Diet Quality Indices and Risk of Type 2 Diabetes Mellitus

Chen, Guo‐Chong; Koh, Woon‐Puay; Neelakantan, Nithya; Yuan, Jian‐Min; Qin, Li–Qiang; Dam, Rob M. van

doi:10.1093/aje/kwy183

Cited by 73 publications

(68 citation statements)

References 37 publications

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“…However, our results indicate that the presence of dyslipidemia was associated with a higher aMED score. Scientific studies published about this issue found that the MedDiet reduces the risk of T2D improving postprandial lipemia, lipid profile, and cardiovascular risk factors [3,4,[38][39][40][41][42][43]. Our results could be due to the fact that participants with dyslipidemia may have received specific dietary counselling based on the MedDiet to improve their lipid profile.…”

Section: Discussionmentioning

confidence: 71%

Spanish People with Type 2 Diabetes Show an Improved Adherence to the Mediterranean Diet

Alcubierre¹,

Granado-Casas

Real

et al. 2020

Nutrients

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The aim of this study was to assess the dietary pattern (i.e., Mediterranean Diet (MedDiet) and healthy eating) in people with type 2 diabetes (T2D) compared with those without diabetes. In addition, we explored clinical factors associated with the dietary pattern. This cross-sectional study was performed with a sample of 476 participants (238 with T2D and 238 participants without diabetes, matched for age and sex). The alternate Mediterranean Diet (aMED) score and the alternate Healthy Eating Index (aHEI) were calculated. Statistical analysis included comparison between groups and multivariable models. Participants with T2D showed higher aMED and aHEI scores (mean (SD): 4.3 (1.5) and 43.9 (6.5), respectively) in comparison with the control group (3.5 (1.8) and 39.4 (7.4), respectively; p < 0.001). In addition, a higher proportion of participants with T2D in higher tertiles of aMED (21.8%) and aHEI (39.9%) was observed compared with participants without diabetes (11.3% for the aMED, and 19.3% for the aHEI; p < 0.001). The adjusted multivariable analysis revealed that T2D (p < 0.001), increasing age (p = 0.006 and p = 0.030, respectively), and physical activity (p = 0.009) were positively associated with higher aMED and aHEI scores. Dyslipidemia and female gender were positively associated with aMED and aHEI (p = 0.031 and p < 0.001, respectively). The specific multivariable analysis for the group with T2D yielded a positive association of age (p < 0.001) and dyslipidemia (p = 0.021) with aMED. Regarding the aHEI, only female gender was positively related with this score in diabetes participants (p = 0.025). Participants with T2D showed a higher adherence to the MedDiet and a healthier eating pattern.

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Section: Discussionmentioning

confidence: 71%

Spanish People with Type 2 Diabetes Show an Improved Adherence to the Mediterranean Diet

Alcubierre¹,

Granado-Casas

Real

et al. 2020

Nutrients

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“…The direction of the associations was mostly consistent across all ethnic groups [ 17 ]. The AHEI has been shown to be inversely associated with the risk of having T2DM in an Asian population aged 45–74 years (multivariable-adjusted hazard ratio 0.93 per 1-SD increase in score) [ 19 ]. A stratified analysis revealed a significant interaction effect of smoking on the association which was only present in non-smokers (p-interaction 0.03) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The AHEI has been shown to be inversely associated with the risk of having T2DM in an Asian population aged 45–74 years (multivariable-adjusted hazard ratio 0.93 per 1-SD increase in score) [ 19 ]. A stratified analysis revealed a significant interaction effect of smoking on the association which was only present in non-smokers (p-interaction 0.03) [ 19 ]. This holds for the alternate MDS as well (multivariable-adjusted hazard ratio of 0.93 per 1-SD increase in score).…”

Section: Discussionmentioning

confidence: 99%

“…Two frequently used diet quality scores are the Alternate Healthy Eating Index (AHEI) [ 9 ] and the Mediterranean Diet Score (MDS) [ 10 ]. Dietary patterns have been consistently associated with T2DM in various studies investigating different ethnic populations, sexes or age groups [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], although metabolic characteristics have so far not been comprehensively accounted for.…”

Section: Introductionmentioning

confidence: 99%

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Association of Dietary Patterns and Type-2 Diabetes Mellitus in Metabolically Homogeneous Subgroups in the KORA FF4 Study

et al. 2020

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There is evidence that a change in lifestyle, especially physical activity and diet, can reduce the risk of developing type-2 diabetes mellitus (T2DM). However, the response to dietary changes varies among individuals due to differences in metabolic characteristics. Therefore, we investigated the association between dietary patterns and T2DM while taking into account these differences. For 1287 participants of the population-based KORA FF4 study (Cooperative Health Research in the Region of Augsburg), we identified three metabolically-homogenous subgroups (metabotypes) using 16 clinical markers. Based on usual dietary intake data, two diet quality scores, the Mediterranean Diet Score (MDS) and the Alternate Healthy Eating Index (AHEI), were calculated. We explored the associations between T2DM and diet quality scores. Multi-variable adjusted models, including metabotype subgroup, were fitted. In addition, analyses stratified by metabotype were carried out. We found significant interaction effects between metabotype and both diet quality scores (p < 0.05). In the analysis stratified by metabotype, significant negative associations between T2DM and both diet quality scores were detected only in the metabolically-unfavorable homogenous subgroup (Odds Ratio (OR) = 0.62, 95% confidence interval (CI) = 0.39–0.90 for AHEI and OR = 0.60, 95% CI = 0.40–0.96 for MDS). Prospective studies taking metabotype into account are needed to confirm our results, which allow for the tailoring of dietary recommendations in the prevention of T2DM.

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“…To our knowledge, only one prospective study on plant-based diets has been conducted in an Asian population. In Singapore, a prospective cohort study found that higher adherence to PDI and hPDI was associated with a lower risk of type 2 diabetes [21].…”

Section: Plos Medicinementioning

confidence: 99%

Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

et al. 2020

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Background Prior studies have shown that plant-based diets are associated with lower risk of cardiovascular risk factors and incident cardiovascular disease, but risks differed by quality of plant-based diets. No prospective studies have evaluated the associations between different types of plant-based diets and incident metabolic syndrome (MetS) and components of MetS. Furthermore, limited evidence exists in Asian populations who have habitually consumed a diet rich in plant foods for a long period of time. Methods and findings Analyses were based on a community-based cohort of 5,646 men and women (40–69 years of age at baseline) living in Ansan and Ansung, South Korea (2001–2016) without MetS and related chronic diseases at baseline. Dietary intake was assessed using a validated food frequency questionnaire. Using the responses in the questionnaire, we calculated 4 plant-based diet indices (overall plant-based diet index [PDI], healthful plant-based diet index [hPDI], unhealthful plant-based diet index [uPDI], and pro-vegetarian diet index). Higher PDI score represented greater consumption of all types of plant foods regardless of healthiness. Higher hPDI score represented greater consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, tea and coffee) and lower consumption of less-healthy plant foods (refined grains, potatoes, sugar-sweetened beverages, sweets, salty foods). Higher uPDI represented lower consumption of healthy plant foods and greater consumption of less-healthy plant foods. Similar to PDI, higher pro-vegetarian diet score represented greater consumption of plant foods but included only selected plant foods (grains, fruits, vegetables, nuts, legumes, potatoes). Higher scores in all plant-based diet indices represented lower consumption of animal foods (animal fat, dairy, eggs, fish/seafood, meat). Over a median follow-up of 8 years, 2,583 participants developed incident MetS. Individuals in the highest versus lowest quintile of uPDI had 50% higher risk of developing incident MetS, adjusting for demographic characteristics and lifestyle factors (hazard ratio [HR]: 1.50, 95% CI 1.31–1.71, P-trend < 0.001). When we further adjusted for body mass index (BMI), those in the highest quintile of uPDI had 24%–46% higher risk of 4 out of 5 individual components of MetS (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein [HDL], and elevated blood pressure) (P-trend for all tests ≤ 0.001). Greater adherence to PDI was associated with lower risk of elevated fasting glucose (HR: 0.80, 95% CI 0.70–0.92, P-trend = 0.003). No consistent associations were observed for other plant-based diet indices and MetS. Limitations of the study may include potential measurement error in self-reported dietary intake, inability to classify a few plant foods as healthy and less-healthy, lack of data on vegetable oil intake, and possibility of residual confounding. Conclusions In this study, we observed that greater adherence to diets consisting of a high intake of refined carbohydrates, sugars, and salty foods in the framework of plant-based diets was associated with an elevated risk of MetS. These results suggest that considering the quality of plant foods is important for prevention of MetS in a population that habitually consumes plant foods.

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Diet Quality Indices and Risk of Type 2 Diabetes Mellitus

Cited by 73 publications

References 37 publications

Spanish People with Type 2 Diabetes Show an Improved Adherence to the Mediterranean Diet

Spanish People with Type 2 Diabetes Show an Improved Adherence to the Mediterranean Diet

Association of Dietary Patterns and Type-2 Diabetes Mellitus in Metabolically Homogeneous Subgroups in the KORA FF4 Study

Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

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