In the United States, type 2 diabetes (T2D) is more common in all racial and ethnic minority groups than in the non-Hispanic white population. T2D that is not properly controlled increases the risk of serious complications, such as high blood pressure, heart disease, chronic kidney disease, and stroke. Maintaining a healthy, balanced diet low in refined grains, added sugars, sodium, and saturated fats is an important part of managing T2D. However, it can be difficult for people with food insecurity to access the nutritious foods needed to maintain a healthy diet. In a new NIMHD-supported study, researchers analyzed the impact of food insecurity, diet quality, and other factors on the management of T2D. They found that having a poor diet, living with food insecurity, being black, African American, Hispanic, or Latino, and not having access to health care were all associated with a higher risk of uncontrolled T2D.
The researchers examined the health data of more than 1,500 adults aged 20 or older with T2D. The data was obtained from the National Health and Nutrition Examination Survey (NHANES), which measures the health and nutrition of people living in the United States. The data used in this study were collected from 2011 to 2016. NHANES used blood test results to detect uncontrolled T2D and questionnaires to collect information on participants, including health screening, food intake, and food security.
Using NHANES data on food intake, the researchers used the 2015 Healthy Eating Index (HEI-2015) to calculate the quality of diets, based on the latest recommendations for a healthy diet. The HEI-2015 index ranks a person’s diet on a scale from 0 to 100, based on the types and amounts of food a person typically eats, including fruits, vegetables, whole grains, dairy, proteins, fats, processed foods, sodium, and sugar. In this study, researchers considered participants with a score of 60 or less as eating a poor-quality diet. To measure food security, researchers analyzed NHANES data from a set of 10 questions that asked whether the participant was always able to obtain safe, nutritious food. The researchers then analyzed this data and other information on factors associated with uncontrolled T2D.
Although most of the participants had their diabetes under control, about 16% of those who experienced uncontrolled T2D also had food insecurity; 68% follow a poor quality diet, and 24% follow a poor diet and are food insecure. Participants who followed a poor-quality diet were about five times more likely to develop uncontrolled T2D than participants who followed a high-quality diet. Participants who were living with food insecurity had more problems managing their T2D; They were eight times more likely to have uncontrolled T2D than participants with constant access to and affordability of healthy food. Participants with poor-quality diet and food insecurity – about a quarter of the group – were more likely to have uncontrolled T2D. In general, the study participants, who all developed T2D, had a lower quality diet and a higher level of food insecurity than was reported for the general public.
The study showed that black or African American participants and Hispanic or Latino participants were more likely to have uncontrolled T2D compared to non-Hispanic white participants. This supports the findings of previous research that found higher rates of uncontrolled T2D and mortality in racial and ethnic minorities. Participants who did not receive regular health care or who were referred to a diabetes specialist were also at high risk of uncontrolled T2D.
Overall, the study results show the interaction between poor diet and food insecurity in controlling diabetes and the importance of improving access to healthy foods, especially for people at risk of uncontrolled T2D. Researchers suggest that food-insecure people may rely on nutritional assistance programs and that public health initiatives that promote access to healthy foods can help improve diet quality and food security. And making culturally sensitive health and nutrition information available in multiple languages can help people who are likely to have uncontrolled T2D understand the importance of healthy food choices. Policies that address the common challenges of food insecurity, poor diet quality, and limited access to health care can help address uncontrolled T2D in racial and ethnic minorities and in disadvantaged communities.
Shaheen, M., Kibe, LW, & Schrod, K.M. (2021). Diet quality, food security, and glycemic control among adults with diabetes. ESPEN Clinical Nutrition, 46, 336–342. doi: 10.1016/j.clnesp.2021.09.735.
Page last updated on September 16, 2022
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