沙特阿拉伯西南部2型糖尿病成人的饮食依从性和身体活动：一项横断面研究

摘要(中文译文)

饮食依从性和身体活动是中东和北非地区2型糖尿病（T2DM）自我管理中关键但研究不足的行为组成部分。本研究旨在量化饮食依从性和身体活动水平，探讨二者之间的关联，并识别沙特阿拉伯西南部成年T2DM患者中与这些结局独立相关的社会人口学和临床因素——该地区在文献中长期缺乏代表性。本研究在一家糖尿病专科中心开展了一项描述性横断面研究（n = 257；2023年12月至2024年3月）。研究采用感知饮食依从性问卷（PDAQ；剔除与总分相关性接近零的回避脂肪条目后，评分范围为0~56分）和全科医学身体活动问卷（GPPAQ），同时从病历中提取体质指数（BMI）和糖化血红蛋白（HbA1c）。统计分析采用Bonferroni校正的非参数双变量检验、带方差膨胀因子诊断的多元线性回归以及二元logistic回归。8条目PDAQ平均得分为20.44 ± 10.04/56（36.5%）；碳水化合物分配是主要薄弱环节（16.4%）。GPPAQ分布为：不活跃10.1%、中度不活跃28.0%、中度活跃49.0%、活跃12.8%，敏感性分析显示两个最低类别的比例为28.0%~47.5%。PDAQ与GPPAQ的相关性较弱（Spearman r = 0.18；95% CI：0.06~0.29；r² = 0.032）。仅BMI即解释了PDAQ评分变异的81.0%（横断面分析；关联方向未确定；完整模型校正R² = 0.826；留一交叉验证R² = 0.820，表明模型稳定）。就业类型与基于GPPAQ的不活跃分类呈现出最强的横断面关联（家庭主妇OR = 5.77；退休/求职者OR = 4.98，均以在职者为参照），这主要由复合评分中的职业活动成分所驱动。饮食依从性显著低于可达到的最高评分；在横断面分析中，BMI是与PDAQ评分关联最强的因素，但该关系的方向无法确定。身体活动水平与职业模式显著相关；与在职者相比，家庭主妇和退休/其他参与者被归类为不活跃或中度不活跃的比值比约高出五倍。PDAQ与GPPAQ的弱相关性（r² = 0.032）提示这两种行为并非强协同决定，并指向针对T2DM人群饮食质量和休闲时间身体活动采取各自独立、以生成假设为导向的干预方法可能具有潜在价值。

Abstract

Dietary adherence and physical activity are pivotal yet understudied behavioral components of self-management of type 2 diabetes mellitus (T2DM) in the Middle East and North Africa region. This study aimed to quantify dietary adherence and physical activity levels, examine their association, and identify sociodemographic and clinical factors independently associated with these outcomes among adults with T2DM in southwest Saudi Arabia-a region chronically underrepresented in the literature. A descriptive cross-sectional study (n = 257; December 2023-March 2024) was conducted at a specialist diabetes center. The Perceived Dietary Adherence Questionnaire (PDAQ; 0-56 after removal of the fat-avoidance item with near-zero item-total correlation) and General Practice Physical Activity Questionnaire (GPPAQ) were administered alongside body mass index (BMI) and glycated hemoglobin (HbA1c) extracted from medical records. Bonferroni-corrected non-parametric bivariate tests, multiple linear regression with variance inflation factor diagnostics, and binary logistic regression were applied. Mean 8-item PDAQ was 20.44 ± 10.04/56 (36.5%); carbohydrate spacing was the critical deficit (16.4%). GPPAQ distribution: 10.1% inactive, 28.0% moderately inactive, 49.0% moderately active, and 12.8% active, with sensitivity analysis ranging 28.0-47.5% in the two lowest categories. PDAQ-GPPAQ correlation was weak (Spearman r = 0.18; 95% CI: 0.06-0.29; r = 0.032). BMI alone accounted for 81.0% of PDAQ score variance (cross-sectional; direction of association not established; full model Adj. R = 0.826; LOO-CV R = 0.820, indicating model stability). Employment type showed the strongest cross-sectional association with GPPAQ-derived inactivity classification (housewife OR = 5.77; retired/seeking OR = 4.98 vs. employed), largely driven by the occupational component of the composite score. Dietary adherence was substantially below the maximum achievable score; BMI was the factor most strongly associated with PDAQ scores in cross-sectional analysis, though the direction of this relationship cannot be established. Physical activity levels were substantially associated with occupational patterns; housewives and retired/other participants faced approximately five-fold greater odds of being classified as inactive or moderately inactive compared with employed individuals. The weak PDAQ-GPPAQ correlation (r = 0.032) suggests these behaviors are not strongly co-determined and points to the potential value of distinct, hypothesis-generating intervention approaches for dietary quality and leisure-time physical activity in T2DM populations.

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