Diabetes Diagnosis Status Impacts Dietary Quality among Hispanic Women with or at Risk for Type 2 Diabetes

Background Diet quality is an important factor contributing to type 2 diabetes (T2D) prevention and control. Although nutrition therapy is recommended as part of standard medical care for T2D patients, it is not known whether diet quality differs among Hispanic women depending on their T2D diagnosis status. This is of particular importance given the low awareness of pre‐diabetes (preD) and T2D in this population. Objective To compare baseline macronutrient intake and dietary quality of overweight/obese Hispanic women with or at‐risk for T2D, based on diagnosis status on their medical record (with or without diagnosis of pre‐D or T2D). Methods Participants included 197 Hispanic women (age = 43.6±10.2 y; weight = 86.6±16.5 kg; BMI = 36.4±6.5 kg/m 2 ; HbA1c = 6.5±1.5 %) with or at risk for T2D enrolled in De Por Vida, a culturally‐tailored weight loss intervention. As recorded in the electronic medical record, 90 participants did not have a formal pre‐D or T2D diagnosis (but were considered at risk based on history of gestational diabetes, hyperlipidemia or hypertension), and 107 participants had an established pre‐D or T2D diagnosis. Regardless of diagnosis status on the medical record, 140 participants had HbA1c ≥ 5.7%. Baseline data dietary data reflecting the prior three months of intake were collected using the Southwestern Food Frequency Questionnaire. Macronutrients and dietary quality, assessed using the Healthy Eating Index (HEI), were compared based on participants' T2D diagnosis status. We compared a total of 23 outcomes using t‐tests and report p values unadjusted for multiple comparisons. Results Mean daily energy intake was 1656±905 kcal, with protein and fat contributing 17.7±3.1 % and 30.7±5.5 % of total energy, respectively. Mean carbohydrate intake was 219±117 g, of which 84±59 g were sugars and 24±12 g were total fiber. Relative to women with no pre‐D/T2D diagnosis, those with a diagnosis reported lower intake of total energy (1508±802 kcal vs. 1832±989 kcal; p=.01) and total carbohydrates (200±99 g vs. 242±132 g; p=.01) Women with a pre‐D/T2D diagnosis had a greater total HEI total score (67.5±8.2) than those with no diagnosis (64.7±10.1, p=.03). Women with a pre‐D/T2D diagnosis had greater HEI subscores for total vegetables (p=.03), fatty acids (p=.048) and empty calories (p=.01) than those with no diagnosis. Other HEI subscores did not differ based on diabetes diagnosis status. Among all participants, HEI adequacy subscores were particularly high (> 80% of maximum) for total vegetables, greens and beans, whole fruit and total protein. Subscores were low (<51% of maximum) for whole grains, sodium and refined grains. Conclusions De Por Vida participants reported adequate intakes of important food groups including vegetables, whole fruit and protein. However, there is room for improving dietary quality through reducing sodium intake and replacing refined grains with their whole counterparts. Having a formal pre‐D/T2D diagnosis was associated with higher diet quality and highlights the importance of awareness of the condition among individuals at risk. Support or Funding Information NIH/NIDDK – 1R01DK099277