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A Low-Fat Vegan Diet Elicits Greater Macronutrient Changes, but Is Comparable in Adherence and Acceptability, Compared with a More Conventional Diabetes Diet among Individuals with Type 2 Diabetes

https://doi.org/10.1016/j.jada.2008.10.049Get rights and content

Abstract

Background

Although therapeutic diets are critical to diabetes management, their acceptability to patients is largely unstudied.

Objective

To quantify adherence and acceptability for two types of diets for diabetes.

Design

Controlled trial conducted between 2004 and 2006.

Subjects/setting

Individuals with type 2 diabetes (n=99) at a community-based research facility. Participants were randomly assigned to a diet following 2003 American Diabetes Association guidelines or a low-fat, vegan diet for 74 weeks.

Main outcome measures

Attrition, adherence, dietary behavior, diet acceptability, and cravings.

Statistical analyses

For nutrient intake and questionnaire scores, t tests determined between-group differences. For diet-acceptability measures, the related samples Wilcoxon sum rank test assessed within-group changes; the independent samples Mann-Whitney U test compared the diet groups. Changes in reported symptoms among the groups was compared using χ2 for independent samples.

Results

All participants completed the initial 22 weeks; 90% (45/50) of American Diabetes Association guidelines diet group and 86% (42/49) of the vegan diet group participants completed 74 weeks. Fat and cholesterol intake fell more and carbohydrate and fiber intake increased more in the vegan group. At 22 weeks, group-specific diet adherence criteria were met by 44% (22/50) of members of the American Diabetes Association diet group and 67% (33/49) of vegan-group participants (P=0.019); the American Diabetes Association guidelines diet group reported a greater increase in dietary restraint; this difference was not significant at 74 weeks. Both groups reported reduced hunger and reduced disinhibition. Questionnaire responses rated both diets as satisfactory, with no significant differences between groups, except for ease of preparation, for which the 22-week ratings marginally favored the American Diabetes Association guideline group. Cravings for fatty foods diminished more in the vegan group at 22 weeks, with no significant difference at 74 weeks.

Conclusions

Despite its greater influence on macronutrient intake, a low-fat, vegan diet has an acceptability similar to that of a more conventional diabetes diet. Acceptability appears to be no barrier to its use in medical nutrition therapy.

Section snippets

Participants

The overall study methods have been previously described (4). Briefly, individuals with type 2 diabetes, defined by a fasting plasma glucose concentration ≥126 mg/dL (≥7.0 mmol/L) on two occasions or a prior physician's diagnosis of type 2 diabetes with the use of hypoglycemic medications for at least 6 months, were recruited through newspaper advertisements in the Washington, DC, area in two cohorts (October through December 2004 and October through December 2005), to complete the 74-week

Participants

Of 1,049 individuals initially screened by telephone, 99 met study criteria and were randomly assigned to the ADbA guidelines (n=50) or vegan (n=49) diet groups. The reasons for exclusion were hemoglobin A1c values outside the required range (n=201), failure to meet other participation criteria (n=279), inability to attend scheduled meetings (n=187), failure to keep interview appointment (n=153), reluctance to change diet (n=72), and other or unspecified (n=58). The sample was predominantly

Discussion

In this group of self-selected research volunteers, those assigned to a low-fat vegan diet reported major changes in nutrient intake that largely persisted for 74 weeks. Reductions in reported fat, saturated fat, and cholesterol intake and increases in carbohydrate and fiber intake were greater in the vegan group, compared with the ADbA guidelines group. These changes are similar to those reported in earlier studies using low-fat vegan diets (13). Neither diet was associated with increases in

Conclusions

Among individuals with type 2 diabetes in a research study, a low-fat vegan diet led to greater reductions in fat, saturated fat, and cholesterol intake and greater increases in fiber and complex carbohydrate intake, compared with a diet following 2003 ADbA guidelines, but was not viewed as less acceptable. Acceptability to patients should not be viewed as a barrier to its clinical use. The vegan diet requires marginally more initial effort, but was experienced as less constraining initially,

N. D. Barnard is with the Department of Medicine, George Washington University, Washington, DC, and founder and president of the Physicians Committee for Responsible Medicine, Washington, DC

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    N. D. Barnard is with the Department of Medicine, George Washington University, Washington, DC, and founder and president of the Physicians Committee for Responsible Medicine, Washington, DC

    J. Cohen is with the Department of Medicine, George Washington University School of Medicine, Washington, DC

    A. A. Green is a staff dietitian, Physicians Committee for Responsible Medicine, Washington, DC

    L. Gloede is with Nutrition Coaching, LLC, Arlington, VA

    D. J. A. Jenkins is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, and Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Canada

    G. Turner-McGrievy is with the Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill

    H. Ferdowsian is with the Department of Medicine, George Washington School of Medicine, Washington, DC, and is director of research policy, Physicians Committee for Responsible Medicine, Washington, DC

    Meets Learning Need Codes 4000, 4110, 5000, and 5190.To take the Continuing Professional Education quiz for this article, log in to ADA's Online Business Center at www.eatright.org/obc, click the “Journal Article Quiz” button, click “Additional Journal CPE Articles,” and select this article's title from a list of available quizzes.

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