A Prospective Study of Overall Diet Quality and Risk of Type 2 Diabetes in Women

Abstract

OBJECTIVE -The aim of this article was to assess the association between the Alternate Healthy Eating Index (AHEI) and risk of type 2 diabetes in women.RESEARCH DESIGN AND METHODS -A total of 80,029 women aged 38 -63 years in the Nurses' Health Study were followed from 1984 to 2002. The AHEI score was computed from dietary information collected from five repeated food frequency questionnaires administered between 1984 and 1998. Relative risks (RRs) for type 2 diabetes were calculated using Cox proportional hazards models and adjusted for known diabetes risk factors. We also examined how changes in score in 4, 6 -8, and 10 -12 years are associated with diabetes risk.RESULTS -We ascertained 5,183 incident cases of type 2 diabetes during 18 years of follow-up. Women who scored high on the AHEI had a lower risk (RR comparing top to bottom score quintile 0.64 [95% CI 0.58 -0.71], P trend Ͻ 0.0001) for diabetes. Women with consistently high AHEI scores throughout follow-up, compared with those with consistently low scores, had the lowest risk for diabetes. In addition, women whose AHEI scores improved during follow-up, even during recent years, had a lower risk of diabetes than did women whose (low) score did not change.CONCLUSIONS -A higher AHEI score is associated with a lower risk of type 2 diabetes in women. Therefore, the AHEI score may be a useful clinical tool to assess diet quality and to recommend for the prevention of diabetes. Diabetes Care 30:1753-1757, 2007T he prevalence of diabetes in the U.S. in 2005 was estimated to be 9.6% among adults aged 20 years and 20.9% among those aged Ն60 years (1). The vast majority of these cases are type 2 diabetes. Although obesity (2-4) and lack of physical activity (5,6) are the major risk factors, certain dietary factors may also modify the risk of developing type 2 diabetes. In particular, intake of whole grains and fiber (7), nuts (8,9), and magnesium (10,11) and moderate intake of alcohol (12,13) may reduce risk. On the other hand, intake of red and processed meats (14,15) and saturated fats (16) may increase risk. Therefore, dietary modifications may play an important role in the prevention of type 2 diabetes.The Alternate Healthy Eating Index (AHEI) was modified from the Healthy Eating Index developed by the U.S. Department of Agriculture (17). It measures diet quality using nine dietary components and can be used for providing dietary guidance for healthy eating. Several of the foods and nutrients included in the index have shown to be associated with risk of type 2 diabetes. The AHEI was previously shown to be inversely associated with risk of cardiovascular disease (18) and estrogen receptornegative breast cancer (19). However, it has not been evaluated in relation to type 2 diabetes. Therefore, we prospectively assessed the association between the AHEI and risk of type 2 diabetes in an ongoing cohort of U.S. women. Using repeated dietary measurement, we also examined the time period (i.e., recent versus distant diet) in which diet may have the greatest impact ...

Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association

“…16 Several different scoring systems have been reported in an effort to quantify the extent of adherence to the Mediterranean dietary pattern. [24][25][26][27][28][29] Crosscultural variability in the application of the Mediterranean diet limits the development of precise associations or conclusive findings on the specific benefits in risk factor reduction, including effects on serum lipids.…”

Diet Quality and Its Association with Cardiometabolic Risk Factors Vary by Hispanic and Latino Ethnic Background in the Hispanic Community Health Study/Study of Latinos

“…Overall diet can be assessed by using composite evidence-based scores that comprise multiple nutrients and food groups, such as the Alternate Healthy Eating Index (AHEI). There is strong evidence of associations between higher AHEI (which reflects better diet quality, based on current evidence) and lower risk of diabetes, CVD, and MetS (11)(12)(13)(14)(15). Some of these studies reported stronger associations with chronic disease risk with the AHEI than with other diet quality scores (12,13,15).…”

“…There is strong evidence of associations between higher AHEI (which reflects better diet quality, based on current evidence) and lower risk of diabetes, CVD, and MetS (11)(12)(13)(14)(15). Some of these studies reported stronger associations with chronic disease risk with the AHEI than with other diet quality scores (12,13,15). This is likely because the AHEI includes specific foods and nutrients, such as legumes, sugar-sweetened beverages, and red or processed meats, which have a role in the development of chronic disease but are absent or incorporated within general food groups in other diet scores (15).…”

Postpartum diet quality in Australian women following a gestational diabetes pregnancy

“…[11][12][13][14] Healthful dietary patterns characterised by high consumption of fruit and vegetables, whole grains, fish and poultry may delay the progression to type 2 diabetes, 13,15 whereas Western dietary patterns have been demonstrated to increase risk. 16 Likewise, a variety of diet quality tools that measure adherence to dietary guidelines have demonstrated that a high-diet quality, representing alignment with national dietary guidelines, is inversely associated with obesity, blood lipids, hyperglycaemia and hyperinsulinaemia, as well as all-cause mortality and indices of selfrated health.…”