Inverse Association of the Adequacy and Balance Scores in the Modified Healthy Eating Index with Type 2 Diabetes in Women

Abstract

Type 2 diabetes (T2DM) has markedly increased among Asians as their diets and lifestyles become more westernized. We, therefore, investigated the hypothesis that the Korean healthy eating index (KHEI) scores are associated with gender-specific T2DM risk in adults. The hypothesis was tested using the data from the Korea National Health and Nutrition Examination Survey-VI (2013-2017) with a complex sample survey design. Along with the KHEI scores, the modified KHEI (MKHEI) scores for the Korean- (KSD) and Western-style diets (WSD) were used as independent parameters, calculated using a validated semi-quantitative food-frequency questionnaire (SQFFQ). We estimated the association between the KHEI or MKHEI and the T2DM risk using logistic regression after adjusting for T2DM-related covariates. The adults with T2DM were more frequently older men who were less educated, married, on a lower income, and living in rural areas compared to those without T2DM. Not only the fasting serum glucose concentrations but also the waist circumferences and serum triglyceride concentrations were much higher in adults with T2DM than in those without T2DM in both genders. Serum HDL concentrations in the non-T2DM subjects exhibited a greater inverse relationship to serum glucose than in the T2DM group in both genders. Twenty-four-hour recall data revealed that women, but not men, had higher calcium, vitamin C, saturated and monounsaturated fatty acids, retinol, and vitamin B2 intakes than the T2DM group. Furthermore, overall, the KHEI score and the adequacy and balance scores among its components were significantly higher in the non-T2DM group than in the T2DM group, but only in women. The KHEI scores were inversely associated with T2DM only in women. The mixed grain intake score was higher in the non-T2DM than the T2DM group only in men. However, there were no differences between the groups in the MKHEI scores for KSD and WSD. In conclusion, high KHEI scores in the adequacy and balance components might prevent and/or delay T2DM risk, but only in women.

Keywords: calcium; health eating index; noodles; type 2 diabetes; vitamin C.

Figure 1

Association of the Korean healthy eating index (KHEI) scores with type 2 diabetes risk. (A) Adjusted odds ratio (ORs) of overall scores of KHEI and 95% confidence intervals (CI). (B) Adjusted ORs of adequacy scores of KHEI and 95% confidence intervals (CI). (C) Adjusted ORs of balance scores of KHEI and 95% confidence intervals (CI). ORs and 95% CI are represented with colored boxes and lines, respectively. Models were generated with different covariates, including age, gender, regions, and area of residence for model 1; covariates for model 1 plus education, income, marital status, and obesity for model 2; and covariates for model 2 plus energy intake, smoking, alcohol consumption, and regular exercise for model 3.

Figure 1

Association of the Korean healthy eating index (KHEI) scores with type 2 diabetes risk. (A) Adjusted odds ratio (ORs) of overall scores of KHEI and 95% confidence intervals (CI). (B) Adjusted ORs of adequacy scores of KHEI and 95% confidence intervals (CI). (C) Adjusted ORs of balance scores of KHEI and 95% confidence intervals (CI). ORs and 95% CI are represented with colored boxes and lines, respectively. Models were generated with different covariates, including age, gender, regions, and area of residence for model 1; covariates for model 1 plus education, income, marital status, and obesity for model 2; and covariates for model 2 plus energy intake, smoking, alcohol consumption, and regular exercise for model 3.

Figure 2

Association of the modified Korean healthy eating index (MKHEI) scores of Korean- and Western-style diets with type 2 diabetes risk. (A) Adjusted ORs of MKHEI scores of Korean-style diets; (B) Adjusted ORs of MKHEI scores of Western-style diets; ORs and 95% CI are represented with colored boxes and lines, respectively. Models were generated with different covariates, including age, gender, regions, and area of residence for model 1; covariates for model 1 plus energy intake, education, income, marital status, and obesity for model 2; and covariates for model 2 plus smoking, alcohol consumption, and regular exercise for model 3.