Academic journal article Journal of Health Population and Nutrition

Factors Associated with Dietary Diversity Score among Individuals with Type 2 Diabetes Mellitus

Academic journal article Journal of Health Population and Nutrition

Factors Associated with Dietary Diversity Score among Individuals with Type 2 Diabetes Mellitus

Article excerpt


Diabetes mellitus remains a major cause of mortality and morbidity worldwide. Factors associated with the continuous upward trend include population growth, ageing, urbanization, increasing prevalence of obesity as well as physical inactivity (1). The prevalence of diabetes worldwide is projected to increase from 8.3% in 2011 to 9.9% in 2030 (2). Among 80 most-populated countries in the world, Malaysia appears to have the highest prevalence of diabetes in the Western Pacific region (3). International Diabetes Federation predicted that the prevalence of diabetes in Malaysia is projected to reach 13.3% in 2030 (3). However, the worrying fact is that the prevalence of diabetes in Malaysia increases even faster than the projection, which recorded 11.6% in 2006 (4) and 15.2% in 2011 (5). It was ranked in the top 10 total burden of disease in Malaysia in terms of premature mortality (6). Individuals with diabetes are at higher risk of suffering from diabetes complications as it frequently coexists with a constellation of cardiovascular (CVD) risk factors and metabolic syndrome (7,8). Dietary management is crucial for preventing diabetes, managing existing condition, and preventing the development of diabetes complications (9). Assessing diet quality among individuals with diabetes may be beneficial for the development of diabetes management intervention, particularly for secondary and tertiary prevention to reduce the burden of disease. Diet quality was found to have a protective effect towards health outcomes, including a reduction of 17-42% for all-cause mortality, 18-53% for CVD mortality, and 14-28% for CVD risk (10). Dietary diversity score (DDS), as one of the diet quality indicator (11,12), was found to be inversely associated with CVD risk (13) and metabolic syndrome (14). Although dietary management is crucial for individuals with diabetes, the studies on diet quality among them are scarce (10,15). Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, and it accounted for 90-95% of all diabetes cases (8). Therefore, this study aims to assess the diet quality as measured using DDS and to determine the factors associated with DDS among individuals with T2DM.



This cross-sectional study was conducted among 113 Malaysian men and women who were aged above 18 years, diagnosed with T2DM, with poor glycaemic control as defined by HbA1c [greater than or equal to] 8.0%, and attended the Medical Outpatient Department of Serdang Hospital, a government-funded multispecialty hospital located in the district of Sepang in the state of Selangor, Malaysia, during July 2010March 2011. The exclusion criteria included those who were severely impaired in vision, hearing, or speech and who were unable to communicate in English, Malay, Mandarin, or Cantonese. In addition, pregnant or lactating women and individuals who were diagnosed with cardiac failure, severe renal disease, gastrointestinal diseases, mental disorientation or other chronic medical conditions that required specific dietary restriction were excluded.

The sample-size was calculated based on Torheim and colleagues' study (12) who found that about 22% of the variance for DDS was explained by sociodemographic characteristics. The effect-size was obtained using the formula as follows (16):

Cohen's [[integral].sup.2] = [R.sup.2]/(1 - [R.sup.2])

where [R.sup.2] is the expected coefficient of determination. The minimum sample-size comprised 92 subjects based on G*Power version 3.1.7 (Franz Faul, University of Kiel, Kiel, Germany) (17), with an expected medium effect-size of 0.282, power of 0.90, alpha ([alpha]) value of 0.05 for a multiple linear regression model with 13 predictors. The final sample-size was further increased to 108 after considering an estimated 15% non-response rate.

Ethical clearance

Ethical approval for the study was obtained from the Medical Research and Ethics Committee of the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia and the Ministry of Health Malaysia. …

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