Association Between Dietary Patterns And Hyperglycemia In Adult In Qingdao,China

Background and Objective:Abnormal glucose metabolism includes impaired glucose regulation（also known as prediabetes）and diabetes mellitus（DM）.The incidence rate of prediabetes and DM increases year by year,and is often accompanied by cardiovascular,cerebrovascular,neurological,eye and foot diseases.Dietary pattern is a dietary structure consisting of a variety of foods or food components in different forms,which can more comprehensively consider the impact of various foods and nutrients on health and disease.Studies have proved that dietary pattern is associated with a variety of chronic diseases,but the impact of dietary pattern on the risk of prediabetes and DM has not been uniformly concluded.Therefore,this study established dietary patterns through the dietary investigation of adult residents in Qingdao area and explored the influence of different dietary patterns on the incidence of prediabetes and DM,so as to provide scientific basis for guiding the reasonable diet of residents.Methods:A cross-sectional study was conducted to analyze the association between dietary patterns and the risk of hyperglycemia.Based on the baseline survey of Qingdao Diabetes Project in 2009,5,542 adult residents who actually participated in the survey were taken as the research objects,excluding those with missing baseline blood glucose,dietary information and abnormal total calorie intake,and finally 5,276 subjects were included in the study.Exploratory factor analysis was used to establish dietary patterns and analyze the prevalence of prediabetes and DM under different dietary patterns.The dietary diversity of adult residents under different dietary patterns was evaluated according to the dietary diversity evaluation criteria in the International Dietary Quality Index（DQI-I）.Logistic regression model was used to investigate the effects of dietary patterns on the risk of prediabetes and DM.The restricted cubic spline model was used to investigate the linear association between dietary patterns and the risk of prediabetes and DM.A prospective cohort study was used to analyze the association between dietary patterns and the risk of hyperglycemia.Based on the cohort established by Qingdao Diabetes Project from 2009 to 2022,4961 subjects with complete baseline glucose information and no DM were selected as subjects in this study,and 2,511 subjects were followed up from 2012 to 2015 and 2019 to 2022 respectively.Patients with baseline dietary information loss,abnormal total calorie intake and follow-up glucose information loss were excluded.2,051 subjects were finally included in this study.Exploratory factor analysis was used to establish dietary patterns,and the incidence of prediabetes and DM under different dietary patterns were analyzed.The dietary diversity of adult residents under different dietary patterns was evaluated according to the dietary diversity evaluation criteria in the DQI-I.Cox proportional hazard regression model was used to investigate the effects of dietary patterns on the risk of prediabetes and DM.The restricted cubic spline model was used to investigate the linear association between dietary patterns and the risk of prediabetes and DM.Results:1.The results of cross-sectional study showed that 2290 patients with prediabetes and 468 patients with DM had a prevalence of 43.4%and 8.9%respectively.Factor analysis showed that adult residents mainly had three dietary patterns,which were meat-beans pattern,vegetable-grain pattern and milk-nut pattern.Adult residents who preferred the milk-nut pattern had better dietary diversity.There were statistically significant differences in the prevalence of prediabetes patients with different intake levels of meat-beans pattern（Q1 to Q4）and the prevalence of DM patients with different intake levels of meat-beans pattern and vegetable-grain pattern（all P<0.05）.After adjusting for sex,age,level of educationmarital,status,urban and rural distribution,occupational physical activity,family history of diabetes,smoking,hypertension and BMI,the Q4 level group of meat-bean pattern was positively correlated with the risk of prediabetes and DM,OR and 95%CI were 1.33（1.12,1.59）and 1.61（1.18,2.18）respectively.Vegetable-grain pattern and milk-nut pattern were not associated with the risk of prediabetes,but the Q4 level group of vegetable-grain pattern and milk-nut pattern were negatively correlated with the risk of DM,OR and 95%CI were 0.72（0.53,0.98）and 0.73（0.54,0.98）respectively.There was a non-linear correlation between meat-beans pattern and the risk of prediabetes and DM.With the increase of meat-beans pattern factor score,the risk of prediabetes and DM showed a trend of decreasing first and then increasing(P_overall<0.05,P_non-linear<0.05).There was a linear correlation between vegetable-grain pattern and the risk of prediabetes and DM.With the increase of vegetable-grain pattern factor score,the risk of prediabetes and DM showed a decreasing trend(P_overall<0.05,P_non-linear>0.05).There was a association between milk-nut pattern and the risk of prediabetes,but the association was not statistically significant(P_overall=0.230,P_non-linear=0.209).The milk-nut pattern and the risk of DM showed a non-linear association.With the increase of milk-nut pattern factor score,the risk of DM increased first and then decreased(P_overall<0.001,P_non-linear=0.045).2.The results of the cohort study showed that 678 patients with prediabetes and 404patients with DM had a prevalence of 33.1%and 19.7%respectively.Factor analysis showed that adult residents mainly had three dietary patterns,which were meat-beans pattern,vegetable-grain pattern and milk-nut pattern.The adult residents who were inclined to the three dietary patterns had better dietary diversity.There were statistical differences in the incidence of DM among different intake levels of milk-nut pattern（P<0.05）.After adjusting for sex,age,marital status,occupational physical activity,family history of diabetes,somking,hypertension and BMI,the meat-beans pattern was not associated with the risk of prediabetes and DM.The Q3 level group of vegetable-grain pattern was a protective factor for prediabetes and DM,RR and 95%CI were 0.76（0.61,0.94）and 0.74（0.55,0.98）,respectively.The Q4 level group of milk-nut pattern was a protective factor for prediabetes and DM,RR and 95%CI were 0.78（0.63,0.97）and 0.66（0.50,0.87）,respectively.There was a linear correlation between the meat-beans pattern and the risk of prediabetes.With the increase of meat-beans pattern factor score,the risk of prediabetes showed an increasing trend(P_overall=0.012,P_non-linear=0.801),the meat-beans pattern was association with the risk of DM but the association was not statistically significant(P_overall=0.280,P_non-linear=0.05).There was a non-linear correlation between vegetable-grain pattern and the risk of prediabetes and DM.With the increase of vegetable-grain pattern factor score,the risk of prediabetes and DM showed a trend of decreasing first and then increasing slowly(P_overall<0.001,P_non-linear<0.05).There was a linear association between the dairy nut pattern and the risk of prediabetes.With the increase of the dairy nut pattern factor score,the risk of prediabetes showed a downward trend(P_overall<0.001,P_non-linear=0.566),and the milk-nut pattern was association with the risk of DM but the association was not statistically significant(P_overall=0.440,P_non-linear=0.417).Conclusion:1.The dietary patterns of adult residents in Qingdao are mainly meat-bean pattern,vegetable-grain pattern and milk-nut pattern.Adult residents who preferred he meat-bean pattern,vegetable-grain pattern and milk-nut pattern had better dietary diversity.2.There were differences in the prevalence of hyperglycemia in the meat-bean pattern,the prevalence of DM in the vegetable-grain pattern,and the incidence of DM in the milk-nut pattern.3.The Cross-sectional studies showed a positive correlation between meat-bean pattern and the risk of hyperglycemia.Vegetable-grain pattern was a downward trend in the risk of prediabetes and it was negatively associated with the risk of DM.The milk-nut pattern was negatively associated with the risk of DM.4.The Cohort studies showed that meat-bean pattern was associated with an increased risk of prediabetes.The vegetable-grain pattern was the protective factor for the risk of hyperglycemia and it was related to the decreasing trend of the risk of hyperglycemia.The milk-nut pattern was a protective factor for the risk of hyperglycemia and it was associated with a downward trend in the risk of prediabetes.