Psychosocial Aspects


Shengxin Liu, Ivan Nyklíček, Frans Pouwer, Jane Speight, Mariska Bot, Giesje Nefs, Sabita S. Soedamah‑Muthu

Mindfulness in Relation to Diet Quality in Adults with Type 1 and Type 2 Diabetes: Results from Diabetes MILES‑The Netherlands. Mindfulness. 2021 Sep;12:2943–2954.

Diet is a very important factor in diabetes self-management, e.g. low-carbohydrate and vegetable/fruit-rich diets, which can yield a ~30% reduction in cardiovascluar risk in people with diabetes. Various psychological factors such as acceptance and mental ability to cope with diabetes, and willingness to change lifestyles (including dietary habits) can affect diabetes management.

The concept of mindfulness (i.e. bringing one’s attention in the present moment without evaluation) comprises 5 interrelated facets:

  • Observing: noticing or attending to internal and external stimuli, such as smells, sights, or sounds
  • Describing: expressing internal experience with words
  • Acting with awareness: doing things with a focus on the present moment
  • Being non-judgmental: taking a non-evaluative stance to internal feelings and thoughts
  • Being non-reactive: allowing feelings and thoughts to happen without reacting to them

Dispositional mindfulness (i.e. mindfulness as personal trait rather than a transient state) has been associated with healthier eating behaviours in a recent meta-analysis, which was not focused on diabetes. Emotional stress may be an explaining factor in the association between mindfulness and diet quality. Indeed, depressive symptoms have been negatively associated with mindfulness and diet quality.

This study, in which Giesje Nefs of Diabeter was involved, was a part of the Diabetes MILES (Management and Impact for Long-term Empowerment and Mindfulness Success)-The Netherlands. It aimed to assess associations between dispositional mindfulness and diet quality in Dutch adults with type 1 diabetes or type 2 diabetes, and the possible role of emotional distress in these associations. A total of 660 people with diabetes (296 type 1 diabetes and 364 type 2 diabetes) completed questionnaires about mindfulness, diet and emotional distress.


Key findings:

  • A higher level of dispositional mindfulness and a higher score on observing were associated with a healthier diet
  • This association was only statistically significant for people with type 1 diabetes, possibly explained by:
    • The fact that from an earlier age people with type 1 diabetes are confronted with the need to make dietary choices based on monitored blood glucose levels
    • More awareness of the effects of diet on their body (interoceptive observation) in people with type 1 diabetes
    • Unhealthy diet being a risk factor for developing type 2 diabetes
  • The association between mindfulness and diet quality was independent of emotional distress

Limitations of this study include:

  • Diet quality, measured in this study, is different from healthy eating behaviours
  • This study was cross-sectional so no conclusions could be made about causality
  • No information on portion size
  • Sample may not be representative of the Dutch population: higher proportion of people who are more active in their diabetes management and who eat healthier

Concluding, the authors state

"Future longitudinal and intervention studies, incorporating more thorough assessments on dietary intakes, would contribute to a more comprehensive understanding of the association" -

Please click here for the pdf file.

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