Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: Results from the boston puerto rican health study

OBJECTIVE: To determine whether dietary patterns associated with food insecurity are associated with poor longitudinal glycemic control. RESEARCH DESIGN AND 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. Foodinsecure 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 foodinsecure than food-secure participants. In adjustedmodels, lower follow-up HbA1c was associatedwith greater HEI 2005 score (b =20.01 HbA1c%per HEI 2005 point per year, P = 0.003) and with subscores of total vegetables (b = 20.09, P = 0.04) and dark green and orange vegetables and legumes (b = 20.06, 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.