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

This is the authors' abstract. We don't add key points for this paper.

AIMS: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.