Sex-differences in dietary macronutrient intake and its association with metabolic syndrome components in adults with type 2 diabetes: a cross-sectional study

Daoud Daoudi; Abderrahmane Moufid; Nouriya Elghoulam; Aichetou Bouh; Aicha Madkour; Hakim Belghiti; Hassan Aguenaou; Souad Benaich; Slimane Mehdad

Daoud Daoudi Physiology and Physiopathology Research Team, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco https://orcid.org/0009-0003-2083-159X
Abderrahmane Moufid Physiology and Physiopathology Research Team, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
Nouriya Elghoulam Physiology and Physiopathology Research Team, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco https://orcid.org/0009-0003-0991-6162
Aichetou Bouh National Institute of Oncology Sidi Mohammed Ben Abdellah, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco https://orcid.org/0000-0002-0564-2403
Aicha Madkour Physiology and Physiopathology Research Team, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco https://orcid.org/0000-0002-7904-3489
Hakim Belghiti Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
Hassan Aguenaou Regional Designated Center of Nutrition AFRA/IAEA, International University of Rabat, Salé, Morocco https://orcid.org/0000-0002-7137-1955
Souad Benaich Physiology and Physiopathology Research Team, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco https://orcid.org/0000-0003-2329-9095
Slimane Mehdad Physiology and Physiopathology Research Team, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco https://orcid.org/0000-0002-3800-6817

Keywords: metabolic diseases, type 2 diabetes mellitus, nutritional intake, isoenergetic substitution, cardiometabolic risk

Abstract

Metabolic syndrome (MetS) is highly prevalent in patients with type 2 diabetes (T2D) and increases cardiovascular risk. Sex-specific associations between macronutrient intake and MetS remain insufficiently explored. This study aimed to assess MetS prevalence and examine sex differences in associations between dietary macronutrient intake and MetS components. A cross-sectional study was conducted among 425 Moroccan adults with T2D. MetS was defined using harmonized IDF, AHA, and NHLBI criteria. Dietary intake was assessed using a 24-hour recall, and isoenergetic macronutrient substitution models were applied. The prevalence of MetS was 72.9%, higher in women than men (81.2% vs. 58.4%). Women showed higher BMI, waist circumference, and poorer metabolic profiles. In men, MetS was associated with central obesity, inadequate sleep, and family history of cardiometabolic disease. Replacing protein with fat was associated with lower odds of MetS (OR=0.58; 95% CI: 0.35–0.98), abdominal obesity (OR=0.60; 95% CI: 0.37–0.97), and hypertriglyceridemia (OR=0.57; 95% CI: 0.33–0.95). No significant associations were observed in women. MetS is highly prevalent among Moroccan adults with T2D, with clear sex differences. Macronutrient substitution was associated with favorable metabolic outcomes only in men, highlighting the importance of sex-specific nutritional strategies.