Diabetes and pre-diabetes are rising health concerns in urban India, influenced by lifestyle changes and dietary patterns. This study aims to assess food consumption and lifestyle profiles of pre-diabetic and Type 2 diabetic adults in Bhubaneswar City, Odisha, to identify contributing factors for preventive measures. A cross-sectional study of 100 adults (aged 35-55 years, 50 from each gender) was conducted to collect data on dietary intake, physical activity, and lifestyle habits.  Semi structured questionnaires and 24-hour dietary recalls were used for date collection. Findings showed high consumption of refined carbohydrates, processed foods, and low fiber intake. A significant association between fast food consumption, physical activity, and both fasting and postprandial blood sugar levels was observed. The study concludes that adopting healthier diets and active lifestyles is critical for diabetes prevention. Public health efforts should focus on dietary education and lifestyle modification for effective intervention.

Type 2 Diabetes Mellitus, Lifestyle Choices, Dietary Habits, Hyperglycemia.

Type 2 Diabetes Mellitus (T2DM) is a significant global health issue affecting adults around the world. Currently, approximately one in ten adults aged 20 to 79 is affected by diabetes. According to the International Diabetes Federation, the number of people living with diabetes was about 537 million in 2021 and is projected to rise to 643 million by 2030 and 783 million by 2045. The majority of these cases are found in low- and middle-income countries, where an estimated 69% of all diabetes cases are expected to occur by 2030. In 2021 alone, diabetes was linked to approximately 6.7 million deaths.

Diabetes is a multifaceted metabolic disorder marked by high blood sugar levels, resulting from a combination of genetic predispositions and environmental factors (Ojo, 2019). T2DM risk factors range from non-modifiable factors, such as age, genetics, and ethnicity, to lifestyle factors, such as high-calorie diets and reduced physical activity. Urbanization and economic development have also contributed to unhealthy lifestyle changes, such as poor dietary habits and physical inactivity, which drive the growing incidence of obesity-a primary factor in the rapid increase of T2DM cases (Hu et al., 2011; Schwingshackl et al., 2017). 

Given the significant economic and health impacts of T2DM, its prevention and management have become global priorities (Ley et al., 2014). Research has shown that certain foods are closely associated with T2DM risk, though these relationships are complex because individuals typically consume mixed diets rather than isolated foods. For this reason, studying dietary patterns provides valuable insights into the nutritional factors linked to diabetes risk and can help improve blood glucose regulation.

Thus, this study aims to assess physical activity levels, dietary patterns, and intake among individuals with pre diabetic and T2DM, as well as to evaluate influence of these factors on the blood glucose levels.

Study Design: The present study is a cross-sectional study conducted at different locations of Bhubaneswar, Odisha.

Study Population: Adults (both male and female) aged 35 to 55 years were included as respondents in this study.

Inclusion criteria

1. Adults with a blood sugar level above 100 mg/dL.

2. Individuals diagnosed with Type 2 Diabetes for more than six months.  

3. Individuals aged 35 to 55 years.  

Exclusion criteria 

1. Individuals with Type 1 diabetes.

2. Patients with gestational diabetes (pregnant women).

3. Individuals not within the age range of 35-55 years.

Sampling Method. The city of Bhubaneswar, Odisha, was purposefully selected as the study location due to its diverse population and the availability of healthcare facilities, which aids in accessing individuals with varying blood sugar levels and diabetes status. 

A simple random sampling technique was employed to select 100 (50 male and 50 female) number of representative adults aged 35 to 55 years with blood sugar level more than 100 mg/dL from different healthcare centers and local clinics within the city. 

Data Collection Tools and procedure. The respondents were interviewed by a pretested semi structured questionnaire to collect information regarding food consumption pattern and lifestyle including physical activity and stress related variables. Food frequency questionnaires (FFQ) and 24-hour dietary recall was used to record the food intake of the respondents and nutrient intake was calculated with the help of food composition table (Gopalan, 1989).

Fasting blood sugar and postprandial blood sugar level was recorded from the recent medical report of the respondents.

Data Analysis. The collected data were analyzed through by using SPSS software. Percentage, mean, standard deviation and chi square tests were used to interpret the data.

Diet plays a crucial role in regulating metabolism and body weight, making it essential for the management and prevention of Type 2 Diabetes Mellitus (T2DM) [American Diabetes Association Standards of Medical Care in Diabetes (2019)]. As shown in Table 1, the food habits and dietary practices of the respondents were analyzed. 
Table 1: Distribution of respondents according to Dietary behavior (N=100).

The majority of respondents identified as non-vegetarian, which aligns with the study conducted among rural diabetic adults of Mysur (Nishchitha et al., 2021). Notably, food allergies were not commonly reported among the respondents, and fast food consumption was relatively low, with only 18-22% expressing a preference for it. In a related study among Diabetic Patients at the Bono Regional Hospital, Ghana, it was found that found that 32% of respondents consumed fast food one to three times a week (Dawudaa et al., 2023).

The analysis of food consumption patterns revealed that a larger proportion of male respondents consumed whole vegetables (42%) and whole fruits (58%) compared to female respondents. In contrast, processed fruit consumption was higher among females (52%). Additionally, female respondents were more likely to consume fruit in the form of juice and squash (60%) than males. Whole dal was consumed by 22-26% of the respondents, while parboiled rice was preferred by more than 60%, compared to only 37% who opted for raw rice. 

In terms of dairy consumption, whole milk was favored by 44% of female respondents, whereas 34% of males preferred it. Only 18% chose skim milk. This is in contrast with a study conducted in Deoria, Uttar Pradesh, which found that 26% of respondents consumed full-cream milk, 53% skim milk, and 21% did not drink any milk (Anand et al., 2020). Additionally, the study highlighted that most respondents did not use whole wheat flour. 
Refined oil was the preferred choice for 70% of female respondents, while less than 40% of males favored it. Mustard oil was selected by only 14% of females and 22% of males.
Table 2: Distribution of respondents according to Frequency of consumption of food stuffs.

The frequency of food consumption among respondents is detailed in Table 2. Cereals and pulses were identified as staple foods, consistently consumed by all participants. Similar finding was also observed among type 2 diabetes in rural area of Mysuru. An average daily intake of 307.11 grams of cereals and 32 grams of pulses was observed (Nishchitha et al., 2021).
Fruits were primarily consumed twice a week by 44% of female respondents and 34% of male respondents. Daily consumption was noted in 32% of male and 16% of female respondents, while 28% of males and 12% of females consumed fruits fortnightly. Less than 10% of both sexes reported eating fruits once a week. A similar pattern was observed for green leafy vegetables, with over 30% consuming them twice a week. Daily consumption was reported by 32% of males and 16% of females, while around 20% consumed them either fortnightly or weekly.
In terms of other vegetables, a majority of male respondents (78%) and 58% of female respondents consumed them daily, with over 20% eating them twice a week. A small percentage (about 11%) consumed other vegetables once a week. Approximately half of the female respondents and slightly fewer males consumed roots and tubers regularly, while 10-24% consumed them weekly, twice a week, or fortnightly.
Animal protein sources were consumed less frequently, with eggs being the most common; only 4% of respondents consumed them daily, while more than 40% had them twice a week. Weekly consumption of eggs was reported by 28% of males and 30% of females, with less than 20% eating them fortnightly. More than half of the respondents consumed poultry weekly, with 14-20% consuming it twice a week or fortnightly. Fish consumption was reported weekly by over half of the females, while 46% of males consumed it twice a week, with fewer than 10% eating it fortnightly.
Other meats were typically consumed fortnightly by half of the respondents, and slightly more than 30% consumed them weekly. Tea and coffee were regular habits for the majority, while over 30% consumed milk and dairy products daily and around 40% twice a week. More than 25% consumed sugar and jaggery fortnightly, with fewer than 20% eating them weekly. Nuts and oilseeds were consumed fortnightly by 18% of females and 28% of males.
The study recorded that only 3.1% reported daily fruit consumption, with 2.6% eating fruits weekly and 23.7% monthly. Rural diabetic adults of Mysuru were observed to consume green leafy vegetables and other vegetables weekly (Nishchitha et al., 2021). A negligible number of respondents consumed eggs daily, and 7.3% did so once a month. Fish was eaten monthly by 27.9% of participants, while beef and poultry were consumed weekly by 78.4%.
Research findings highlighted that fruit and vegetable consumption correlated with body mass, with normal weight diabetic patients consuming a higher average (492.74 g/day) than overweight and obese diabetics (Laissaoui and Allem 2016). Weekly consumption of meat, fish, and eggs (MFE) was relatively low among normal weight diabetics compared to their overweight counterparts, with no significant difference (P > 0.05).
Additionally, it was noted that 67% of female and 73% of male respondents consumed chicken and red meat more than twice a week, while over 70% regularly ate lentils. In another study, consumption of fried foods and excessive saturated fats was reported by 18% and 21% of respondents, respectively (Rashid et al., 2023).

Table 3:  Distribution of respondents according to Nutrient intake (N=100).

Higher diet quality is linked to a reduced risk of Type 2 Diabetes Mellitus (T2DM) (Fung et al., 2021) and better glucose control (Antonio et al., 2019). Additionally, a nutritious diet is associated with various metabolic biomarkers and risk factors in individuals with T2DM. In contrast, lower diet quality is correlated with increased risks of hyperglycemia, dyslipidemia, and excess weight among adults with T2DM (Sanjeevi et al., 2023). 

To assess dietary quality, nutrient intake was evaluated and presented in Table 3. The mean intake of calories, carbohydrates, fat, and Vitamin A exceeded reference values among the respondents, while intake of all other nutrients fell below the recommended levels. Male respondents consumed slightly more calories than the Recommended Dietary Allowance (RDA), whereas female respondents showed a larger deficit. Both male and female respondents had fiber and calcium intakes significantly below the reference values. Interestingly, while male respondents had a Vitamin A intake lower than the recommended level, female respondents exceeded it.

Low fiber intake among respondents was also reported among diabetic Patients at Sunyani, Ghana (Dawudaa et al., 2023). Similarly, Thewjitcharoen et al. (2018) noted that their participants had low intakes of saturated fat (<10% of total energy), free sugars (≤5% of total energy), and fiber (≥14 grams per 1000 kcal).  

Table 4: Distribution of respondents according to life style practices (N=100).

Unhealthy lifestyle behaviors are a significant risk factor in the development of Type 2 Diabetes Mellitus (T2DM). Various lifestyle factors, including physical activity, sleep patterns, stress, and addiction behaviors, were analyzed and are presented in Table 4. 

A higher percentage of male respondents (58%) reported engaging in regular exercise, primarily walking and yoga, compared to less than 40% of female respondents. Only 4% of male respondents practiced swimming.

The World Health Organization recommends at least 150 minutes of moderate-intensity aerobic activity each week, such as jogging, swimming, cycling, or brisk walking, along with flexibility, balance, and strength exercises at least two to three times a week [World Health Organization. Global Recommendations on physical activity for health, (2010). In a study it was found that 69% of participants never exercised, while only 14% exercised daily (Senadheera et al., 2016). In another study conducted among diabetic adults, it was reported that 34% of respondents engaged in physical activity, with men constituting 52% and women 48% (Rashid et al., 2023).

Sleep patterns revealed that over 70% of respondents slept for less than 6 hours, while only 17% managed to sleep for 6 to 8 hours, and a mere 12% reported sleeping for more than 8 hours. 
Regarding stress, health-related stress was reported by 27% of respondents, followed by marital stress (16%) and work-related stress (12%). Additionally, a substantial portion (60%) of respondents reported addictions to various substances, with 31% addicted to betel, 11% to alcohol, and less than 10% to either chewing tobacco or smoking. A study conducted among Type 2 Diabetes in Subotica, found that only 25% of respondents consumed alcohol, with men drinking more frequently than women (14%). The study also noted that 22 patients were habitual smokers, averaging ten cigarettes per day (Požar et al., 2016).
Table 5:  Distribution of respondents according to performance of physical activities (N=100).

The physical activity levels among respondents, including household chores, modes of transportation, and the use of energy-saving devices, are detailed in Table 5. It was noted that 58% of respondents participated in household work, with 44% of that group being female. Additionally, only a small number of respondents reported walking or cycling to their workplaces. Most respondents primarily used bikes or scooters as their main mode of transportation. Furthermore, a significant 88% of respondents utilized energy-saving devices for household tasks.

The consumption of fried and fast foods has been closely linked to Type 2 Diabetes (T2D) (Cahill et al., 2014). Table 6 presents the relationship between fast food consumption and blood sugar levels. The calculated χ² values (12.1 and 6.42) exceeded the critical value from the χ² table (5.99), indicating that an increase in fast food consumption among respondents was associated with higher fasting and postprandial blood sugar levels. 

Recent research has shown that the intake of grilled, sugary, and processed foods is related to lower fasting plasma glucose levels. Moreover, meals high in fat have been associated with impaired glucose tolerance (IGT). There is also evidence connecting processed food consumption with combined glucose intolerance (Pramono et al., 2023).

Table 7: Association between blood sugar level and physical activity.

Regular exercise is associated with prevention and minimization of weight gain, reduction in blood pressure, improvement in insulin sensitivity and glucose control, and optimization of lipoprotein profile, all of which are independent risk factors for the development of T2D (Pramono et al., 2023; Piercy et al., 2018). 

The relationship between physical activity and both fasting and postprandial blood sugar levels was assessed using χ² analysis, as shown in Table 7. The calculated χ² values exceeded the critical table values, indicating a statistically significant association between physical activity and both fasting and postprandial blood sugar levels.

Research has indicated that glycemic regulation is more effectively achieved through a combination of resistance and aerobic training than through either type of exercise alone. High-intensity exercise, particularly high-intensity interval training, has also been shown to have beneficial effects on diabetes management (Zheng et al., 2020). A meta-analysis found that diabetic patients who engaged in regular physical activity experienced blood glucose control that was 2.4 times better than those who did not. According to Ambelu and Teferi (2023), fasting blood glucose waw significantly lower in the combined (aerobic plus strength) treatment, indicating that the combined exercise intervention was more successful in altering the blood glucose levels (Ambelu and Teferi 2023).

Future studies could expand on this work by conducting longitudinal research to observe changes over time in dietary habits and diabetes progression. Expanding the sample size to include diverse populations across regions would improve generalizability. Adding biomarker analysis, such as HbA1c and lipid profiles, could offer more precise insights into diet-related physiological impacts. Interventional studies to test specific dietary and physical activity programs would provide practical strategies for diabetes prevention. Additionally, exploring psychological factors like stress and motivation could help understand adherence to lifestyle changes in diabetes management.

Assessment of Food Consumption Pattern and Lifestyle Profile of Pre-Diabetic and Type 2 Diabetic Adults in Bhubaneswar City, Odisha (2024). Tanmayee Mousumee Maharana, Snehalata Nanda, Suryamani Patro and Anmayee Nanda. Biological Forum – An International Journal, 16(11): 95-101.