Dietary Quality and Comorbidities of Adults at Medical Risk for Diabetes


Background and aims: The current study evaluates following a special diet with diet quality and comorbidities (hypertension, hypercholesterolemia, and obesity) in four racial/ethnic groups diagnosed with prediabetes or “at risk for diabetes”. Methods and results: This is a cross-sectional analysis of data from the National Health and Nutrition Examination Surveys (NHANES), 2007-2008 and 2009-2010. Sample weights were used to achieve a representative sample. Data were available for N = 2666 adults, aged ≥20 years (508 Mexican American, 294, Other Hispanic, 616 Black non-Hispanic, and 1248 White non-Hispanic) who were medically diagnosed with either prediabetes or “at risk for diabetes”. Those reporting following a special diet had greater odds of meeting saturated fat guidelines (<10% of calories) but no greater odds of adequate fiber (14 g/4184 kJ (1000 Kcal)) as compared to those not following a special diet. There was a significant association of following a diet by number of comorbidities. Regardless of race/ethnicity, reporting following a special diet was more likely for those having more comorbidities; however, number of comorbidities was not associated with diet quality. There were racial/ethnic differences in following a special diet and its association with adequate fiber intake for persons having health risks for diabetes. Black non-Hispanics who did not follow a special diet had lower odds of meeting fiber intake requirements. Conclusion: Low adherence (<15%) to fiber dietary guidelines was found across race/ethnicity for adults diagnosed at health risk for diabetes.

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Vaccaro, J. , Safina, D. , Grunspan, L. and Huffman, F. (2014) Dietary Quality and Comorbidities of Adults at Medical Risk for Diabetes. Open Journal of Preventive Medicine, 4, 138-144. doi: 10.4236/ojpm.2014.44019.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Centers for Disease Control and Prevention (2011) National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta.
[2] DeFronzo, R.A. and Abdul-Ghani, M. (2011) Assessment and Treatment of Cardiovascular Risk in Prediabetes: Impaired Glucose Tolerance and Impaired Fasting Glucose. American Journal of Cardiology, 108, 3B-24B.
[3] Nonogaki, K. (2012) Dysglycemia and Cardiovascular Risk. Journal of the American College of Cardiology, 60, 1121.
[4] American Diabetes Association (2013) Standards of Medical Care in Diabetes—2013. Diabetes Care, 36, S11-S66.
[5] Knowler, W.C., Barrett-Connor, E., Fowler, S.E., et al. (Diabetes Prevention Research Group) (2002) Reductions in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. The New England Journal of Medicine, 346, 393-403.
[6] Knowler, W.C., Fowler, S.E., Hamman, R.F., et al. (2009) 10-Year Follow-Up of Diabetes Incidence and Weight Loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374, 1677-1686.
[7] Jaakko Tuomilehto, J., Lindström, J., Eriksson, J.G., et al. (2001) Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. The New England Journal of Medicine, 344, 343-1350.
[8] Pan, X.R., Li, G.W., Hu, Y.H., et al. (1997) Effects of Diet and Exercise in Preventing NIDDM in People with Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study. Diabetes Care, 20, 537-544.
[9] Harvard School of Public Health (2013) Simple Steps to Preventing Diabetes.
[10] US Department of Agriculture and US Department of Health and Human Services (2010) Dietary Guidelines for Americans. US Government Printing Office, Washington DC.
[11] American Heart Association Nutrition Committee, Lichtenstein, A.H., Appel, L.J., Brands, M., et al. (2006) Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee. Circulation, 114, 82-96.
[12] National Health and Nutrition Examination Survey (2013) Questionnaires, Datasets and Related Documentation. questionnaires.htm
[13] National Cholesterol Education Program (NCEP) ATP III. US Department of Health and Human Services (2013) Public Health Service National Institutes of Health National Heart, Lung and Blood Institute NIH 2012. Publication No. 01-3305.
[14] Jellinger, P.S., Smith, D.A., Mehta, A.E., et al. (2012) American Association of Clinical Endocrinologists (AACE) Guidelines for the Management of Dyslipidemia and Prevention of Atherosclerosis. Endocrine Practice, 18, 1-78.
[15] (2013) Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). NIH Publication No. 03-5231.
[16] (2013) National Health and Nutrition Examination Survey (NHANES): Analytical and Reporting Guidelines, 2011-2012. National Center for Health Statistics (NCHS): Center for Disease Control and Prevention, Hyattsville.
[17] Orzech, K.M., Vivian, J., Torres, M.A., Armin, J. and Shaw, S.J. (2013) Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups. Health Education & Behavior, 40, 56-66.
[18] Jan, N.K. and Becker, M.H. (1984) The Health Model a Decade Later. Health Education Quarterly, 11, 1-47.
[19] Hendrychova, T., Vytrisalov, M., Vlcek, J., Smahelova, A. and Kubena, A.A. (2013) An Analysis of Fat-Related and Fiber-Related Behavior in Men and Women with Type 2 Diabetes Mellitus: Key Findings for Clinical Practice. Patient Prefer Adherence, 7, 877-884.
[20] Absetz, P., Valve, R., Oldenburg, B., Heinonen, H., Nissinen, A., Fogelhom, M., Llvesmaki, V., Taljia, M. and Uutell, A. (2007) Type 2 Diabetes Prevention in the “Real World.” One Year Results of the GOAL Implementation Trial. Diabetes Care, 30, 2465-2470.
[21] Vermunt, P.W.A., Milder, I.E., Wielaard, F., Baan, C.A., Schelfhout, J.D.M., Westert, G.P. and van Oers, H.A.M. (2013) Behavior Change in a Lifestyle Intervention for Type 2 Diabetes Prevention in Dutch Primary Care: Opportunities for Intervention Content. BMC Family Practice, 14, 78.
[22] Lakerveld, J., Bot, S.D., Chinapaw, M.J., van Tlder, M.W., Kostense, P.J., Dekker, J.M. and Nijpels, G. (2013) Motivational Interviewing and Problem Solving Treatment to Reduce Type 2 Diabetes and Cardiovascular Disease Risk in Real Life: A Randomized Controlled Trial. International Journal of Behavioral Nutrition and Physical Activity, 10, 47.
[23] Cardona-Morrell, M., Rychetnik, L., Morrell, S.L., Espinel, P.T. and Bauman, A. (2010) Reduction of Diabetes Risk in Routine Clinical Practice: Are Physical Activity and Nutrition Interventions Feasible and Are the Outcomes from Reference Trials Replicable? A Systematic Review and Meta-Analysis. BMC Public Health, 10, 653.

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