Adherence to Dietary Indexes by Diabetes and Hypertension Status among PLCO Cancer Screening Trial Participants

Background: A healthy diet is an effective strategy for glycemia and blood pressure control with adherence key to its success. Optimal nutrient intake can be measured via dietary patterns. We quantified adherence to several dietary indices among individuals with diabetes (DM) and/or hypertension (HTN) and compared it with controls in the PLCO Cancer Screening Trial. Methods: Participants in PLCO who filled out a baseline food-frequency questionnaire, with age, sex, body mass index (BMI), DM, and HTN status recorded were selected for analysis. Indices for Healthy Eating 2005 (HEI), Dietary Approaches to Stop Hypertension (DASH), and the Mediterranean (MEDI) diets were calculated. Adherence to each item was given a point with maximum total possible scores of 7, 9, and 10, respectively. Quartiles of scores for each index were calculated and used to create 4 ordered categories. Their association with DM and/or HTN controlling for differing covariates across exposures was evaluated using logistic regression. Results: 60,408 adults 55–74 y of age provided baseline data. Age, sex, and BMI differed across exposure groups. Participants with DM independently of HTN were twice more likely than controls to high adherence to the HEI diet, and 1.3–1.5 times to the DASH and MEDI diets (all p-v <0.001) (Figure 1). Highest adherence among diabetics was to vegetable, grains, and meat portions in HEI and DASH, and sugar in HEI. They were slightly less compliant with fat rations. Hypertensive adults did not differ in adherence to controls, not even in salt consumption as per DASH. Regular physical activity and female sex was predictive of high adherence. Conclusions: Management of DM in mature and older adults via diet is feasible in about 34% highly adherent to the HEI 2005 diet. A similar level will only be achieved by 20% of those with HTN. Exercising regularly identifies those likely to adhere. Figure 1