Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study

Abstract

Aims/hypothesisFew studies have investigated the relationship between predefined dietary patterns and type 2 diabetes incidence; little is known about the generalisability of these associations. We aimed to assess the association between predefined dietary patterns and type 2 diabetes risk in European populations.MethodsFrom among a case-cohort of 12,403 incident diabetes cases and 16,154 subcohort members nested within the prospective European Prospective Investigation into Cancer and Nutrition study, we used data on 9,682 cases and 12,595 subcohort participants from seven countries. Habitual dietary intake was assessed at baseline with country-specific dietary questionnaires. Two diet-quality scores (alternative Healthy Eating Index [aHEI], Dietary Approaches to Stop Hypertension [DASH] score) and three reduced rank regression (RRR)-derived dietary-pattern scores were constructed. Country-specific HRs were calculated and combined using a random-effects meta-analysis.ResultsAfter multivariable adjustment, including body size, the aHEI and DASH scores were not significantly associated with diabetes, although for the aHEI there was a tendency towards an inverse association in countries with higher mean age. We observed inverse associations of the three RRR-derived dietary-pattern scores with diabetes: HRs (95% CIs) for a 1-SD difference were 0.91 (0.86, 0.96), 0.92 (0.84, 1.01) and 0.87 (0.82, 0.92). Random-effects meta-analyses revealed heterogeneity between countries that was explainable by differences in the age of participants or the distribution of dietary intake.Conclusions/interpretationAdherence to specific RRR-derived dietary patterns, commonly characterised by high intake of fruits or vegetables and low intake of processed meat, sugar-sweetened beverages and refined grains, may lower type 2 diabetes risk.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-013-3092-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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

“…Yet, several other prospective studies reported null findings, e.g., the EPIC-InterAct study for the AHEI [32], the Health Professionals Follow-Up Study (HPFS) for the HEI [31], and the CARDIA study for the DQI [6]. Differences in range of index scores may partly explain discrepant findings across studies unless standardized scores are used.…”

“…For the DASH index, two prospective studies in US populations described significant inverse associations with type 2 diabetes risk [5, 31], whereas a study in seven European countries detected no association [32]. Reasons for the discrepancy might be the use of study-specific categories in the DASH index and the consumption of foods specific to geographic environments, such as preferences for different types of meat in the US than European countries [35].…”

“…We chose the definition based on Fung et al . [23], which is most common one used in US populations [12], whereas the definition of the DASH index in the InterAct Study [32] was based on the DASH eating plan [24]. A recent report comparing different definitions of DASH indexes concluded that all indexes capture an underlying construct inherent to the DASH diet targeted for the prevention of hypertension, but suggested that the specific index might affect results [37].…”

Epidemiology of diabetes

“…Dietary risk factors have recently emerged: risk is increased by high consumption of red and processed meat 13 and sugar-sweetened beverages, 14 and reduced by intake of fruit and vegetables, 15 some types of dairy products, 16 and some overall dietary patterns. 17 Novel strategies to use quantifiable nutritional biomarkers are paving the way for more detailed understanding of the association between diet and diabetes. Although the heritability of type 2 diabetes is high (30–70%) and more than 60 genetic variants related with diabetes risk have now been identified, 18 the individual effects of genetic variants are modest, and even when combined into a genetic score, known genes contribute little to the prediction of diabetes.…”

Review of a priori dietary quality indices in relation to their construction criteria

“…Such exploratory post hoc techniques aggregate intake variables into factors to reveal common underlying food consumption patterns within a population. 2 , 3 Because a posteriori–defined dietary patterns are derived specifically for the population under consideration, they are often not reproducible across populations. 1 Furthermore, a posteriori–defined patterns do not necessarily define the healthiest patterns because they are not derived from current nutritional knowledge or evidence-based diet–health relationships.…”