Abstract
BackgroundThe diet quality of adults living in the United States has improved overtime. We aim to determine whether diet quality among adults with diabetes mellitus has changed over time, and to examine trends in socioeconomic disparities in diet quality.MethodsRepeated cross-sectional analysis of eight National Health and Nutrition Examination Survey (NHANES) cycles (1999–2000 through 2013–2014). We included 5882 adult participants (age 20 or older) with diabetes mellitus (type 1 or 2) who completed 24-h dietary recalls. Diet quality was measured by the Healthy Eating Index 2010 (HEI) score (range 0–100, higher scores indicate better diet quality). We tested whether there were differences in diet quality across education, income, and food security categories, and whether any differences changed over time, using weighted linear regression models accounting for the complex survey design and adjusted for age, gender, and race/ethnicity.ResultsTwenty nine percent of US adults with diabetes had less than a high school diploma, 17% had income < 100% of federal poverty level, and 15% reported food insecurity. Average adjusted HEI score increased from 49.4 to 52.4 over the study period (p for trend = 0.003). We observed differences in HEI between high and low education (4.1, 95% CI 3.0–5.3), high and low income (3.7, 95%CI 2.4–5.0) and food secure relative to food insecure (2.1, 95% CI 0.8–3.3). These differences did not improve over time for education (p = 0.56), income (p = 0.65) or food security (p = 0.39) categories.ConclusionsDiet quality for adults with diabetes in the U.S. has improved overall; however, substantial disparities exist and have not improved. A concerted effort to improve diet quality in vulnerable groups may be needed.
Highlights
The diet quality of adults living in the United States has improved overtime
When the analyses were stratified by method of diabetes diagnosis, we found that the unadjusted mean Healthy Eating Index 2010 (HEI) score for those who self-reported a diagnosis of diabetes was 51.7 (95%CI 51.0 to 52.4), and the mean HEI score for those who were diagnosed with diabetes on the basis of laboratory values only was 48.0 (Additional file 1: Table S5 and Additional file 1: Table S6)
The long study period allows adequate power to detect subtle trends that may be missed with shorter follow-up. Adults with both diabetes and lower SES and/or food insecurity experience important disparities in diet quality. These disparities have not improved over time, and lower SES individuals are more than a decade behind their peers in realizing dietary improvements
Summary
We aim to determine whether diet quality among adults with diabetes mellitus has changed over time, and to examine trends in socioeconomic disparities in diet quality. Among all US adults, diet quality has increased over the last decade [6]; disparities in diet quality between individuals with high and low socioeconomic status have increased [6]. Differences in diet quality may be an important explanation for socioeconomic disparities in diabetesrelated health outcomes, including glycemic control, CVD events, and mortality [7, 8]. Despite the importance of diet quality on diabetes-related health outcomes and disparities in outcomes, the extent of socioeconomic differences in diet quality among individuals with diabetes is not well studied. We hypothesize that individuals with indicators of lower socioeconomic status will have lower diet quality, and that this difference will not have improved over time
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