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Food-Insecure Dietary Patterns Are Associated With Poor Longitudinal Glycemic Control in Diabetes: Results From the Boston Puerto Rican Health Study
Authors:Seth A. Berkowitz  Xiang Gao  Katherine L. Tucker
Affiliation:1.Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA;2.Department of Medicine, Harvard Medical School, Boston, MA;3.Department of Nutrition, Harvard School of Public Health, Boston, MA;4.Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
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.
Keywords:
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