Major dietary patterns of community dwelling adults and their associations with impaired blood glucose and central obesity in Eastern Ethiopia: Diet-disease epidemiological study

**Background:** Unhealthy dietary intake is a major preventable risk factor for obesity and impaired blood glucose (IBG), which are early indicators of non-communicable diseases (NCDs). Dietary pattern analysis is considered a stronger predictor of health outcomes than individual food or nutrient analysis because it accounts for confounding, interaction, and synergistic effects. Ethiopia faces a growing burden of NCDs, with an estimated 4.2% prevalence of diabetes mellitus and up to 39% central obesity. However, evidence on dietary patterns and their association with metabolic risk factors in Ethiopia is lacking. This study aimed to evaluate major dietary patterns and their association with central obesity and IBG among adults in Eastern Ethiopia.

**Methods:** A community-based cross-sectional study was conducted from September 10 to November 6, 2021, among 501 randomly selected adults (≥18 years) from Dire Dawa and Harar, Eastern Ethiopia. Exclusion criteria included pregnancy, abdominal swelling, spinal deformity, serious psychiatric disorders, and known diabetes on treatment. Data were collected via face-to-face interviews using a semi-structured questionnaire covering sociodemographic and lifestyle factors, along with a validated 89-item food frequency questionnaire capturing dietary intake over the past month. Physical activity was assessed using the 16-item WHO GPAQ tool, with <600 MET/week classified as physically inactive. Central obesity was defined as waist circumference ≥94 cm (men) or ≥80 cm (women), or waist-to-hip circumference ratio ≥0.90 (men) or ≥0.85 (women). Fasting blood glucose was measured from capillary samples; IBG was defined as 100–125 mg/dL. Principal component analysis with varimax rotation was used to derive dietary patterns. Multivariable logistic regression was performed with odds ratios, 95% confidence intervals, and p-values reported.

**Key Results:** The response rate was 95.3% (501 participants). Mean age was 41 years (±12); 66.7% were female. Five dietary patterns explaining 71% of total variance were identified: nutrient-dense foods (42% variance), high fat and protein foods (11.2%), processed foods (9.0%), traditional alcoholic drinks (5.0%), and cereal diets (3.83%). The prevalence of IBG was 20.4% (95% CI: 17.0–24.2%), central obesity by WC was 14.6% (95% CI: 11.8–17.9%), and 94.6% (95% CI: 92.3–96.3%) had an increased waist-to-hip circumference ratio. Physical inactivity was reported by 76.8% of participants (median MET 240, IQR: 0–500). In multivariable analysis, central obesity was significantly associated with upper wealth status (AOR=6.92; 95% CI: 2.91–16.5), physical inactivity (AOR=21.1; 95% CI: 2.77–161.4), and highest tercile of cereal diet consumption (AOR=4.06; 95% CI: 1.87–8.82). IBG was significantly associated with upper wealth status (AOR=2.36; 95% CI: 1.36–4.10), sweet and soda drink consumption (AOR=2.46; 95% CI: 1.30–4.66), middle tercile of processed foods (AOR=1.97; 95% CI: 1.01–3.86), and highest tercile of cereal diet consumption (AOR=3.87; 95% CI: 1.66–9.02).

**Clinical Implications:** This study demonstrates that IBG and central obesity are prevalent among adults in Eastern Ethiopia and are strongly associated with specific dietary patterns, particularly high consumption of cereal diets and processed foods. The finding that 94.6% of participants had an elevated waist-to-hip circumference ratio indicates a very high cardiovascular risk burden in this population. The strong association between physical inactivity and central obesity (AOR=21.1) underscores the importance of promoting physical activity alongside dietary interventions. The association between higher wealth status and both outcomes suggests that economic development may be accompanied by dietary transitions that increase metabolic risk. These findings can inform context-specific dietary guidelines and public health strategies in Ethiopia, emphasizing reduced consumption of processed foods and cereal-based diets while promoting balanced, diversified diets. The study is limited by its cross-sectional design (precluding causal inference), potential recall bias in dietary assessment, and focus on urban settings, which may limit generalizability to rural populations.