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Dietary adherence is the degree to which participants follow prescribed dietary protocol. Without measuring adherence, it is not possible to validly measure the effect of the intervention. Assessing adherence allows the investigator to better determine whether the results are due to the diet itself. The overall goal of the analyses presented in this thesis was to assess if dietary adherence was higher on a whole grain versus refined grain provided food protocol with specific prescription for calorie consumption. Eighty-two men and women between the ages of 40-65 were assigned to either a refined or whole grain feeding protocol, using a 3-day rotating menu for 6 weeks. Daily food logs were used to assess adherence to the prescribed diets and calculate total energy consumed and macronutrient content. The first objective was to determine the caloric and macronutrient content of the assigned diets, and to compare whether the reported nutrient content was the same as the provided nutrient content. Overall, the median whole grain group consumption was 45.0 kcal per day more than they were assigned to, and the median refined grain group consumption was 10.5 kcal per day less than assignment. The refined grain diet's macronutrient composition was 52.1% carbohydrate, 19.9% protein, and 28.1% fat, whereas the whole grain group's macronutrient composition was 54.4% carbohydrate, 18.0% protein, and 27.6% fat. Both diets were within the average daily macronutrient recommendations of 50-55% carbohydrate, 15-20% protein, and 25-30% fat. There was a statistically significant difference in the percentage of carbohydrate and protein between groups. The second objective was to determine if two different diets had any effect on deviation from the protocol. Overall, there was an 8.9 kcal/day difference in deviation between the two groups throughout the study. When stratifying by diet level, there was no consistent pattern of deviations from the assigned protocol. On the 2000 kcal diet, those in the refined grain group consumed 184.5 kcals/day more than those in the whole grain group. In contrast on the 2500 kcal diet, the whole grain group consumed 105.0 kcal/day more than the refined grain group, while on the 3000 kcal/day diet, those in the refined grain group consumed slightly more kcals/day on average (12.5kcal/day) than the whole grain group. The study found no consistent difference in caloric consumption between the whole and refined grain groups, as well as no consistent difference in deviations from the assigned diet protocol. These results imply that dietary adherence can be achieved in a provided food whole grains study.

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This thesis examines the economic and time barriers to dietary adherence for T2D patients living in Edmonton by using utility theory, household production theory and the concept of health capital. Socio-demographic, food consumption, food purchase and time use information was obtained by administering a questionnaire and a food record; collecting grocery receipts and a blood sample; conducting a telephone interview, and taking measurements. Multivariate regression analysis and correlations showed a negative association between fruit and vegetable expenditure and A1c. Diet quality was negatively associated with A1c and total food expenditure but had an inverted U-shaped association with income. While working time was negatively correlated with diet quality and positively correlated with A1c, regression analysis showed a negative association between working time and diet quality only among higher income participants. Budget constraints and time constraints appear to be the barriers to dietary adherence among low-income and high-income patients, respectively. / Agricultural and Resource Economics

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Type 2 diabetes is a chronic metabolic disorder and the seventh leading cause of death in the United States. Type 2 diabetes is linked to many chronic diseases, including cardiovascular disease, stroke, and chronic kidney failure. African American adults have a high prevalence of Type 2 diabetes with early onset of diabetes complications. Poor dietary behavior is the primary cause of Type 2 diabetes and its complications, changing dietary behaviors can prevent the onset of diabetes complications or impede existing ones. The purpose of this phenomenological study was to explore patients' perceptions of diet-only therapy in the prevention of diabetes complications. Face-to-face interviews were conducted with six African American adults with Type 2 diabetes between 40 to 64 years using purposeful sampling method. Health belief model formed the conceptual framework of the study. I applied inductive coding process and manually analyze data for themes. Participants expressed fear of diabetes complications, acknowledged effectiveness of dietary therapy, physician communication and strong family support in Type 2 diabetes management. Findings can produce positive social change among African American adults with type 2 diabetes. Patients can be motivated to change their dietary behaviors to prevent disability and death from diabetes complications. Adherence to diet can reduce medical costs associated with Type 2 diabetes and its complications at the individual, family, community, and government levels. Health care providers can apply the findings in their interactions with patients to provide a more patient-centered education that integrates patients' cultural and dietary preferences to facilitate adoption of dietary interventions and long-term adherence.