Alaofè Halimatou, Okechukwu Abidemi, Amoussa-Hounkpatin Waliou, Hakim Iman A, Mizéhoun-Adissoda Carmelle, Gninkoun Jules, Bedrick Edward John, Ehiri John
Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, United States of America.
School of Nutrition and Food Science and Technology, Faculty of Agricultural Sciences of the University of Abomey-Calavi (FSA-UAC) Campus d' Abomey-Calavi, Calavi, Benin.
PLoS One. 2025 Apr 1;20(4):e0320235. doi: 10.1371/journal.pone.0320235. eCollection 2025.
Families and cultural contexts can impact dietary adherence and glycemic control of type 2 diabetes (T2D). Yet little is known about these relationships in Africa, where poor dietary adherence and glycemic control are prevalent. To address this gap, this study investigated whether dietary adherence mediates family functioning and glycemic control among T2D adults in Benin, West Africa. We also explored whether cultural identity affected the association between family functioning and dietary adherence.
A cross-sectional study of 512 T2D patients from six health centers was conducted to assess: 1) family functioning with the 12-item McMaster Family Assessment Device-General Functioning Subscale (FAD-GF); 2) dietary adherence via the Perceived Dietary Adherence Questionnaire (PDAQ); and 3) cultural identity with the 12-item Multigroup Ethnic Identity Measure (MEIM). The three-month glycemic control was determined with Glycated Hemoglobin - HbA1c. Mediation and moderation analyses were conducted using Stata's structural equation model (SEM).
Healthy family functioning, good dietary adherence and good glycemic control rates were 56.8%, 33%, and 30.5% respectively. Path analysis showed that healthy family functioning was significantly associated with lower HbA1c levels (-0.34, 95% CI: [-0.72, -0.03]), and there was a significant indirect effect via greater dietary adherence (-0.12, 95% CI: [-0.22, -0.01]). However, cultural identity did not significantly impact the relationship between family functioning and dietary adherence.
Our study revealed that family functioning, adherence to dietary recommendations, and glycemic control are interconnected in adults with T2D. Interventions should target modifiable factors like dietary adherence and address relevant risk and resilience sources to improve glycemic control in urban African families.
家庭和文化背景会影响2型糖尿病（T2D）患者的饮食依从性和血糖控制。然而，在饮食依从性差和血糖控制不佳普遍存在的非洲，人们对这些关系知之甚少。为了填补这一空白，本研究调查了饮食依从性是否在西非贝宁的T2D成年人中调节家庭功能与血糖控制之间的关系。我们还探讨了文化认同是否会影响家庭功能与饮食依从性之间的关联。
对来自六个健康中心的512名T2D患者进行了一项横断面研究，以评估：1）使用12项麦克马斯特家庭评估设备-总体功能分量表（FAD-GF）评估家庭功能；2）通过感知饮食依从性问卷（PDAQ）评估饮食依从性；3）使用12项多群体种族认同量表（MEIM）评估文化认同。用糖化血红蛋白-HbA1c测定三个月的血糖控制情况。使用Stata的结构方程模型（SEM）进行中介和调节分析。
健康的家庭功能、良好的饮食依从性和良好的血糖控制率分别为56.8%、33%和30.5%。路径分析表明，健康的家庭功能与较低的HbA1c水平显著相关（-0.34，95%CI：[-0.72，-0.03]），并且通过更高的饮食依从性存在显著的间接效应（-0.12，95%CI：[-0.22，-0.01]）。然而，文化认同并未显著影响家庭功能与饮食依从性之间的关系。
我们的研究表明，家庭功能、饮食建议的依从性和血糖控制在T2D成年人中相互关联。干预措施应针对饮食依从性等可改变因素，并解决相关的风险和恢复力来源，以改善非洲城市家庭中的血糖控制。
