Nutrition Intervention
Participants were provided the option to initiate nutrition counseling at diagnosis or during induction. Dietitians or trained study staff at each institution counseled participants on following a low glycemic index (GI) diet at weekly intervals for three months (intervention phase) and then at monthly intervals for the next three months (maintenance phase). Counseling sessions were conducted in person during routine clinic visits or hospital admission or via telemedicine. A low GI diet was selected due to the data supporting its efficacy in weight management in both adult and pediatric settings.12Briefly, GI describes how a controlled portion of food affects postprandial rise in blood glucose; high GI foods result in faster and higher increases in blood glucose compared to low GI foods. Glycemic load (GL) accounts for the GI and quantity of available carbohydrate in the food. The intervention followed the Traffic Light approach, which has been utilized successfully in counseling children and adolescents.13 Standardized nutrition education materials were provided to each collaborating institution. Hospital and cafeteria menus were also categorized according to the Traffic Light approach. Participants and their families received written education materials in English or Spanish to support the counseling sessions, which provided instruction on grocery shopping and dining out. Caloric restriction was not emphasized due to research supporting the satiety effects of a low GI diet.14