Differences in Dietary Intake Exist Among U.S. Adults by Diabetic Status Using NHANES 2009-2016

Abstract

ObjectivesInsulin takers’ diets have rarely been described although insulin dosing is highly dependent on dietary intake. The objective of this paper was to determine the most frequently consumed food or beverage items, food subcategories, and food categories, and those that contributed most to total energy intake among U.S. insulin takers, those with type 2 diabetes (T2D) not taking insulin and those without diabetes; the groups were also compared at the broad food category level.MethodsThe Laboratory tests and questionnaires of the NHANES 2009–2016 classified 774 insulin takers, 2,758 T2D not taking insulin, and 17,796 participants without diabetes. USDA assigned 8-digit food codes identifying each food item and its membership to a category and subcategory of foods were used to categorize foods based on the WWEIA categories. Raw and weighted frequency and energy contributions of each food item, food subcategory, and food category were calculated and ranked. Comparisons among groups by broad food category used the Rao–Scott modified chi-square test.ResultsDiet soft drinks ranked as the 4th and 7th most consumed food subcategory in insulin takers and T2D not taking insulin, respectively. Soft drinks ranked as the 8th and 6th most consumed food subcategory in T2D not taking insulin and those without diabetes, and contributed 5th and 2nd most to energy, respectively. Protein foods represented 4 of the top 10 highest energy contributing food subcategories among insulin takers, 3 of the top 10 food subcategories among those with T2D not taking insulin, and only 1 subcategory among those without diabetes. Insulin takers had higher consumption frequency of grains, and lower consumption frequency of sweets and alcohol, and a larger share of energy comprising protein, vegetables, and grains, and a smaller share of energy comprising beverages and alcohol compared to participants without diabetes.ConclusionsDifferences in dietary intake exist among U.S. adults by diabetic status. Insulin takers are likely to consume more protein foods and less regular soft drinks compared to other 2 groups. Lists of the most frequently reported foods and foods contributing most to energy may be helpful for nutrition education, prescribing diets, and digital-based dietary assessment for insulin takers.