Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)-a cross-sectional study

Abstract

Objectives: Diabetes is increasing rapidly in low-income and middle-income countries. We aimed to estimate the prevalence of diabetes, describe its correlates and its associated dietary intake in urban adults from Colombia.

Setting: The Colombian Study of Nutritional Profiles was a population-based, cross-sectional, multi-stage probabilistic sampling survey designed to represent the five main Colombian cities.

Participants: Between June and November 2018, we studied 736 non-pregnant participants aged 18 or older. Diabetes was defined as a random plasma glucose ≥200 mg/dL, self-reported prior diagnosis of diabetes or use of any oral or injectable antidiabetic medication(s). Participants also fulfilled a detailed 157-item food-frequency questionnaire.

Primary and secondary outcome measures: Prevalence of diabetes, dietary intake of key nutrients, achievement of dietary goals among individuals with diabetes.

Results: The overall estimated prevalence of diabetes was 10.1%, with no difference by sex (9.6% in women, 10.8% in men, p=0.43). The association between diabetes and education level depended on sex, diabetes was more prevalent among more educated men and less educated women. Abdominal obesity was associated with a 65% increase in diabetes prevalence among men, and a 163% increase in women. Individuals with diabetes reported lower mean consumption of all nutrients, but after adjustment by sex, age, socioeconomic level (SEL) and body mass index, only their lower sodium consumption remained significant (p=0.013). The proportion of non-achievement of dietary intake goals among participants with diabetes was 94.4% for saturated fats, 86.7% for sodium, 84.4% for fibre and 80% for trans fats. In multivariate logistic regression models, age was the strongest independent correlate of diabetes.

Conclusions: Diabetes by self-report, random plasma glucose or medication use was highly prevalent among Colombian adults. There were large differences by abdominal obesity status, region of residence, SEL and educational level. The proportion of individuals with diabetes meeting dietary recommendations was alarmingly low.

Keywords: epidemiology; general diabetes; nutrition & dietetics; preventive medicine.

Figure 1

Prevalence of diabetes, by age and sex. Data are prevalences using sampling weights. P value for the overall difference in prevalence among age groups <0.001. P value for the trend in diabetes prevalence with increasing age group <0.001.

Figure 2

Prevalence of diabetes, by educational level (A) and socioeconomic level (SEL) (B), and sex. Educational level refers to the highest level completed. SEL was classified according to Colombia’s official Statistics Department-DANE stratification scheme. Low SEL includes strata 1 and 2, medium SEL includes only stratum 3 and high SEL includes strata 4, 5 and 6. Data are prevalences using sampling weights. P value for the overall difference in diabetes prevalence among SELs=0.11. P value for the trend in diabetes prevalence with increasing SEL=0.04.

Figure 3

Per cent difference in adjusted nutrient intake, between individuals with diabetes and individuals without diabetes. Dots represent medians and lines represent Q1–Q4. Differences were estimated using linear regressions including diabetes status, age, sex, body mass index and socioeconomic level as predictors. *P=0.013 for the adjusted comparison of individuals with versus without diabetes.