Table 2.
Characteristics of the studies that assessed the effectiveness of the Medical Nutrition Therapy to improve dietary pattern and diabetes self-management education and support in adolescents with type 1 diabetes.
| Author | Sample size | Age of participants | Intervention | Outcomes | Findings |
|---|---|---|---|---|---|
| Randomized Clinical Trials | |||||
| Dłużniak-Gołaska et al. [16] |
N = 70 intervention with interactive methods and education (group E) N = 81 intervention with education without interactive methods (group C) |
8–17 years | Interactive methods, i.e., quiz + multimedia application | Nutrition Knowledge |
Nutrition Knowledge: Index of healthy diet: mean change (95% CI): −2.98 (−5.10;−0.86), p < 0.01 in the group C. Total NKS: mean change (95% CI): 3.00 (1.73;4.27), p < 0.001 in the group C, and 3.70 (2.56;4.84), p < 0.001 in the group E; p = 0.422 for the intergroup difference after 6 months. |
| Nansel et al. [17] |
N = 66 intervention N = 70 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods |
HEI-2005 WPFD |
HEI-2005 (mean (SE) = 64.6 (2.0) intervention group vs. 57.4 (1.6) control group, p = 0.015). WPFD (mean (SE) = 2.2 (0.1) intervention group vs. 1.7 (0.1) control group, p = 0.004) |
| Marquard et al. [20] |
N = 9 OMD group N = 8 low-GI group |
6–14 years |
Two groups: - Optimized mixed diet - Flexible low-glycemic index diet |
Nutritional Quality Index Macronutrient and micronutrient composition |
OMD group (mean (SD)): Energy intake (Kcal) = 1767 (300) at baseline and 1532 (386) at follow-up; p = 0.05 Carbohydrate (g/day) = 214 (34) at baseline and 191 (62) at follow-up; p = 0.17 Total fat (g/day) = 72 (20) at baseline and 58 (15) at follow-up; p = 0.05 Protein (g/day) = 60 (10) at baseline and 57 (12) at follow-up; p = 0.09 Nutritional Quality Index = 79.5 (10.0) at baseline and 75.9 (14.0) at follow-up; p = 0.68 Low-GI group (mean (SD)): Energy intake (Kcal/day) = 1847.0 (281.0) at baseline and 1675.0 (203.0) at follow-up; p = 0.13. Carbohydrate (g/day): 236.0 (46.0) at baseline and 197.0 (31.0) at follow-up; p = 0.04 Total fat (g/day): 70.0 (19.0) at baseline and 70.0 (12.0) at follow-up; p = 0.99 Protein (g/day): 64.0 (16.0) at baseline and 59.0 (13.0) at follow-up; p = 0.17 Nutritional Quality Index = 79.5 (13.0) at baseline and 76.5 (10.0) at follow-up; p = 0.50 |
| Pichert et al. [23] | N = 69 participants | 9–15 years | MNT | Nutrition knowledge skills | All skills improved (p < 0.01) over time, achieving the primary goal of improving campers’ nutrition knowledge skills. |
| Hackett et al. [24] | N = 119 families | Mean (SD): 11.4 (3.3) of the younger group, and 12.4 (3.6) of the older group. | MNT | Dietary intake | Changes in diet were not significant. |
| Post-hoc from RCT | |||||
| Lipsky et al. [26] |
N = 66 intervention N = 70 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods |
HEI-2005 WPFD Family meal frequency |
Associations of parent-child diet quality by treatment assignation (control group as reference): (β (SE) = 1.57 (1.32) p = 0.23 for aHEI, and 0.21 (0.12), p = 0.08 for WPFD. Diet quality resemblance at final study: HEI (β (SE) = 0.29 (0.11), p = 0.009) of the intervention group WPFD (β (SE) = 0.33 (0.09), p < 0.001) of the intervention group |
| Nansel et al. [29] |
N = 66 intervention N = 70 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods |
HEI-2005 WPFD Pickiness subscale of the Child Feeding Questionnaire |
The intervention effect on diet quality was positive for picky eaters only (WPFD p < 0.001; HEI p = 0.04). |
| Eisenberg-Colman et al. [30] |
N = 42 intervention N = 48 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods |
Adherence to diabetes management tasks Disordered eating behaviors (DEB) DEPS-R |
Intervention on DEB: β (SE) = 0.00 (0.00), p = 0.84 DEPS-R vs. diabetes management: β (SE) = −0.20 (0.09), p = 0.03 |
| Eisenberg et al. [31] |
N = 66 intervention N = 70 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods |
Dietary intake Whole Plant Food Density (WPFD) Self-Efficacy for Healthy Eating Outcome Expectations for Healthy Eating Barriers to Healthy Eating Treatment Self-Regulation Parent Nutrition Knowledge |
Parent self-efficacy vs. WPFD (β = 0,21, p = 0.02) Autonomous motivation vs. WPFD (β = 0.17, p = 0.002) Nutrition knowledge vs. WPFD (β = 0.01, p = 0.03) Barriers to Healthy Eating vs. WPFD (β = −0.19, p = 0.02) Negative Outcomes Expectation vs. WPFD (β = −0.20, p = 0.008) Parent positive outcome expectations vs. WPFD (β = 0.07, p = 0.45) Controlled motivation vs. WPFD (β = −0.03, p = 0.56) |
| Gilbertson et al. [27] |
N = 38 CHOx group N = 51 low-GI group |
8–13 years | Comparison between the CHOx with low-GI |
Macronutrient intake Carbohydrate food sources Carbohydrate distribution of meals and snacks |
Energy intake (MJ/day): CHOx group vs. low-GI group (mean (SD) = 9.1 (1.7) vs. 9.3 (1.4), respectively). Protein (%): CHOx group vs. low-GI group (mean (SD) = 16.3 (1.9) vs. 16.3 (4.1), respectively). Total fat (%): CHOx group vs. low-GI group (mean (SD) = 35.3 (5.4) vs. 36.2 (6.3), respectively). Carbohydrate (%): CHOx group vs. low-GI group (mean (SD) = 48.3 (5.2) vs. 47.7 (6.2), respectively). Sugars (%): CHOx group vs. low-GI group (mean (SD) = 17.3 (5.8) vs. 18.8 (5.2), respectively). Fiber (g/day): CHOx group vs. low-GI group (mean (SD) = 22.4 (4.1) vs. 23.0 (7.2), respectively). No differences in carbohydrate distribution meals between bot groups. |
| Pre-post intervention | |||||
| Marigliano et al. [36] | N = 25 participants | 7–14 years | Carbohydrate counting with standard nutritional education | Dietary intake |
Energy intake (Kcal) (mean (SD) = 1595 (293.7) at baseline and 1766 (376.9) at follow-up, p < 0.01). Carbohydrates (%) (mean (SD) = 53.9 (4.6) at baseline and 56.7 (3.0) at follow-up, p < 0.01). Total fat (%) (mean (SD) = 30.8 (4.3) at baseline and 28.9 (2.7) at follow-up, p < 0.05). Protein (%) (mean (SD) = 15.0 (1.6) at baseline and 13.9 (1.7) at follow-up, p < 0.01). |
| Cadario et al. [37] | N = 64 participants | 13–19 years | Nutritional education according to the American Diabetes Association recommendations | Dietary intake |
Energy intake (Kcal/day) mean (SEM) = 1846.3 (43.8) at baseline and 1570.0 (36.6) at follow-up; p value was not significant. Carbohydrates (g/day) mean (SEM) = 238.2 (6.5) at baseline and 228.1 (5.5) at follow-up; p value was not significant. Total fat (g/day) mean (SEM) = 72.1 (2.5) at baseline and 49.1 (1.8) at follow-up; p < 0.05. Protein (g/day) mean (SEM) = 70.9 (1.5) at baseline and 68.2 (2.1) at follow-up; p value was not significant. Cholesterol (mg/day) mean (SEM) = 265.7 (9.1) at baseline and 94.1 (7.6) at follow-up; p < 0.01. Fiber (g/day) mean (SEM) = 18.5 (0.6) at baseline and 29.3 (1.1) at follow-up; p < 0.01. |
| Lorini et al. [38] | N = 36 participants | 9–21 years | Intensive MNT | Dietary intake |
Energy intake (Kcal/d) (mean (SD)): 2083 (554) vs. 1695 (581), p < 0.001. Total fat (%) (mean (SD)): 38.7 (6.2) vs. 34.3 (6.4), p < 0.01 Protein (%) (mean (SD)): 16.1 (2) vs. 15.4 (2), p was not significant. Carbohydrate (%) (mean (SD)): 44.8 (6.9) vs. 50 (8.2), p < 0.001. Carbohydrate-simple (g) (mean (SD)): 59.2 (23.8) vs. 65.2 (22.2), p < 0.05. Saturated fatty acid (g) (mean (SD)): 34.4 (9.6) vs. 27.3 (7.8), p < 0.001. PUFA (g) (mean (SD)): 12.1 (8.1) vs. 7.9 (3), p < 0.01. Fiber (g) (mean (SD)): 3.2 (1.6) vs. 3.8 (1.9), p < 0.05. |
BMI body mass index, CI confidence interval, CHOx traditional carbohydrate-exchange dietary advice, HbA1c glycated hemoglobin, HEI-2005 Healthy Eating Index-2005, KomPAN questionnaire for the study of views and dietary habits, low-GI low-glycemic index diet, MNT medical nutrition therapy, NKS Nutrition Knowledge Survey, OMD optimized mixed diet, PUFA polyunsaturated fatty acids, SE standard error, SD standard deviation, WPFD whole plant food density.