【目的】应用中国膳食质量问卷评价糖尿病及高危人群的膳食质量，探索膳食质量与糖尿病前期和糖尿病患病的相关性，为相关人群的膳食干预提供依据。

【方法】本研究于2023年8月至2024年1月针对符合条件的糖尿病高危人群开展口服葡萄糖耐量试验（Oral Glucose Tolerance Test，OGTT）、体格测量和实验室检测，通过面对面问卷调查收集人口学特征、膳食情况等信息。使用经过本土化验证的中国膳食质量问卷（Diet  Dietary Questionnaire, DQQ）收集膳食信息，并计算全球膳食推荐（Global Diet Recommendation，GDR）评分及其子成分（NCD-Protect评分和NCD-Risk评分）和食物组充足性评分（Consumed All Five Recommended Food Groups ，All-5）。根据《中国糖尿病防治指南（2024版）》诊断标准确定人群的糖代谢状态，分为正常血糖、糖尿病前期和糖尿病。完成OGTT和中国膳食质量问卷的研究对象纳入数据分析。根据数据类型采用方差分析、Kruskal-Wallis检验和χ²检验比较组间差异，采用Bonferroni校正法进行多组间两两比较。采用Cochran-Armitage趋势检验分析不同膳食质量评分下的糖尿病前期和糖尿病患病率的分布趋势。采用多因素logistic回归分析膳食质量评分与糖尿病前期和糖尿病患病的相关性。本研究以P＜0.05为差异有统计学意义（双侧检验）。

【结果】2 469名研究对象纳入数据分析，平均年龄（45.8±6.2）岁，男性1 485人（60.2%），正常血糖、糖尿病前期和糖尿病分别为1 052人（42.6%）、908人（36.8%）和509人（20.6%）。研究对象的GDR评分为（10.8±1.9）分，NCD-Protect评分为3.0 （2.0, 4.0）分，NCD-Risk评分为1.0 （1.0, 2.0）分，All-5评分为（4.0±0.9）分，满足食物组充足性推荐的比例为34.3%。具体来看，研究对象对水果类和大豆及坚果类消费率较低，谷薯类中对全谷物和薯类的消费率较低，蔬菜类中对深色蔬菜的消费率较低，动物性食物中对禽肉、鱼和海鲜、奶及奶制品的消费率较低。不同糖代谢状态人群的GDR评分、NCD-Protect评分和All-5评分间的差异有统计学意义（P<0.05）。与正常血糖人群相比，糖尿病前期人群膳食质量评分的差异无统计学意义（P>0.05），糖尿病人群的GDR评分、NCD-Protect评分和All-5评分较低，且差异有统计学意义（P<0.05）。在调整年龄、性别、文化程度、吸烟、饮酒和身体活动水平相关协变量后，多因素logistic回归分析显示，GDR评分（OR=0.925，95% CI ：0.872~0.982）、NCD-Protect评分（OR=0.904，95% CI ：0.845~0.968）和All-5评分（OR=0.862，95% CI ：0.763~0.974）与糖尿病患病风险呈负相关，NCD-risk评分与糖尿病患病风险的相关性无统计学意义；仅发现All-5评分（OR=0.896，95% CI ：0.809~0.994）与糖尿病前期患病风险呈负相关，GDR评分、NCD-Protect评分和NCD-Risk评分与糖尿病前期患病风险的相关性无统计学意义。

【结论】本研究基于中国膳食质量问卷评估了糖尿病及高危人群的膳食质量。发现研究对象普遍未能满足食物组充足性的推荐, 对健康食物组的消费率较低。此外，还发现基于该问卷评估的膳食质量与糖尿病前期和糖尿病的患病风险呈负相关。因此，建议该人群要提高膳食多样化水平，特别要增加对健康食物组的消费，进而控制血糖水平，降低糖尿病患病风险。

Objective: Apply the China Diet Quality Questionnaire to assess dietary intake in diabetes and high-risk populations and explore the correlation between dietary quality and the prevalence of prediabetes and diabetes, to provide evidence for dietary interventions for relevant populations.

Methods: This study was conducted from August 2023 to January 2024, targeting high-risk populations for diabetes. Oral glucose tolerance tests (OGTT), physical measurements, and laboratory tests were performed, and a face-to-face questionnaire was used to collect demographic characteristics, dietary information, and other details. The dietary information was collected using the validated and localized China Dietary Quality Questionnaire, and the Global Diet Recommendation (GDR) score, along with its subcomponents (NCD-Protect score and NCD-Risk score), as well as the adequacy score for food groups (Consumed All Five Recommended Food Groups, All-5), were calculated. Glucose metabolism status was determined according to the diagnostic criteria of the "Chinese Diabetes Prevention and Treatment Guidelines (2024 Edition) " and categorized into normal glucose tolerance, prediabetes, and diabetes. Study participants who completed the OGTT and China Dietary Quality  questionnaires were included in the data analysis. Differences between groups were compared using analysis of variance, Kruskal-Wallis test, and χ² test, with Bonferroni correction applied for multiple pairwise comparisons. Cochran-Armitage trend tests were used to analyze the changes in the prevalence of prediabetes and diabetes under different dietary quality scores. Multivariable logistic regression was employed to examine the correlation between dietary quality scores and abnormal glucose metabolism. In this study, the difference was statistically significant at P<0.05 (two-sided test).

Results: A total of 2,469 study participants were included in the data analysis, with an average age of 45.8±6.2 years. Among them, 1,485 were male (60.2%), and the number of individuals with normal blood glucose, prediabetes, and diabetes were 1,052 (42.6%), 908 (36.8%), and 509 (20.6%), respectively. The GDR score for study participants was (10.8±1.9) points, the NCD-Protect score was 3.0 (2.0, 4.0) points, the NCD-Risk score was 1.0 (1.0, 2.0) points, the All-5 score was (4.0±0.9) points, and the proportion of individuals meeting the recommended food group adequacy was 34.3%. Specifically, the study participants had a lower consumption rate of fruits, soybeans, and nuts; among grains and tubers, the consumption rate of whole grains and tubers was lower; in the vegetable category, the consumption rate of dark-colored vegetables was lower; and in animal-based foods, the consumption rate of poultry, fish and seafood, as well as milk and dairy products, was lower.  There were statistically significant differences in the GDR score, NCD-Protect score, and All-5 score among populations with different glucose metabolism statuses (P < 0.05). Compared to the normal blood glucose group, there was no statistically significant difference in dietary quality scores between the prediabetic group (P>0.05). However, the diabetic group had lower GDR scores, NCD-Protect scores, and All-5 scores, with statistically significant differences (P<0.05).After adjusting for relevant covariates such as age, gender, education level, smoking, alcohol consumption, and physical activity levels, the multivariate logistic regression analysis showed that GDR score (OR=0.925, 95% CI: 0.872–0.982), NCD-Protect score (OR=0.904, 95% CI: 0.845–0.968), and All-5 score (OR=0.862, 95% CI: 0.763–0.974) were negatively correlated with the risk of diabetes, but the correlation between the NCD-risk score and the risk of diabetes was not statistically significant. It was found that only the All-5 score (OR=0.896, 95% CI: 0.809–0.994) was negatively correlated with the risk of prediabetes, while the GDR score, NCD-Protect score, and NCD-Risk score showed no statistically significant correlation with the risk of prediabetes.

Conclusion: This study assessed the dietary quality of people with diabetes and those at high risk using the Chinese Diet Quality Questionnaire. It was found that this population generally did not meet the recommended adequacy of food groups and had a low consumption rate of healthy food groups. Additionally, the dietary quality assessed by the questionnaire was negatively correlated with the risk of prediabetes and diabetes. Therefore, it is recommended that this population improve their dietary diversity, particularly by increasing the consumption of healthy food groups, in order to better control blood sugar levels and reduce the risk of diabetes.