Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil.
Centro de Estudos em Alimentação e Nutrição (CESAN), HCPA/UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.
Nutr J. 2017 Nov 21;16(1):74. doi: 10.1186/s12937-017-0296-8.
This study aimed to evaluate the concordance between two dietary indexes, the Healthy Eating Index (HEI) and the Diabetes Healthy Eating Index (DHEI), in evaluating diet quality and its possible association with therapeutic targets in patients with type 2 diabetes.
Cross-sectional study of outpatients with type 2 diabetes mellitus treated at a university hospital. Dietary information was obtained from a quantitative food frequency questionnaire (previously validated for use in patients with type 2 diabetes) and converted into daily intakes. Diet quality was assessed using two dietary indexes: HEI (12 components, nine food groups and three moderation components) and DHEI (10 components, six food groups, three nutrient groups, and one for variety of diet). In both indexes, the sum of the scores for each component yields an overall score converted on a scale from 0 to 100%; diet quality is subsequently ranked as low (<51%), needing improvement (51-80%), or high (>80%). Patients underwent clinical and laboratory assessment. Those with fasting blood glucose values 70-130 mg/dL, A1c < 7%, total cholesterol <200 mg/dL, LDL-cholesterol <100 mg/dL, and triglycerides <150 mg/dL were considered to meet therapeutic targets. All analyses were conducted in PASW Statistics 18.0, and p < 0.05 deemed significant.
We analyzed 148 patients with type 2 diabetes (73% white, mean age 63.2 ± 9.4 years, median diabetes duration 10 [IQR 5-19] years, mean A1c% 8.4 ± 2.0%, and mean BMI 30.5 ± 4.2 kg/m). Mean energy intake was 2114 ± 649 kcal/day. DHEI scores were 17.0 (95%CI -6.8 to 41.0) points lower than HEI scores (55.9 ± 14.2% vs. 72.9 ± 10.7%, respectively; P < 0.001), suggesting there is no agreement (Bland-Altman method), and the Pearson correlation coefficient was 0.55 (P < 0.001). More patients were classified as having a low-quality diet by the DHEI than by the HEI (38.5% vs. 1.4%; P < 0.001). A higher proportion of patients (35.7%) with out-of-target total cholesterol levels had a low-quality diet evaluated by the DHEI (P = 0.03). We did not find associations between overall score of HEI and therapeutic targets.
In its intended population of patients with type 2 diabetes, the DHEI seems to be a more rigorous tool to evaluate association between diet quality and changes in metabolic parameters.
本研究旨在评估两种饮食指数（健康饮食指数[HEI]和糖尿病健康饮食指数[DHEI]）在评估饮食质量及其与 2 型糖尿病患者治疗目标的可能相关性方面的一致性。
这是一项在一所大学医院接受治疗的 2 型糖尿病门诊患者的横断面研究。饮食信息来自定量食物频率问卷（先前在 2 型糖尿病患者中验证过）并转换为每日摄入量。使用两种饮食指数评估饮食质量：HEI（12 个成分，9 个食物组和 3 个适度成分）和 DHEI（10 个成分，6 个食物组，3 个营养组和 1 个饮食多样性组）。在这两个指数中，每个成分的得分总和得出一个转换为 0 到 100 分制的总分；随后将饮食质量排名为低（<51%）、需要改进（51-80%）或高（>80%）。患者接受临床和实验室评估。那些空腹血糖值为 70-130mg/dL、A1c<7%、总胆固醇<200mg/dL、LDL-胆固醇<100mg/dL 和甘油三酯<150mg/dL 的患者被认为达到了治疗目标。所有分析均在 PASW Statistics 18.0 中进行，p<0.05 被认为具有统计学意义。
我们分析了 148 名 2 型糖尿病患者（73%为白人，平均年龄 63.2±9.4 岁，中位糖尿病病程 10[IQR 5-19]年，平均 A1c%为 8.4±2.0%，平均 BMI 为 30.5±4.2kg/m2）。平均能量摄入量为 2114±649kcal/天。DHEI 评分比 HEI 评分低 17.0（95%CI -6.8 至 41.0）点（分别为 55.9±14.2%和 72.9±10.7%；P<0.001），这表明两者之间没有一致性（Bland-Altman 方法），Pearson 相关系数为 0.55（P<0.001）。与 HEI 相比，DHEI 评估的低质量饮食患者比例更高（38.5%与 1.4%；P<0.001）。DHEI 评估的总胆固醇水平不达标的患者（35.7%）比例更高（P=0.03）。我们没有发现 HEI 整体评分与治疗目标之间的相关性。
在其预期的 2 型糖尿病患者人群中，DHEI 似乎是一种更严格的工具，可用于评估饮食质量与代谢参数变化之间的关系。
