medwireNews: Research indicates that efforts to improve diet on a population basis would do more to prevent diabetes in higher than lower socioeconomic status (SES) groups, because of the effect of multiple concurrent diabetes risk factors among less affluent people.
The researchers found that poor diet quality accounted for a higher proportion of type 2 diabetes cases in the upper than lower SES groups (based on education level), with adjusted population attributable fractions of 37.3%, 40.1%, and 14.8% among people with high, middle, and low SES, respectively.
“It is a common perception that poor diet quality is predominantly a problem in lower socioeconomic classes,” write Petra Vinke (University Medical Center Groningen, the Netherlands) and study co-authors in EClinicalMedicine.
“Nonetheless, the large proportion of diabetes cases preventable by diet quality improvement in middle and high SES, illustrates that there is still lots of room for improvement across all three levels of SES.”
Their findings, based on data from 91,025 participants of the prospective Dutch Lifelines Cohort study of whom 1045 developed type 2 diabetes during a median 44 months of follow-up, are in line with previous research.
The intvestigators show that, as expected, the highest risk for diabetes occurred in people who were in the lowest SES tertile plus the lowest quintile for diet quality. Their risk was 3.66-fold greater than that of people in the highest SES tertile as well as the highest diet quality quintile.
But they also found that people with low SES had an increased diabetes risk even if they were in the highest quintile for diet quality, at 2.06 times that of those in the highest SES group.
The team explains that the multiple additional risk factors often present in people of low SES, such as genetic predisposition, smoking, and lack of physical activity, mean that an increased diabetes risk will remain even if diet quality is improved.
Thus having a poor- versus high-quality diet increased the diabetes risk of someone in the low SES group 1.48-fold, after accounting for factors including age, sex, smoking status, and BMI, whereas it increased the risk a markedly larger 2.04-fold in the high SES group, where fewer competing risk factors exist.
“This lower health benefit of adhering to a high quality diet may be one of the mechanisms underlying socioeconomic inequalities with regard to diabetes,” write Vinke and team.
Nevertheless, they stress that “the absolute number of cases preventable by diet quality improvement is more comparable over all levels of SES because of the higher diabetes incidence in low SES,” saying that it “can potentially prevent one in three cases of diabetes.”
This underlines the importance of public health interventions to improve diet quality at all SES levels, say the researchers, but they stress that “multifaceted lifestyle interventions are needed to reduce diabetes burden in low SES and to narrow the socioeconomic health gap.”
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EClinicalMedicine 2020; doi:10.1016/j.eclinm.2019.100252