Research Paper Volume 13, Issue 7 pp 10112—10127

Association of fourteen years diet quality trajectories and type 2 diabetes mellitus with related biomarkers

Therese Martin Cheteu Wabo1,2, , Victorine Raïssa Ngo Nkondjock1, , Justina Ucheojor Onwuka3, , Changhao Sun1, , Tianshu Han1, , Jackson Sira2,4, ,

  • 1 Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin 150081, China
  • 2 Department of Biomedical Sciences, Faculty of Sciences, University of Ngaoundere, Ngaoundere, Cameroon
  • 3 Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, China
  • 4 Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin 150081, China

Received: September 19, 2020       Accepted: December 23, 2020       Published: March 26, 2021
How to Cite

Copyright: © 2021 Wabo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Diet quality fluctuates throughout one’s adulthood, yet it remains unclear how long-term diet quality changes are related to type 2 diabetes mellitus (T2DM) and its biomarkers. We aimed to examine the association of long-term diet quality with T2DM and its biomarkers. Diet quality was assessed by the revised DBI-07, in which diet quality distance levels (DQD) represented the overall diet quality. Participants were clustered into classes sharing similar DQD levels using latent class mixed model. We used Cox regression and random effect linear regression to assess DQD trajectories’ association with T2DM and its biomarkers. Three DQD trajectories were derived: moderate to gradual decrease, high to moderate, high stable DQD level representing 2.14%, 6.18% and, 91.68% of the population. Compared to class 1, class 2 and 3 were associated with an increased risk of T2DM [HR=4.40; 95%CI: 2.02-9.59]; [HR=3.68; 95% CI: 2.11-6.43]. When class 3 was used as a reference, class 1 was also associated with an increased risk of TDM [HR=2.71; 95%CI: 1.55-4.73]. Our findings suggest that a long-term unhealthy diet is associated with an increased risk of T2DM. Gradually reducing DQD level may not make a difference, which establishes the importance of promoting healthy eating habits at early adulthood.


DQD: Diet Quality Distance; T2DM: Type 2 Diabetes Mellitus; CHNS: China health nutrition survey; DBI-07: Diet Balance Index-2007; DBI-DQD: Diet Quality Distance; DBI-LBS: Low Bound Score; DBI-HBS: High Bound Score; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; Hs-CRP: High-sensitivity C-reactive protein; FPG: Fasting Plasma Glucose; TG: Triglycerides; HDL-C: High-Density Lipoprotein; UA: Uric Acid; HOMA-IR: Homeostatic Model Assessment for Insulin Resistance; HbA1C: Hemoglobin; RAAS: Renin-Angiotensin-Aldosterone system; AVP: Arginine Vasopressin.