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OBJECTIVE To describe diet and exercise practices from a nationally representative sample of U.S. adults with type 2 diabetes.
METHODS We analyzed data from 1,480 adults older than 17 years with a self-reported
diagnosis of type 2 diabetes in the Third National Health and Nutrition Examination Survey
(NHANES III). Fruit and vegetable consumption was obtained from a food frequency questionnaire; the percentages of total calories from fat and saturated fat were obtained from a 24-h food
recall. Physical activity was based on self report during the month before the survey.
RESULTS Of individuals with type 2 diabetes, 31% reported no regular physical activity
and another 38% reported less than recommended levels of physical activity. Sixty-two percent
of respondents ate fewer than five servings of fruits and vegetables per day. Almost two thirds of
the respondents consumed 30% of their daily calories from fat and 10% of total calories from
saturated fat. Mexican Americans and individuals over the age of 65 years ate a higher number
of fruits and vegetables and a lower percentage of total calories from fat. Lower income and
increasing age were associated with physical inactivity. Thirty-six percent of the sample were
overweight and another 46% were obese.
CONCLUSIONS The majority of individuals with type 2 diabetes were overweight, did
not engage in recommended levels of physical activity, and did not follow dietary guidelines for
fat and fruit and vegetable consumption. Additional measures are needed to encourage regular
physical activity and improve dietary habits in this population.
Diabetes Care 25:17221728, 2002
iet and exercise are considered important components of the treatment strategy for adults with type 2
diabetes. Appropriate use of diet and exercise can improve insulin sensitivity and
glycemic control and decrease the need
for oral medications or insulin (1,2). Although there is some controversy over the
optimal diet for adults with type 2 diabetes (high fiber, glycemic index approaches, low versus moderate fat) (3,4),
there is a consensus to increase consumption of fruits and vegetables and decrease
daily consumption of saturated fats (4,5).
Regular, moderate-intensity physical ac-
From the 1Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, Seattle; the
2
Department of Medicine, University of Washington, Seattle; the 3Epidemiologic Research and Information
Center, VA Puget Sound Health Care System, Seattle; and the 4Department of Epidemiology and Health
Services, University of Washington, Seattle, Washington.
Address correspondence and reprint requests to Karin Nelson, MD, MSHS, VA Puget Sound Health Care
System, 1660 South Columbian Way (S-111-GIMC), Seattle, WA 98108-1597. E-mail:
karin.nelson@med.va.gov.
Received for publication 15 April 2002 and accepted in revised form 10 July 2002.
Abbreviations: BRFSS, Behavioral Risk Factor Surveillance System; NHANES III, the Third National
Health and Nutrition Examination Survey.
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
factors for many substances.
1722
Age (years)
HbA1c (%)
Female
Race/ethnicity
White
African American
Mexican American
Income (% of federal poverty level)*
100%
101200%
201300%
301%
Education
Less than high school
High school
College
Diabetes treatment
Diet alone
Oral medication
Insulin
BMI (kg/m2)
25
2529.9
30.0
Physical activity
Inactive
Insufficient
Recommended level
Dietary intake
Daily calories from fat
3040%
40%
10% of daily calories from saturated fat
5 daily servings of fruits and vegetables
Data
(mean SE or %)
1,480
1,253
840
61 0.6
7.6 0.1
56
592
408
452
78
16
6
380
422
220
269
17
28
20
35
923
315
229
45
32
23
352
667
461
27
45
28
268
510
531
18
36
46
563
524
393
31
38
31
480
289
695
812
42
26
61
62
Adults with type 2 diabetes in NHANES III, n 1,480. Data for age and HbA1c are given as mean SE; the
rest are %. Percentages are weighted to account for complex survey design. Column totals may vary due to
missing data or rounding error. *Data available for n 1,291. Data available for n 1,309. Physical
activity: inactive; no reported leisure-time physical activity; insufficient; some physical activity, but less than
recommended; recommended; 5 or more episodes of moderate physical activity/week or 3 or more episodes
of vigorous physical activity per week.
Age (years)
65
65
Sex
Female
Male
Race/ethnicity
White
African American
Mexican American
Income (% of federal poverty level)
100%
101200%
201300%
301%
Education
Less than high school
High school
College
BMI (kg/m2)
25
2529.9
30.0
Diabetes treatment
Diet alone
Oral medication
Insulin
No difficulty
Walking 1/4 mile
Walking 10 steps without resting
Inactive
Insufficient activity
Recommended levels of
physical activity
25 (20, 31)
38 (35, 43)
44 (37, 52)
29 (24, 35)
31 (24, 38)*
32 (27, 38)
40 (36, 44)
20 (15, 26)
34 (29, 38)
42 (34, 51)
27 (22, 36)
37 (31, 45)
30 (26, 34)
39 (34, 44)
35 (29, 41)
38 (32, 45)
39 (34, 44)
37 (31, 44)
32 (27, 38)*
22 (19, 26)
28 (20, 38)
50 (40, 59)
36 (28, 44)
27 (20, 36)
17 (12, 24)
29 (21, 38)
29 (24, 34)
47 (37, 58)
47 (37, 58)
22 (16, 29)
36 (28, 45)
26 (16, 38)
36 (26, 47)
40 (34, 45)
27 (21, 33)
20 (14, 28)
35 (29, 41)
38 (29, 47)
43 (33, 54)
26 (21, 31)*
35 (27, 44)
37 (28, 47)
31 (22, 41)
25 (20, 31)
33 (27, 40)
31 (22, 42)
43 (36, 50)
40 (32, 48)
38 (29, 47)
32 (25, 40)
27 (20, 35)
30 (23, 38)
26 (21, 31)
41 (34, 48)
41 (30, 52)
40 (35, 46)
30 (23, 38)
30 (22, 39)*
34 (27, 41)
29 (23, 36)
16 (13, 21)
17 (13, 22)
43 (35, 51)
43 (36, 51)
41 (34, 48)
40 (32, 47)
Data are % (95% CI). Percentages are weighted to account for complex survey design; row percentages may vary due to missing data or rounding error. Pearsons
2 *P 0.05 P 0.001. Physical activity classification: Inactive, no reported leisure-time physical activity; insufficient; some physical activity, but less than
recommended; recommended, 5 or more episodes of moderate physical activity/week or 3 or more episodes of vigorous physical activity per week.
RESULTS Table 1 displays the population characteristics from this nationally representative sample of individuals
with type 2 diabetes. The mean age was
61 years, and the majority of the sample
was white. Almost one fifth had incomes
below the federal poverty level, and 45%
had less than a high school education.
Eighty-two percent of the sample had a
BMI 25 kg/m2, with 36% classified as
overweight and 46% as obese. Almost one
third of the sample reported no regular
physical activity in the month before the
survey, and another 38% reported an insufficient amount of physical activity.
Forty-two percent of respondents reported consumption of 30 40% of their
daily calories from fat, and 26% reported
intakes of 40% of their daily calories
from fat. Sixty-two percent of individuals
reported eating fewer than five servings of
5 servings of fruits or
vegetables/day
77 (70, 82)*
56 (50, 62)
69 (62, 74)*
50 (45, 55)
70 (64, 76)*
51 (46, 56)
66 (58, 72)
72 (65, 79)
60 (54, 65)
63 (56, 70)
63 (57, 68)
60 (53, 66)
71 (65, 77)
66 (61, 72)
60 (53, 67)
64 (58, 69)
60 (54, 65)
53 (47, 59)
62 (57, 68)
65 (58, 72)
44 (37, 51)
65 (55, 73)
65 (56, 73)
83 (76, 88)
66 (58, 73)
57 (48, 66)
61 (52, 69)
73 (65, 80)
60 (52, 66)
62 (52, 72)
61 (54, 69)
68 (60, 76)
60 (52, 67)
66 (61, 71)
71 (63, 77)
72 (58, 82)
62 (57, 67)
59 (50, 67)
65 (53, 75)
62 (56, 68)
66 (58, 73)
55 (45, 64)
65 (55, 73)
69 (63, 73)
70 (61, 78)
57 (49, 64)
61 (54, 68)
63 (54, 71)
57 (47, 66)
55 (48, 61)
68 (62, 74)
70 (61, 78)
71 (62, 77)
64 (54, 73)
62 (54, 70)
61 (53, 68)
61 (52, 70)
64 (57, 70)
62 (55, 68)
60 (53, 66)
Age (years)
65
65
Sex
Female
Male
Race/ethnicity
White
African American
Mexican American
Income (% of federal poverty level)
100%
101200%
201300%
301%
Education
Less than high school
High school
College
BMI (kg/m2)
25
2529.9
30.0
Diabetes treatment
Diet alone
Oral medication
Insulin
Data are % (95% CI). Percentages are weighted to account for complex survey design. Pearsons 2. *P 0.001; P 0.05.
5 servings of fruits or
vegetables/day
1,149
1.9 (1.2, 3.0)
2.3 (1.5, 3.4)
1,051
0.4 (0.3, 0.6)
1.0 (0.6, 1.6)
1,127
0.4 (0.3, 0.6)
1.1 (0.8, 1.7)
Reference
1.0 (0.7, 1.5)
1.0 (0.7, 1.5)
Reference
0.9 (0.6, 1.3)
0.6 (0.4, 0.9)
Reference
1.0 (0.6, 1.7)
0.4 (0.3, 0.6)
Reference
1.6 (0.9, 3.2)
1.8 (1.0, 3.6)
4.2 (2.0, 9.2)
Reference
2.1 (1.3, 3.6)
1.4 (0.8, 2.4)
1.0 (0.6, 1.9)
Reference
1.6 (1.0, 2.5)
1.2 (0.7, 2.1)
0.9 (0.5, 1.6)
Reference
1.4 (0.6, 2.9)
1.8 (1.0, 3.3)
Reference
0.7 (0.4, 1.5)
1.0 (0.5, 1.9)
Reference
1.7 (1.0, 2.9)
1.7 (1.0, 2.9)
Reference
0.8 (0.5, 1.2)
1.2 (0.7, 2.2)
Reference
1.1 (0.6, 1.9)
1.0 (0.6, 1.6)
Reference
0.9 (0.5, 1.5)
1.4 (0.9, 2.2)
Reference
0.9 (0.5, 1.4)
1.4 (0.8, 2.4)
Reference
1.0 (0.6, 1.6)
0.9 (0.5, 1.9)
Reference
0.7 (0.5, 1.0)
0.8 (0.6, 1.2)
n
Age 65 yearsa
Female gender
Race/ethnicity
White
African American
Mexican American
Income (% of federal poverty level)
301%
201300%
101200%
100%
Education
College
High school
high school
BMI (kg/m2)
25
2529.9
30.0
Diabetes treatment
Diet alone
Oral Medication
Insulin
Data are odds ratios (95% CI). Adults with type 2 diabetes in NHANES III. Odds ratio 1 indicates reporting no regular exercise, consuming greater than 10% of
calories from fat or less than 5 servings of fruits and vegetables/day. *Compared to individuals less than 65 years of age. P 0.05; P 0.001.
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