| Objective To use validated scales to describe dietary quality and depression in patients with type 2 diabetes. To explore the relationship between diet quality and depression, so that some evidence can be provided to alleviate depression in type 2 diabetes mellitus through dietary interventions.Methods A cross-sectional descriptive survey was used in this study. By convenience sampling, a total of 322 inpatients with type 2 diabetes in the Department of Endocrinology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were enrolled from February 2014 to September 2014. Self-designed questionnaire was used to collect information on demographic, disease condition. Three 24-hour un-consecutive food intake was measured with the 24-hour dietary recall questionnaire and diet quality was assessed by the Healthy Eating Index-2005(HEI-2005). Depression was evaluated using the Self-rating Depression Scale(SDS). All datas above were analyzed by SPSS 20.0, using frequeney, rate, mean and standard deviation for descriptiveStatisties; using t-test, ANOVA,Kruskal-WalliS H test and logistic regression analysis for the statistical. Significance was set at P<0.05 and all analysis were two sided.Results1.The distribution of the HEI-2005 scores were 43.35～86.62 in the participants with type 2 diabetes, the mean score of HEI-2005 was (59.43±7.58). The total fruit score was (2.64 ±0.46), not meet the recommended amount of the dietary guideline. Whole fruit score was (2.42 ±0.39) less than the total fruit score. The average score of vegetable was (3.69±0.61), however, dark green and orange vegetables and legumes score was only (1.17±0.20). Total grains and whole grains scores were (3.92±1.25) and (0.94±0.11), respectively. Milk score was (6.56± 1.42). Meat and beans intake basically meet the standard, was (9.89±0.13). Oils score was (8.65±1.20). The intake of saturated fat, sodium and solid fat, alcohol and added sugar(SoFAAS) were more than the best recommended value of the guideline, achieved relatively low scores.2. The SDS score of 322 participants was (51.53±10.86), the item of somatic symptom achieved the highest score.138 participants get a score of 53 points or more in the SDS assessment and 184 subjects were less than 53 points. The prevalence of depression was 42.85%. Among the 138 patients with T2DM, the percentages of mild, moderate and severe depression were 69.57%,26.81% and 3.62%, respectively.3. Compared the different ages, BMI, smoking, drinking, course of disease, chronic complications, blood sugar status and depression, all above contribute to the different HEI-2005 score (P<0.05). Specifically, the group of 60～69 years old in the patients with higher HEI-2005 scores than the group of 18～40 years old. HEI-2005 score was significantly decreased among the patients of overweight and obesity than the normal. The subjects who are smoking or drinking also achieve a lower SDS score. The participants whose duration of diabetes mellitus was more than 15 years has a higher HEI-2005 score compared with the patients who were less than 5 years duration. A better control of blood glucose is beneficial to get a more excellient HEI-2005 score. The HEI-2005 score of the patients with depressive symptoms was significantly lower than those who were not depressive. There was no statistical difference between the other variables and the HEI-2005 score (P> 0.05).4. Compared the different ages, educational levels, income per month, reimbursement ratios of medical expenses, smoking, drinking, sleepy condition, duration of diabetes, family history of diabetes, chronic complications of diabetes, glycemic status and dietary qualities, there was significant difference in the SDS scores (P< 0.05). Exactly, the group of 60～69 years old with significantly higher SDS scores than the group of 18～40 year old. The subjects with an education of junior middle school or below acquired the lowest score. SDS scores were higher in the participants whose income below 3000 yuan and over 8000 yuan every month. The patients whose reimbursement ratios of medical expenses up to 90%, the degree of depression were reduced. The participants whose duration of diabetes mellitus was less than 5 year or more than 15 years has a higher SDS scores. The smokers and drinkers has poor SDS scroes. Interestingly, the subjects who with a family history of diabetes achieved decreased SDS scores. Cocombined with complications and poor glycemic control induced higer SDS scores. The participants whose HEI-2005 score below 57.25 acquired poorer SDS scores than the contrast (P<0.05). There were no significant differences between the other variables and the HEI-2005 score (P>0.05).5. The HEI-2005 score was with analysed by logistic regression analysis in the form of continuous variables initially. There was a negtive relationship between the HEI-2005 score and the SDS score before adjusted the confused factors(OR=2.356, P=0.016). Then the HEI-2005 score were analyzed by logistic regression analysis in the form of binary valuable, the results showed that the lower HEI-2005 score associated with the greater SDS score, after adjusting for age, gender (Model 2) and adjusting for age, gender, BMI, culture degree, marriage status, occupation, per capita income, medical expenses reimbursement ratio, is not smoking, drinking, sleeping, duration of diabetes, family history of diabetes, complications, glycemic status and other confounding factors(Model 3). In the Model 2 and 3, the subjects who with poor dietary quality increased the risk of depression compared with the contrast (OR=1.638, OR=1.975). Although OR values were alleviated than the unadjusted, but the difference is still significant (P <0.05).Conclusion1. The dietary quality in the patients with type 2 diabetes needs to be improved, especially the whole fruit, dark green and orange vegetables and legumes, whole grains and milk intake is seriously inadequate, and the saturated fat, sodium and SoFAAS intake is excessive.2. The prevelance of depression in patients with type 2 diabetes is higher than the normal, accounting for 42.85%, and the main symptoms were somatic disorders.69.57% of these patients were mild depression.3. Compared the different ages, BMI, smoking, drinking, chronic complications, durations of diabetes, glycemic control and depressive states in patients with type 2 diabetes, differences were found in the dietary qualities (P<0.05).4. Compared the different ages, culture levels, income per month, reimbursement ratios of medical expenses, smoking, drinking, sleepy status, durations of diabetes, family history of daibetes, chronic complications, glycemic control and dietary qualities, differences were found in the degree of depression (P<0.05).5.The dietary quality of patients with type 2 diabetes is intimately related to depression. Specifically, poor dietary quality is a major risk factor for depression, and after adjusted confounding factors,such as the variables of demographic and disease status, the risk is still exists (OR=1.975, P<0.05). |
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