Unpacking the Links: How Lifestyle and Sociodemographics Influence Diabetes Risk Among Overweight Turkish Adults

The results of this research suggest that most participants fall into a mild risk category for diabetes. Influencing elements such as low educational attainment, marital status, employment, smoking habits, and the existence of comorbid conditions were found to heighten the likelihood of developing T2DM. Furthermore, a deterioration in dietary quality appeared as another notable factor contributing to the raised risk of T2DM.

The development of T2DM is shaped by various demographic and lifestyle elements, including age, gender, ethnic identity, family medical history, low socioeconomic standing, obesity, hypertension, smoking, dietary habits, and sedentary behavior [26,27,28,29]. Research in Turkey has indicated that diabetes risk factors are consistent with those identified in earlier studies conducted elsewhere. The TURDEP-II study revealed that elevated diabetes risk was related to age, waist circumference, BMI, less than eight years of education, and hypertension, whereas smoking was uniquely linked to a diminished risk in females. For males, higher age, BMI, and hypertension correlated with a greater risk, while being unmarried was associated with a lower risk [15]. In parallel, Çevik et al. [13] pinpointed advancing age, low education, familial history, inactivity, obesity, escalation in waist circumference, heart diseases, and hypertension as main risk elements for diabetes. Conversely, Cosansu et al. [30] determined that marital status had no effect on diabetes risk. In accordance with these results, this study also recognized low education, marriage, employment, smoking, and comorbidities as critical factors elevating the risk of developing T2DM.

Besides demographic factors, eating patterns significantly influence T2DM risk since they are modifiable lifestyle components. Following a nutritious diet, such as the Mediterranean diet, DASH diet, diets low on the glycemic index, and low-calorie, low-fat diets, while minimizing the consumption of red meats, processed meats, and sugary beverages, has been associated with a reduced likelihood of developing T2DM [31]. Research within the Turkish population demonstrated that 37.5% of university students and 61% of working adults were at risk for diabetes, with a substantial number consuming high-sugar drinks daily (62% and 54.7%, respectively) [32]. Additionally, another study indicated that unhealthy dietary patterns were linked to an elevated diabetes risk [33], whereas increased fruit and vegetable intake contributed to a reduction in this risk [34]. However, investigations concerning diet and diabetes risk in Turkey have largely focused on university students, with insufficient representation from the larger population segments.

The HEI-2015, a measure of dietary quality, has been linked with a decreased risk of T2DM and other chronic diseases [9, 35]. However, findings regarding the connection between dietary quality and T2DM development are inconsistent. A six-year prospective follow-up examination indicated no significant effect of adhering to the HEI-2015 on T2DM risk [36]. In Turkey, research analyzing the link between diet quality and diabetes risk remains limited. A recent investigation among adult females found no variation in diet quality scores concerning diabetes risk classification [12]. In this study, the HEI-2015 did not exhibit a significant association with the FINDRISC score; however, when evaluated alongside certain demographic characteristics and lifestyle habits, a decrease in diet quality was noted to elevate the likelihood of T2DM (see Table 4). These observations imply that while diet quality by itself might not serve as a direct predictor of diabetes risk, its interplay with other factors, such as sociodemographic characteristics and lifestyle habits, may considerably influence T2DM risk.

Moreover, the exploration of the connection between HEI-2015 components and diabetes risk unveiled a marginal, yet statistically meaningful, negative correlation between diabetes risk and scores for dietary sodium and fatty acids. In this exploration, despite most participants presenting low diet quality, the negative association observed between sodium intake and diabetes risk could be linked to the heightened presence of individuals with hypertension and diabetes risk, which may lead to heightened attention to salt consumption.

Literature suggests that consumption of monounsaturated and polyunsaturated fatty acids might avert the onset of prediabetes and T2DM [37]. A five-year follow-up research in Japan involving 19,088 participants noted a negative relationship between MUFA and PUFA intake and T2DM [38]. In this study, the inverse correlation between the fatty acid score and diabetes risk indicates that increasing dietary unsaturated fatty acid intake may mitigate diabetes risk, corroborating prior studies’ findings.

A possible limitation of this research is that body weight and height measurements were based on self-reporting, which may introduce inaccuracies. Additionally, the FINDRISC serves as a non-invasive screening tool, which, while valuable for pinpointing at-risk individuals, may not encompass all risk factors for T2DM. Furthermore, although the 24-hour recall approach is advantageous for evaluating dietary intake, it may not completely reflect typical eating patterns and could be affected by recall bias. Another limitation is the lack of a non-obese control group, which might have provided extra insights into comparing diabetes risk factors between obese and non-obese individuals. Additionally, social desirability bias could have influenced self-reported lifestyle variables, and the absence of income data is another shortcoming, as it could be a vital factor in comprehending diabetes risk. A notable strength of this research is its substantial sample size, enhancing the credibility of the findings. Moreover, this represents one of the few studies within the Turkish population that investigates the relationship among sociodemographic characteristics, lifestyle factors, and diet quality concerning diabetes risk in overweight and obese adults.

In summary, a marked rise in diabetes risk was noted with reduced education levels and among married individuals, as well as in lifestyle and health-related aspects such as smoking, the presence of comorbidities, and low dietary quality among overweight and obese Turkish adults. It can be particularly affirmed that unsaturated fatty acids might confer a protective effect against the onset of diabetes; however, further inquiries are required for more conclusive outcomes. Overall, these findings highlight that sociodemographic aspects, lifestyle choices, and diet quality greatly contribute to the heightened risk of diabetes in overweight and obese individuals. Promoting healthy lifestyle practices may serve as an efficacious strategy for diabetes prevention in Turkish overweight and obese adults.