Macronutrient intake and glycemic control in a population-based sample of American Indians with diabetes: The strong heart study

Background: Little research has explored the association of macronutrient intake and glycated hemoglobin (HbA_1c) in adults with diabetes. Objective: The objective of the study was to examine the cross-sectional association between macronutrient intake and HbA_1c in diabetic American Indians. Design: A total of 1284 participants aged 47-80 y who had diabetes for ≥1 y at the second examination (1993-1995) of the Strong Heart Study were included in this study. Dietary intake was assessed by using a 24-h recall. Logistic regression models were used to evaluate the odds of poor glycemic control(HbA_1c ≥7%) among sex-specific quintiles of macronutrient intake, after adjustment for the possible confounders age, sex, study center, body mass index, duration of diabetes, diabetes treatment, smoking, alcohol drinking, total energy intake, and physical activity. Results: Higher total fat (>25-30% of energy), saturated fatty acids (>13% of energy), and monounsaturated fatty acids (>10% of energy) and lower carbohydrate intake (<35-40% of energy) were associated with poor glycemic control. Lower fiber intake and higher protein intake were marginally associated with poor glycemic control (P for trend = 0.06 and 0.09, respectively). No significant association was found between polyunsaturated fatty acids or trans fatty acids and glycemic control in this population. Conclusions: These data suggest that a higher consumption of total fat and saturated and monounsaturated fatty acids and a lower intake of carbohydrates are associated with poor glycemic control in diabetic American Indians. Clinical trials focusing on whether modifications of macronutrient composition improve glycemic control in persons with diabetes are needed.