{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T07:41:59Z","timestamp":1761550919280,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T00:00:00Z","timestamp":1761436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Taiwanese Association of Diabetes Educators","award":["TADE-17-S-019-1"],"award-info":[{"award-number":["TADE-17-S-019-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Aims: To examine the association between the total dietary quality score (TDQS) and metabolic outcomes among adults with type 2 diabetes (T2DM) in Taiwan. Methods: This cross-sectional study enrolled 981 adults with T2DM from 40 diabetes health promotion institutions (DHIPs). Registered dietitians assessed dietary behavior adherence (DBA) and dietary portion adherence (DPA) using a validated dietary quality questionnaire, which were combined into a TDQS. Participants were categorized into tertiles: G1 (\u2264106.7), G2 (106.8\u2013118.7), and G3 (\u2265118.8). Associations with metabolic outcomes were analyzed using ANOVA, logistic, and multiple linear regression. Results: Participants in the highest TDQS tertile (G3) had significantly lower BMI, waist circumference (WC), fasting blood glucose (FBG), HbA1c, total cholesterol, and triglyceride levels, and a higher proportion achieved HbA1c &lt; 7%. Compared with lower tertiles, G3 participants consumed more vegetables and derived a greater proportion of total energy from protein, whereas participants with a lower TDQS reported higher total energy and fat intakes. Each 1-point increase in TDQS was independently associated with reductions in WC (\u22120.155 cm), BMI (\u22120.151 kg\/m2), FBG (\u22120.106 mg\/dL), HbA1c (\u22120.136%), total cholesterol (\u22120.076 mg\/dL), and triglyceride levels (\u22120.148 mg\/dL). Conclusions: Higher TDQS is significantly associated with improved metabolic outcomes in adults with T2DM, supporting its use as a practical, multidimensional tool for clinical nutrition assessment and personalized dietary intervention.<\/jats:p>","DOI":"10.3390\/nu17213366","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T07:31:58Z","timestamp":1761550318000},"page":"3366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Total Dietary Quality Score, Dietary Behavior Adherence, and Dietary Portion Adherence with Metabolic Factors Among People with Type 2 Diabetes Mellitus"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5440-0382","authenticated-orcid":false,"given":"Pi-Hui","family":"Hsu","sequence":"first","affiliation":[{"name":"Ancare Nursing Home, Taitung City 950024, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9134-7653","authenticated-orcid":false,"given":"Ming-Chieh","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Division of Endocrinology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 104217, Taiwan"},{"name":"Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City 100225, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiao-Ya","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 104217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6742-3935","authenticated-orcid":false,"given":"Chih-Yuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City 100225, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Hospital, Chang Gung University College of Medicine, Kaohsiung City 833401, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1202-7409","authenticated-orcid":false,"given":"Shih-Te","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua City 500006, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horng-Yih","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 704302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Chuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Division of Endocrinology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 104217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,26]]},"reference":[{"key":"ref_1","unstructured":"International Diabetes Federation (2025). 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