Background:
Diet is pivotal in the management of obese patients with type 2 diabetes (T2D). We aimed to examine the association between dietary quality and obesity in Chinese adults with T2D.
Methods:
Chinese adults with T2D who had undergone comprehensive diabetes assessments at a university-affiliated hospital between April and November 2016 were invited to join this study. Participants were categorized into non-obese (body mass index [BMI] = 18.5- 24.9 kg/m2) and obese (BMI ≥30 kg/m2) groups. Four dietary quality indices, including Alternate Healthy Eating Index 2010 (AHEI), Dietary Quality Index-International (DQI-I), Dietary Approach to Stop Hypertension (DASH) diet score and Mediterranean Diet Score (MDS), were derived from the dietary intake data collected by a validated food frequency questionnaire.
Results:
A total of 211 Chinese T2D (54.5% men, mean age ± standard deviation = 54.0 ± 8.6 years, mean disease duration of diabetes = 8.8 ± 7.7 years) were recruited. Compared with the non-obese group, the obese group had significantly higher total energy intake (2158.9 ± 547.2 kcal vs. 1889.0 ± 442.1 kcal), lower vigorous and moderate physical activity days (1.02 ± 1.85 days vs. 2.02 ± 2.62 days), AHEI-2010 (57.8 ± 11.3 vs. 63.08 ± 12.15), DQI-I (51.70 ± 7.03 vs. 54.3 ± 7.79) and DASH diet score (21.7 ± 4.8 vs. 23.5 ± 5.4) (all p<0.05), but no difference in MDS. After adjusted for sociodemographic covariates, anti-diabetic medications and physical activity level, AHEI, DQI-I and DASH diet score remained to be inversely associated with obesity (all P <0.05). However, such associations became insignificant after further adjusted for total energy intake.
Conclusion:
Low dietary quality was associated with obesity in Chinese type 2 diabetic adults and its effect was attenuated by total energy intake. Our results suggest that both dietary quality and energy restriction are pertinent in planning and implementing dietary intervention for obese T2D.