The goal of
diabetes management is to achieve glycemic control or the control of
glycosylated hemoglobin (HbA1c) levels. The American Diabetes Association
recommends HbA1c levels of less than 7 percent as the treatment goal.
Diet is one of
the key factors in glycemic control that can affect the physical quality and emotional
quality of life as well. The National Institute of Mental Health suggests that
diet plays a major role in depression. However, it is not very clear whether
poor nutritional habits cause depression or vice versa, that is, depression
influences poor dietary choices. Whatever the cause, both have a negative
effect on glycemic control in patients with type-2 diabetes.
research has been done in the areas of depression factors in Cuban-American
population (the largest Hispanic subgroup) with type-2 diabetes.
Therefore, this study led by Joel Exebio, Florida International University,
Robert Stempel School of Public Health and Social Work, Department of Dietetics
and Nutrition, Miami, and colleagues, was conducted with the aim to
determine the association between diet quality and symptoms of depression among
Cuban-Americans living in South Florida.
were male and female Cuban-Americans with and without type-2 diabetes (183
Cuban-Americans with diabetes and 173 without pre-diagnosed diabetes) and equal
to or more than 30 years of age. Exclusion criteria were pregnant or lactating
women, presence of any thyroid disorders and any major psychiatric disorders
(not including depression).
symptoms were measured using the Beck Depression Inventory (BDI) - a 21-item,
self-reported questionnaire that measures the presence and severity of
depressive symptoms using a self-rating scale from 0 to 3 (0 being least
depressed and 3 being most depressed).
quality was determined using the Healthy Eating Index-2005 (HEI-05) score. HEI
is a measure of diet quality that assesses conformance to Federal dietary
guidance created by the U.S. Department of Agriculture (USDA) in 1995. Release
of new Dietary Guidelines for Americans in 2005 motivated a revision of the
HEI, and renamed - HEI-05. For components and standards for scoring in HEI
refer to the following url:
blood (15 ml) was collected from each subject after an overnight fast (at least
8 hours) by a certified phlebotomist using standard laboratory techniques.
Specifically, the blood collected was used to test for glycosylated hemoglobin
results of this study revealed that -
• Diet quality was not associated
with symptoms of depression based on the regression analysis. Significant differences in symptoms of
depression according to diabetes status and gender were found only among
those with the lower diet quality.
• Overall amount of 'bad' food
consumed in the diet may be more relevant to depression than the
proportion it represents in the overall diet.
• Subjects with diabetes had better HEI-05 scores
because they were eating fewer
kilocalories than subjects without diabetes.
• Participants with diabetes had a
significantly higher BDI score compared to those without diabetes, but
also a higher HEI-05 score, which means that, even though they had better
nutritional habits, they still had more depressive symptoms. This implied
that other factors like gender and
diabetes status may be better predictors of depression in this particular
sample of Cuban-Americans
of the study included -
sectional design of the study which cannot establish causality;
basis of diagnosing depression was self-reported BDI score; and
study was not representative of the general Cuban-American population, so the
results cannot be generalized.
researchers concluded that 'Cuban-American males with type-2 diabetes and
females without type-2 diabetes with poor overall diet quality had higher
symptoms of depression'.
Exebio, J. C., etl. Healthy Eating Index scores
associated with symptoms of depression in Cuban-Americans with and without type
2 diabetes: a cross sectional study. Nutrition journal. 12/2011; 10(1):135.