how well they are followed, and if there are corresponding clinical benefits.

Methods: Cross-sectional data from the Centre for cArdiometabolic Risk Reduction in South-Asia (CARRS) Cohort Study were used to estimate prevalence of following diabetic diets in participants with self-reported diabetes, undiagnosed diabetes, and no diabetes. Participants with self-reported diabetes were divided into four groups based on whether they were prescribed and/or followed diabetic diets. These groups were assessed for differences in socio-demographic characteristics, clinical variables, and dietary intake. Linear and logistic regression models were used to estimate associations between prescription and/or following of diabetic diets with achievement of diabetes care goals.

Results: 5.65% of all participants reported following diabetic diets. Those with self-reported diabetes were more likely to follow diabetic diets (34.6%) than those with undiagnosed diabetes (4.1%) or no diabetes (1.8%), p<0.001. Of those with reported diabetes, those prescribed diabetic diets were 4.2 (95% CI: 3.27, 5.34) times more likely to follow diabetic diets than those who were not prescribed them. Higher income was associated with diet prescription, while higher education was associated with both prescription and following of diabetic diets(p<0.001). Whole grain intake was greater in those who were prescribed a diet than those who were not prescribed a diet, and, complementary to this, refined grain intake was lower (p<0.0001). Following a diet was associated with lower LDL cholesterol levels, even after adjusting for socio-demographic characteristics; however, the effect was attenuated after adjusting for history of hypertension and hyperlipidemia to the models.

Discussion: Though patients who were prescribed diabetic diets were more likely to follow them, the majority of patients with diabetes in urban South Asia were neither prescribed nor followed such diets. Being prescribed and/or adhering to diabetic diets was associated with positive changes in dietary intake. However, despite differences in diet, there were limited associations with cardio-metabolic outcome variables beyond lower LDL cholesterol.

Table of Contents

Chapter 1: Overview.......................................................1

Background....................................................................1

Therapeutic Goals..........................................................1

Lifestyle Modification and Diabetes...............................2

Primary Prevention........................................................2

Secondary and Tertiary Prevention................................3

Dietary Modification......................................................4

Barriers to Dietary Change.............................................4

Nutritional Understanding.............................................5

Physician Recommendations.........................................6

Cultural/Religious Practices...........................................6

Limited Access to Dietary Alternatives..........................7

Project Aims...................................................................7

Chapter 2: Manuscript...................................................9

Abstract.........................................................................10

Introduction..................................................................11

Methods........................................................................13

Sample..........................................................................13

Exposure assessment....................................................13

Outcome assessment.....................................................14

Covariates......................................................................15

Statistical analysis.........................................................15

Results............................................................................17

Discussion......................................................................20

Acknowledgements........................................................25

Chapter 3: Tables and Figures........................................26

References......................................................................33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	Diet Diabetes South Asia
Committee Chair / Thesis Advisor	Jaacks, Lindsay, Emory University Ali, Mohammed K, Emory University
Partnering Agencies	University, college or educational institution (other than Emory)

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