Lifestyle Behaviors in Relation to Dietary Quality by Diabetes Status in U.S. Adults

Background: Limited studies have examined the contribution of lifestyle behaviors to dietary quality among individuals with and without type 2 diabetes. Objective: To examine the relationship between selected lifestyle behaviors independently, and in combination with other lifestyle behaviors, and dietary quality by diabetes status. Methods: This study used a representative sample of U.S. adults 20+ years of age (n = 4097) using NHANES 20072010. Six individual lifestyle behaviors were selected as main exposure variables: Self-reported alcohol consumption, sleep adequacy, on a special diet, supplement intake, smoking status, and physical activity. Total HEI-2010 and the AHEI-2010 were used as measures of dietary quality and were calculated using data from the first 24-hour dietary recall. Multivariable Linear Regression was used to examine relationships among lifestyle behaviors independently, and in combination with total HEI-2010 and AHEI-2010 scores, after adjusting for demographic and health characteristics. Results: Selected lifestyle behaviors independently, and in combination, were significantly associated with total HEI2010 and AHEI-2010 scores by diabetes status (p < 0.05). Diabetics were more likely to report being on a special diet, taking dietary supplements, and not drinking alcohol but were less likely to report getting adequate sleep and meeting physical activity guidelines. Results indicate that being on a special diet and taking dietary supplements had the highest coefficient in relation to dietary quality for diabetics [total HEI-2010 score: β = 5.08, p = 0.0011 for on a special diet, total AHEI-2010 score: β = 3.89, p = 0.0019 for supplement intake]. However, the coefficients of the combined Lifestyle Behaviors score in relation to dietary quality were fairly similar for diabetics and prediabetics (p < 0.001). Conclusion: Diabetics did better on several of the lifestyle indicators and had higher HEI-2010 and AHEI-2010 scores, suggesting that diabetic education and nutrition counseling may have influence on their behavior.