Investigating dietary quality among South Africans aged 15 years and over by diabetes status using demographic and health survey data

The 2016 South African Demographic and Health Survey (SADHS) estimated that 11.7% of individuals aged 15 years and older had poor glycaemic control, despite only 4.7% reporting a previous diabetes diagnosis. Entrenched socioeconomic inequalities may present barriers to maintaining a healthy diet, a key factor in diabetes management. Using 2016 SADHS data, this study investigated whether dietary choices differ by diabetes status, defined by previous diagnosis and HbA1c levels, and whether the diet of people living with diabetes (PLWD) varies according to key sociodemographic factors. Reporting of fruit, vegetables, sugar-sweetened beverages, fruit juice, and fast-food consumption was used to construct a dietary quality index. Ordered logistic regression models were employed to examine the effects of diabetes status and sociodemographic variables on diet. Concurrent low fruit and vegetable consumption was common among both the general population and PLWD. In the general population, previous diabetes diagnosis, age ≥55 years, non-Black African population group, and high wealth quintile were significantly associated with higher odds of a healthier diet. Among PLWD, high wealth remained significantly associated with a healthier diet, while female gender and having health insurance also became significant predictors of healthier dietary patterns. Future dietary-related public health interventions should focus on improving access to fruits and vegetables for younger, Black, and socioeconomically disadvantaged populations, regardless of diabetes status. Key words: Type 2 diabetes, diet, fruit and vegetables, sub-Saharan Africa.