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. 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. 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.