Subjective food perceptions in type 2 diabetic patients and their impact on the structure of the diet
Authors: Starostina Elena G. 
Published: July 2022

Background. Subjective food perceptions in various aspects that could impact food choices and diet adherence by the Russian patients with type 2 diabetes mellitus (T2DM) have not been studied.
Aim to assess food perceptions in T2DM patients in the reference group of dairy products and their potential influence on the nutritional structure.
Aim: To assess food perceptions in T2DM patients in the reference group of dairy products and their potential influence on the nutritional structure.
Materials and methods: This cross-sectional study included 300 consecutive out- and in-patients with T2DM (mean age standard deviation, 60,8 10,2 years, duration of diabetes 1 to 35 years). The patients underwent standard clinical and laboratory work-up and filled in the questionnaire on food perceptions of six dairy products (low fat cottage cheese, low fat milk, high fat milk, sour cream, cheese, and sweet cheese curds) in the following five aspects: impact on general health, impact on prevention of cardiovascular diseases, impact on glycemic control, taste and convenience of the use. These perception aspects were compared with the self-reported frequencies of the use of each product, patients demographic and clinical characteristics.
Results: The patients considered low fat cottage cheese to be most healthy for their general health, with low fat milk and cheese ranking 2nd (р 0.0001 compared to low fat cottage cheese). Fat milk and sour cream were perceived as unhealthy (р 0.0001 compared to healthy products). Sweet cheese curds were perceived by the patients as the most unhealthy/harmful (р 0.0001 compared with each of the rest products). All other medical aspects of food perceptions (impact on cardiovascular prevention and diabetes control) moderately or strongly correlated between each other and with the perception for general health (Spearman's r from 0.42 to 0.72, all р 0.0001). Taste perceptions of all products, except sour cream, demonstrated moderate correlation with their perception in terms of convenience of the use (Spearman's r from 0.36 to 0.47, all р 0.0001). Male patients perceived low fat milk as more tasty and sour cream as more healthy, than female patients (р = 0.029 and 0.046, respectively). Female patients found sour cream more tasty (р = 0.019), and low fat cottage cheese and cheese as more healthy, than males (р = 0.009 and 0.014, respectively). The frequencies of the product use was associated with medical aspects of their perceptions: patients use to eat/drink low fat milk, low fat cottage cheese and cheese significantly more often, than high fat milk and sweet cheese curds (р 0.0001), whereas sour cream was in an intermediate position as per its frequency of the use. Low fat cottage cheese and cheese ranked first according to the proportion of their consumers (91.3 and 90.7% of the patients, respectively), low fat milk ranked second (82% of the patients), and sour cream third (75%), whereas most patients abstain from the use of fat milk and sweet cheese curds (32 and 32.3% using them, respectively). The frequency of the reference product use was to a significantly lesser extent associated with perceptions of their taste or convenience of the use and was not at all associated with their costs/prices.
Conclusions: T2DM patients are able to clearly differentiate the products of the reference group (dairy products) for such aspects, as their impact on their general health, cardiovascular system and glycemic control. In most cases, these attitudes were not associated with their taste perceptions. It is exactly medical aspects of subjective food perceptions that have a higher impact on the nutritional structure (real-life use) than their taste or convenience of the use. This fact may become a favorable background for patient education in the area of rational nutrition and diet; however, patients knowledge on the food nutritional content and on their real impact on the health status need significant improvements.
Methods. This cross-sectional study included 300 consecutive out- and in-patients with T2DM (mean age SD, 60,810,2 years, duration of diabetes 1 to 35 years). The patients underwent standard clinical and laboratory work-up and filled in the questionnaire on food perceptions of six dairy products (low fat cottage cheese, low fat milk, high fat milk, sour cream, cheese, and sweet cheese curds) in the following five aspects: impact on general health, impact on prevention of cardiovascular diseases, impact on glycemic control, taste and convenience of the use. These perception aspects were compared with the self-reported frequencies of the use of each product, patients demographic and clinical characteristics. Between-group comparisons were done with Students t-test, Mann-Whitney test (depending on the data distribution etc.), chi-square test, and ANOVA. Any associations between food perceptions and frequencies of the food use were assessed by Spearmans correlations.
Results. The patients considered low fat cottage cheese to be most healthy for their general health, with low fat milk and cheese ranking 2nd (р 0.0001 compared to low fat cottage cheese). Fat milk and sour cream were perceived as unhealthy (р 0.0001 compared to healthy products). Sweet cheese curds were perceived by the patients as the most unhealthy/harmful (р0.0001 compared with each of the rest products). All other medical aspects of food perceptions (impact on cardiovascular prevention and diabetes control) moderately or strongly correlated between each other and with the perception for general health (Spearmans r from 0,42 to 0,72, all р 0.0001). Taste perceptions of all products, except sour cream, demonstrated moderate correlation with their perception in terms of convenience of the use (Spearmans r 0,36 to 0.47, all р 0.0001). Male patients perceived low fat milk as more tasty and sour cream as more healthy, than female patients (р = 0,029 and 0,046, respectively). Female patients found sour cream more tasty (р = 0,019), and low fat cottage cheese and cheese as more healthy, than males (р=0,009 and р = 0,014, respectively). The frequencies of the product use was associated with medical aspects of their perceptions: patients use to eat/drink low fat milk, low fat cottage cheese and cheese significantly more often, than high fat milk and sweet cheese curds (р0.0001), whereas sour cream was in an intermediate position as per its frequency of the use. Low fat cottage cheese and cheese ranked first according to the proportion of their consumers (91,3% and 90,7% of the patients, respectively), low fat milk ranked second (82% of the patients), and sour cream third (75%), whereas most patients abstain from the use of fat milk and sweet cheese curds (32% and 32,3% using them, respectively). The frequency of the reference product use was to a significantly lesser extent associated with perceptions of their taste or convenience of the use and was not at all associated with their costs/prices.
Conclusions. T2DM patients are able to clearly differentiate the products of the reference group for such aspects, as their impact on their general health, cardiovascular system and glycemic control. In most cases, these attitudes were not associated with their taste perceptions. It is exactly medical aspects of subjective food perceptions that have a higher impact on the nutritional structure (real-life use) than their taste or convenience of the use. This fact may become a favorable background for patient education in the area of rational nutrition and diet; however, patients knowledge on the food nutritional content and on their real impact on the health status need significant improvements.