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Diet Quality and Its Association with Type 2 Diabetes and Major Cardiometabolic Risk Factors among Adults in China


Wang, Zhihong; Siega-Riz, Anna Maria; Gordon-Larsen, Penny; Adair, Linda S.; Zhang, Bing; & Popkin, Barry M. (2018). Diet Quality and Its Association with Type 2 Diabetes and Major Cardiometabolic Risk Factors among Adults in China. Nutrition, Metabolism & Cardiovascular Diseases, 28(10), 987-1001. PMCID: PMC6135658


AIM: We examined the association between diet quality and diabetes and major cardiometabolic risks among adults in China.
METHODS AND RESULTS: We developed the China Dietary Guideline Index (CDGI) based on the 2007 Chinese dietary guidelines and tailored the Alternate Healthy Eating Index 2010 (which we call the tAHEI) to assess diet quality. Our analysis linked the dietary intake and covariates measured in 2006 with CM risk factors measured in 2009. We used diet data the longitudinal China Health and Nutrition Survey 2006 collected in 3 consecutive 24-h recalls from 4440 adults aged 18 to 65 to calculate both the tAHEI and the CDGI scores. We performed multivariable logistic regressions to analyze the association of each 2006 score with diabetes, abdominal obesity, elevated blood pressure, and lipid-related cardiometabolic risk factors in 2009. After we adjusted for potential confounders, adults in the top quintile compared with the bottom quintile of the tAHEI scores showed 36% lower odds of high low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.46, 0.90] in men and 33% lower odds (OR 0.67; 95% CI 0.49, 0.91) in women, while the CDGI scores showed 35% lower odds of high LDL-C (OR 0.65; 95% CI 0.46, 0.92) in men only. Further, the CDGI scores indicated 55% lower odds of diabetes in the top versus the bottom quintile (OR 0.45; 95% CI 0.23, 0.87) in men only, whereas a null association was observed for the tAHEI scores for both sexes. Both index scores showed null associations with other cardiometabolic risk factors.
CONCLUSIONS: Chinese diets that scored high on both the CDGI and the tAHEI showed similarly negative associations with high LDL-C risk, whereas only CDGI score was negatively related to diabetes risk in men.


Reference Type

Journal Article

Year Published


Journal Title

Nutrition, Metabolism & Cardiovascular Diseases


Wang, Zhihong
Siega-Riz, Anna Maria
Gordon-Larsen, Penny
Adair, Linda S.
Zhang, Bing
Popkin, Barry M.