Low diet quality is associated with adverse levels of metabolic health markers and clustering of risk factors in adults with type 2 diabetes

J Hum Nutr Diet. 2023 Feb;36(1):31-39. doi: 10.1111/jhn.13020. Epub 2022 May 8.

Abstract

Background: Nutritional recommendations for diabetes management emphasise an overall, healthful diet consistent with the guidelines for the general population. The present study assessed the relationship of diet quality, as measured by Healthy Eating Index-2015 (HEI-2015), with metabolic health markers and risk factor clustering in type 2 diabetes patients using National Health and Nutrition Examination Survey 2011-2016 data.

Methods: HEI-2015 diet quality scores were calculated using 24-h dietary recalls. Adults with type 2 diabetes (n = 2220) were assessed for: (1) hyperglycaemia; (2) overweight/obesity; (3) dyslipidaemia; and (4) hypertension. Logistic regression examined associations of diet quality quartiles with odds of hyperglycaemia, overweight/obesity, dyslipidaemia and hypertension, as well as odds of clustering of these risk factors.

Results: Odds of overweight/obesity and hyperglycaemia were significantly greater for participants in the lowest HEI-2015 quartile compared to those in the highest quartile. Furthermore, individuals in the bottom two HEI-2015 quartiles had increased odds of dyslipidaemia. Those in the lowest quartile also had significantly higher odds of having ≥ 2, ≥ 3 and 4 risk factors (vs. having ≤ 1 risk factor).

Conclusions: Low diet quality was related to increased odds of hyperglycaemia, dyslipidaemia, overweight/obesity and risk factor clustering. Findings imply poorer prognosis of diabetes in individuals with low diet quality.

Keywords: Healthy Eating Index; NHANES; clustering; diet quality; metabolic health; type 2 diabetes.

MeSH terms

  • Adult
  • Cluster Analysis
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / epidemiology
  • Diet / adverse effects
  • Humans
  • Hyperglycemia* / epidemiology
  • Hyperglycemia* / etiology
  • Hypertension* / epidemiology
  • Hypertension* / etiology
  • Nutrition Surveys
  • Obesity / complications
  • Obesity / epidemiology
  • Overweight / complications
  • Overweight / epidemiology
  • Risk Factors