Trends in dietary macronutrient composition and diet quality among US adults with diagnosed and undiagnosed elevated glycemic status: a serial cross-sectional study
Trends in dietary macronutrient composition and diet quality among US adults with diagnosed and undiagnosed elevated glycemic status: a serial cross-sectional study
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DOI：
10.1093/ajcn/nqac061
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发表时间：
2022-03-10
影响因子：
7.1
通讯作者：
Liu, Liegang
中科院分区：
文献类型：
--
作者：
Yin, Jiawei;Huang, Yue;Liu, Liegang
背景知识血糖状态可能会影响糖尿病和前驱糖尿病患者的饮食摄入。目的：我们的目的是确定在美国成年糖尿病和糖尿病前期患者中，大量营养素摄入和饮食质量的趋势是否因血糖状态的诊断而不同。方法对1999-2016年NHANES数据进行分析。确诊病例通过自我报告确定，未确诊病例通过实验室标准（糖化血红蛋白≥ 5.7%，空腹血糖≥ 100 mg/dL，或2小时口服葡萄糖耐量试验≥ 140 mg/dL）确定。使用差中差模型来比较两组之间的时间趋势。结果7502例确诊和12,974例未确诊的血糖升高患者纳入研究。在1999-2016年期间，诊断病例中低质量碳水化合物的摄入量较低，而高质量碳水化合物，动物蛋白，植物蛋白和不饱和脂肪的摄入量以及2015年健康饮食指数（HEI-2015）评分高于未诊断病例（P < 0.001）。然而，在1999年至2016年的趋势分析中，确诊病例中优质碳水化合物摄入量的增加小于未确诊病例（差异：-1.16%; 95%CI：-1.82%，-0.50%; P = 0.001）。此外，与未确诊病例相比，确诊病例中低质量碳水化合物摄入量的减少较小（差异：0.79%; 95% CI：0.01%，1.57%; P = 0.05），饱和脂肪摄入量的增加较大（差异：0.44%; 95% CI：0.08%，0.79%; P = 0.02）。确诊和未确诊病例之间的HEI-2015评分的时间趋势也存在显著差异，有利于未确诊病例（差异：-2.56; 95%CI：-3.71，-1.41; P < 0.001）。结论：虽然确诊糖尿病和糖尿病前期的成年人的饮食习惯比未确诊的病例好，但这些优势在过去的20年里一直在减弱。
Background Knowledge of glycemic status may affect dietary intake for subjects with diabetes and prediabetes. Objectives We aimed to determine whether trends of macronutrient intake and dietary quality differed by diagnosis of glycemic status among US adults with diabetes and prediabetes. Methods Data from NHANES 1999-2016 were analyzed. Diagnosed cases were established by self-report, and undiagnosed cases were defined by laboratory criteria (glycated hemoglobin >= 5.7%, fasting plasma glucose >= 100 mg/dL, or 2-h oral-glucose-tolerance test >= 140 mg/dL). A difference-in-differences model was used to compare the temporal trends between the 2 groups. Results There were 7502 diagnosed and 12,974 undiagnosed cases with elevated glycemic status included in the study. During 1999-2016, the intake of low-quality carbohydrates was lower, whereas intakes of high-quality carbohydrates, animal protein, plant protein, and unsaturated fat and the Healthy Eating Index 2015 (HEI-2015) score were higher, among the diagnosed cases than among the undiagnosed cases (P < 0.001 for all). However, in the trend analyses from 1999 to 2016, the increase in intake of high-quality carbohydrates was smaller among the diagnosed cases than among the undiagnosed cases (difference: -1.16%; 95% CI: -1.82%, -0.50%; P = 0.001). Moreover, the decrease in low-quality carbohydrate intake was smaller (difference: 0.79%; 95% CI: 0.01%, 1.57%; P = 0.05) and the increase in saturated fat intake was larger (difference: 0.44%; 95% CI: 0.08%, 0.79%; P = 0.02) among the diagnosed cases than among the undiagnosed cases. A significant difference of temporal trends in the HEI-2015 score between the diagnosed and undiagnosed cases was also observed, in favor of the undiagnosed cases (difference: -2.56; 95% CI: -3.71, -1.41; P < 0.001). Conclusions Although dietary habits among adults with diagnosed diabetes and prediabetes were better than those among the undiagnosed cases, these advantages have been diminishing during the past 2 decades.