Assessment of Dietary Behavior as a Risk Factor for Obesity, Diabetes and Cardiovascular Disease in a Group of Patients in Arges County

ROȘESCU Ruxandra1*, TARCEA Monica2

1Emergency Clinical Hospital for Children, Cluj-Napoca, Romania

2Department of Community Nutrition and Food Safety, University of Medicine, Pharmacy, Science and Technology from Targu-Mures, Romania


Introduction: The lifestyle represents a group of beliefs and habits practiced by the citizens of a region, which have considerable consequences on life quality and healthy status. Diet plays an important role in maintaining a balanced lifestyle, with a normal weight and a good quality of life. The aim of this study was to analyze dietary behavior among a target group from Curtea de Arges city and to identify the relationship between eating habits and gender, residence, body mass index, and risk profile for developing diabetes mellitus or cardiovascular diseases.

Methods: This pilot study included 95 adult subjects, with ages between 18 and 78 years old, from Curtea de Arges city, Argeș County, without diabetes mellitus, which were questioned with the occasion of the clinical examination in the family doctor’s office during May-June 2019. There were collected demographics data, information about the medical history, and anthropometric measures. All participants completed a questionnaire about diet and lifestyle. The FINDRISC (The Finnish Diabetes Risk Score) was used to estimate the risk for mellitus diabetes. 

Results: There was a statistically significant positive correlation between the FINDRISC and body mass index (p < 0.0001). Most subjects had an omnivorous diet. There were statistically significant association between the consumption of vegetables and the FINDRISC (p=0.0133), the consumption of vitamins and body mass index (p=0.0307), respectively, the consumption of fat and the medical history related to risk for cardiovascular diseases (p=0.0379).

Conclusions: The higher body mass index, the higher the risk of developing type 2 diabetes mellitus in the next 10 years. Eating behaviors has a considerable role in maintaining the health status, and it is necessary to give greater interest to the study of eating habits. This profile allows us for more targeted and effective community education measures.

Keywords: lifestyle, eating behaviors, FINDRISC, type 2 diabetes mellitus, body mass index, obesity, cardiovascular diseases


According to the World Health Organization, health is defined as physical, mental and social well-being, not just the absence of disease or infirmity. Lifestyle represents a set of values, habits and daily practices that considerably influence the health status. Unhealthy eating habits, as well as other unhealthy habits (for example: sedentary lifestyle, excessive alcohol consumption, smoking) are associated with increased risk of developing cardiovascular disease and diabetes [1,2]. Multiple behavioral changes in health prevent mortality and morbidity and improve the quality of life of patients. It is recommended to approach measures to prevent various diseases by methods of health education and to change bad habits of lifestyle [3].

The subject of this study derived from the need to know as much as possible the target group we are addressing in order to allow the promotion of a healthy lifestyle in an individualized way, respectively, so that health education measures can be effective in the target population. Thus, the objectives of this research are to analyze the eating habits of a certain population and to identify whether or not they are associated with the risk of developing diabetes, overweight or obesity, respectively, with the presence of cardiovascular diseases.


This pilot study included a group of adult patients from Arges county in the Central South of Romania, who were questioned during the routine presentation at the family doctor’s office, between May and June 2019. The inclusion criteria were adults patients, over 18 years old, with no diagnosis for diabetes or cardiovascular diseases. For data collection we obtained the approval of the family doctor and the consent of the patients to the Informed Consent included in the questionnaires.

To identify dietary preferences and habits we used a survey of 38 questions related to the consumption of the main food groups, alcohol and tobacco consumption, stress, rest time and physical activity, family and personal medical history. Regarding the diet, the main questions were: “What kind of diet do you have?”, “How many servings of cereals do you consume in a day?”, “What kind of bread do you eat?”, “How many servings of fruit do you eat?”, “How many servings of vegetables do you eat?”, “How do you prefer to eat vegetables / fruits?”, “How often do you consume soy?”, “How often do you consume nuts / seeds?”, “How often do you eat eggs?”, “How often do you consume milk?”, “How often do you eat meat dishes?”, “How often do you consume sweets?”, “What types of fat do you consume?”, “What are your habits related to salt consumption?”, “What are your habits related to the consumption of irritating spices?”, “Are you having breakfast?”, “Do you eat food between main meals?”, “Do you consume vitamins?”.

Gender, age and residence data were collected from all participants. Weight and height were also measured. We calculated the body mass index (BMI) using the formula weight / height2 (kg/cm2) and interpreted the results as follows: underweight (under 18.49 kg/cm2), normal weight (18.50-24.99 kg/cm2), overweight (25.00–29.99 kg/cm2), obesity (over 30 kg/cm2) [4,5].

We calculated the risk of developing type 2 diabetes mellitus (T2DM) over the next 10 years using the Finnish Diabetes Risk Score (FINDRISC score), which sums up the answers to questions related to age, BMI, waist circumference, personal history of hyperglycemia, family history of type 1 and 2 diabetes, frequency of daily intake of vegetables and fruits, daily physical activity, frequency of administration of antihypertensive drugs. The risk of developing T2DM in the next 10 years is low if the score is below 7, slightly high between 7–11, moderate between 12–14 and high between 15-20. The FINDRISC has been validated in several studies both in original form and in simplified formula [6-10].

We used Excel and GraphPad InStat (Version 3.06) statistical software for data processing and statistical analysis. We performed a descriptive statistic for quantitative variables (the FINDRISC, BMI). They passed the normality test and we calculated the mean and the standard deviation (SD).  Being paired, we used the Pearson test to analyze whether the FINDRISC and BMI correlate statistically significantly. Regarding the qualitative variables (answers to the questions in the questionnaire) we applied 2×2 contingency tables, respectively, extended Chi2 test. We performed the statistical interpretation considering the statistical significance threshold p < 0.05.


In this study there were included 95 patients with age between 18 to 78 years old, 62.11% were females and 56.84% from urban areas.  The FINDRISC and BMI data are presented in figures 1 and 2.

Fig. 1. Distribution of the patients by Body Mass Index

Fig. 2. Distribution of the patients by the FINDRISC score

We analyzed the relationship between the FINDRISC and BMI in Figure 5. There is a statistically significant positive correlation between the two variables (p < 0.0001). The higher the BMI, the higher the risk of developing T2DM in the next 10 years.

Regarding diet, we analyzed whether there are associations between dietary preferences and habits and the FINDRISC, BMI, presence of cardiovascular diseases, respectively, gender and residence. Over 97% of our patients are omnivorous, and the rest have an ovo-lacto-vegetarian food style. The diet is not statistically significantly associated with any of the above variables.

Regarding the consumption of cereals, the study showed that more than half of the patients do not consume them at all. Subjects living in the city consume more cereals than rural residents, the difference being statistically significant (p=0.0164). White bread is the top preference, followed by whole and intermediate bread, with no statistically significant differences between the groups of patients (p > 0.05).

Fig. 3. Correlation between the FINDRISC and body mass index

We did not record statistically significant differences between the groups of patients and the consumption of fruits, vegetables and legumes, except for a significant association between the FINDRISC and the consumption of vegetables. More than half of the patients consume vegetables daily, a third 2-3 times a week and a lower percentage consumes vegetables rarely or not at all. Patients who consume vegetables daily or weekly have lower values of the FINDRISC compared to those who consume vegetables less often or not at all (p =0.0133).

Regarding soy consumption, women occasionally consume soy in a higher percentage than men, the difference being statistically significant (p=0.0086). Apart from this, there are no statistically significant differences according to residence, BMI, the FINDRISC or medical history of cardiovascular diseases, but it was observed that most do not consume soy at all. The same thing we noticed about the intake of nuts or seeds.

Rural residents consume one or more eggs per day in a higher percentage than those in cities, the latter consuming 2-3 eggs per week, the difference being statistically significant (p<0.0001). Most participants consume 2-3 eggs per week, and men consume more eggs than women (p=0.0459). As for milk, the majority consume 2-3 servings of milk weekly, with no statistically significant difference between subjects (p>0.05). There are statistically significant differences between the living environment and meat consumption, those from rural areas consuming more meat at each meal, daily compared to those from urban areas, who consume meat daily or at 2-3 days (p = 0.0239).

As for fats, most prefer vegetable oil, followed by butter and lard, without noticing association with gender, BMI and the FINDRISC. On the other hand, we found that in the rural area more butter, lard or bacon is cosnsumed than vegetable oils, while in the urban area both products are consumed almost to the same extent (p=0.0467). Patients with cardiovascular disease consume more fat than those without cardiac pathology (p=0.0379). Salt is consumed in a balanced way and 80% of patients avoid irritating spices (p>0.05).

The consumption of sweets is higher in urban versus rural areas, the difference being statistically significant (0.0139). Overweight patients take vitamins occasionally or periodically in greater numbers than other weight categories, while subjects with normal weight or obesity consume vitamins rarely or never and in smaller numbers occasionally or more frequently (p=0.0307). Those in urban areas consume vitamins rarely or never in greater numbers than those in rural areas who consume more frequently vitamins.

With regard to the food schedule, there are no differences in the frequency of breakfast and food consumption between the basic meals (p>0.05). Most do not eat between main meals or it happens rarely and occasionally, and 70% of patients eat breakfast daily or almost daily.

Discussions and conclusions

In our study we observed that there are statistically significant positive correlations between BMI and the FINDRISC. The higher a patient has a BMI, the higher the risk of developing T2DM in the next 10 years. In a study carried out on 263 patients without diabetes who were counseled on a healthy lifestyle for about 10 months and then that was followed the next 3 years, the Gilis-Januszewska et al. have shown that the weight loss after a whole year of lifestyle changes, as well as the keeping the healthy habits has led to a decrease in the risk of developing diabetes [11]. Another study (Ishaque A et al.) reinforces the idea of the importance of maintaining weight and waist circumference within normal limits, daily consumption of vegetables and fruits, as well as physical activity more than 30 minutes daily to reduce the risk of developing diabetes [12]. Overweight and physical inactivity are risk factors for developing diabetes. Therefore, changing the lifestyle and especially the compliance of healthy habits from an early age plays an important role in decreasing the risk of developing T2DM [13].

Regarding unhealthy eating behavior, we did not notice very many significant associations between diet and BMI, FINDRISC, medical history of cardiovascular disease, gender and provenance, but we came to some relevant conclusions related to the participants’ diet. Most of the subjects in the study adopt an omnivorous food style, with higher consumption of cereals in the urban environment. Daily consumption of vegetables is associated with a low or slightly high risk of developing T2DM in the next 10 years. Women consume soybeans occasionally compared to men who consume soybeans rarely or not at all. Concerning animal products, rural residents consume eggs and meat more frequently than those in urban areas. As for fats, vegetable oil, butter and lard are preferred. The salt is consumed in a balanced way among the patients in this study, and the irritating spices are avoided by the majority. Sweets are consumed more frequently in urban areas than in rural areas. Regarding the food schedule, most patients have breakfast daily and a smaller number of subjects consume food between main meals.

Satija et al. demonstrated in a large cohort study that a plant-rich diet with healthy foods is associated with lower cardiovascular risk while unhealthy eating leads to increased cardiovascular risk [14]. A diet rich in fruits, legumes, especially fresh and unprepared vegetables is associated with the reduction of non-cardiovascular risk and total mortality, and for this effect is recommended a daily consumption of 350-500g or the equivalent of 3-4 servings per day [15].

Djousse L et al. showed in a prospective study conducted on 3898 adults that egg consumption is not associated with the risk of developing diabetes, low egg consumption does not lead to significant clinical differences in fasting glycaemia and fasting insulin [16]. Similarly, a meta-analysis conducted on 22 independent cohorts from 16 studies published until 2012 suggested that there is no association between egg consumption and a higher risk of cardiovascular disease, ischemic heart disease, stroke, and increased risk of mortality. Instead, they observed a potential possibility that those who consume one egg a day have a higher risk of developing diabetes compared to those who do not eat eggs at all, and the risk of cardiovascular disease is higher in patients who consume eggs only if they have diabetes [17]. Another meta-analysis performed on two adult cohorts showed the consumption of eggs (on average 3 eggs per week) does not influence the risk of diabetes, cardiovascular disease and all causes of mortality in healthy men, instead, is associated with the risk of stroke and increased blood glucose in patients with impaired glucose tolerance or T2DM [18]. On the other hand, meat consumption is independently associated with the risk of developing diabetes, as shown by Sabate et al in their study of 55,851 subjects without diabetes [19].

Zhu Y et al. found in a meta-analysis performed on cohort studies that the risk of cardiovascular disease is associated with polyunsaturated fatty acids, but not with the consumption of total fats, saturated and polyunsaturated fatty acids [20]. Limiting the intake of refined carbohydrates, in addition to reducing excess adiposity contributes to lowering the risk of cardiovascular diseases, this being observed from the differentiated effects of dietary fats and carbohydrates towards particles of low density lipoproteins [21].

The results of this study proved the importance of knowing the target groups according to personal factors, such as gender, residence, BMI, FINDRISC profile and presence of cardiovascular diseases. This allows a better adaptation of primary medicine to promote a healthy lifestyle in the most effective way and to optimize the integration of healthy principles and habits in daily life. Conducting such studies on larger groups of participants could bring more results in this regard.


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