(P19-032-24) Sustainable Eating in Medical Nutrition Therapy for Type 2 Diabetes – A Qualitative Exploration of Clinical Practice Guidelines and Patient Education Resources

Objectives: Adopting sustainable eating patterns can help address climate change and manage chronic diseases like type 2 diabetes (T2D). Medical nutrition therapy (MNT) is known to improve T2D outcomes. The sizable populations living with T2D can contribute to the widespread dietary shifts needed to mitigate environmental harms engendered by food systems. As such, MNT stands to benefit from promoting sustainable eating patterns with lower environmental impacts, while also considering the accessibility and cultural acceptability of food choices. It is unclear if such sustainability concepts are included in MNT guidelines for T2D. This study aims to explore if and how dietary guidelines used in Canadian MNT for T2D include the domains of sustainability.

Methods: A systematic grey literature search identified 46 clinical practice guidelines and 295 patient education resources used in Canadian MNT for T2D. Qualitative content analysis of documents was conducted using the Sustainability in Food Based Dietary Guidelines Framework, which specifies five domains of sustainability (health; food security; markets; sociocultural; environment).

Results: When assessing document contents in aggregate, all sustainability domains were included, but in different proportions. Health was the most frequently included domain, followed by sociocultural and food security. Markets and environment domains were minimally included, and most environment concepts emerged from documents for Indigenous populations. When assessing documents individually, < 5% included all sustainability domains. While not explicitly stated, opportunities for co-benefits and trade-offs among domains were observed. For example, some dietary patterns recommended for managing T2D (e.g. vegetarian) may benefit the environment, while others (e.g. low carbohydrate) may increase environmental strain.

Conclusions: While different sustainability domains were identified in MNT guidelines for T2D, few comprehensively included all domains, and information on the environmental and economic implications of food choice was minimal. To help people living with T2D adopt dietary patterns that benefit personal and planetary health, existing recommendations can be leveraged to include broader sustainability concepts.

Funding Sources: Canadian Institutes of Health Research
University of British Columbia