Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong SAR, China.
Nutr J. 2018 Jul 3;17(1):63. doi: 10.1186/s12937-018-0374-6.
Diet quality has been linked to obesity, but this relationship remains unclear in individuals with type 2 diabetes (T2D). The aim of this study is to examine the association between diet quality and obesity in Chinese adults with T2D.
Between April and November 2016, a total of 211 Chinese T2D adults who underwent assessment of diabetes-related treatment goals and metabolic control were recruited into two groups based on their body mass index (BMI): obese group (BMI ≥30 kg/m) and non-obese group (BMI = 18.5-24.9 kg/m). Diet quality indices including Alternate Healthy Eating Index-2010 (AHEI-2010), Diet Quality Index-International (DQI-I), and Dietary Approach to Stop Hypertension (DASH) score, were derived from a validated food frequency questionnaire.
Obese T2D patients had significantly lower AHEI-2010 (P < 0.001), DQI-I (P < 0.001), and DASH total scores (P = 0.044) than their non-obese counterparts, independent of age and sex. They also had higher total energy (P < 0.001), protein percentage of energy (P = 0.023), and meat, poultry and organ meat (P < 0.001), but lower vegetable (P = 0.014) intakes. Our multivariate logistic regression analyses demonstrated that the AHEI-2010, but not DQI-I and DASH, total score had an inverse association with obesity, independent of sociodemographics, anti-diabetic medication use, physical activity level and total energy intake (odds ratio [OR] per standard deviation (1-SD) increase: 0.95, 95% confidence interval [CI]: 0.91-0.99, P = 0.020). This association remained significant after further adjustment for glycemic control. Inverse associations were also found between obesity and multivariate-adjusted component scores, including AHEI-2010 red/processed meat (OR per 1-SD: 0.71, 95% CI: 0.51-0.99, P = 0.044), DQI-I variety (OR per 1-SD: 0.63, 95% CI: 0.46-0.86, P = 0.004), and DASH red/processed meat (OR per 1-SD: 0.57, 95% CI: 0.38-0.84, P = 0.005).
Better diet quality, as characterized by higher AHEI-2010 scores, was associated with lower odds of obesity in Chinese adults with T2D. Dietary patterns reflecting high consumption of plant-based foods and low consumption of animal-based, high-fat, and processed foods may be imperative to optimize nutritional guidance for obesity management in this population.
饮食质量与肥胖有关，但在 2 型糖尿病（T2D）患者中，这种关系尚不清楚。本研究旨在探讨中国 T2D 成人中饮食质量与肥胖的关系。
2016 年 4 月至 11 月，共招募了 211 名接受糖尿病相关治疗目标和代谢控制评估的中国 T2D 成年人，根据体重指数（BMI）分为两组：肥胖组（BMI≥30 kg/m）和非肥胖组（BMI=18.5-24.9 kg/m）。饮食质量指数包括替代健康饮食指数-2010（AHEI-2010）、饮食质量指数-国际（DQI-I）和停止高血压的饮食方法（DASH）评分，均来自经过验证的食物频率问卷。
与非肥胖组相比，肥胖 T2D 患者的 AHEI-2010（P<0.001）、DQI-I（P<0.001）和 DASH 总分（P=0.044）明显较低，独立于年龄和性别。他们的总能量摄入也更高（P<0.001）、蛋白质占能量的百分比更高（P=0.023）、肉类、家禽和器官肉类摄入量更高（P<0.001），但蔬菜摄入量较低（P=0.014）。我们的多变量逻辑回归分析表明，AHEI-2010 与肥胖呈负相关，但 DQI-I 和 DASH 总分没有这种相关性，独立于社会人口统计学、抗糖尿病药物使用、身体活动水平和总能量摄入（每标准偏差（1-SD）增加的比值比[OR]：0.95，95%置信区间[CI]：0.91-0.99，P=0.020）。在进一步调整血糖控制后，这种关联仍然显著。肥胖与多变量调整后的成分得分之间也存在负相关，包括 AHEI-2010 红色/加工肉类（每 1-SD 的 OR：0.71，95%CI：0.51-0.99，P=0.044）、DQI-I 品种（每 1-SD 的 OR：0.63，95%CI：0.46-0.86，P=0.004）和 DASH 红色/加工肉类（每 1-SD 的 OR：0.57，95%CI：0.38-0.84，P=0.005）。
在中国 T2D 成人中，较高的 AHEI-2010 评分表明饮食质量更好，与肥胖的几率较低有关。反映高植物性食物摄入和低动物源性、高脂肪和加工食品摄入的饮食模式对于优化该人群的肥胖管理营养指导可能至关重要。
