Sociodemographic and behavioral factors associated with diet quality in low-income adults with prediabetes and type 2 diabetes.

Abstract

Low-income adults face barriers to diabetes prevention and self-management, especially healthy eating. This study assessed factors associated with diet quality in low-income adults with prediabetes or type 2 diabetes (T2D), particularly modifiable factors that could be targeted in diabetes self-management education and support (DSMES). This secondary analysis of a cohort of low-income health center patients in Boston, Massachusetts determined the association between diet quality and sociodemographic (e.g., race/ethnicity, social support) and behavioral (e.g., depression) factors in adults with prediabetes or T2D. Primary outcome was Healthy Eating Index-2020 (HEI; range 0-100, higher=healthier). Random forests, interpreted using Shapley Additive Explanation values, were fit to determine relative importance of factors in predicting HEI. Of 278 participants, 42 % had prediabetes and 58 % had T2D. Median age (IQR) was 52 (43, 57); 58 % were Hispanic. Top factors associated with higher HEI were older age, female gender, and Hispanic ethnicity; other important factors were non-smoking, greater dietary variety, less time sitting, higher sleep quality, lower stress, more social support, and fewer depression symptoms. Modifiable factors for low diet quality, such as dietary variety, social support, and stress, could be emphasized in diabetes prevention and DSMES programs tailored for low-income populations.