标题：Effects of Food Label Use on Diet Quality and Glycemic Control Among Latinos With Type 2 Diabetes in a Community Health Worker–Supported Intervention
摘要：Objectives. To determine the impact of an intervention led by community health workers (CHWs) on food label use and to assess whether food label use and diet quality mediate the intervention’s impact on glycemic control. Methods. From 2006 to 2010, 203 Latinos (intervention group, n = 100; control group, n = 103) in Hartford County, Connecticut, with type 2 diabetes were randomized to an intervention that included 17 CHW-led home-based sessions over a 12-month period in addition to the standard of care available in both study arms. Data on food label use, diet quality, covariates, and glycated hemoglobin (HbA1c) were collected at baseline and at 3, 6, 12, and 18 months. Data were analyzed via mixed effects and multilevel structural equation modeling. Results. Food label use in the intervention (vs control) group was significantly higher at 3, 12, and 18 months (odds ratio = 2.99; 95% confidence interval = 1.69, 5.29). Food label use and diet quality were positive mediators of improved HbA1c levels. Conclusions. Culturally tailored interventions led by CHWs could increase food label use. Also, CHW-delivered food label education may lead to better diet quality and improve glycemic control among Latinos with type 2 diabetes. Type 2 diabetes is increasing in epidemic proportions in the United States, 1 where it is a leading cause of mortality, 2 renal failure, 3 nontraumatic limb amputations, 4 and blindness. 4 Although proper diabetes self-care behaviors have proven benefits in improving glycemic control and reducing associated comorbidities, 5 affected individuals frequently lack understanding of such behaviors, especially with respect to diet. 6 A systematic review of studies conducted among diabetes patients identified a need for improved patient-initiated behaviors, including dietary modifications to improve type 2 diabetes self-management. 7 Use of food labels may play an important role in sustaining such modifications. These labels, compulsory on prepackaged foods since the Nutrition Labeling and Education Act of 1990, 8 contain food-specific information including serving size, nutrient content per serving, and percentage daily values, 9 and as such they can help individuals make informed food choices. 10 Evidence from studies focusing on Latinos with type 2 diabetes (Kollannoor-Samuel et al., unpublished data, 2016) and general population studies 11,12 suggests the positive impact of food label use on dietary choices. Similarly, positive associations between dietary components (foods with a low glycemic index, 13 high-fiber foods, 13 fruits and vegetables 14 ) and glycemic control have been reported. Latinos, the largest minority group in the United States, 15 continue to suffer from a high prevalence of type 2 diabetes 16 and related complications 16,17 as well as poor health care access. 18 Latinos with type 2 diabetes often report poor diabetes health literacy 19 and self-care behaviors, 20,21 including low diet quality and nonuse of food labels (Kollannoor-Samuel et al., unpublished data, 2016). There is limited empirical evidence of which we are aware documenting the effects of diabetes-specific education on food label use among Latinos with type 2 diabetes. Similarly, little is known about the impact of food label use or diet quality on glycemic control in this group. Culturally appropriate educational interventions have proven benefits with respect to type 2 diabetes management among members of racial/ethnic minority groups. 22,23 For example, in the Diabetes among Latinos Best Practices Trial (DIALBEST), we previously demonstrated improvements in glycated hemoglobin (HbA1c) levels among Latinos with type 2 diabetes who received health education from community health workers (CHWs). 23 Although various facets of diabetes care, including physical activity, weight management, and medication adherence, may have contributed to the improved HbA1c levels observed among DIALBEST participants, our primary aim in this study was to examine the mediating effects of 2 interrelated self-care behaviors, namely food label use and diet quality. We hypothesized that an educational intervention delivered by CHWs would have a positive impact on food label use among DIALBEST participants and that food label use and diet quality would mediate the HbA1c improvements attributed to the intervention.
