Small Rice Bowl-Based Meal Plan for Energy and Marcronutrient Intake in Korean Men with Type 2 Diabetes: A Pilot Study

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1 Originl Article doi: 1.493/dmj pissn eissn D I A B E T E S & M E T A B O L I S M J O U R N A L Smll Rice Bowl-Bsed Mel Pln for Energy nd Mrcronutrient Intke in Koren Men with Type Dibetes: A Pilot Study Hee Jung Ahn 1,*, Kyung Ah Hn,*, Jin Young Jng 1, Je Hyuk Lee, Kng Seo Prk, Kyung Wn Min 1 Dibetes Center, Eulji Hospitl, Eulji University School of Medicine, Seoul, Deprtment of Internl Medicine, Eulji University School of Medicine, Dejeon, Kore Bckground: Korens et rice, which is usully served in rice bowl. We investigted the effect of mel pln using smll rice bowls on the totl energy intke (TEI) nd the mrcronutrient intke in Koren men with type dibetes. Methods: A totl of 6 men with type dibetes were divided by body mss index (BMI) (norml weight [NW], BMI<3 kg/ m ; overweight [OW], 3 BMI<5 kg/m ; obese [OB], BMI 5 kg/m ) nd proportions of crbohydrte intke to TEI (PCI) (low crbohydrte intke [LC], <55%; recommended crbohydrte intke [RC], 55% nd 6%; high crbohydrte intke [HC], >6%). The 3-dy dietry records were nlyzed for TEI nd proportions of mcronutrients, before nd weeks fter smll-sized (3 ml) rice bowl bsed eduction ws given. Results: There were no significnt differences in the ge nd BMI within the sub-groups by BMI nd PCI groups. In bseline, the rtio of TEI to recommended totl energy intke (RTR) of OW nd OB were higher thn tht of NW. The PCI of HC ws higher thn tht of LC nd lcohol intke of HC ws lower thn tht of LC. After eduction, the reduction of RTREI in OB ws higher thn tht in OW nd NW. The reduction of PCI in HC ws higher thn tht of LC. Conclusion: A smll rice bowl bsed mel pln ws effective for the reduction of energy intke nd control of mrcronutrient intke in Koren obese men with type dibetes consuming high crbohydrte diet. Keywords: Crbohydrte-restrict; Dibetes mellitus, type ; Dibetic diet; Men INTRODUCTION Medicl nutritionl therpy is n importnt prt of dibetes prevention, mngement nd plys n importnt role in preventing complictions with blood glucose control. In order to chieve these gols, dequte totl energy intkes (TEI) nd mcronutrient compositions re recommended for dibetes ptients, nd these informtions must be presented to ptients using the esily understndble methods [1]. Dietry ptterns re closely ssocited with blood glucose control levels in type dibetes ptients. Nnri et l. [] reported tht dietry chrcterized by frequent intke of white rice ws positively ssocited with glycted hemoglobin (HbA1c) levels in Jpnese men nd women. According to the 8 Koren Ntionl Helth Sttistic nd the Koren Ntionl Helth nd Nutritionl Exmintion Survey [3,4], rice s the min source of crbohydrte rich foods in Koren mle ptients ws investigted nd proportion of crbohydrte intke to TEI (PCI) ws 66.%, which ws higher thn the level recommended by the Koren Dibetes Assocition [5]. These results show tht control of rice consumption is importnt point to reduce the level of crbohydrtes consumption in Koren mle Corresponding uthor: Kyung Wn Min Dibetes Center, Eulji Hospitl, 8-1 Hgye 1-dong, Nowon-gu, Seoul , Kore E-mil: minyungw@gmil.com Received: Oct. 1, 1; Accepted: Dec. 8, 1 * Hee Jung Ahn nd Kyng Ah Hn contributed eqully to this study s first uthors. This is n Open Access rticle distributed under the terms of the Cretive Commons Attribution Non-Commercil License ( which permits unrestricted non-commercil use, distribution, nd reproduction in ny medium, provided the originl work is properly cited. Copyright 11 Koren Dibetes Assocition

2 Ahn HJ, et l. dibetes ptients. Ahn et l. [6] reported tht there ws n ssocition between the size of the rice bowl nd energy intke from the rice in mles, nd he investigted the effectiveness of the 38 ml rice bowls to reduce crbohydrte consumption in dibetes ptients. It ws shown tht the size of the rice bowls should be reduced depended on ech subject. Additionlly, report of tsk force tem for bsic sttisticl study [7] showed tht mle dibetes ptients et out more often thn femle ptients, nd 61.5% of mle dibetes ptients consume lcohol more thn once month, while 19.5% of femle dibetes ptients consume lcohol more thn once month, which denotes gender bsed difference in eting out nd lcohol consumption. In order to regulte energy intke nd mrcronutrient compositions in type dibetes ptients, food exchnge lists re commonly used [8-1]. However, it is difficult for ptients who hve low cognitive bilities to understnd the contents of the eductionl informtion [1-1]. For this reson, simplified eduction method is recommended. Europen countries use this kind of simplified method to convey the messge tht medium sized bowl will help control energy intke nd mrcronutrient composition [1,11,1]. However, reserch is lcking in how to simplify wys to reduce crbohydrte intke in Koren mle type dibetes ptients whose consumption ptterns re unlike those of individuls from foreign countries. In this study, the effects of mel pln method using the bowl which is smller thn conventionlly used bowl on TEI md mrcronutrient composition ccording to the body mss index (BMI) nd PCI in mle type dibetes ptients with different dietry ptterns from femle. This study ws shortterm week study tht ws prt of preliminry study exmining mle dibetes ptients for effective mel plnning bsed on bowl size. METHODS Subjects This study ws performed between July 9 nd Februry 1 t the Eulji Hospitl Dibetes Center on dibetes ptients between the ges of 3 to 7. This study nlyzed totl of 6 ptients, nd excluded ptients with glycted hemoglobin levels between 7% nd 11%, specil diets (e.g., vegetrin), type 1 dibetes, cncer, secondry dibetes, ptients who were difficult to follow, ptients who refused to follow up, ptients with indigestion or poor ppetites, ptients undergoing renl replcement therpy, ptients who ordinrily used rice bowls smller thn 3 ml, nd ptients who consumed foods tht were different from their usul diet for three dys. Group definitions bsed on BMI nd PCI Mle dibetes ptients were clssified by BMI nd PCI, nd the detils were nlyzed. The groups for BMI were seprted into the norml weight group (NW; BMI<3 kg/m, n=13) overweight group (OW; 3 kg/m BMI<5 kg/m, n=16), nd obese group (OB; BMI 5 kg/m, n=33), nd then comprtilvely nlyzed. The groups for PCI by the Koren Dibetes Assocition (KDA) recommendtion [5] were seprted into the low crbohydrte intke (LC; <55%, n=18), recommended crbohydrte intke (RC; 55% nd 6%, n=18), nd high crbohydrte intke (HC; >6%, n=6) Diet intervention After 3 ml rice bowl (Sungwoo, Seoul, Kore) tht held pproximtely 3 kcl ws supplied for study prticipnts, 5-minute 1:1 individul eduction session ws provided regrding tips on how to fill the bowl nd methods for utiliztion. The rice of 3 kcl ws clculted below method. First, required dily TEI of the mle prticipnts ws used on nthropometric dt from multicenter study performed by Sohn et l. [13], nd the method recommended by the KDA (idel body weight 3 kcl). Using this method, dily TEI ws clculted to be 1,9 kcl/dy, the mcronutrient consumption recommended by the KDA ws considered, nd the serving portion for ech mel ws set t 3 kcl, nd the size of the rice bowl ws determined. We educted to hve the prticipnts use the bowl for every mel, nd they were educted to fill it with rice so it did not overflow nd to use restrint. We offered leflets contining pictures nd tips on how to fill rice bowls to prticipnts so tht they could pss the informtion on to their spouses. Noodles could substitute for rice but ny specific mount for tht ws not suggested. Crbohydrte sources such s bred, rice, pottoes, sweet pottoes, flour pnckes, etc., were limited through the leflet nd fruit consumption ws educted regrding the mount tht cn be consumed dily. Through preliminry investigtion, leflet ws mde bout common foods for dieting such s fish nd vegetble side dishes. For fish, met, nd vegetbles, the subjects were educted with pictures of diet fitting ech food exchnges unit nd were sked to prctice it but tht ws not emphsized intensively t ech visit. 74

3 Smll rice bowl-bsed mel pln in men with type dibetes Survey of bowl size nd bowl use complince The subjects were sked to bring the bowl tht they used most often. Becuse the shpe nd sizes of the bowls were vried, bowls were filled with wter, nd the volume of the wter from the bowls ws mesured with 1 ml nd 5 ml grduted cylinders. In order to evlute the complince of bowl use, subjects were instructed to record whether they used the provided bowls for brekfst, lunch, nd dinner, nd then ptients were instructed to bring those records to their biweekly visits. During ech visit, the reported vlues were verged nd overll complince ws clculted s: Complince of use of bowl (%)=number of using bowl/number of totl mels 1 Definitions nd nlysis of the intke of stple foods, sncks, nd lcohol Stple foods were defined s the mels of consuming t the three regulr mel times. Sncks were defined s the fruit nd diry group clssified into the food exchnge list nd the mel of consumed outside of regulr mel times (excluding lcohol). Intke of stple foods, sncks, nd lcohol were monitored using 3 dy dietry record ( weekdys, 1 weekend dy). The subjects were educted on the diet record method simply before writing the record sheet ctully nd they were sked to write mount nd kinds of ll foods tken for mel, nutrition supplementry foods nd snck for dy on the dietry record sheet by themselves. To increse ccurcy of the record, registered dietitin reviewed contents of the sheets by using relsized food models mesuring cups, mesuring spoons, when the sheets were returned. For dietry record resource, CAN- Pro (computer-ided nutritionl nlysis progrm, version.; Koren Nutrition Society, Seoul, Kore) ws used to convert nutrient intke for further nlysis [14]. Anthropometric mesurement nd biochemicl tests The height nd body weight of ll study prticipnts ws mesured. Subjects were mesured for height nd body weight dressed in thin clothe. BMI ws clculted by dividing body weight (kg) with the squre of the height (m ). Wist circumference ws mesured in the nrrowest re between the bottom of the ribs to the top of the ilic crest using tpe mesure when subjects were relxed nd hd exhled. Venous blood smples were collected following 1-hour or longer fst. Smples were seprted vi centrifuge t 3, rpm for 15 minutes. Serum ws isolted, stored t -7 C, nd used for nlysis. Fsting plsm glucose ws mesured using the glucose oxidtion method, nd glycted hemoglobin (HbA1c) ws mesured using high performnce liquid chromtogrphy. Totl cholesterol, triglycerides, high density lipoprotein cholesterol, nd low density lipoprotein cholesterol were exmined with kit using enzymtic rections nd n utomtic biochemicl nlyzer (Hitchi 717; Hitchi Co., Tokyo, Jpn). Sttisticl nlysis Using the sttistics progrm SPSS version 15. (SPSS Inc., Chilcgo, IL, USA), we clculted mens nd stndrd devitions for the mesured items. To determine the differences in physicl chrcteristics nd nutritionl intke between mesurements before nd fter the weeks mong the groups ws nlyzed by one-wy ANOVA test nd those for ech group were by pired t-test, A Kruskl-Wllis test ws used to nlyze vribles from the three group comprison tht did not follow norml distribution. P vlues under.5 were considered to be sttisticlly significnt. RESULTS Chrcteristics of study prticipnts A totl of 7 ptients were recruited in this study, but mong them, ptients who te bnorml foods (n=), ptients who declined to prticipte (n=3), nd ptients who used bowls tht were under 3 ml (n=3) were exclude. The men ge of subjects ws 55.6±9., dibetes durtion ws 8.8±7.5 yers, BMI ws 5.4±.9 kg/m, nd HbA1c ws 8.4±1.7%. For dibetes tretments, the proportion of insulin, orl hypoglycemic gents nd lifestyle modifiction only were 38.7%, 41.9%, nd 19.4%, respectively. A totl of 8.3% of the subjects hd received dibetes eduction before prticipting this study, 71.% of the subjects hd jobs. The men number of eting out per week ws 4.5±4.3, the number of consummimg lcohol per week ws 1.3±1.5, nd when they consumed lcohol, they consumed 4.5±6.6 servings of lcohol (1 serving=15 g lcohol) (Tble 1) [15]. The medin surveyed vlue of the volumes of the rice bowls mesured with the grduted cylinders ws ml. However, the sizes rnged from 31 ml to 74 ml mening tht the lrgest bowl ws.4 times lrger thn the smllest bowl, nd there ws only 65.% complince with use of the rice bowl provided for the study. When the groups were clssified by BMI nd PCI, there were no significnt differences in the dropout rte, verge ge, dibetes durtion, HbA1c, 75

4 Ahn HJ, et l. Tble 1. Bseline clinicl nd metbolic chrcteristics of study subjects Chrcteristic Vlue No. of subjects 6 Age, yr 55.6±9. Height, cm 167.4±5.6 Weight, kg 71.1±9. BMI, kg/m 5.4±.9 Wist, cm 89.5±7. SBP, mm Hg 13.6±13.8 DBP, mm Hg 78.4±7.6 Dibetes durtion, yr 8.8±7.5 No. of people treted with Diet nd exercise only 1 (19.4) Orl hypoglycemic gents 6 (41.9) Insulin 4 (38.7) Employed Yes 44 (71.) No 18 (9.) HbA1c, % 8.4±1.7 Totl cholesterol, mg/dl 17.±44.3 Triglyceride, mg/dl 145.5±14. HDL-C, mg/dl 46.7±11.3 LDL-C, mg/dl 94.1±38.1 Rice bowl size, ml 378.8±64. The vlues re presented s men±stndrd devition or frequency (%). P vlue ws clculted from one-wy ANOVA test or chi-squred test. BMI, body mss index; SBP, systolic blood pressure; DBP, distolic blood pressure; HbA1c, glycosylted hemoglobin; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol. tretmentmethods, occuption, the number of eting out, nd bowl size. Chnges in TEI nd mrcronutrient composition by BMI As dietry TEI differed ccording to BMI, the rtio of TEI to recommended TEI (RTR) ws ssessed for ech ptient. The recommended TEI ws obtined by multiplying 3 kcl per idel body weight (IBW). When the groups were clssified by the BMI, the RTR in the OW nd OB group ws significntly higher thn in the NW group (P=.9) t bseline. However, the reduction of RTR in the OB group ws -6.3±4.5%, which ws much lrger reduction thn in the NW group (P=.43) (Tble, Fig. 1). At bseline, the proportions of the crbohydrte, protein nd ft to TEI were 58.8%, 17.1%, nd.1%, which were within the recommednded the KDA (crbohydrte:protein:ft=55-6%: 15%:5%). The chnges in the proportions of crbohydrtes, protein, nd ft to TEI showed no significnt difference between the three groups (Tble, Fig. 1). At bseline, lcohol consumption ws not different between the three groups, nd the reduction in lcohol intke mong the three groups ws lso not different (Tble ). Chnges in the PCI nd mrcronutrient intke When the groups were clssified by the PCI, the RTR ws not different mong the groups t bseline, nd the chnges in the RTR were lso not different mong the groups fter intervention. At bseline, the PCI in the HC group ws higher thn the LC group (P<.1), nd the proportions of protein (P=.3) nd proportions of ft (P<.1) ws lower. In prticulr, the PCI froms stple foods in the HC group ws higher thn the LC group (P=.5). The PCI from snck ws not different mong the groups. The decrese in the PCI ws significntly higher in the HC group thn the LC nd RC groups (P=.1). The increse in the proportions of protein to TEI ws significntly higher in the HC group nd RC group thn in the LC group (P=.1), nd the increse in the proportions of ft to TEI ws significntly higher in the HC group thn in the RC nd LC groups (P=.1) (Tble 3, Fig. ). The results of the nlysis of PCI from stple foods nd sncks showed tht the reduction in PCI from stple foods ws significntly higher in the HC group thn in the LC group (P=.5), however, there ws no significnt difference of the PCI from the snck mong the groups. At bseline, the lcohol consumption of the LC group ws 157±173 kcl/dy, which ws significntly higher thn in the RC nd HC groups (P=.), nd fter intervention, there ws no significnt difference in the reduction of lcohol consumption between the three groups. Chnges in body weight As the chnge in body weight differed ccording to obesity, the rtio of body weight to idel body weight (RBI) ws ssessed for ech ptient. The RBI ws clculted s: current body weight/idel body weight 1. When the groups were clssified by BMI, the RBI ws significntly higher in the OB thn in the OW nd NW group 76

5 Smll rice bowl-bsed mel pln in men with type dibetes Tble. Chnge in dietry totl energy intke, mcronutrient composition by BMI NW (n=13) OW (n=16) OB (n=33) P vlue Dietry TEI, kcl Bseline 1,96.4±174.9,113.1±.8,37.9± Dietry TEI, % of recommended TEI weeks 1,869.5±16.,38.9±.8 1,917.4± Bseline 11.8±5. 11.± ± weeks 99.9±7. 18.± ± Crbohydrte intke, % of TEI Bseline 58.7± ±6. 59.± weeks 53.4± ± ±7..58 Protein intke, % of TEI Bseline 18.4± ± ±..86 weeks 19.± ± ±.7.11 Ft intke, % of TEI Bseline 3.6±5.5 3.±5.3 1.± weeks 5.±.9 5.6±6.6 3.± Alcohol intke, kcl/dy c Bseline 38.±7. 5.± ± weeks 5.9± ± ± PIBW, % Bseline 97.6± ±3. 15.±8.6,b <.1 weeks 97.5± ± ±8.9,b <.1 The vlues re presented s men±stndrd devition. Recommended TEI is obtined by multiplying 3 kcl per idel body weight. Percent of idel body weight is body weight (kg)/idel body weight (kg) 1. The P vlues re for comprison of the 3 groups by one-wy ANOVA test. BMI, body mss index; NW, norml weight (<3 kg/m ); OW, overweight ( 3 kg/m nd <5 kg/m ); OB, obese ( 5 kg/m ); TEI, totl energy intke; PIBW, percent of idel body weight. P<.5 vs. NW, b P<.5 vs. OW, c The P vlues re for comprison of the 3 groups by Kruskl-Wllis test. NW OW OB NW OW OB Chnge in TEI., % of recommended TEI -6-8,b A Chnge in crbohydrte intke, % of TEI -6-8 B Chnge in protein intke, % of TEI 6 4 NW OW OB C Chnge in ft intke, % of TEI 6 4 NW OW OB D Fig. 1. Chnge in totl energy intke (% of recommended TEI) (A), crbohydrte intke (% of TEI) (B), protein intke (% of TEI) (C), nd ft intke (% of TEI) (D) ccording to body mss index fter weeks of bowl bsed eduction in men with type dibetes mellitus. NW, norml weight (<3 kg/m ); OW, overweight ( 3 kg/m nd <5 kg/m ); OB, obese ( 5 kg/m ); TEI, totl energy intke. P vlues<.5 vs. Bseline, b P vlues<.5 vs. NW. 77

6 Ahn HJ, et l. Tble 3. Chnge in dietry totl energy intke, mcronutrient composition by crbohydrte intke LC (n=18) RC (n=18) HC (n=6) P vlue Dietry TEI, kcl Bseline,6.3±3.4,14.9±195.1,3.4±5.7.8 Dietry TEI, % of recommended TEI weeks,8.±14.8 1,913.±9.1 1,919.6± Bseline 19.5± ± ± weeks 17.1± ± ± Crbohydrte, % of TEI Bseline 49.4± ± ±3.8,b <.1 weeks 49.9± ± ±5.,b <.1 Protein, % of TEI Bseline 18.9± ±. 16.±1.9.3 weeks 17.8± ± ± Ft, % of TEI Bseline 7.± ± ±4.1,b <.1 weeks 6.5± ±3.4.3±5.5.4 Alcohol, kcl/dy c Bseline 157.3± ± ±58.. weeks 14.1± ± ± PIBW, % Bseline 115.± ± ± weeks 114.9± ± ± The vlues re presented s men±stndrd devition. Recommended TEI is obtined by multiplying 3 kcl per idel body weight. Percent of idel body weight is body weight (kg)/idel body weight (kg) 1. The P vlues re for comprison of the 3 groups by one-wy ANOVA test. LC, low crbohydrte intke (<55%); RC, recommended crbohydrte intke ( 55% nd 6%); HC, high crbohydrte intke (>6%); TEI, totl energy intke; PIBW, percent of idel body weight. P<.5 vs. LC, b P<.5 vs. RC, c The P vlues re for comprison of the 3 groups by Kruskl-Wllis test. Chnge in TEI, % or recommended TEI -6-8 LC RC HC A Chnge in crbohydrte intke, % of TEI LC RC HC,b,c B Chnge in protein intke, % of TEI 6 4,b,b LC RC HC C Chnge in ft intke, % of TEI 1 5,b,c -5 LC RC HC D Fig.. Chnge in totl energy intke (% of recommended TEI) (A), crbohydrte intke (% of TEI) (B), protein intke (% of TEI) (C), nd ft intke (% of TEI) (D) ccording to proportions of crbohydrte intke fter weeks of bowl bsed eduction in men with type dibetes mellitus. LC, low crbohydrte intke (<55%); RC, recommended crbohydrte intke ( 55% nd 6%); HC, high crbohydrte intke (>6%); TEI, totl energy intke. P vlues<.5 vs. Bseline, b P vlues<.5 vs. LC, c P vlues<.5 vs. RC. 78

7 Smll rice bowl-bsed mel pln in men with type dibetes (P<.1) t bseline, but the chnges in the RBI ws not different mong the three groups. When the groups were clssified by PCI, the RBI ws not different mong the groups t bseline, nd the chnge in the RBI ws lso not different mong the groups. When the groups were clssified by BMI, the RBI of the OB group ws significntly decresed fter weeks (P=.16). When the groups were clssified by PCI, the RBI of the HC group ws significntly decresed fter weeks nd tht it ws close to the idel body weight (P=.8). DISCUSSION According to the 8 Koren Ntionl Helth Sttistics [3], mles consume 1.7 times more met thn femles, lso lcohol nd beverge consumption of mles ws.3 times higher thn femles, therefore, it ws reported tht mles consume more protein nd ft rich foods thn femles. Dt from the 5 Koren Ntionl Helth nd Nutrition Exmintion Survey [4], demonstrte tht the PCI in mle type dibetes ptients ws 66.%, which ws lower thn tht of femles, t 7.3%, nd the proportions of ft to TEI in mles ws reported to be higher thn in femles. Nevertheless, the PCI in mle dibetes ptients ws still higher thn tht recommended by the KDA [5], lthough the proportions of ft to TEI were within the recommended levels. However, the proportions of crbohydrte, protein nd ft to TEI in mle dibetes ptients who prticipted in this study were 58.8%, 17.1%, nd.1%, respectively, which re within the vlues recommended by the KDA [5], but this ws lower thn the PCI dt from the 5 Koren Ntionl Helth nd Nutrition Exmintion Survey [4]. However, in studies tht exmined the reltionship between lcohol nd mrcronutrient composition in mle type dibetes ptients performed by Chung nd Chng [16] nd Yoen et l. [17], the proportions of crbohydrte, protein, nd ft to TEI were reported to be 58.% to 6.4%, 16.% to 17.1%, nd 3.6% to 5.%, respectively. Those results were similr to the results from our study. These vritions were considered to result from similrity in mrcronutrient composition ccording to ge [18], the vilbility of dibetes eduction [19,], nd socil clsses [13]. When the groups were clssified by BMI, the 3 ml bowl bsed mel pln ws more effective for reduction of TEI in OB group thn the NW group. However, in femle dibetes ptients, these results showed tht reduction of TEI ws more effective in both the OW nd OB groups thn the NW group. When the groups were clssified by BMI, there were no significnt differences in chnges on mcronutrient composition in men nd women. The TEI for Koren dibetes ptients who et rice-bsed diet is dependent on the bsolute mount of rice consumed nd it hs been shown tht the energy intke from the rice hs n influence on the energy intke from side dishes s well [4]. For these resons, lthough there ws lrge reduction in TEI in the OB group, it is likely tht there will be no chnge in mrcronutrient composition. When the groups were clssified by PCI, t bseline, the PCI ws higher in the HC group thn in the LC group, nd the proportions of protein nd the proportions of ft were lower. The proportions of crbohydrte from stple foods were especilly high, nd the proportions of ft nd lcohol consumption were lower. Alcohol only provides energy (kcl), nd ws listed s n empty clorie food. Nevertheless, the reson there is difference in mrcronutrient composition for those who consume lcohol is tht foods served with lcohol hs n incresed the proportions of ft. Chung nd Chng [16] reported tht the proportions of crbohydrte, protein, nd ft from foods consumed with lcohol ws 1.4%, 5.9%, nd 6.3%, respectively, but these results demonstrted tht this is cused by high proportions of ft intke in the high lcohol consumption group. After the plnned mels using the smll 3 ml rice bowls, the PCI decresed in the HC group significntly more thn in the LC group, nd the proportions of protein nd ft to TEI incresed. These results show tht mle dibetes ptients who comume smll mount of lcohol nd high crbohydrte mels of over 6% from stple foods hd decresed the proportions of crbohydrte from stple foods, which chnges mrconutrient composion; this ws effective t reducing totl energy intke. According to the Kng et l. [5], there ws no difference in TEI nd mrcronutrient composition between eduction group who ws educted for 1 yer vi individul nd e mil with regulr mel, limited sncks nd lcohol, incresed consuming of fruits nd vegetbles nd control group. Although compring the results directly nd drwing conclusion re difficult becuse of difference in the study period nd eduction method of ech study, mking chnges in long term dietry energy nd mrcronutrient composition ws chllenging in mle dibetes ptients. In the study performed by Kng et l. [5], even when edu- 79

8 Ahn HJ, et l. ction ws performed continuously for 1 yer, nd dily lcohol consumption chnged from 3 kcl to 66 kcl fter 1 yer, which ws very smll chnge in consumption, these results were consistent with the results from our study. There ws no significnt decrese in the lcohol consumption of mle dibetes ptients who were using the plnned mels with the 3 ml bowls provided in this study, even though we hd expeceted tht using eduction regrding the smller bowl would hve positive effect. Therefore, this shows tht different eductionl pproch is required. When the groups were clssified by BMI or PCI, there ws no significnt difference in body weight loss wtihin both groups. However, in the before nd fter weeks comprion, the OB group nd HC group showed decrese in body weight. In which, the result my indicte to the possibility of long term weight loss. Our study period ws two-week to exmine chnges of TEI fter using smller rice bowl, but this short perid mde it difficult to determine the effect reducing body weight, lipid nd blood glucose level. In this study, the sizes of bowls regulrly used were between 31 ml nd 74 ml, nd when the ptients were educted on using the 3 ml rice bowl, they complined bout hunger. However, before nd fter eduction, the visul nlogue scle mesurement results for hunger nd stiety levels exhibited no sttisticl differences (dt not presented). This reduced the mount of rice consumed from the rice bowl method in the OB group, which gretly reduced totl energy consumption, long with the increse in side dish consumption, demonstrted this expected result s well. In ddition, 71% of study subjects hd jobs, so there were difficulties with using the bowl during resturnt mels. Nevertheless, the rice bowl consistency expectncy ws set t 65% complince, nd excluding dining out, bowl complince ws over 9% (dt not presented). A previous study tht nlyzed the obstcles nd the complince of using rice bowl indicted tht ptients who hve experienced in using bowls before developed sense for correct volumes [6]. Thus, ptients with tht experience could control the mount of food consumed even without using the bowls, which might hve worked positively in controlling the mount of their food intke. A smll rice bowl bsed mel pln ws n effective eduction method for the reduction of energy intke in obese men with type dibetes nd reduction of PCI s stple foods in men with type dibetes consuming more thn 6% PCI s stple foods. In order to generlize the effect of using the smll rice bowl for plnned mels in mle dibetes ptients, more study subjects nd more observtion in long-term energy consumption, mrcronutrient composition, nd clinicl chnges re needed. CONFLICTS OF INTEREST No potentil conflict of interest relevnt to this rticle ws reported. REFERENCES 1. Ridl M, Spin K, Lnting R, Lockrd M, Johnson S, Spencer M, Snt L, Welch J, Liddil A, Hrtmn-Cunninghm M. The helthy dibetes plte. Prev Chronic Dis 7;4:A1.. Nnri A, Mizoue T, Yoshid D, Tkhshi R, Tkyngi R. Dietry ptterns nd A1C in Jpnese men nd women. Dibetes Cre 8;31: Ministry of Helth, Welfre nd Fmily Affirs, Kore Centers for Disese Control nd Prevention. 8 Ntionl Helth Sttistics. Avilble from: (updted 1 Jul 13). 4. Kore Centers for Disese Control nd Prevention. The Koren Ntionl Helth Nutrition Exmintion Survey (KNHANES III). Avilble from: (updted 9 Mr 19). 5. Koren Dibetes Assocition. A guideline for dibetes eduction. th ed. Seoul: Gold Agency; 6. p Ahn HJ, Koo BK, Jung JY, Kwon HR, Chung MY, Ku YH, Kim JT, Hn KA, Min KW. Assocition between volume of bowls nd the dietry intkes in subjects with type dibetes. Koren Dibetes J 9;33: Koren Dibetes Assocition, Helth Insurnce Review nd Assessment Service. Report of tsk force tem for bsic sttisticl study of Koren dibetes mellitus: dibetes in Kore 7. Seoul: Goldfishery; Wheeler ML, Frnz M, Brrier P, Holler H, Cronmiller N, Delhnty LM. Mcronutrient nd energy dtbse for the 1995 exchnge lists for mel plnning: rtionle for clinicl prctice decisions. J Am Diet Assoc 1996;96: Kitmur S. Diet therpy nd food exchnge lists for dibetic ptients. Dibetes Res Clin Prct 1994;4 Suppl:S Cho JW. The present sttus of dibetes eduction nd opinion reserch of food exchnge list. Koren Dibetes J 8;3:S19-8

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