Diabetes Nutrition and Complications Trial: adherence to the ADA nutritional recommendations, targets of metabolic control, and onset of diabetes complications. A 7-year, prospective, population-based, observational multicenter study The Diabetes and Nutrition Study Group of the Spanish Diabetes Association (GSEDNu)4

Objective: To know the adherence to the ADA nutritional recommendations and its relation to targets of metabolic control and onset of diabetic complications in a sample of diabetic people in Spain. Research Design and Methods: The Diabetes Nutrition and Complications Trial (DNCT) is a prospective, population-based, observational multicenter study designed to know the nutritional pattern, based on the 7-day food diaries, of a population with long-standing diabetes mellitus (93/99 type 1/type 2 diabetic patients, 20/18 years of duration of diabetes, and 6.9%/6.4% HbA1c values) and its relation with the onset of microvascular and macrovascular diabetes complications between 1993 and 2000. Results: After a median follow-up period of 6.5 years, more than 55% of diabetic people complied with the recommendation of protein intake between 15% and 20%, but only 27% consumed less than 10% of saturated fatty acids (SFAs), the 13% achieved up 10% of polyunsaturated fatty acids (PUFAs) intake, the 39% consumed more than 60% from carbohydrate and monounsaturated fatty acids (MUFAs), and the 30% consumed b300 mg/day of cholesterol. In spite of these, more than 90% had an optimal HDL cholesterol and nonHDL cholesterol level, and triglycerides level, while less than 41% of diabetic people had an HbA1c value N7.5%. Moreover, more than 69% consumed a MUFAs-to-SFAs ratio N1.5 and the 46% a PUFAs-to-SFAs ratio N0.4. Nonadherence to nutritional recommendation, but MUFAs/SFAs ratio N1.5 and PUFAs/SFAs ratio N0.4, was associated with a reduction between 3.4and 8.2-fold in the risk of onset of diabetic complications. Conclusions: The adherence to ADA nutritional recommendations for people with diabetes in Spain is rather poor except for the protein consumption. Only PUFAs/SFAs N0.4 and MUFAs/SFAsN1.5 were associated to near-optimal targets of metabolic control and a reduction in the risk of the onset of diabetic complications. These data suggest that other nutritional recommendations should be taken in mind. D 2006 Elsevier Inc. All rights reserved.