Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: results from the Boston Puerto Rican Health study

Seth A Berkowitz, Xiang Gao, Katherine L Tucker, Seth A Berkowitz, Xiang Gao, Katherine L Tucker

Abstract

Objective: To determine whether dietary patterns associated with food insecurity are associated with poor longitudinal glycemic control.

Research design and methods: In a prospective, population-based, longitudinal cohort study, we ascertained food security (Food Security Survey Module), dietary pattern (Healthy Eating Index-2005 [HEI 2005]), and hemoglobin A1c (HbA1c) in Puerto Rican adults aged 45-75 years with diabetes at baseline (2004-2009) and HbA1c at ∼2 years follow-up (2006-2012). We determined associations between food insecurity and dietary pattern and assessed whether those dietary patterns were associated with poorer HbA1c concentration over time, using multivariable-adjusted repeated subjects mixed-effects models.

Results: There were 584 participants with diabetes at baseline and 516 at follow-up. Food-insecure participants reported lower overall dietary quality and lower intake of fruit and vegetables. A food insecurity*HEI 2005 interaction (P < 0.001) suggested that better diet quality was more strongly associated with lower HbA1c in food-insecure than food-secure participants. In adjusted models, lower follow-up HbA1c was associated with greater HEI 2005 score (β = -0.01 HbA1c % per HEI 2005 point, per year, P = 0.003) and with subscores of total vegetables (β = -0.09, P = 0.04) and dark green and orange vegetables and legumes (β = -0.06, P = 0.048). Compared with the minimum total vegetable score, a participant with the maximum score showed relative improvements of HbA1c of 0.5% per year.

Conclusions: Food insecurity was associated with lower overall dietary quality and lower consumption of plant-based foods, which was associated with poor longitudinal glycemic control.

© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

References

    1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA, Centers for Disease Control and Prevention, 2011.
    1. Beckles GL, Chou CF, Centers for Disease Control and Prevention (CDC) . Diabetes - United States, 2006 and 2010. MMWR Surveill Summ 2013;62(Suppl. 3):99–104
    1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security, Revised. Alexandria, VA, U.S. Department of Agriculture Food and Nutrition Service, 2000
    1. Berkowitz SA, Baggett TP, Wexler DJ, Huskey KW, Wee CC. Food insecurity and metabolic control among U.S. adults with diabetes. Diabetes Care 2013;36:3093–3099
    1. Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002. J Gen Intern Med 2007;22:1018–1023
    1. Seligman HK, Jacobs EA, López A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care 2012;35:233–238
    1. Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. N Engl J Med 2010;363:6–9
    1. Cunha DB, Sichieri R, de Almeida RM, Pereira RA. Factors associated with dietary patterns among low-income adults. Public Health Nutr 2011;14:1579–1585
    1. Dachner N, Ricciuto L, Kirkpatrick SI, Tarasuk V. Food purchasing and food insecurity among low-income families in Toronto. Can J Diet Pract Res 2010;71:e50–e56
    1. Drewnowski A. The economics of food choice behavior: why poverty and obesity are linked. Nestle Nutr Inst Workshop Ser 2012;73:95–112
    1. Drewnowski A, Darmon N. The economics of obesity: dietary energy density and energy cost. Am J Clin Nutr 2005;82(Suppl.):265S–273S
    1. Martin KS, Wu R, Wolff M, Colantonio AG, Grady J. A novel food pantry program: food security, self-sufficiency, and diet-quality outcomes. Am J Prev Med 2013;45:569–575
    1. Mello JA, Gans KM, Risica PM, Kirtania U, Strolla LO, Fournier L. How is food insecurity associated with dietary behaviors? An analysis with low-income, ethnically diverse participants in a nutrition intervention study. J Am Diet Assoc 2010;110:1906–1911
    1. Nackers LM, Appelhans BM. Food insecurity is linked to a food environment promoting obesity in households with children. J Nutr Educ Behav 2013;45:780–784
    1. Ramsey R, Giskes K, Turrell G, Gallegos D. Food insecurity among adults residing in disadvantaged urban areas: potential health and dietary consequences. Public Health Nutr 2012;15:227–237
    1. American Diabetes Association . Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl. 1):S14–S80
    1. Gao X, Scott T, Falcon LM, Wilde PE, Tucker KL. Food insecurity and cognitive function in Puerto Rican adults. Am J Clin Nutr 2009;89:1197–1203
    1. Tucker KL, Mattei J, Noel SE, et al. . The Boston Puerto Rican Health Study, a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities. BMC Public Health 2010;10:107.
    1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26(Suppl. 1):S5–S20
    1. Tucker KL, Bermudez OI, Castaneda C. Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin. Am J Public Health 2000;90:1288–1293
    1. Coleman-Jensen A, Nord M, Andrews M, Carlson S. Statistical Supplement to Household Food Security in the United States in 2011. Washington, DC, U.S. Department of Agriculture Economic Research Service, 2012
    1. Center for Nutrition Policy and Promotion. Healthy Eating Index. United States Department of Agriculture, 2013. Available from . Accessed 22 January 2014
    1. Ye X, Scott T, Gao X, Maras JE, Bakun PJ, Tucker KL. Mediterranean diet, healthy eating index 2005, and cognitive function in middle-aged and older Puerto Rican adults. J Acad Nutr Diet. 2013;113:276–281.e1–3
    1. Lyles CR, Wolf MS, Schillinger D, et al. . Food insecurity in relation to changes in hemoglobin A1c, self-efficacy, and fruit/vegetable intake during a diabetes educational intervention. Diabetes Care 2013;36:1448–1453
    1. Nord M, Andrews M, Carlson S. Household Food Security in the United States, 2005. United States Department of Agriculture, 2006, (Economic Research Report No. ERR-29). Available at: . Accessed 15 May 2014
    1. Estruch R, Ros E, Salas-Salvadó J, et al. PREDIMED Study Investigators . Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–1290
    1. Peek ME, Wilkes AE, Roberson TS, et al. . Early lessons from an initiative on Chicago’s South Side to reduce disparities in diabetes care and outcomes. Health Aff (Millwood) 2012;31:177–186
    1. Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ 2010;341:c3337.
    1. Basu S, Seligman H, Bhattacharya J. Nutritional policy changes in the supplemental nutrition assistance program: a microsimulation and cost-effectiveness analysis. Med Decis Making 2013;33:937–948
    1. Nord M, Golla M. Does SNAP Decrease Food Insecurity? Untangling the Self-Selection Effect. Washington, DC, U.S. Department of Agriculture, 2009 (Economic Research Report ERR-85)

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever