ASSOCIATIONS OF HEALTH MARKERS, PERCEPTIONS, AND LIFESTYLE BEHAVIORS WITH DIET QUALITY INDICES AND TYPE 2 DIABETES STATUS IN U.S. ADULTS

Abstract

There is growing evidence that adherence to healthful dietary patterns reduces the risk of type 2 diabetes (T2DM). The Healthy Eating Index 2010 (HEI-2010) and the Alternate Healthy Eating Index 2010 (AHEI-2010) are recognized as assessment tools for measuring dietary quality. This research had three main objectives: 1) Determine whether the AHEI-2010 provides a more accurate assessment of dietary quality than the HEI-2010 in relation to diabetes status; 2) Examine the relationship between diabetes status and discrepancies between perceived diet quality (PDQ) and measured diet quality (MDQ) (using total HEI-2010 and AHEI-2010 scores, respectively); 3) Examine the relationships between selected lifestyle behaviors independently, and in combination with other lifestyle behaviors, and dietary quality (using total HEI-2010 and AHEI-2010 scores) by diabetes status. Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 were used to analyze participants age 20 years and older (n = 4097). Overall, the total HEI-2010 and AHEI-2010 scores for the sample indicate that U.S. adults need dietary improvement (mean total HEI-2010 score = 47.3 ± 0.4; mean total AHEI-2010 score = 38.2 ± 0.4). Diabetics had higher total HEI-2010 and AHEI-2010 scores compared to prediabetics and non diabetics, but did not have better health markers. Results indicate no predictive value of total HEI-2010 and AHEI-2010 scores (OR = 1.00, p > 0.05) in relation to diabetes status. In addition, the associations between diabetes status and discrepancy scores (for both HEI-2010 and AHEI-2010) were not significant after adjusting for perceived health status (p > 0.05). However, there were significant associations between individual lifestyle behaviors and total HEI-2010 and AHEI-2010 scores by diabetes status (p < 0.05). In addition, the combined Lifestyle Behaviors score was a significant predictor of total HEI-2010 and AHEI-2010 scores (p < 0.05) by diabetes status. In conclusion, these findings suggest that dietary quality, measured with HEI-2010 or AHEI-2010 is associated with health markers, perceptions, and lifestyle behaviors, all of which can influence the development of T2DM. Findings of this research have implications for developing more successful strategies to improve compliance with dietary guidelines and evidence-based recommendations for disease management and prevention.