Associations of Total Dietary Quality Score, Dietary Behavior Adherence, and Dietary Portion Adherence with Metabolic Factors Among People with Type 2 Diabetes Mellitus

TL;DR

This study shows that better dietary quality is linked to improved metabolic health in people with type 2 diabetes in Taiwan.

Contribution

The study introduces a total dietary quality score as a multidimensional tool for assessing and improving diabetes management.

Findings

Higher dietary quality scores correlated with lower BMI, waist circumference, and blood sugar levels.

Participants with better dietary scores consumed more vegetables and protein while eating less fat.

Each point increase in the score led to measurable improvements in multiple metabolic markers.

Abstract

Aims: To examine the association between the total dietary quality score (TDQS) and metabolic outcomes among adults with type 2 diabetes (T2DM) in Taiwan. Methods: This cross-sectional study enrolled 981 adults with T2DM from 40 diabetes health promotion institutions (DHIPs). Registered dietitians assessed dietary behavior adherence (DBA) and dietary portion adherence (DPA) using a validated dietary quality questionnaire, which were combined into a TDQS. Participants were categorized into tertiles: G1 (≤106.7), G2 (106.8–118.7), and G3 (≥118.8). Associations with metabolic outcomes were analyzed using ANOVA, logistic, and multiple linear regression. Results: Participants in the highest TDQS tertile (G3) had significantly lower BMI, waist circumference (WC), fasting blood glucose (FBG), HbA1c, total cholesterol, and triglyceride levels, and a higher proportion achieved HbA1c < 7%. Compared with lower tertiles, G3 participants consumed more vegetables and derived a greater proportion of total energy from protein, whereas participants with a lower TDQS reported higher total energy and fat intakes. Each 1-point increase in TDQS was independently associated with reductions in WC (−0.155 cm), BMI (−0.151 kg/m2), FBG (−0.106 mg/dL), HbA1c (−0.136%), total cholesterol (−0.076 mg/dL), and triglyceride levels (−0.148 mg/dL). Conclusions: Higher TDQS is significantly associated with improved metabolic outcomes in adults with T2DM, supporting its use as a practical, multidimensional tool for clinical nutrition assessment and personalized dietary intervention.