Diabetes is a growing epidemic in the U.S., related in part to the poor quality of dietary intake patterns of Americans. Hispanics and non-Hispanic Blacks have higher prevalence of type 2 diabetes (T2D), and have been found to have poorer diet quality than non-Hispanic Whites. Elevated markers of inflammation, poorer glycemic control, and higher blood pressure have also been observed in minority populations when compared to non-Hispanic Whites. Higher levels of these biomarkers are independently associated with increased all- cause mortality and other poor health outcomes. T2D is an inflammatory and metabolic disease, as hyperglycemia related to insulin resistance causes increases in inflammatory markers. Associations between blood pressure (BP) and inflammation are also appearing in the literature, but little is known about these associations in T2D. Research has suggested that dietary intake may affect inflammation and glycemia, and the Mediterranean diet has been shown to decrease C-reactive protein (CRP) and glycated hemoglobin (HbA1c). Similarly, the USDA Food Guidelines for Americans have also been associated with improved biomarkers. The associations between dietary intake patterns, inflammation, glycemic control, and BP in T2D have not been examined comprehensively in relation to race and ethnicity. The proposed research study is a secondary analysis of data collected from NHANES 2009-2010. Dietary assessment through 24-hour recall among adults with and without T2D will provide data to create Mediterranean Diet (MSDPS) and Healthy Eating Index (HEI) Scores, and the relation between these scores and CRP, HbA1c, and BP will be examined. Race and ethnicity will be examined as the grouping variable, as the disparity in health outcomes across race/ethnicity is what this study aims to explain. Specifically, the aims of the proposed research are to 1) examine the direct and indirect effects between race/ethnicity and CRP, HbA1c, and BP as mediated by dietary pattern score (measured by the MSDPS and HEI scores), and BMI;and 2) explore whether the indirect effects of race/ethnicity to CRP, HbA1c, and BP, as mediated by dietary intake pattern (measured by the MSDPS and HEI scores) and BMI, are moderated by T2D status. The findings from this study will provide insight into the associations between dietary intake patterns and health outcomes, and demonstrate how they differ between racial and ethnic groups. This study will contribute to knowledge regarding the association between diet and health outcomes, and provide the foundation for the development of future experimental research examining dietary interventions in multiethnic populations in relation to health outcomes.

Public Health Relevance

T2D disproportionately affects non-Hispanic Blacks and Hispanics in the United States, yet the reason for this health disparity is unclear. Racial and Ethnic minority groups also tend to have higher prevalence of risk factors for complications in T2D, such as poor dietary intake, inflammation, and poor glycemic control. The proposed secondary analysis will explore the etiology of this problem by assessing the association between dietary intake patterns (as measured by Mediterranean Diet and HEI scores), inflammation, glycemic status, and blood pressure in non-Hispanic White, non-Hispanic Black, and Hispanic adults who participated in the National Health and Nutrition Examination Survey (NHANES) with T2D.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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New York University
Schools of Nursing
New York
United States
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