Eating Patterns and Health Outcomes in Patients With Type 2 Diabetes

Roberta Aguiar Sarmento; Juliana Peçanha Antonio; Ingrid Lamas de Miranda; Bruna Bellicanta Nicoletto; Jussara Carnevale de Almeida


J Endo Soc. 2018;2(1):42-52. 

In This Article

Abstract and Introduction


Purpose To evaluate the relationship between eating patterns and therapeutic target's achieving in patients with type 2 diabetes.

Methods In this cross-sectional study, patients underwent clinical, laboratory, and nutritional evaluations. Dietary intake was assessed by a quantitative food frequency questionnaire and eating patterns identified by cluster analysis. The therapeutic targets were as follows: blood pressure, <140/90 mm Hg; BMI, <25 kg/m2 (<27 kg/m2 for elderly); waist circumference, <94 cm for men and <80 cm for women; fasting plasma glucose, <130 mg/dL; HbA1c, <7%; triglycerides, <150 mg/dL; HDL-cholesterol, >40 mg/dL for men and >50 mg/dL for women; LDL-cholesterol, <100 mg/dL.

Results One hundred ninety seven patients were studied. We identified two eating patterns: "unhealthy" (n = 100)—high consumption of refined carbohydrates, ultra-processed foods, sweets and desserts (P < 0.05); and "healthy" (n = 97)—high intake of whole carbohydrates, dairy, white meat, fish, fruits and vegetables (P < 0.05). The healthy group more frequently achieved therapeutic targets for fasting plasma glucose, HbA1c, and LDL-cholesterol than the unhealthy group. Poisson regression confirmed the association of healthy eating pattern with attaining the therapeutic target for fasting plasma glucose [PR, 1.59 (95% CI, 1.01 to 2.34); P = 0.018], HbA1c [PR, 2.09 (95% CI, 1.17 to 3.74); P = 0.013], and LDL-cholesterol [PR, 1.37 (95% CI, 1.01 to 1.86); P = 0.042].

Conclusions A healthy eating pattern, including the frequent intake of whole carbohydrates, dairy, white meat, fish, fruits, and vegetables, is associated with reduced fasting plasma glucose, HbA1c, and LDL cholesterol levels in patients with type 2 diabetes.


Medical nutrition therapy is one of the cornerstones of diabetes management.[1] Evidence from prospective cohort studies and clinical trials has shown the importance of individual nutrients and foods for diabetes prevention and management,[2,3] but the overall effect of diet in achieving the recommended therapeutic targets has not been fully elucidated.[1]

Eating patterns are defined as the quantities, proportions, variety, or combinations of different foods and beverages in diets, and the frequency with which they are habitually consumed.[4] The identification of eating patterns can be useful to investigate the relationship between diet and disease, especially when more than one dietary component (nutrients or foods) seem to be involved, as in diabetes.[5] This evaluation can be analyzed in two ways: a priori, eating patterns are defined based on guidelines and nutritional recommendations, or a posteriori, when data from dietary surveys are aggregated through specific statistical analysis.[6,7]

Several eating patterns defined a priori such as Mediterranean, low glycemic index, moderately low carbohydrate, or vegetarian diets have been recommended for the management of weight and glucose control in diabetes.[1,8] However, recently the American Diabetes Association stated that there is no single ideal dietary distribution of calories from carbohydrates, fats, and protein for diabetes patients.[1] In this context, the choice of eating pattern should be individualized, taking into account the patient's current consumption preferences and the goal of metabolic targets.[1,9]

The aim of this cross-sectional study was to evaluate the relationship between eating patterns defined a posteriori and achieving recommended therapeutic targets (blood pressure, body weight, glycemic control, and lipid profile) in patients with type 2 diabetes in Southern Brazil.