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