Patient’s understanding of type 2 diabetes management

A qualitative investigation of patients’ understanding of carbohydrate in the clinical management of type 2 diabetes

Breen et al., JHND Early View


A healthy diet is the cornerstone of type 2 diabetes (T2DM) self-management. Carbohydrate is of particular interest as the nutrient with the greatest direct effect on blood glucose (BG) levels. The present study aimed to explore T2DM patients’ understanding of carbohydrate and beliefs around the role of carbohydrate in T2DM management.


Fifteen semi-structured interviews were conducted with T2DM patients. Interviews were audio-recorded and transcribed, and a deductive thematic approach to analysis was employed using the Framework method.


Four significant themes emerged: (i) a naïve conceptual understanding of carbohydrate and sugar-centric specificity to dietary behaviours; (ii) a narrow focus on BG management to the neglect of overall dietary balance; (iii) positive reception of moderate dietary advice focused on portion control from healthcare professionals (HCPs); and (iv) the impact of external moderators of dietary choices, including the influence of significant others, emotional and opportunistic eating and budgetary constraints.


Participants’ beliefs and understanding of carbohydrate led to an overemphasis on sugar restriction for blood glucose control to the neglect of their overall dietary balance. Diabetes educators need to place greater emphasis on the role of various types of carbohydrate foods for glycaemic control, as well as on concepts of wider metabolic health, during T2DM dietary education. Participants placed a high level of trust and value on practical, moderate portion control advice from HCPs regarding carbohydrate foods. However, HCPs need to be cognisant of external moderators of behaviour, such as the influence of family and friends, budgetary constraints and environmental eating triggers.

Food and experiences after cancer treatment

An exploration of food and the lived experience of individuals after treatment for colorectal cancer using a phenomenological approach

Burden et al. JHND Early View


There is a paucity of qualitative literature investigating people’s experiences of food and nutrition after treatment for cancer. The present study aimed to explore people’s relationships with food and nutrition throughout their colorectal cancer journey.


In-depth semi-structured interviews were conducted with 25 participants who had undergone surgery for colorectal cancer. The study design was informed by principles of phenomenology. Data were collected then transcribed and analysed using an inductive coding process and a thematic analysis to allow the themes to highlight people’s lived experiences.


Data enabled five primary themes to be drawn including: ‘appetite swings’, ‘emotions on a changing physicality’, ‘the medicalisation of food’, ‘taking control of symptom management’ and a cross-cutting theme ‘drivers and vehicles for action’. Feelings and emotions described by participants around their relationship with food and nutritional status often guided decisions on what was eaten more than objective nutritional measure or dietary advice. Participants used weight changes, appetite and food as barometers to measure their overall recovery. Food was an area over which people exhibited control of their lives and they could quantify, in measurable units, their overall well-being and rehabilitation. They did this either by using the currency of body weight in pounds or the size of portions eaten.


Appetite, weight and symptoms influenced dietary intake substantially and were poignant issues affecting people’s lives. The relationship people have with food determines their eating habits and an understanding of the essences and nuances of their experiences is essential to enable the delivery of patient-centred care.

Apologies if we are keeping you waiting

December and January are difficult times for journal editors. The peer review of papers is dependent upon a key resource. Peer reviewers. These are hard to find during these months as before Christmas holidays they are not receptive to invitations to review requiring action within 28 days and after the holidays they are so bogged down with other things (resumption of teaching, catching up with the email backlog, etc) that they tend to ignore requests to review. Add to that the fact that manuscript submissions seem to peak in January (we had 19 last week- normally expect 6 in a week), presumably because people delay submitting before the holidays, or come back with a New Years resolution to get that paper submitted. Anyway, we’re struggling a little at the moment.

We apologise if you are one of the authors currently experiencing a delay.

Out now- Special issue on Obesity and Related Disorders

Obesity and Related Disorders

The second of our 2015 Special Supplements is now published.

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Review article

A systematic review and meta-analysis of interventions for weight management using text messaging. Siopis et al.,

Original articles

The relationship between pretreatment dietary composition and weight loss during a randomised trial of different diet approaches. McVay et al.,

Factors predictive of drop-out and weight loss success in weight management of obese patients. Ortner et al.,

Factors associated with dropout in a group weight-loss programme: a longitudinal investigation. Yokobovitch-Gavan et al.,

Health literacy issues surrounding weight management among African American women: a mixed methods study. James et al.,

Revised Healthy Lifestyle-Diet Index and associations with obesity and iron deficiency in schoolchildren: The Healthy Growth Study. Manios et al.,

Candy consumption in childhood is not predictive of weight, adiposity measures or cardiovascular risk factors in young adults: the Bogalusa Heart Study. O’Neill et al.,

Liquid versus solid energy intake in relation to body composition among Australian children. Zheng et al.,

Overweight adolescents eat what? And when? Analysis of consumption patterns to guide dietary message development for intervention. Smith et al.,

Poor quality diet is associated with overweight status and obesity in patients with polycystic ovary syndrome. Rodrigues et al.,

Counting the cost of undernutrition in hospitals

Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs

Guerra et al., JHND Early View


Undernutrition is associated with higher hospitalisation costs. The present study aims (i) to explore whether undernutrition status at hospital admission, as evaluated by different screening and diagnostic tools, can predict patient’s hospitalisation costs and (ii) to provide an updated economic analysis of undernutrition burden.


A prospective study was conducted in a university hospital. Participants’ (n = 637) nutritional risk was evaluated within 72 h of admission using the Nutritional Risk Screening (NRS–2002) and the Malnutrition Universal Screening Tool (‘MUST’). Undernutrition status was determined by Academy of Nutrition and Dietetics (AND) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommended clinical characteristics and by the Patient Generated Subjective Global Assessment (PG–SGA). The hospitalisation cost was calculated for each inpatient using the diagnosis–related group system. Multivariable linear regression analysis was conducted to identify predictors of hospitalisation costs via percentage deviation from the mean cost, after adjustment for patients’ characteristics and comorbidities.


Undernutrition risk according to NRS-2002 and high undernutrition risk according to ‘MUST’ increased patient’s costs, respectively, by 21.1% [95% confidence interval (CI) = 9.0–33.2%] and 28.8% (95% CI = 13.7–39.9%). Severe undernutrition by AND-ASPEN recommended clinical characteristics and by PG-SGA was also associated with higher hospitalisation costs, respectively 19.4% (95% CI = 7.3–31.5%) and 27.5% (95% CI = 14.0–41.1%). The cost of a nutritionally-at-risk or undernourished patient is between €416 (95% CI = €156–675) and €617 (95% CI = €293–855) higher than the average of the respective diagnosis-related group.


Undernutrition is a predictor of hospitalisation costs, increasing costs by between 19% and 29%. Undernutrition screening tools have an ability for predicting hospitalisation costs similar to that of diagnostic tools. An updated analysis of undernutrition associated costs was provided, highlighting the economic burden of undernutrition.