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Diabetes Care. 2014 Sep;37(9):2587-92. doi: 10.2337/dc14-0753. Epub 2014 Jun 26.

Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: results from the Boston Puerto Rican Health study.

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  • 1Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
  • 2Department of Medicine, Harvard Medical School, Boston, MA Department of Nutrition, Harvard School of Public Health, Boston, MA.
  • 3Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA.



To determine whether dietary patterns associated with food insecurity are associated with poor longitudinal glycemic control.


In a prospective, population-based, longitudinal cohort study, we ascertained food security (Food Security Survey Module), dietary pattern (Healthy Eating Index-2005 [HEI 2005]), and hemoglobin A1c (HbA1c) in Puerto Rican adults aged 45-75 years with diabetes at baseline (2004-2009) and HbA1c at ∼2 years follow-up (2006-2012). We determined associations between food insecurity and dietary pattern and assessed whether those dietary patterns were associated with poorer HbA1c concentration over time, using multivariable-adjusted repeated subjects mixed-effects models.


There were 584 participants with diabetes at baseline and 516 at follow-up. Food-insecure participants reported lower overall dietary quality and lower intake of fruit and vegetables. A food insecurity*HEI 2005 interaction (P < 0.001) suggested that better diet quality was more strongly associated with lower HbA1c in food-insecure than food-secure participants. In adjusted models, lower follow-up HbA1c was associated with greater HEI 2005 score (β = -0.01 HbA1c % per HEI 2005 point, per year, P = 0.003) and with subscores of total vegetables (β = -0.09, P = 0.04) and dark green and orange vegetables and legumes (β = -0.06, P = 0.048). Compared with the minimum total vegetable score, a participant with the maximum score showed relative improvements of HbA1c of 0.5% per year.


Food insecurity was associated with lower overall dietary quality and lower consumption of plant-based foods, which was associated with poor longitudinal glycemic control.

© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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