Dysfunctional Eating Behaviors and Adiposity Markers Among Adults with Prediabetes and Type 2 Diabetes in Puerto Rico Restricted; Files Only
Parra Pulgarin, Salma (Spring 2025)
Abstract
Introduction: Dysfunctional eating behaviors—including emotional eating (EE), uncontrolled eating (UE), and cognitive restraint (CR)—have increasingly emerged as modifiable risk factors for type 2 diabetes (T2D) and other cardiometabolic conditions. These behaviors are linked to increased adiposity and elevated cardiovascular disease risk. Research on these behaviors in Latinx adults with prediabetes and T2D, especially in Puerto Rico (PR), remains limited despite pronounced disparities. This study examines the associations between EE, UE, and CR and markers of adiposity—body mass index (BMI) and waist circumference (WC)—and explores sex as a potential effect modifier in adults with prediabetes and T2D in PR.
Methods: Data from 810 participants with prediabetes or T2D were obtained from baseline interviews from the PROSPECT study. EE, UE, and CR were assessed using the Three-Factor Eating Questionnaire (TFEQ-R18 V2) and categorized as no/moderate/high. Multivariable linear regression examined associations between each dysfunctional eating behavior (EE, UE, and CR) and adiposity markers, BMI and WC, adjusting for demographic, psychosocial, behavioral, and clinical factors. Effect modification by sex was also tested.
Results: Higher levels of EE and CR were significantly associated with greater adiposity. In adjusted models, moderate and high EE were associated with higher BMI (β = 1.5, 95% CI: 0.4, 2.7; β = 1.6, 95% CI: 0.4, 2.9, respectively) and waist circumference (WC) (β = 2.9, 95% CI: 0.2, 5.5; β = 3.3, 95% CI: 0.5, 6.1, respectively) compared to no EE. Moderate CR was also associated with a higher BMI (β = 1.6, 95% CI: 0.3, 3.0). UE was not associated with BMI or WC after adjustment. No significant interactions by sex were observed.
Conclusion: In a sample of adults residing in PR with prediabetes and T2D, specific dysfunctional eating behaviors, particularly EE and CR, were associated with greater adiposity, while UE showed no association. Longitudinal research is needed to confirm these findings and identify opportunities for intervention.
Table of Contents
TABLE OF CONTENTS
CHAPTER I: BACKGROUND 1
LITERATURE REVIEW 1
Type 2 Diabetes in U.S. Hispanic/Latinxs 1
Prediabetes, Type 2 Diabetes, and Cardiovascular Disease in Puerto Rico 2
Dysfunctional Eating Behaviors 3
Adiposity Markers: Body Mass Index and Waist Circumference 5
Dysfunctional Eating Behaviors and Adiposity 6
Sex Differences in Eating Behaviors and Cardiometabolic Health 8
Addressing the Research Gap: The Present Study 10
CHAPTER II: MANUSCRIPT 11
INTRODUCTION 11
METHODS 13
Study Design and Population 13
Dysfunctional Eating Behaviors 15
Adiposity 16
Covariates 16
Statistical Analyses 18
RESULTS 19
Sample Characteristics 19
Bivariate Analysis 20
Multivariable Analysis 21
Interaction by Sex 22
DISCUSSION 22
CHAPTER III. IMPLICATIONS FOR PRACTICE, POLICY, AND RESEARCH 28
PUBLIC HEALTH IMPLICATIONS 28
Behavioral Health Interventions 28
Clinical Applications 30
Health Policy Considerations 30
Future Research Directions 31
REFERENCES 33
TABLES 42
Table 1. 42
Table 2. 44
Table 3. 45
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File download under embargo until 15 May 2027 | 2025-04-24 20:27:39 -0400 | File download under embargo until 15 May 2027 |
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