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Diabetes and Diet: Food Choices

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Diabetes and Diet: Food Choices Diabetes and diet: food choices CENTRALE LANDBOUWCATALOGU S 0000 0330 5675 Promotoren:dr .J.G.A.J .Hautvast ,hoogleraa ri nd elee rva nd evoedin g end evoedselbereidin g dr.ir.N.G .Röling ,hoogleraa ri nd evoorlichtingskund e A.C. Niewind Diabetes anddiet : food choices PROEFSCHRIFT terverkrijgin gvei nd egraa dva n doctori nd elandbouwwetenschappen , opgeza gva nd erecto rmagnificus , dr.H.C .va nde rPlas , inhe topenbaa rt everdedige n opwoensda g7 jun i198 9 desnamiddag st evie ruu ri nd eaul a vand eLandbouwuniversitei tt eWageninge n BIBLIOTHEEK LANDBOUWUNIVERSITEIT WAGENINGEN HetDiabete sProjec twaarva nd estudies ,di ei ndi tproefschrif tworde n beschreven,dee luitmaken ,wer dfinanciee londersteun ddoo rhe tMinisteri eva n Welzijn,Volksgezondhei de nCultuu re ndoo rd eLandbouwuniversitei t Wageningen. (OWC7CH, \d&ô STELLINGEN 1. Mensenme tdiabete slegge nzichzel fonnodig ee ni nhe tlich tva n gezondevoedin gonjuist ebeperkinge no pi nhu nvoedselkeuze . (ditproefschrift ) 2. Veeldieetadvieze ndi eaa ndiabete nworde ngegeven ,zij nnie tgeën to p dehuidig ewetenschappelijk einzichten . (ditproefschrift ) 3. Voordiabete ni she tvolge nva nhe tdieetadvie she tmoeilijkst easpec t vand ebehandelin gva ndiabetes . (o.a.di tproefschrift ) 4. Bijhe tverandere nva nvoedingsgewoonte nmoe te rva nuitgegaa nworde n datvoedse lzowe lgezondheidswaard eal sgenotswaard eheeft . 5. Aaninsuline-afhankelijk ediabete nzonde rovergewich tzo ugee nvast e hoeveelheidenergi ei nd evoedin gmoete nworde nvoorgeschreven . 6. Dieet/voedingsadviezenworde nte nonrecht egeïnterpreteer d inge -e n verboden. 7. Wanneerdiabete ndieetadvieze nnie topvolgen ,i sdi tnie tt ewijte naa n onvoldoendemotivatie ,maa raa nonvoldoend ekenni sva nhe tdoe lva nhe t dieete naa nontoereikend evoorlichting . 8. Iti smuc heasie rt ochang ea ninsuli nregime ntha nt ochang ea person'seatin ghabits . Nuttal,F.Q. :J .AM .Coll .Nutr .6 ,5-9 ,1987 . 9. Wehav et oremembe rtha tdietar yguideline sar esuggestion st ohel pt o maintaingoo dhealth .The yar en oprescription st osav elives ;i ti s likesayin gth eTe nCommandment swil lge tyo uint oheaven . Kritchevsky,D. :JAOC S6 ,708-717 ,1986 . 10.D ebijdrag eaa nhe tto tstan dkome nva nee nproefschrif tva nd e laatstgenoemde inhe tvoorwoor dword tonderschat . 11.Gezie nd ebeperkthei dva nd eNederlands eonderzoekswerel d isvoo r wetenschappersee nverblij fi nhe tbuitenlan dee nnoodzaak . 12.He ti sergerniswekken dda the tmestoverscho tva nd eklein ehuisdiere n opstraa tword tgedeponeerd . 13.He tgetuig tva nweini ginzich ti nd eprobleme nva nslachtoffer sva n geweldplegingal sme nhu nallee npsycho-social ehul pbied te ngee n financiëlecompensatie . 14.D ediscussi eove rho evrouwe nhe topvoede nva nkindere nkunne n combinerenme the tverrichte nva nbetaald earbei dtoon taa nda td e emancipatieva nd evrou wno gnie ti svoltooid . 15.D ediscussi eove rho evrouwe nhe topvoede nva nkindere nkunne n combinerenme the tverrichte nva nbetaald earbei dtoon taa nda td e emancipatieva nd ema nno gnie ti svoltooid . ProefschriftA.C .Niewin d Diabetesan dDiet :Foo dChoice s Wageningen,7 jun i198 9 aanmij nouder s aanChri s DIABETESAN DDIET :FOC »CHOICE S THESIS,DEPARTMEN TO FHUMA NNUTRITION ,WAGENINGE NAGRICULTURA LUNIVERSITY ,TH E NETHERLANDS,JUN E7 1989 . A.C. Niewind This thesis reportso n the foodchoice s ofdiabeti c patients.Tw o studieswer e undertaken considering thebarrier s thesepatient sexperienc ewit h the diabeticdiet .Furthermore ,th echange s infoo d choicesdurin g the firstyear s after thediagnosi so f insulin-dependentdiabete sa swel l aspatients 'foo d choicemotive swer e investigated. It isconclude d thatdespit e the barriers diabeticpatient sexperienc ewit h theirdiets ,the yar emotivate d tochang e food choices forhealth-relate d reasonso na short-terman d amor e long-term basis.However ,th eactua l changes infoo dus epatient smak eafte r being diagnosed asdiabetic s areonl ypartl y inagreemen twit h theprinciple so f the diabeticdiet .Man yo f thechange s infoo dus ear eno tnecessar yan d some are evenundesirabl e froma nutritiona l perspective. It isadvise d thatpatients ' understanding of thediabeti cdie ta swel l asnutritio neducatio n programmes fordiabeti cpatient snee d tob e improved. CONTENTS Page Voorwoord 1 Chapter 1Introductio n 3 Part I Chapter 2Th ediabeti cdiet :Patients 'perspective s (submitted) 11 Chapter 3Barrier s experiencedwit h thedie tamon g insulin-treateddiabeti c patients (submitted) 21 Part II Chapter 4Change s in food choiceso f recently diagnosed insulin-dependent diabetic patients (submitted) 32 Chapter 5Change s in food choiceso f insulin-dependent diabetic patients:on eyea r follow-up (submitted) 46 Part III Chapter 6Foo d perceptionsan d foodus eo f recently diagnosed insulin-dependentdiabeti c patients (submitted) 57 Chapter 7Difference s infoo dperception san d foodus e between insulin-dependentdiabeti c and non-diabetic subjects (submitted) 68 Chapter 8Genera l discussion 78 Summary 84 Samenvatting 88 Curriculumvita e 92 -1- Voorwoord Dei ndi tproefschrif tbeschreve nonderzoeke nmake ndee lui tva nhe t DiabetesProjec tda tsind s198 5word tuitgevoer do pd eVakgroe pHuman e Voedingva nd eLandbouwuniversitei tWageningen .D eLandbouwuniversitei t Wageningene nhe tMinisteri eva nWelzijn ,Volksgezondhei de nCultuu r leverdenaa ndi tonderzoe kfinanciël ebijdragen .I nhe tDiabete sProjec t staatd evraa gcentraal :Wa tbeteken the to mnie tlange rt ekunne nete n waarj ezi ni nhebt ,maa ree ndieetadvie st emoete ngaa nhoude nal sgevol g vanhe tkrijge nva nDiabete sMellitu s(suikerziekte )e ndi tadvie sda gi n daguit ,jaa ri njaa ruit ,t emoete nvolgen ? Vand evel emense ndi ehu nbijdrag ehebbe ngelever daa ndi tproefschrif twi l ikenkele ni nhe tbijzonde rnoemen .I nd eeerst eplaat swi li kmij npromoto r prof.dr .J.G.A.J .Hautvas tbedanke nvoo rzij nenthousiast ebegeleidin gva n hetonderzoe ke nzij nvel ewaardevoll eadvieze no ppraktisc he nwetenschap ­ pelijkgebied ,e nmij nander epromotor ,weliswaa rwa tmee r 'opafstand' , prof.dr .ir .N.G .Rölin gvoo rzij nzinvoll ee ncreatiev einbren gvanui td e voorlichtingskunde.Hu nbereidhei do md emanuscripten ,waa rda noo kte r wereld,kritisc he nzee rsne lva ncommentaa rt evoorzie ne nhe ti nmi j gesteldevertrouwe nhe bi kzee rgewaardeerd . Dedagelijks ebegeleidin gva nhe tonderzoe kwa sgedurend ed eeerst ejare ni n handenva nMw .drs .J.M.P .Edema .Haa rwi li kdan kzegge nvoo rhaa r kritischekanttekeninge ne nvoo rhe tzee rnauwkeuri gdoorleze nva nd e manuscripten. Graagwi li koo kdr .Magdalen aKrond lnoeme ndi emi jtijden smij n verblijfaa nd euniversitei tva nToront ova n1983-198 5z oenthousias thaa r ideeënove rhe tonderzoe knaa rvoedingsgewoonte nbijbracht ,da ti ka lgau w gefascineerd raaktedoo rdi ttyp eresearch .Tijden she tuitvoere nva nhe t DiabetesProjec the bi kno gvaa kaa nonz ediscussie sgedach te ne rmij n voordeelme egedaan .Thank ss omuch . Vand ebegeleidingscommissi ebe ni ki nhe tbijzonde rdr .Fran sva nde r Horstzee rerkentelij kvoo rzij nnuttig esuggesties . Hetmees tintensie fhe bi ksamengewerk tme tRolan dFriele .Same nhebbe nw e hetDiabete sProjec topgeze te nuitgevoerd .Me tvee lplezie rden ki kteru g aanonz eurenlang ediscussie sove rhe tonderzoe ke nander ezaken .I khe b grotewaarderin gvoo rvoo rzij ncreatiev eideeën ,enthousiasm ee n gezelligheid.Vee lsucce swen si khe mto ebi jhe tschrijve nva nzij n proefschrift. Eenaanta lander emedewerker sva nd eVakgroe pHuman eVoedin gdroe goo k hunsteentj ebi jaa ndi tonderzoek :Kee sd eGraa fi nd evor mva nwaardevo l commentaaro ptwe eva nd emanuscripten ;Ja nBurem adoo rhe tlevere nva n statistischeadvieze ne nAde lde nHarto gdoo rzij nbetrokkenhei dbi jhe t wele nwe eva nhe tonderzoek . Essentieelwa sd emedewerkin gva nd eDiabete sVerenigin gNederlan d (DVN),di ehaa rledenbestan dte rbeschikkin gsteld evoo rdi tonderzoe ke n hetbestuu rva nd eDV Ni nd eregi oEde-Wageningen ,da tregelmati gtij dvri j maakteo mo pdrukk ebestuursvergaderinge nove rhe tonderzoe kt eprate ne n velebruikbar esuggestie sdeed .Apart evermeldin gverdiene nuiteraar dall e deelnemerse ndeelneemster saa ndi tonderzoek .Zonde rhu ntoegewijd e medewerkingzo uhe tDiabete sProjec tonmogelij kzij ngeweest .Alle nhee l hartelijkbedankt . Bijd everzamelin ge nverwerkin gva nd egegeven sspeelde nvele nee nrol . JaapjeNooy-Michel sna mee ngroo tdee lva nd einterview svoo rhaa rrekenin g endee ddi tuiters tnauwkeurig .Mariett aEimers ,In eHalverkam pe nJaco bva n Klaverenorganiseerde nd ecomputerverwerkin gva nd egegeven se nvoerde n nauwgezetvel eberekeninge nuit .Oo kleverd eee naanta ldoktoraalstudente n enstagiaire sbelangrijk ebijdrage naa nhe tonderzoek .He nwi li kbedanke n voord evaa kinspirerend esamenwerkin ge nconsciëntieus ewijz eva nwerken : JacolienBakker ,Annemiek eva nBerlo-Wijma ,Ensk eGerbrandy ,Jok e Hoogenboom,Carienek eKandou ,Jeann eva nLoon ,Stepha nMeershoek ,Harrie t Ordelman,Rit ad eVries ,Petr ava nWezel ,Margrie td eWinke le nIngri d Wijtten. Praktischeondersteunin gi sbi jiede ronderzoe kva nwezenlij kbelang .Pie t Middelburge nMarce lva nLeutere nwi li kgraa gdan kzegge nvoo rhu nhul pbi j definanciël ee npraktisch ekante nva nhe tonderzoek ,Sjoeki eKroes-Li e voorhe topzoeke nva nliteratuur .Bab ste nHage nontwier pd eomsla gva ndi t proefschrift.Cole tBroekmeije re nKari nHum ebe ni kzee rerkentelij kvoo r hetcorrigere nva nd eEngels etekste ne nd emedewerkers/ster sva nhe t secretariaatva nd eVakgroe pHuman eVoeding ,me tnam eBianc aDijksterhuis , voorhe tz ozorgvuldi guittype nva ndi tproefschrift
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