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Research Letters |

The Accuracy of Nutrition Information on the Internet for Type 2 Diabetes FREE

Robert E. Post, MD; Arch G. Mainous III, PhD
[+] Author Affiliations

Author Affiliations: Department of Family Medicine, Medical University of South Carolina, Charleston.


Arch Intern Med. 2010;170(16):1504-1506. doi:10.1001/archinternmed.2010.289.
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Published online

A key strategy of diabetes self-management is medical nutrition therapy,1 which has been shown to reduce hemoglobin A1c and low-density lipoprotein cholesterol levels in patients with type 2 diabetes mellitus.2,3 The American Diabetes Association (ADA) recommends a specific diet as part of medical nutrition therapy for secondary and tertiary prevention in patients with diabetes.1

Forty to sixty percent of Americans search for health-related information on the Internet.4,5 Studies regarding health information accuracy on the Internet have shown that health advice varies in quality and accuracy regarding a wide range of topics.68 There is a scarcity of literature regarding the accuracy of self-management strategies for chronic disease on the Internet, especially regarding type 2 diabetes. Therefore, we evaluated the accuracy of nutrition information for type 2 diabetes on the Internet.

A search of “diabetes and nutrition” was performed on both Google and Yahoo on March 18, 2010. The first 100 search results from each search engine were examined. Web sites were excluded from analysis for the following reasons: (1) need to register or pay for an account to access all information or if the Web site (2) was a portal to other Web sites, (3) was a link to a medical journal article, (4) contained information only for type 1 or gestational diabetes, (5) was for the sale of a particular product, eg, a book on diabetic nutrition, (6) was under the same domain as a previously included Web site, (7) was the official Web site of another country's diabetes association, or (8) was the Web site for diabetes education services at a medical center or other setting and did not include specific nutritional information. If a Web site appeared as a search result on both search engines, it was only counted once. Internal links to other pages within the same domain name were followed to try to account for as much information as possible. External links to other Web sites were not followed.

The information collected included recommendations for the 11 dietary aspects included in the established ADA nutrition guidelines for patients with diabetes1 and when the Web site was last updated. The main outcome measures were the proportion of Web sites where information matched that of the ADA recommendations for each of the dietary aspects. Web sites were considered to match the recommendations if the Web sites explicitly stated the same recommendations as the ADA (Table). An overall matching score (maximum score, 11), which was the number of dietary aspects that matched the ADA guidelines, was also assigned to each Web site.

Table Graphic Jump LocationTable. American Diabetes Association Recommendations for Various Aspects of an Appropriate Diet for Type 2 Diabetes Mellitusa

A comparison was also performed of Web sites that updated information before or after the most recent ADA recommendations in 2008. The χ2 test was used to compare the proportions of Web sites that contained information matching each dietary aspect of the ADA recommendations. The independent, 2-sample t test was used to compare the mean matching score assigned to the Websites in each group. Statistical analysis was performed using OpenEpi software.9

Of the first 200 combined search results, 161 Web sites were excluded because of our prespecified exclusion criteria, leaving 39 for analysis (Figure 1). The least frequent recommendation was consumption of 2 or more servings of nonfried fish per week (15.4%) and the most frequent recommendation was to monitor carbohydrates (82.1%) (Figure 2). The mean (SD) matching score for all Web sites was 3.56 (2.20) (Figure 3). The mean matching score for Web sites updated before 2008 was not statistically different from the mean score for those Web sites updated in 2008 or later (3.61 vs 3.50; P = .88).

Place holder to copy figure label and caption
Figure 1.

Flowchart for selection of Web sites for analysis.

Graphic Jump Location
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Figure 2.

Proportion of Web sites matching the dietary aspects of the American Diabetes Association (ADA) recommendations for medical nutrition therapy for type 2 diabetes.

Graphic Jump Location
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Figure 3.

Distribution of matching scores among Web sites included in the study.

Graphic Jump Location

Nutrition information that is freely available on the Internet for patients with type 2 diabetes is not complete compared with the most recent, established ADA recommendations. Of note, many of these Web sites do not provide misinformation, but rather a lack of information. Examples include many Web sites that mentioned to increase fiber or limit saturated fat intake but did not give a specific range or cutoff for patients to target as a goal. Clear guidance may be more helpful to patients in changing their behaviors. A few Web sites included dietary advice that was close to the ADA recommendations but not accurate. One example advised readers to limit saturated fat intake to less than 10% of daily caloric intake. Though it is true that the ADA recommendation of less than 7% is within this range, this is still incorrect information.

The date of when the Web sites were updated did not affect the accuracy of the information. Web sites that were updated after the most recent ADA recommendations did not include more information matching the recommendations than the older Web sites. Even though the content of these Web sites is being checked on a more frequent basis, the authors of the Web sites are not up to date with the literature.

Web sites that provide nutritional advice for patients with diabetes should reference evidence-based sources for their information. Only 10 of the 39 articles (26%) in this study referenced peer-reviewed sources. Advising diabetic patients to use the Internet to supplement advice given in the office is not recommended at this time and should not be recommended until Web sites improve the accuracy of their information.

Correspondence: Dr Post, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St, Charleston, SC 29425 (rpostmd@gmail.com).

Author Contributions: Dr Post had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Post and Mainous. Acquisition of data: Post. Analysis and interpretation of data: Post. Drafting of the manuscript: Post. Critical revision of the manuscript for important intellectual content: Post and Mainous. Statistical analysis: Post. Study supervision: Mainous.

Financial Disclosure: None reported.

Bantle  JPWylie-Rosett  JAlbright  AL  et al. American Diabetes Association, Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31 ((suppl 1)) S61- S78
PubMed
Pastors  JGFranz  MJWarshaw  HDaly  AArnold  MS How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc 2003;103 (7) 827- 831
PubMed
Yu-Poth  SZhao  GEtherton  TNaglak  MJonnalagadda  SKris-Etherton  PM Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr 1999;69 (4) 632- 646
PubMed
Hesse  BWNelson  DEKreps  GL  et al.  Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med 2005;165 (22) 2618- 2624
PubMed
Baker  LWagner  THSinger  SBundorf  MK Use of the Internet and e-mail for health care information: results from a national survey. JAMA 2003;289 (18) 2400- 2406
PubMed
Scullard  PPeacock  CDavies  P Googling children's health: reliability of medical advice on the internet [published online April 6, 2010]. Arch Dis Child
PubMed10.1136/adc.2009.168856
Morr  SShanti  NCarrer  AKubeck  JGerling  MC Quality of information concerning cervical disc herniation on the Internet. Spine J 2010;10 (4) 350- 354
PubMed
van der Marel  SDuijvestein  MHardwick  JC  et al.  Quality of web-based information on inflammatory bowel diseases. Inflamm Bowel Dis 2009;15 (12) 1891- 1896
PubMed
Dean  AGSullivan  KMSoe  MM OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2.3. http://www.OpenEpi.com. Updated May 20, 2009; accessed April 13, 2010

Figures

Place holder to copy figure label and caption
Figure 1.

Flowchart for selection of Web sites for analysis.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Proportion of Web sites matching the dietary aspects of the American Diabetes Association (ADA) recommendations for medical nutrition therapy for type 2 diabetes.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Distribution of matching scores among Web sites included in the study.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable. American Diabetes Association Recommendations for Various Aspects of an Appropriate Diet for Type 2 Diabetes Mellitusa

References

Bantle  JPWylie-Rosett  JAlbright  AL  et al. American Diabetes Association, Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31 ((suppl 1)) S61- S78
PubMed
Pastors  JGFranz  MJWarshaw  HDaly  AArnold  MS How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc 2003;103 (7) 827- 831
PubMed
Yu-Poth  SZhao  GEtherton  TNaglak  MJonnalagadda  SKris-Etherton  PM Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr 1999;69 (4) 632- 646
PubMed
Hesse  BWNelson  DEKreps  GL  et al.  Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med 2005;165 (22) 2618- 2624
PubMed
Baker  LWagner  THSinger  SBundorf  MK Use of the Internet and e-mail for health care information: results from a national survey. JAMA 2003;289 (18) 2400- 2406
PubMed
Scullard  PPeacock  CDavies  P Googling children's health: reliability of medical advice on the internet [published online April 6, 2010]. Arch Dis Child
PubMed10.1136/adc.2009.168856
Morr  SShanti  NCarrer  AKubeck  JGerling  MC Quality of information concerning cervical disc herniation on the Internet. Spine J 2010;10 (4) 350- 354
PubMed
van der Marel  SDuijvestein  MHardwick  JC  et al.  Quality of web-based information on inflammatory bowel diseases. Inflamm Bowel Dis 2009;15 (12) 1891- 1896
PubMed
Dean  AGSullivan  KMSoe  MM OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2.3. http://www.OpenEpi.com. Updated May 20, 2009; accessed April 13, 2010

Correspondence

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