Associação entre a qualidade da dieta e níveis de hemoglobina glicada em pessoas com Diabetes Mellitus tipo 1

Abstract

Introduction: diet plays a fundamental role in the treatment of type 1 diabetes mellitus and can interfere at the glycated hemoglobin levels. However, studies investigating diet quality and glycated hemoglobin are still controversial. Objetive: to estimate the association between diet quality and food portions and glycated hemoglobin levels in people with type 1 diabetes mellitus. Methods: a cross-sectional study was conducted with 136 oupatients with type 1 diabetes mellitus, of both sexes and aged over 12 years (admission criteria for outpatient clinics). A semi-quantitative Food Frequency Questionnaire was applied to assess food intake. To assess diet quality, the Brazilian Healthy Eating Index-Revised was used, consisting of a scoring system based on the number of food portions consumed of each food component. The food portions were calculated from the conversion of the amounts of food consumed in grams or milliliters to caloric values, which were converted into equivalent food portions according to the food groups presented by Guia Alimentar para a População Brasileira (2006). Sociodemographic, clinic and anthropometric data were also collected. Glycated hemoglobin levels ≥ 7% were considered inadequate. Beta regression models were applied to estimate the association between diet quality and food group servings (main exposures) with glycated hemoglobin levels (outcome). The models were adjusted for confounding variables based on clinical relevance, such as age, sex, insulin doses, education, Body Mass Index, practice of physical activity and duration of diabetes. Models were performed separately for each exposure and a global model in which the portions were adjusted to each other (unadjusted model and adjusted model) with glycated hemoglobin levels. Results: younger participants (≤ 19 years), with lower level of education and duration of diabetes had higher glycated hemoglobin levels. The whole grain component and whole grain food portions, when evaluated separately with confounders, were inversely associated with glycated hemoglobin levels (β = -0,03 ± 0,01, p = 0,03; β = -0,13 ± 0,06, p = 0,04). Moreover, an increase of one unit of the index component (score) or portion of whole grains was associated with a reduction on glycated hemoglobin levels at 3% (odds ratio = 0,97; CI 0,95-0,99) and 12% (odds ratio = 0,88; CI 95% 0,78-0,99), respectively. In the global model adjusted for food portions, the food portions of whole grains were inversely associated with glycated hemoglobin levels (β = -0,13 ± 0,06, p = 0,03). The increase of one portions of whole grains in the adjusted global model was associated with a reduction on glycated hemoglobin levels at 12% % (odds ratio = 0,88; CI 95% 0,78-0,99), even with the intake of other portions that were part of the model. Conclusion: the highest intake of foods from the whole grain group was associated to a better glycated hemoglobin levels. No significant associations were found between total score of diet quality or another components or food portions with glycated hemoglobin levels.