Association of Diet Quality and Food Insecurity with Metabolic Syndrome in Obese Adults

Ahmed Abdurahman, Mohammed Bule, Masoume Fallahyekt, Maryem Abshirini, Leila Azadbakht, Mostafa Qorbani, A. R. Dorosty


Background: The link between diet quality, food insecurity (FI), and metabolic syndrome (MetS) remains unclear in obese adults. The aim of this study was to examine the association of diet quality and FI with MetS in obese Iranian adults. Methods: This cross‑sectional study was conducted on 300 obese adults. Dietary intake was assessed using a validated 168‑item food frequency questionnaire. Diet quality and FI were measured using the Diet Quality Index‑International (DQI‑I) and an adapted USDA2000 household food security status questionnaire, respectively. MetS was defined according to the International Diabetes Federation diagnostic criteria. Association was determined using logistic regression analysis adjusting for potential confounders. Results: MetS subjects had lower DQI‑I score than subjects without MetS (67.5 ± 8.7 vs 71.5 ± 7.4, P = 0.05). The prevalence of food insecurity was 48.6% (95% confidence interval (CI): 41.2, 56.1) in MetS subjects and 39.4% (95% CI: 29.4, 49.9) in subjects without MetS. After adjustment, participants in the fourth quartile of DQI‑I score had 70% lower odds of MetS (Adjusted odds ratio [AOR], 0.3; 95% CI: 0.1–0.7), 70% lower odds of hypertriglyceridemia (AOR, 0.3; 95% CI: 0.2–0.7) and 60% lower risk of reduced high‑density lipoprotein [HDL] (AOR, 0.4; 95% CI: 0.2–0.9) compared with the first quartile. Obese food insecure adults had 60% higher odds of high blood pressure (AOR, 1.6; 95% CI: 1.0–2.6) and 70% higher odds of hypertriglyceridemia (AOR, 1.7; 95% CI: 1.0–2.8) compared with food‑secure obese adults. There was no statistically significant interaction observed between DQI‑I and food insecurity on MetS. Conclusions: Lower DQI‑I score and food insecurity were associated with an increased risk of MetS and some features such as hypertriglyceridemia, reduced HDL, and high blood pressure in obese Iranian adults.


Diet quality; food security; metabolic syndrome; obesity

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Friend A, Craig L, Turner S. The prevalence of metabolic

syndrome in children: A systematic review of the literature.

Metab Syndr Relat Disord 2013;11:71‑80.

Dalvand S, Bakhshi E, Zarei M, Asl MT, Ghanei R. Prevalence

of metabolic syndrome in Iran: A systematic review and

meta‑analysis. Med‑Surg Nur J 2017;5:1‑14.

Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK,

et al. Metabolic syndrome and risk of incident cardiovascular

events and death: A systematic review and meta‑analysis of

longitudinal studies. J Am Coll Cardiol 2007;49:403‑14.

Rubenstein AH. Obesity: A modern epidemic. Trans Am Clin

Climatol Assoc 2005;116:103.

Lindström J, Ilanne‑Parikka P, Peltonen M, Aunola S,

Eriksson JG, Hemiö K, et al. Sustained reduction in the incidence

of type 2 diabetes by lifestyle intervention: Follow‑up of the

Finnish Diabetes Prevention Study. Lancet 2006;368:1673‑9.

Eckel RH, Jakicic JM, Ard JD, De Jesus JM, Miller NH,

Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle

management to reduce cardiovascular risk: A report of the

American College of Cardiology/American Heart Association

Task Force on Practice Guidelines. J Am Coll Cardiol


Ferranti E. Dietary Quality and Cardiometabolic Risk after

Gestational Diabetes. Emory University; 2013.

Kesse‑Guyot E, Ahluwalia N, Lassale C, Hercberg S, Fezeu L,

Lairon D. Adherence to Mediterranean diet reduces the risk of

metabolic syndrome: A 6‑year prospective study. Nutr Metab

Cardiovasc Dis 2013;23:677‑83.

Radimer K. Measurement of household food security in the

USA and other industrialized countries. Public Health Nutr


Garriguet D. Diet quality in Canada. Health Rep 2009;20:41.

Elmadfa I, Meyer AL. Diet quality, a term subject to change over

time. Int J Vitam Nutr Res 2012;82:144‑7.

Burchi F, De Muro P. From food availability to nutritional

capabilities: Advancing food security analysis. Food Policy


Wirt A, Collins CE. Diet quality–what is it and does it matter?.

Public Health Nutr 2009;12:2473‑92.

Kim S, Haines PS, Siega‑Riz AM, Popkin BM. The Diet Quality

Index‑International (DQI‑I) provides an effective tool for

cross‑national comparison of diet quality as illustrated by China

and the United States. J Nutr 2003;133:3476‑84.

Florence MD, Asbridge M, Veugelers PJ. Diet quality and

academic performance. J Sch Health 2008;78:209‑15.

Schwingshackl L, Hoffmann G. Mediterranean dietary pattern,

inflammation and endothelial function: A systematic review and

meta‑analysis of intervention trials. Nutr Metab Cardiovasc Dis


Koloverou E, Esposito K, Giugliano D, Panagiotakos D. The

effect of Mediterranean diet on the development of type 2

diabetes mellitus: A meta‑analysis of 10 prospective studies and

,846 participants. Metabolism 2014;63:903‑11.

Pan Y, Pratt CA. Metabolic syndrome and its association with

diet and physical activity in US adolescents. J Am Diet Assoc


Schwingshackl L, Missbach B, König J, Hoffmann G. Adherence

to a Mediterranean diet and risk of diabetes: A systematic review

and meta‑analysis. Public Health Nutr 2015;18:1292‑9.

Parker ED, Widome R, Nettleton JA, Pereira MA. Food security

and metabolic syndrome in US adults and adolescents: Findings

from the National Health and Nutrition Examination Survey,

–2006. Ann Epidemiol 2010;20:364‑70.

Mirmiran P, Hosseini Esfahani F, Azizi F. Relative validity and

reliability of the food frequency questionnaire used to assess

nutrient intake: Tehran Lipid and Glucose Study. Iranian J

Diabetes Lipid Disord 2009;9:185‑97.

Health UDo, Services H. Dietary Guidelines for Americans

‑2020: Skyhorse Publishing Inc.; 2017.

Mohammadi F, Omidvar N, Houshiar‑Rad A, Khoshfetrat MR,

Abdollahi M, Mehrabi Y. Validity of an adapted household food

insecurity access scale in urban households in Iran. Public Health

Nutr 2012;15:149‑57.

Moghaddam MH, Aghdam FB, Jafarabadi MA,

Allahverdipour H, Nikookheslat SD, Safarpour S. The Iranian Version of International Physical Activity Questionnaire (IPAQ)

in Iran: Content and construct validity, factor structure, internal

consistency and stability. World Appl Sci J 2012;18:1073‑80.

Alberti KG, Zimmet P, Shaw J. The metabolic syndrome—A

new worldwide definition. Lancet 2005;366:1059‑62.

Cheung LT, Chan RS, Ko GT, Lau ES, Chow FC, Kong AP. Diet

quality is inversely associated with obesity in Chinese adults

with type 2 diabetes. Nutr J 2018;17:63.

Micklesfield LK, Goedecke JH, Dickie K, Chantler S.

Determinants of change in body weight and body fat distribution

over 5.5 years in a sample of free‑living black South African

women: Cardiovascular topics. Cardiovasc J Afr 2016;27:367‑74.

Kim M, Kim J, Bae W, Kim S, Lee Y, Na W, et al. Relationship

between nutrients intakes, dietary quality, and serum

concentrations of inflammatory markers in metabolic syndrome

patients. Korean J Community Nutr 2011;16:51‑61.

Mariscal‑Arcas M, Romaguera D, Rivas A, Feriche B, Pons A,

Tur J, et al. Diet quality of young people in southern Spain

evaluated by a Mediterranean adaptation of the Diet Quality

Index‑International (DQI‑I). Br J Nutr 2007;98:1267‑73.

Gregory CO, McCullough ML, Ramirez‑Zea M, Stein AD. Diet

scores and cardio‑metabolic risk factors among Guatemalan

young adults. Br J Nutr 2008;101:1805‑11.

Alkerwi AA, Vernier C, Crichton GE, Sauvageot N, Shivappa N,

Hébert JR. Cross‑comparison of diet quality indices for

predicting chronic disease risk: Findings from the Observation of

Cardiovascular Risk Factors in Luxembourg (ORISCAV‑LUX)

study. Br J Nutr 2015;113:259‑69.

Zamora D, Gordon‑Larsen P, He K, Jacobs DR, Shikany JM,

Popkin BM. Are the 2005 Dietary Guidelines for Americans

associated with reduced risk of type 2 diabetes and

cardiometabolic risk factors?: Twenty‑year findings from the

CARDIA study. Diabetes Care 2011;34:1183‑5.

Kastorini CM, Panagiotakos DB. Dietary patterns and prevention

of type 2 diabetes: From research to clinical practice; a

systematic review. Curr Diabetes Rev 2009;5:221‑7.

Rashad AS, Sharaf MF. Economic growth and child malnutrition

in Egypt: New evidence from national demographic and health

survey. Soc Indic Res 2018;135:769‑95.

Seligman HK, Laraia BA, Kushel MB. Food insecurity is

associated with chronic disease among low‑income NHANES

participants. J Nutr 2009;140:304‑10.

Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM,

Kushel MB. Food insecurity is associated with diabetes mellitus:

Results from the National Health Examination and Nutrition

Examination Survey (NHANES) 1999–2002. J Gen Intern Med


Abdurahman AA, Chaka EE, Nedjat S, Dorosty AR,

Majdzadeh R. The association of household food insecurity with

the risk of type 2 diabetes mellitus in adults: A systematic review

and meta‑analysis. Eur J Nutr 2019;58:1341‑50.