Next Article in Journal
Shades of Fear—Mental and Physical Health Reactions to the COVID-19 Pandemic: A Representative Study of Polish Society
Previous Article in Journal
Exploring the Joint Association of Road Traffic Noise and Air Quality with Hypertension Using QGIS
Previous Article in Special Issue
Glycemic and Insulinemic Responses of Healthy Humans to a Nutrition Bar with or without Added Fibersym® RW, a Cross-Linked Phosphorylated RS4-Type Resistant Wheat Starch
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 20
Issue 3
10.3390/ijerph20032246
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Adherence to the Taiwan Daily Food Guide and the Risk of Type 2 Diabetes: A Populational Study in Taiwan

by
Tsung-Ju Tsai
1 and
Ming-Chieh Li
2,3,*
1
Department of Traditional Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
2
Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei 10610, Taiwan
3
Department of Public Health, College of Public Health, China Medical University, Taichung 406040, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(3), 2246; https://doi.org/10.3390/ijerph20032246
Submission received: 10 December 2022 / Revised: 19 January 2023 / Accepted: 25 January 2023 / Published: 27 January 2023
(This article belongs to the Special Issue Nutrition and Diabetes: A Health Issue)
Versions Notes

Abstract

:
This study aims to examine whether adherence to the Taiwan Daily Food Guide relates to the risk of type 2 diabetes. A population-based study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016. Dietary intakes were assessed using a validated food-frequency questionnaire. Type 2 diabetes was defined as a fasting serum HbA1c level of 6.5% or higher or participants who have received treatment for type 2 diabetes or have reported a physician diagnosis of type 2 diabetes. A total of 2534 Taiwanese adults aged 19 and above were included. We found that the Daily Food Guide adherence was negatively associated with the prevalence of type 2 diabetes. The odds ratios (ORs) for those in the fourth quartile of the recommended total servings was 0.67 (95% confidence interval (CI) = 0.45–0.99) compared with those in the first quartile. In addition, those who were men (OR = 1.46, 95% CI = 1.07–1.98), aged more than 50 to 65 (OR = 6.48, 95% CI = 2.57–16.35), or more than 65 (OR = 6.81, 95% CI = 2.56–18.08), with body mass index (BMI) of 24 to less than 27 (OR = 2.08, 95% CI = 1.55–2.79), had BMI of more than 27 (OR = 3.63, 95% CI = 2.73–4.83), had an education level of junior high and high school (OR = 1.68, 95% CI = 1.03–2.74), were divorced, separated, widowed, or refused to answer (OR = 1.39, 95% CI = 1.03–1.88) were associated with an increased prevalence of type 2 diabetes. In conclusion, people who adhere better to the Taiwan Daily Food Guide were found to have a reduced risk of type 2 diabetes.

1. Introduction

Type 2 diabetes is a significant public health concern worldwide. Unfortunately, the global burden of diabetes mellitus continues to increase, particularly in developed countries and regions [1]. Additionally, approximately one-third of diabetes-related deaths occur in individuals under the age of 60, raising further concerns about the impact of the disease [2]. Type 2 diabetes not only reduces the quality of life and leads to morbidity and premature mortality [3] but also poses a significant economic burden, projected to increase from USD 1.3 trillion in 2015 to USD 2.1 trillion by 2030 [4]. Taiwan is no exception to this trend, with the age-standardized prevalence of diabetes increasing from 6.2% in 1993–1996 to 7.8% in 2005–2008, and reaching 8.8% in 2017 [5]. Given the global pandemic of diabetes and the severe consequences it causes, it is crucial to identify effective prevention strategies to combat the disease.
The incidence of type 2 diabetes has been on the rise in recent years, and several factors have been identified as contributing to this trend. Studies have suggested that unhealthy lifestyle choices, being overweight or obese, and the aging of the human population may all contribute to the increased burden of type 2 diabetes [6,7,8]. Furthermore, research indicates that dietary patterns also play a significant role in the development of type 2 diabetes [9]. For example, a systematic review and meta-analysis found that dietary patterns characterized by a high intake of vegetables, legumes, fruits, poultry, and fish were negatively associated with type 2 diabetes, while patterns characterized by high consumption of red and processed meats, refined grains, high-fat dairy, eggs, and fried products were positively associated with an increased risk of type 2 diabetes [10]. To sum up, the evidence suggests that a diet rich in plant-based foods may protect against developing type 2 diabetes.
Although adopting certain dietary patterns is associated with a decreased risk of type 2 diabetes, policymakers often prefer to promote general dietary guidelines rather than a specific dietary pattern. Similarly, in Taiwan, the most updated version of the Taiwan Daily Food Guide was released by the government in 2018, aimed to prevent nutrient deficiencies by ensuring that a diet provides at least 70% of the Dietary Reference Intakes (DRIs) and also considered evidence from epidemiological studies to reduce the risk of cardiovascular and metabolic diseases [11,12]. However, there is limited knowledge on how adherence to the Taiwan Daily Food Guide relates to disease status, including type 2 diabetes. Therefore, the aim of this study is to examine whether adherence to the Taiwan Daily Food Guide is associated with the risk of type 2 diabetes.

2. Materials and Methods

We conducted a population-based study using nationally representative data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016. The objective of NAHSIT was to monitor the overall nutrition status of the Taiwanese people through detailed interviews and examinations. The details of the survey method can be found in the literature [11,13,14]. In brief, three-stage probability sampling covering 359 townships or city districts was conducted to select study participants. The Latin square design was used to consider seasonal variations in dietary consumption. Physical examinations, including measuring body mass index (BMI), were conducted at temporary health examination stations. Participants also underwent a face-to-face interview to collect demographic data such as age, sex, education, marital status, smoking and alcohol consumption habits, physical activity levels, and medical history.
The study participants were restricted to participants aged ≥ 19, corresponding to the definition of the Taiwan Daily Food Guide. This study was approved by the China Medical University & Hospital Research Ethics Center (CRREC-108-136). The NAHSIT participants gave informed consent for their data to be used for research purposes.

2.1. Defining Type 2 Diabetes Mellitus

Type 2 diabetes was defined as (1) a fasting serum HbA1c level of 6.5% or higher; (2) those who had received treatment for type 2 diabetes; or (3) those who have been diagnosed with type 2 diabetes.

2.2. Accessing the Taiwan Daily Food Guide Adherence

The Taiwan Daily Food Guide details were described elsewhere [11,15]. Briefly, in 2018, the Health Promotion Administration published the Taiwan Daily Food Guide, which contains six food groups: (1) cereals and whole grains; (2) protein-rich foods (soybean, fish, egg, and meat); (3) dairy products; (4) vegetables; (5) fruits; (6) fats, oils, and nuts. The guide recommends minimal servings of the six food groups based on one’s daily energy needs (Supplementary Table S1). Dietary intakes were accessed using a validated 79-item food-frequency questionnaire (FFQ) [16].
We constructed a Daily Food Guide index to measure the Daily Food Guide adherence of study participants. The details of the methods were described elsewhere [11,17,18]. Because the FFQ used in this study is not a validated method for assessing the intake of fat and oil, we decided not to assess the intake of fat and oil adherence. For each participant, the recommended quantity of each food group was estimated based on their estimated energy needs. Participants’ physical activity, healthy weight, and resting metabolic rate were utilized to calculate the estimated energy needs [11,12,19]. In the Taiwan Daily Food Guide, the level of physical activity is determined based on predefined criteria used to determine the recommended daily caloric intake for that person. For example, based on the statement, “Most of the time is spent sitting studying, doing homework, talking, and some of the time watching TV or listening to music, and there is about an hour spent on activities that require less energy consumption such as walking”, it can be inferred that the individual has low physical activity. In the Taiwan Daily Food Guide, participants are assigned a point based on their level of physical activity. For example, those with low physical activity would receive a score of 1.3, while those with high physical activity would receive a score of 1.9. This score is then used in the formula to calculate estimated energy needs: energy needs (kcal) = healthy weight (kg) × resting metabolic rate (kcal/kg/day) × level of physical activity. The adherence score for each food category was calculated according to the recommended number of servings for daily energy needs (Supplementary Table S1). For instance, if someone consumed exactly the recommended servings of a specific food group, they scored 1 for the specific food group; if someone consumed no serving of a specific food group, they received a score of 0. The score was calculated proportionately if someone consumed servings between zero and the recommended number or consumed servings higher than recommended.

2.3. Statistical Analysis

Descriptive analyses were conducted using Chi-square or Fisher’s exact test. We classified participants into categories defined by their adherence scores. Those who had a score higher than 6 were classified into group 5, meaning they had intakes greater than the recommended total servings from all food groups. The rest of the participants, with scores of or less than 1, were classified by the quartile of the adherence score.
We conducted multiple logistic regression models to investigate the association of adherence with the prevalence of type 2 diabetes. All logistic regression models were adjusted for age, sex, BMI, education level, alcohol intake, marital status, family income, smoking status, and physical activity. High physical activity was defined as engaging in high-intensity activity for at least 30 min per day, such as lifting heavy objects weighing 10 kg or more or jogging. Medium physical activity was defined as engaging in medium-intensity activity for at least 30 min per day, such as lifting objects weighing between 4.5 and 9 kg or brisk walking.
Study participants might change their dietary habits if they know they are diabetic. To reduce the temporal bias, we further conducted subgroup analyses by defining type 2 diabetes as an HbA1c level of 6.5% or more. In addition, we excluded those who had received treatment for type 2 diabetes or had been diagnosed with type 2 diabetes. All analyses were performed by SAS 9.4 (SAS Institute, Cary, NC, USA).

3. Results

A total of 2534 study participants were included in the final analyses without missing data. Of them, 386 had type 2 diabetes. Table 1 displays the demographic comparisons between those with or without type 2 diabetes. We found that those who have type 2 diabetes tended to be men (55.96% vs. 47.25%); to be older (age > 50: 90.16% vs. 56.00%); to have abnormal BMI (BMI ≥ 24: 72.28% vs. 44.79%); to be less educated (college or above: 8.55% vs. 23.93%); to be ever or current smokers (36.27% vs. 27.98%); to be either married or living with a partner (72.28% vs. 67.83%); to have lower family income (less than New Taiwan dollar (NT) $40,000: 38.86% vs. 27.66%); and to have low physical activity (57.51% vs. 35.57%).
The associations between the Taiwan Daily Food Guide adherence and the prevalence of type 2 diabetes are shown in Table 2. After controlling for potential confounders, the odds ratios (ORs) for those in the fourth quartile of the recommended total servings (group 4) was 0.67 (95% confidence interval (CI) = 0.45–0.99) compared with those in the first quartile (group 1). In addition, those who were men (OR = 1.46, 95% CI = 1.07–1.98), aged more than 50 to 65 (OR = 6.48, 95% CI = 2.57–16.35) or more than 65 (OR = 6.81, 95% CI = 2.56–18.08), with BMI of 24 to less than 27 (OR = 2.08, 95% CI = 1.55–2.79) or BMI more than 27 (OR = 3.63, 95% CI = 2.73–4.83), had an education level of junior high and high school (OR = 1.68, 95% CI = 1.03–2.74), and divorced, separated, widowed, or refused to answer (OR = 1.39, 95% CI = 1.03–1.88), were associated with an increased prevalence of type 2 diabetes.
Participants may change their dietary behavior if they know they are diabetic patients. To avoid the bias induced by the aforementioned issue, subgroup analyses were conducted by defining type 2 diabetes as an HbA1c level of 6.5% or higher and, at the same time, excluding those who had received treatment for type 2 diabetes or had been diagnosed with type 2 diabetes. The results are shown in Supplementary Table S2. Similar but more evident findings were observed. The OR for those in the fourth quartile of the recommended total servings (group 4) was 0.44 (95% CI = 0.25–0.80) compared with those in the first quartile (group 1).
In Table S3, we examined the relationship between individual food group adherence and the prevalence of type 2 diabetes. After controlling for potential confounders, we found that the adherence score for food group 5 (fruits) was negatively related to the risk of type 2 diabetes.

4. Discussion

In this study, we found that participants reporting better adherence to the Taiwan Daily Food Guide were associated with a reduced risk of having type 2 diabetes. Protective effects still existed when participants had intakes of more than the recommended servings, although it was not statistically significant.
Although dietary guidelines in the Daily Food Guide were designed based on nutritional health knowledge [20], rather limited epidemiologic studies have been conducted to investigate whether guideline adherence benefits health outcomes. It is also true in Taiwan. Although previous studies in Taiwan have identified the possible dietary patterns related to several health effects [13,16,21], little is known about how adherence to the Daily Food Guide relates to diseases. The recommendations, in total, may be beneficial for certain diseases but not for others [22]. In Taiwan, the prevalence of diabetes was around 9.8% and ranked second in health insurance spending [23]. Since dietary intake plays an important role in the pathogenesis of type 2 diabetes [24], it is important to determine whether the national Daily Food Guide is potentially beneficial for diabetic management. Our findings provide preliminary evidence that adherence to the Taiwanese Daily Food Guide might provide benefits for type 2 diabetes. In addition, although we did not aim to examine the effects of individual food groups on the risk of type 2 diabetes, we found a negative relation between intakes of fruits and the risk of type 2 diabetes, consistent with previous findings [10]. Participants consuming vegetables higher than recommended servings also had a lower risk of type 2 diabetes, but the finding was not statistically significant.
The association between dietary patterns and the development of type 2 diabetes has been extensively investigated in the literature. For example, the Mediterranean diet, characterized by high consumption of fruits, vegetables, legumes, and fish, is associated with a reduced risk of type 2 diabetes [24,25,26]. Furthermore, a systematic review and meta-analysis found that dietary patterns high in vegetables, legumes, fruits, poultry, and fish were negatively associated with type 2 diabetes, whereas patterns high in red and processed meats, refined grains, high-fat dairy, eggs, and fried products were positively associated with an increased risk of type 2 diabetes [10]. Studies in Asia have also provided evidence for beneficial dietary patterns concerning the prevention of type 2 diabetes. For instance, a study in Japan found that a dietary pattern characterized by higher consumption of vegetables, potatoes, seaweeds, fruits, and soybean products was related to a lower incidence of type 2 diabetes [27]. Additionally, a study conducted in Singapore found that a higher intake of vegetables, fruits, and soy foods was associated with a decreased risk of type 2 diabetes [28]. Another study in China found that consuming potatoes, beef and mutton, fresh fruits, freshly squeezed juice, and soy products was associated with the onset of type 2 diabetes [29]. In conclusion, the literature suggests that dietary patterns characterized by high intake of plant-based foods, such as fruits, have protective effects against developing Type 2 Diabetes, consistent with our findings.
In the current study, we also found that men, older participants, those with higher BMI, and those with lower education levels had an increased risk of type 2 diabetes, consistent with previous studies [30,31,32,33]. Those who were divorced, separated, widowed, or refused to answer also had an increased risk of type 2 diabetes. The underlying mechanism for the difference in effects on dietary habits between “single” and “divorced, separated, or widowed” is poorly understood. However, previous studies have shown that marital transitions can influence dietary and other health behaviors [34]. Single individuals do not experience marital transitions and may not change their dietary or health behaviors as a result. We also found no association between physical activity, family income, smoking status, and alcohol consumption with type 2 diabetes, which contradicts previous studies. This discrepancy may be due to the cross-sectional design of the study, which could lead to the misclassification of covariates and bias toward the null hypothesis.
The present study has some strengths and weaknesses. Strengths include a sufficient sample size to examine the effects of the Taiwan Daily Food Guide on type 2 diabetes and a population-representative sample that allows for the generalization of the findings to a wider population. Weaknesses include: (1) The cross-sectional design of the study precludes determination of the causal direction of the association between adherence level and type 2 diabetes. However, in subgroup analyses, we excluded participants who had already been diagnosed with or treated for type 2 diabetes and found similar findings. This suggests that the reverse relationship between type 2 diabetes influencing dietary intake is unlikely to occur. (2) The current study only assessed dietary intake at one time point, which may introduce non-differential misclassification of exposures and outcomes. However, non-differential misclassification of exposure typically biases towards the null, which would result in an underestimated effect. (3) The Taiwan Daily Food Guide also includes recommendations for fat and oil intake, but our study was unable to assess their impact on type 2 diabetes due to limitations in the dietary assessment tool used. Previous studies have shown an inverse association of ruminant trans-palmitoleic acid [35] and vegetable fat [36] with the risk of type 2 diabetes. This limitation in our study should be considered when interpreting the findings.
In conclusion, the current study found that participants reporting better adherence to the Taiwan Daily Food Guide in total were associated with a reduced risk of having type 2 diabetes. Additionally, the study found that men, older participants, those with higher BMI, and those with lower education levels had an increased risk of type 2 diabetes. Furthermore, we also found that a higher intake of fruits may have protective effects against developing type 2 diabetes. More prospective cohort studies are warranted to confirm our findings.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph20032246/s1, Table S1: The Daily Food Guide for adults in Taiwan; Table S2: Associations between the Daily Food Guide adherence score and the prevalence of type 2 diabetes; Table S3: Associations between the levels of adherence to individual food group index and the prevalence of type 2 diabetes.

Author Contributions

M.-C.L. contributed to the conception and design of the study, performed the statistical analysis and organized the database, manuscript revision, read, and approved the submitted version. T.-J.T. contributed to writing the first draft of the manuscript, contributed to manuscript revision, read, and approved the submitted version. All authors have read and agreed to the published version of the manuscript.

Funding

M.-C.L. was supported by the China Medical University, Taiwan (CMU108-N-12) and the National Science and Technology Council, Taiwan (NSTC 111-2410-H-003-100-SSS).

Institutional Review Board Statement

This study was approved by the China Medical University & Hospital Research Ethics Center (CRREC-108-136).

Informed Consent Statement

All participants signed informed consent during the Nutrition and Health Survey, including consent for their data to be used for future research purposes.

Data Availability Statement

Data from the Nutrition and Health Survey in Taiwan (NAHSIT) are available for research purposes, but an application must be submitted to and approved by the Ministry of Health and Welfare in Taiwan.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Khan, M.A.B.; Hashim, M.J.; King, J.K.; Govender, R.D.; Mustafa, H.; Al Kaabi, J. Epidemiology of Type 2 Diabetes-Global Burden of Disease and Forecasted Trends. J. Epidemiol. Glob. Health 2020, 10, 107–111. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Alotaibi, A.; Perry, L.; Gholizadeh, L.; Al-Ganmi, A. Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview. J. Epidemiol. Glob. Health 2017, 7, 211–218. [Google Scholar] [CrossRef] [PubMed]
  3. Ramtahal, R.; Khan, C.; Maharaj-Khan, K.; Nallamothu, S.; Hinds, A.; Dhanoo, A.; Yeh, H.C.; Hill-Briggs, F.; Lazo, M. Prevalence of self-reported sleep duration and sleep habits in type 2 diabetes patients in South Trinidad. J. Epidemiol. Glob. Health 2015, 5, S35–S43. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  4. Bommer, C.; Sagalova, V.; Heesemann, E.; Manne-Goehler, J.; Atun, R.; Bärnighausen, T.; Davies, J.; Vollmer, S. Global economic burden of diabetes in adults: Projections from 2015 to 2030. Diabetes Care 2018, 41, 963–970. [Google Scholar] [CrossRef] [Green Version]
  5. Wang, J.S.; Wu, Y.L.; Shin, S.J.; Tien, K.J.; Chin, M.C.; Hwu, C.M. Hospitalization in patients with type 2 diabetes mellitus in Taiwan: A nationwide population-based observational study. J. Formos. Med. Assoc. 2019, 118 (Suppl. 2), S90–S95. [Google Scholar] [CrossRef]
  6. Narayan, K.V.; Boyle, J.P.; Thompson, T.J.; Gregg, E.W.; Williamson, D.F. Effect of BMI on lifetime risk for diabetes in the US. Diabetes Care 2007, 30, 1562–1566. [Google Scholar] [CrossRef] [Green Version]
  7. Ahima, R.S. Connecting obesity, aging and diabetes. Nat. Med. 2009, 15, 996–997. [Google Scholar] [CrossRef]
  8. Hu, F.B. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care 2011, 34, 1249–1257. [Google Scholar] [CrossRef] [Green Version]
  9. Sami, W.; Ansari, T.; Butt, N.S.; Ab Hamid, M.R. Effect of diet on type 2 diabetes mellitus: A review. Int. J. Health Sci. 2017, 11, 65. [Google Scholar]
  10. Jannasch, F.; Kröger, J.; Schulze, M.B. Dietary Patterns and Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Prospective Studies. J. Nutr. 2017, 147, 1174–1182. [Google Scholar] [CrossRef] [Green Version]
  11. Li, M.C.; Fang, H.Y. Adherence to Daily Food Guides Is Associated with Lower Risk of Metabolic Syndrome: The Nutrition and Health Survey in Taiwan. Nutrients 2020, 12, 2955. [Google Scholar] [CrossRef] [PubMed]
  12. Ministry of Health and Welfare. Daily Food Guides. Available online: https://www.hpa.gov.tw/Pages/EBook.aspx?nodeid=1208 (accessed on 19 September 2022).
  13. Chuang, S.-Y.; Lo, Y.-L.; Wu, S.-Y.; Wang, P.-N.; Pan, W.-H. Dietary patterns and foods associated with cognitive function in Taiwanese older adults: The cross-sectional and longitudinal studies. J. Am. Med. Dir. Assoc. 2019, 20, 544–550.e4. [Google Scholar] [CrossRef] [PubMed]
  14. Chang, H.Y.; Suchindran, C.M.; Pan, W.H. Using the overdispersed exponential family to estimate the distribution of usual daily intakes of people aged between 18 and 28 in Taiwan. Stat. Med. 2001, 20, 2337–2350. [Google Scholar] [CrossRef] [PubMed]
  15. Tzeng, M.S. From dietary guidelines to daily food guide: The Taiwanese experience. Asia Pac. J. Clin. Nutr. 2008, 17 (Suppl. 1), 59–62. [Google Scholar] [PubMed]
  16. Lo, Y.L.; Hsieh, Y.T.; Hsu, L.L.; Chuang, S.Y.; Chang, H.Y.; Hsu, C.C.; Chen, C.Y.; Pan, W.H. Dietary pattern associated with frailty: Results from nutrition and health survey in Taiwan. J. Am. Geriatr. Soc. 2017, 65, 2009–2015. [Google Scholar] [CrossRef] [PubMed]
  17. Li, M.-C. Better Adherence to the Taiwan Daily Food Guide is Associated with a Reduced Risk of Osteoporosis: A Population-Based Study in Taiwan. Risk Manag. Healthc. Policy 2022, 15, 2023–2030. [Google Scholar] [CrossRef]
  18. Li, M.-C. Associations between adherence to the Taiwan Daily Food Guide and psychiatric morbidity: A population-based study in Taiwan. Front. Psychiatry 2022, 13, 1022892. [Google Scholar] [CrossRef]
  19. Academia Sinica Nutrition Information Network. How Many Calories Should I Eat? Available online: https://www.ibms.sinica.edu.tw/health/plan.html (accessed on 19 September 2022).
  20. Boylan, S. Consumer responses to government dietary guidelines in the management and prevention of obesity. Manag. Prev. Obes. Behav. Factors Diet. Interv. 2014, 301. [Google Scholar]
  21. Yeh, C.-J.; Chang, H.-Y.; Pan, W.-H. Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: From NAHSIT 1993–1996 to NAHSIT 2005–2008. Asia Pac. J. Clin. Nutr. 2011, 20, 292. [Google Scholar]
  22. Shikany, J.M.; White Jr, G.L. Dietary guidelines for chronic disease prevention. South. Med. J. 2000, 93, 1138–1151. [Google Scholar] [CrossRef]
  23. Lin, C.L.; Chang, Y.T.; Liu, W.C.; Huang, L.C.; Tsao, S.Y.; Chen, Y.H.; Chen, R.Y. Exploring and Developing a New Culturally-Appropriate Diabetes Distress Scale in Taiwan. Front. Public Health 2022, 10, 838661. [Google Scholar] [CrossRef]
  24. Ley, S.H.; Hamdy, O.; Mohan, V.; Hu, F.B. Prevention and management of type 2 diabetes: Dietary components and nutritional strategies. Lancet 2014, 383, 1999–2007. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  25. Uusitupa, M.; Khan, T.A.; Viguiliouk, E.; Kahleova, H.; Rivellese, A.A.; Hermansen, K.; Pfeiffer, A.; Thanopoulou, A.; Salas-Salvadó, J.; Schwab, U.; et al. Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients 2019, 11, 2611. [Google Scholar] [CrossRef] [PubMed]
  26. Salas-Salvadó, J.; Bulló, M.; Estruch, R.; Ros, E.; Covas, M.I.; Ibarrola-Jurado, N.; Corella, D.; Arós, F.; Gómez-Gracia, E.; Ruiz-Gutiérrez, V.; et al. Prevention of diabetes with Mediterranean diets: A subgroup analysis of a randomized trial. Ann. Intern. Med. 2014, 160, 1–10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  27. Morimoto, A.; Ohno, Y.; Tatsumi, Y.; Mizuno, S.; Watanabe, S. Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population. Asia Pac. J. Clin. Nutr. 2012, 21, 601–608. [Google Scholar]
  28. Odegaard, A.O.; Koh, W.P.; Butler, L.M.; Duval, S.; Gross, M.D.; Yu, M.C.; Yuan, J.M.; Pereira, M.A. Dietary patterns and incident type 2 diabetes in chinese men and women: The singapore chinese health study. Diabetes Care 2011, 34, 880–885. [Google Scholar] [CrossRef] [Green Version]
  29. Zhao, Y.; Song, C.; Ma, X.; Ma, X.; Wang, Q.; Ji, H.; Guo, F.; Qin, G. Synergistic Effect of Family History of Diabetes and Dietary Habits on the Risk of Type 2 Diabetes in Central China. Int. J. Endocrinol. 2017, 2017, 9707284. [Google Scholar] [CrossRef] [Green Version]
  30. Sattar, N. Gender aspects in type 2 diabetes mellitus and cardiometabolic risk. Best Pract. Res. Clin. Endocrinol. Metab. 2013, 27, 501–507. [Google Scholar] [CrossRef]
  31. Chiu, M.; Austin, P.C.; Manuel, D.G.; Shah, B.R.; Tu, J.V. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care 2011, 34, 1741–1748. [Google Scholar] [CrossRef] [Green Version]
  32. Meneilly, G.S.; Tessier, D. Diabetes in elderly adults. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2001, 56, M5–M13. [Google Scholar] [CrossRef]
  33. Saydah, S.; Lochner, K. Socioeconomic status and risk of diabetes-related mortality in the US. Public Health Rep. 2010, 125, 377–388. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Lee, S.; Cho, E.; Grodstein, F.; Kawachi, I.; Hu, F.B.; Colditz, G.A. Effects of marital transitions on changes in dietary and other health behaviours in US women. Int. J. Epidemiol. 2005, 34, 69–78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  35. de Souza, R.J.; Mente, A.; Maroleanu, A.; Cozma, A.I.; Ha, V.; Kishibe, T.; Uleryk, E.; Budylowski, P.; Schünemann, H.; Beyene, J.; et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies. Bmj 2015, 351, h3978. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  36. Neuenschwander, M.; Barbaresko, J.; Pischke, C.R.; Iser, N.; Beckhaus, J.; Schwingshackl, L.; Schlesinger, S. Intake of dietary fats and fatty acids and the incidence of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective observational studies. PLoS Med. 2020, 17, e1003347. [Google Scholar] [CrossRef]
Table
Table 1. Demographic descriptions of included participants. (n = 2534).
Table 1. Demographic descriptions of included participants. (n = 2534).
Participants without Type 2 DiabetesParticipants with Type 2 Diabetes
Variablesn = 2148n = 386p-Value
Sex
 Men1015 (47.25%)216 (55.96%)<0.01
 Women1133 (52.75%)170 (44.04%)
Age
 Age ≤ 30346 (16.11%)7 (1.81%)<0.0001
 40 ≥ age > 30273 (12.71%)6 (1.55%)
 50 ≥ age > 40326 (15.18%)25 (6.48%)
 65 ≥ age > 50650 (30.26%)160 (41.45%)
 Age > 65553 (25.74%)188 (48.71%)
Body mass index
 BMI < 241186 (55.21%)107 (27.72%)<0.0001
 27 > BMI ≥ 24522 (24.30%)120 (31.09%)
 BMI ≥ 27440 (20.49%)159 (41.19%)
Education level
 Elementary school or lower1106 (51.49%)165 (42.75%)<0.0001
 Junior high and high school528 (24.58%)188 (48.70%)
 College or above514 (23.93%)33 (8.55%)
Current alcohol intake
 No996 (46.37%)191 (49.48%)0.0746
 Rarely881 (41.01%)136 (35.23%)
 Frequently271 (12.62%)59 (15.28%)
Smoking status
 Never smoked1547 (72.02%)246 (63.73%)<0.001
 Former smoker286 (13.31%)81 (20.98%)
 Current smoker315 (14.67%)59 (15.29%)
Marital status
 Single407 (18.95%)14 (3.63%)<0.0001
 Married or lived together1457 (67.83%)279 (72.28%)
 Divorced, separated, widowed, or
 refused to answer		284 (13.22%)93 (24.09%)
Family income
 <NT $10,000161 (7.50%)49 (12.69%)<0.0001
 NT $10,000 ≤ Income < NT $40,000433 (20.16%)101 (26.17%)
 NT $40,000 ≤ Income < NT $80,000550 (25.61%)78 (20.21%)
 >NT $80,000 524 (24.39%)60 (15.54%)
 Don’t know or refuse to answer480 (22.34%)98 (25.39%)
Physical activity
 Low764 (35.57%)222 (57.51%)<0.0001
 Median1325 (61.69%)157 (40.67%)
 High59 (2.74%)7 (1.82%)
NT: New Taiwan dollars. In 2016, the minimum wage in Taiwan was TWD 126 per hour.
Table
Table 2. Associations of the Taiwan Daily Food Guide adherence and the prevalence of type 2 diabetes.
Table 2. Associations of the Taiwan Daily Food Guide adherence and the prevalence of type 2 diabetes.
Variables n = 2534
Diet score group
 Total scores equal to or lower than
 recommendation
  Group 1Reference
  Group 20.75 (0.51–1.11)
  Group 3 0.55 * (0.36–0.84)
  Group 4 0.67 * (0.45–0.99)
 Total scores higher than
 recommendation
  Group 50.81 (0.56–1.17)
Sex
 WomenReference
 Men1.46 * (1.07–1.98)
Age
 Age ≤ 30Reference
 40 ≥ age > 300.80 (0.25–2.58)
 50 ≥ age > 402.43 (0.91–6.46)
 65 ≥ age > 506.48 * (2.57–16.35)
 Age > 656.81 * (2.56–18.08)
Body mass index
 BMI < 24Reference
 27 > BMI ≥ 242.08 * (1.55–2.79)
 BMI ≥ 273.63 * (2.73–4.83)
Education level
 College or aboveReference
 Junior high and high school1.68 * (1.03–2.74)
 Elementary school or lower1.25 (0.81–1.93)
Current alcohol intake
 NoReference
 Rarely0.95 (0.72–1.24)
 Frequently0.90 (0.62–1.31)
Smoking status
 Never smokedReference
 Former smoker1.10 (0.77–1.57)
 Current smoker1.04 (0.71–1.52)
Physical activity
 LowReference
 Median0.82 (0.59–1.15)
 High1.18 (0.47–2.94)
Marital status
 Married or lived togetherReference
 Single0.70 (0.35–1.40)
 Divorced, separated, widowed, or
 refused to answer		1.39 * (1.03–1.88)
Family income
 <NT $10,000Reference
 NT $10,000 ≤ Income < NT $40,0001.07 (0.71–1.63)
 NT $40,000 ≤ Income < NT $80,0001.08 (0.69–1.69)
 >NT $80,000 1.08 (0.66–1.77)
 Don’t know or refuse to answer1.08 (0.71–1.64)
*: p-Value < 0.05; NT: The New Taiwan dollars; BMI: Body mass index; All logistic models were adjusted for age, sex, BMI, education level, alcohol drinking, smoking status, physical activity, marital status, and family income. Those with a score higher than 6 were classified into group 5, meaning they had intakes greater than the recommended servings in total from all food groups. The rest of the participants with scores of or less than 1 were classified by the quartile of the adherence score.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Tsai, T.-J.; Li, M.-C. Adherence to the Taiwan Daily Food Guide and the Risk of Type 2 Diabetes: A Populational Study in Taiwan. Int. J. Environ. Res. Public Health 2023, 20, 2246. https://doi.org/10.3390/ijerph20032246

AMA Style

Tsai T-J, Li M-C. Adherence to the Taiwan Daily Food Guide and the Risk of Type 2 Diabetes: A Populational Study in Taiwan. International Journal of Environmental Research and Public Health. 2023; 20(3):2246. https://doi.org/10.3390/ijerph20032246

Chicago/Turabian Style

Tsai, Tsung-Ju, and Ming-Chieh Li. 2023. "Adherence to the Taiwan Daily Food Guide and the Risk of Type 2 Diabetes: A Populational Study in Taiwan" International Journal of Environmental Research and Public Health 20, no. 3: 2246. https://doi.org/10.3390/ijerph20032246

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop