*Article* **Diet Quality Is Associated with Glucose Regulation in a Cohort of Young Adults**

**Elizabeth Costello 1,\*, Jesse Goodrich 1, William B. Patterson 2, Sarah Rock 1, Yiping Li 1, Brittney Baumert 1, Frank Gilliland 1, Michael I. Goran 1,3, Zhanghua Chen 1, Tanya L. Alderete 2, David V. Conti <sup>1</sup> and Leda Chatzi <sup>1</sup>**


**Abstract:** Young-onset type 2 diabetes and prediabetes is a growing epidemic. Poor diet is a known risk factor for T2D in older adults, but the contribution of diet to risk factors for T2D is not welldescribed in youth. Our objective was to examine the relationship of diet quality with prediabetes, glucose regulation, and adiposity in young adults. A cohort of young adults (*n* = 155, age 17–22) was examined between 2014–2018, and 89 underwent a follow-up visit from 2020–2022. At each visit, participants completed diet and body composition assessments and an oral glucose tolerance test. Adherence to four dietary patterns was assessed: Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI), Mediterranean diet, and Diet Inflammatory Index (DII). Regression analyses were used to determine adjusted associations of diet with risk for prediabetes and adiposity. Each one-point increase in DASH or HEI scores between visits reduced the risk for prediabetes at follow-up by 64% (OR, 95% CI: 0.36, 0.17–0.68) and 9% (OR, 95% CI: 0.91, 0.85–0.96), respectively. The DASH diet was inversely associated with adiposity, while DII was positively associated with adiposity. In summary, positive changes in HEI and DASH scores were associated with reduced risk for prediabetes in young adults.

**Keywords:** diet quality; dietary patterns; type 2 diabetes; prediabetes; obesity; body composition; young adults
