Department of Internal Medicine, Amsterdam University Medical Center, VU University Medical Center, 1081 HV Amsterdam, The Netherlands.
Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA.
Nutrients. 2024 Oct 16;16(20):3512. doi: 10.3390/nu16203512.
Various dietary risk factors for type 2 diabetes have been identified. A short assessment of dietary patterns related to the risk for type 2 diabetes mellitus may be relevant in clinical practice given the largely preventable nature of the disease. The aim of this study was to investigate the reproducibility of a short food frequency questionnaire based on available knowledge of diabetes-related healthy diets. In addition, we aimed to investigate whether a Diabetes Dietary Quality Index based on this questionnaire was related to metabolic risk factors, including measures of beta cell function and insulin sensitivity.
A short food frequency questionnaire was composed by selecting fourteen questions (representing eight dietary factors) from existing food frequency questionnaires on the basis of their reported relationship with diabetes risk. Healthy participants (N = 176) from a Dutch family study completed the questionnaire and a subgroup (N = 123) completed the questionnaire twice. Reproducible items from the short questionnaire were combined into an index. The association between the Diabetes Dietary Quality index and metabolic risk factors was investigated using multiple linear regression analysis. Measures of beta cell function and insulin sensitivity were derived from a mixed meal test and an euglycemic-hyperinsulinemic and modified hyperglycemic clamp test.
Our results show that this new short food frequency questionnaire is reliable (Intraclass Correlations ranged between 0.5 and 0.9). A higher Diabetes Dietary Quality index score was associated with lower 2 h post-meal glucose (β -0.02, SE 0.006, < 0.05), HbA1c (β -0.07, SE 0.02, < 0.05), total cholesterol, (β -0.02, SE 0.07, < 0.05), LDL cholesterol, (β -0.19, SE 0.07, < 0.05), fasting (β -0.4, SE 0.16, < 0.05) and post-load insulin, (β -3.9, SE 1.40, < 0.05) concentrations and the incremental AUC of glucose during MMT (β -1.9, SE 0.97, < 0.05). The scores obtained for the oral glucose insulin sensitivity-derived mixed meal test were higher in subjects who scored higher on the Diabetes Dietary Quality index (β 0.89, 0.39, < 0.05). In contrast, we found no significant associations between the Diabetes Dietary Quality index and clamp measures of beta cell function.
We identified a questionnaire-derived Diabetes Dietary Quality index that was reproducible and inversely associated with a number of type 2 diabetes mellitus and metabolic risk factors, like 2 h post-meal glucose, Hba1c and LDL, and total cholesterol. Once relative validity has been established, the Diabetes Dietary Quality index could be used by health care professionals to identify individuals with diets adversely related to development of type 2 diabetes.
已经确定了各种与 2 型糖尿病相关的饮食风险因素。鉴于这种疾病在很大程度上是可以预防的，因此对与 2 型糖尿病风险相关的饮食模式进行简短评估可能与临床实践相关。本研究的目的是调查基于糖尿病相关健康饮食知识的简短食物频率问卷的可重复性。此外，我们旨在调查基于该问卷的糖尿病饮食质量指数是否与代谢风险因素相关，包括β细胞功能和胰岛素敏感性的测量。
根据与糖尿病风险的相关性，从现有的食物频率问卷中选择 14 个问题（代表 8 种饮食因素），组成简短的食物频率问卷。来自荷兰家族研究的健康参与者（N=176）完成了问卷，其中一个亚组（N=123）完成了两次问卷。从简短问卷中选择可重复的项目组合成一个指数。使用多元线性回归分析研究糖尿病饮食质量指数与代谢风险因素之间的关系。β细胞功能和胰岛素敏感性的测量值来自混合餐试验和正糖高胰岛素钳夹试验。
我们的结果表明，这种新的简短食物频率问卷是可靠的（组内相关系数在 0.5 到 0.9 之间）。较高的糖尿病饮食质量指数与较低的餐后 2 小时血糖（β-0.02，SE 0.006， <0.05）、糖化血红蛋白（β-0.07，SE 0.02， <0.05）、总胆固醇（β-0.02，SE 0.07， <0.05）、低密度脂蛋白胆固醇（β-0.19，SE 0.07， <0.05）、空腹（β-0.4，SE 0.16， <0.05）和负荷后胰岛素（β-3.9，SE 1.40， <0.05）浓度以及 MMT 期间葡萄糖的增量 AUC（β-1.9，SE 0.97， <0.05）有关。在糖尿病饮食质量指数得分较高的受试者中，口服葡萄糖胰岛素敏感性衍生的混合餐试验的评分更高（β 0.89，0.39， <0.05）。相比之下，我们没有发现糖尿病饮食质量指数与钳夹试验的β细胞功能测量值之间存在显著相关性。
我们确定了一个基于问卷的糖尿病饮食质量指数，该指数具有可重复性，并与 2 型糖尿病和代谢风险因素呈负相关，如餐后 2 小时血糖、HbA1c 和 LDL 以及总胆固醇。一旦相对有效性得到确立，糖尿病饮食质量指数就可以被医疗保健专业人员用于识别饮食与 2 型糖尿病发生不良相关的个体。
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