A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort

Abstract

Aim Dietary patterns have been associated with type 2 diabetes incidence, but little is known about the impact of ethnicity on this relation. This study evaluated the association of four a priori dietary quality indexes and type 2 diabetes risk among whites, Japanese Americans, and Native Hawaiians in the Hawaii component of the Multiethnic Cohort (MEC). Methods After excluding participants with prevalent diabetes and missing values, the analysis included 89,185 participants (11,217 cases). Dietary intake was assessed at baseline with a quantitative food frequency questionnaire designed for use in the relevant ethnic populations. Sex- and ethnicity-specific hazard ratios were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension (DASH). Results We observed significant inverse associations between higher scores of the DASH index and type 2 diabetes risk in white men and women, as well as in Japanese American women and Native Hawaiian men with respective risk reductions of 37, 31, 19 and 21% (highest compared to lowest index category). A higher adherence to the AHEI-2010 and aMED diet was related to a 13–28% lower type 2 diabetes risk in white participants but not in other ethnic groups. No significant associations with type 2 diabetes risk were observed for the HEI-2010 index. Conclusions The small ethnic differences in type 2 diabetes risk associated with scores of a priori-defined dietary patterns may be due to different consumption patterns of food components and the fact that the original indexes were not based on Asians and Pacific Islanders.

High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort

“…40 In the Hawaii component of the MEC, high scores for the DASH were related to a 10–30% lower risk of Type 2 diabetes, whereas the AHEI-2010 and aMED score showed weaker associations, and the HEI-2010 was not related to the risk of Type 2 diabetes. 41 When looking into individual components for the HEI-2010, which had stronger associations compared with the other three indexes in the current study, 4 components, greens and beans, dairy, sodium, and empty calories, among the 12 components showed a statistically significant association with colorectal cancer risk. The associations with the aMED score were less strong than those with the other three indexes.…”

The Mediterranean Diet Score Is More Strongly Associated with Favorable Cardiometabolic Risk Factors over 2 Years Than Other Diet Quality Indexes in Puerto Rican Adults

“…In the Multiethnic Cohort, significant associations with type 2 diabetes were observed for DASH in non-Hispanic white men and women, Japanese American women, and Native American men, whereas AHEI and an alternative MeDS were associated with diabetes in non-Hispanic white participants only; the HEI was not significantly associated with diabetes in any ethnic or sex group (21). The authors suggested that differences in associations may have been due to particular consumption patterns and food components, particularly as most scores were originally developed in non-Hispanic white populations.…”

“…However, the composition, weight, and cutoffs of intake of the foods and nutrients included in each score vary widely (4,11), suggesting that their association with disease outcomes may also vary. Studies that have directly contrasted scores have been inconsistent; some show that all scores predict death, risk of diabetes (12)(13)(14) and cardiovascular disease (CVD) (13,(15)(16)(17), or weight changes (18) with comparable magnitude of association, whereas others show larger differences in the association of various scores and cardiometabolic markers within a population (19)(20)(21)(22).…”

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study

“…Although there was no apparent association between ideal PA and ideal diet with incident diabetes mellitus in our analysis, both have been associated with a reduction in diabetes mellitus risk in previous studies. [32][33][34][35] Data from the Diabetes Prevention Program showed that weight loss achieved through PA and a healthy low-fat, lowcalorie diet reduced the incidence of diabetes mellitus by 61% in blacks, when compared with placebo. 5 Diabetes mellitus risk reduction was greatest in the lifestyle group, compared with the other groups.…”