Berkowitz Seth A, Ochoa Aileen, Donovan Jenna M, Dankovchik Jenine, LaPoint Myklynn, Kuhn Marlena L, Morrissey Suzanne, Gao Mufeng, Hudgens Michael G, Basu Sanjay, Gold Rachel
Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
SSM Popul Health. 2024 Sep 3;27:101709. doi: 10.1016/j.ssmph.2024.101709. eCollection 2024 Sep.
To estimate the association between food needs and diabetes outcomes.
Longitudinal cohort study, using a target trial emulation approach. 96,792 adults with type 2 diabetes mellitus who underwent food need assessment in a network of community-based health centers were followed up to 36 months after initial assessment. We used targeted minimum loss estimation to estimate the association between not experiencing food needs, compared with experiencing food needs, and hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. The study period was June 24th, 2016 to April 30th, 2023.
We estimated that not experiencing food needs, compared with experiencing food needs, would be associated with 0.12 percentage points lower (95% Confidence Interval [CI] -0.16% to -0.09%, p = < 0.0001) mean HbA1c at 12 months. We further estimated that not experiencing food needs would be associated with a 12-month SBP that was 0.67 mm Hg lower (95%CI -0.97 to -0.38 mm Hg, p < .0001), DBP 0.21 mm Hg lower (95%CI -0.38 to -0.04 mm Hg, p = .01). There was no association with lower LDL cholesterol. Results were similar at other timepoints, with associations for HbA1c, SBP, and DBP of similar magnitude, and no difference in LDL cholesterol.
We estimated that not experiencing food needs may be associated with modestly better diabetes outcomes. These findings support testing interventions that address food needs as part of their mechanism of action.
评估食物需求与糖尿病结局之间的关联。
纵向队列研究，采用目标试验模拟方法。对在社区卫生中心网络中接受食物需求评估的96,792名2型糖尿病成年人进行了初始评估后长达36个月的随访。我们使用目标最小损失估计法来评估未经历食物需求（与经历食物需求相比）与糖化血红蛋白（HbA1c）、收缩压和舒张压（SBP和DBP）以及低密度脂蛋白胆固醇之间的关联。研究期间为2016年6月24日至2023年4月30日。
我们估计，与经历食物需求相比，未经历食物需求在12个月时平均HbA1c会低0.12个百分点（95%置信区间[CI]为-0.16%至-0.09%，p = <0.0001）。我们进一步估计，未经历食物需求与12个月时收缩压低0.67毫米汞柱（95%CI为-0.97至-0.38毫米汞柱，p <.0001）、舒张压低0.21毫米汞柱（95%CI为-0.38至-0.04毫米汞柱，p =.01）相关。与较低的低密度脂蛋白胆固醇无关联。在其他时间点结果相似，HbA1c、SBP和DBP的关联幅度相似，低密度脂蛋白胆固醇无差异。
我们估计未经历食物需求可能与糖尿病结局略有改善相关。这些发现支持对将解决食物需求作为其作用机制一部分的干预措施进行测试。
