BACKGROUND: Despite the efforts of health care providers, adherence of patients with type 2 diabetes to the recommended diet is poor. The aim of this study was to describe the eating habits with emphasis on fat and fiber-related behavior (FFB) as well as the relationship between FFB behavior and parameters of diabetes control in men and women with type 2 diabetes mellitus. METHODS: The subjects in this observational cross-sectional study were 200 patients (54.5% male, mean age 66.2 ± 10.1 years, mean Diabetes Control and Complications Trial [DDCT] glycosylated hemoglobin [HbA1c] 7.6% ± 1.7%) recruited from diabetes outpatient clinics in the Czech Republic. The subjects filled out the Fat- and Fiber-related Diet Behavior Questionnaire. The most recent patient data on diabetes control and drug therapy were derived from patient medical records. RESULTS: Patients tend to modify the dishes they are used to, rather than remove them completely from their diet and replace them by other types of foods. It is easier to perform healthier fat-related behaviors than fiber-related ones. Women scored significantly better than men on the fat-related diet habits summary scale (P = 0.002), as well as on "modify meat" (P = 0.001) and "substitute specially manufactured low-fat foods" (P = 0.045) subscales. A better score on the fat-related diet habits summary scale was significantly associated with higher HbA1c (ρ = -0.248; P = 0.027) and higher waist circumference (ρ = -0.254; P = 0.024) in women. CONCLUSION: Type 2 diabetes patients are likely to vary in their FFB behavior, and their dietary habits depend on gender. Health care professionals should pay attention to these facts when providing specific education. Emphasis should be placed on how to increase the fiber intake in diabetic patients.

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Kralove Charles University Prague Czech Republic

See more in PubMed

Nutrition Sub-Committee of the Diabetes Care Advisory Committee of Diabetes UK The dietitians challenge: the implementation of nutritional advice for people with diabetes. J Hum Nutr Diet. 2003;16:421–452. PubMed

Vermeire E, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2:CD003638. PubMed PMC

Broadbent E, Donkin L, Stroh JC. Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients. Diabetes Care. 2011;34:338–340. PubMed PMC

Archuleta M, VanLeeuwen D, Halderson K, et al. Cooking schools improve nutrient intake patterns of people with type 2 diabetes. J Nutr Educ Behav. 2012;44:319–325. PubMed

American Diabetes Association Nutrition recommendations for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):S61–S78. PubMed

Quandt SA, Bell RA, Snively BM, Vitolins MZ, Wetmore-Arkader LK, Arcury TA. Dietary fat reduction behaviors among African American, American Indian, and white older adults with diabetes. J Nutr Elder. 2009;28:143–157. PubMed PMC

Shannon J, Kristal AR, Curry SJ, Beresford SAA. Application of a behavioral approach to measuring dietary change: the Fat- and Fiber-related Diet Behavior Questionnaire. Cancer Epidemiol Biomarkers Prev. 1997;6:355–361. PubMed

Shatenstein B, Ghadirian P. Influences on diet, health behaviours and their outcome in select ethnocultural and religious groups. Nutrition. 1998;14:223–230. PubMed

Satia JA. Diet-related disparities: understanding the problem and accelerating solutions. J Am Diet Assoc. 2009;109:610–615. PubMed PMC

Teufel NI. Development of culturally competent food-frequency questionnaire. Am J Clin Nutr. 1997;65(Suppl):1173S–1188S. PubMed

Fitzgerald JT, Anderson RM, Davis WK. Gender differences in diabetes attitudes and adherence. Diabetes Educ. 1995;21:523–529. PubMed

Voss S, Kroke A, Klipstein-Grobusch K, Boeing H. Is macronutrient composition of dietary intake data affected by underreporting? Results from the EPIC-Potsdam Study. European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr. 1998;52:119–126. PubMed

Heerstrass DW, Ocké MC, Bueno-de-Mesquita HB, Peeters PHM, Seidell JC. Underreporting of energy, protein and potassium intake in relation to body mass index. Int J Epidemiol. 1998;27:186–193. PubMed

Kretsch MJ, Fong AK, Green MW. Behavioral and body size correlates of energy intake underreporting by obese and normal-weight women. J Am Diet Assoc. 1999;99:300–306. PubMed

Bowen DJ, Beresford SAA, Vu T, et al. Baseline data and design for a randomized intervention study of dietary change in religious organizations. Prev Med. 2004;39:602–611. PubMed

Hart A, Tinker LF, Bowen DJ, Satia-Aboutia J, McLerran D. Is religious orientation associated with fat and fruit/vegetable intake? J Am Diet Assoc. 2004;104:1292–1296. PubMed

Glasgow RE, Perry JD, Toobert DJ, Hollis JF. Brief assessments of dietary behavior in field setting. Addict Behav. 1996;21:239–247. PubMed

Mannucci E, Tesi F, Ricca V, et al. Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord. 2002;26:848–853. PubMed

Mannucci E, Bartali B, Molino L, et al. Eating habits in elderly diabetic subjects: assessment in the InCHIANTI Study. Nutr Metab Cardiovasc Dis. 2008;18:278–282. PubMed

Beresford SAA, Farmer EMZ, Feingold L, Graves KL, Summer SK, Baker RM. Evaluation of a self-help dietary intervention in a primary care setting. Am J Public Health. 1992;82:79–84. PubMed PMC

Kristal AR, White E, Shattuck AL, et al. Long-term maintenance of a low-fat diet: durability of fat-related dietary habits in the Women’s Health Trial. J Am Diet Assoc. 1992;92:553–559. PubMed

Kristal AR, Shattuck AL, Patterson E. Differences in fat-related dietary patterns between black, Hispanic and white women: results from the Women’s Health Trial Feasibility Study in Minority Populations. Public Health Nutr. 1999;2:253–262. PubMed

Spoon MP, Devereux PG, Benedict JA, et al. Usefulness of the food habits questionnaire in a worksite setting. J Nutr Educ Behav. 2002;34:268–272. PubMed

Hart A, Tinker L, Bowen DJ, Longton G, Beresford SAA. Correlates of fat intake behaviors in participants in the eating for a healthy life study. J Am Diet Assoc. 2006;106:1605–1613. PubMed

Dickson-Spillmann M, Siegrist M. Consumers’ knowledge of healthy diets and its correlation with dietary behaviour. J Hum Nutr Diet. 2011;24:54–60. PubMed

Epel ES, Spanakos A, Kasl-Godley J, Brownell KD. Body shape ideals across gender, sexual orientation, socioeconomic status, race, and age in personal advertisements. Int J Eat Disord. 1996;19:265–273. PubMed

Hoffman JM, Brownell KD. Sex differences in the relationship of body fat distribution with psychosocial variables. Int J Eat Disord. 1997;22:139–145. PubMed

Peel E, Parry O, Douglas M, Lawton J. Taking a biscuit? A discursive approach to managing diet in type 2 diabetes. J Health Psychol. 2005;10:779–791. PubMed

Satia JA, Galanko JA. Comparison of three methods of measuring dietary fat consumption by African-American adults. J Am Diet Assoc. 2007;107:782–791. PubMed

Czech Diabetes Society Guidelines for the treatment of type 2 diabetes mellitus 2011Available from: http://www.diab.cz/dokumenty/dm2_2011.pdfAccessed February 6, 2012Czech

Fat- and fiber-related diet behavior among type 2 diabetes patients from distinct regions