title: Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: results from the Boston Puerto Rican Health study.
abstract: OBJECTIVE
  To determine whether dietary patterns associated with food insecurity are associated with poor longitudinal glycemic control.
  
  
  METHODS
  In a prospective, population-based, longitudinal cohort study, we ascertained food security (Food Security Survey Module), dietary pattern (Healthy Eating Index-2005 [HEI 2005]), and hemoglobin A1c (HbA1c) in Puerto Rican adults aged 45-75 years with diabetes at baseline (2004-2009) and HbA1c at ∼2 years follow-up (2006-2012). We determined associations between food insecurity and dietary pattern and assessed whether those dietary patterns were associated with poorer HbA1c concentration over time, using multivariable-adjusted repeated subjects mixed-effects models.
  
  
  RESULTS
  There were 584 participants with diabetes at baseline and 516 at follow-up. Food-insecure participants reported lower overall dietary quality and lower intake of fruit and vegetables. A food insecurity*HEI 2005 interaction (P < 0.001) suggested that better diet quality was more strongly associated with lower HbA1c in food-insecure than food-secure participants. In adjusted models, lower follow-up HbA1c was associated with greater HEI 2005 score (β = -0.01 HbA1c % per HEI 2005 point, per year, P = 0.003) and with subscores of total vegetables (β = -0.09, P = 0.04) and dark green and orange vegetables and legumes (β = -0.06, P = 0.048). Compared with the minimum total vegetable score, a participant with the maximum score showed relative improvements of HbA1c of 0.5% per year.
  
  
  CONCLUSIONS
  Food insecurity was associated with lower overall dietary quality and lower consumption of plant-based foods, which was associated with poor longitudinal glycemic control.
authors: Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA saberkowitz@partners.org.
authors: Seth A
authors: SA
authors: Berkowitz
authors: Department of Medicine, Harvard Medical School, Boston, MA Department of Nutrition, Harvard School of Public Health, Boston, MA.
authors: Xiang
authors: X
authors: Gao
authors: Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA.
authors: Katherine L
authors: KL
authors: Tucker
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004032:Diet / Q000009:adverse effects*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005523:Food Supply; D006442:Glycated Hemoglobin / Q000032:analysis; D006304:Health Status; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D007003:Hypoglycemia / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011647:Puerto Rico
chemical_list: D006442:Glycated Hemoglobin