Exploring the Diets of Adults with Obesity and Type II Diabetes from Nine Diverse Countries: Dietary Intakes, Patterns, and Quality

Abstract

Background: Calorie-dense diet is a main driver of the global epidemics of obesity and type 2 diabetes (T2DM). While various dietary strategies and patterns are efficacious in reducing risk and improving glycemic control, dietary intake and diet quality have been inadequately studied among individuals who remain living in their native environments. There is also little published on dietary patterns of diverse ethnic, cultural, or regional populations. Objective: To explore dietary intakes, patterns and overall diet quality in adults with obesity and T2DM from diverse countries. We hypothesized that individuals sharing a common clinical phenotype (age, BMI, years since T2DM diagnosis and inadequate glycemic control) would demonstrate comparable high calorie “western” dietary patterns and low diet quality despite differences in geographic regions and cultures. Design: Diet data were acquired from 611 adults in Argentina, Germany, Poland, Serbia, Slovakia, Slovenia, Spain, Turkey and the USA via three 24-h diet recalls. Contribution of 168 foods to 14 primary food groups was confirmed by Spearman’s rank-order correlations and Principle Component Factor Analysis identified dietary patterns. Diet quality was assessed using the Healthy Eating Index 2015. Results: Eleven dietary patterns were extracted; the most common were a “Mediterranean-like” pattern shared by six countries and a “Calorie Dense” pattern shared by five countries. Also common were “Lacto-Vegetarian, “Pesco-Vegetarian,” and “Vegan” patterns. Only 2.1% of subjects had good diet quality (HEI-2015 score >80). Conclusions: The diet pattern data suggest that influences of more traditional region-specific diets remain. However, overall diet quality was poor and may contribute to inadequate glycemic control, possibly due to excess intake of high calorie/nutrient poor foods, which may be associated with global transitions occurring in the available food supply.