Dietary pattern and mortality in Japanese elderly patients with type 2 diabetes mellitus: Does a vegetable‐ and fish‐rich diet improve mortality? An explanatory study

Abstract

Aim:To assess the effect of dietary patterns on all deaths and diabetes-related deaths in the Japanese Elderly Diabetes Intervention Trial (J-EDIT). Methods:We investigated relationships between that of overall mortality and dietary pattern, and diabetes-related deaths and dietary pattern as observed among 912 registered cases of the J-EDIT study, which is a prospective follow-up study of elderly Japanese type 2 diabetic patients.Results: Factor analysis with the factor number 3 led to deriving three dietary patterns (healthy type, snack type and greasy type). The relationship between these patterns and overall mortality or diabetes-related death was investigated. Although not statistically significant, there was a lower tendency of overall mortality and diabetes-related deaths for the healthy type dietary pattern. When the tendencies of overall mortality were analyzed for "young-old," who are younger than 75 years-of age, and "old-old" of over 75 years-of-age, the mortality rate for the greasy type and healthy type dietary patterns were nearly the same and higher than the snack type dietary pattern in young-old. In contrast, in old-old, a higher mortality rate was reported for the greasy type dietary pattern and a lower mortality rate was reported for the healthy type dietary pattern. The hazard ratio by Cox regression analysis for greasy type to healthy type in old-old was 3.03 (P = 0.04, CI 1.07-8.57). Furthermore, in old-old, as vegetable consumption increased, the lower the tendency for overall mortality, and the more fish that was consumed, the overall mortality significantly decreased (P = 0.020) in the tertile. Conclusions:The greasy type dietary pattern with an increased amount of sugar, fat and meat led to poor life prognosis for elderly Japanese type 2 diabetic patients. The healthy type dietary pattern rich in vegetable and fish, which is similar to the Mediterranean diet and Dietary Approach to Stop Hypertension diet, was suggested to improve life prognosis. Geriatr Gerontol Int 2012; 12 (Suppl. 1): 59-67.Keywords: dietary pattern, elderly type 2 diabetes mellitus, mortality, sugar-fat-and meat-rich diet, vegetable-and fish-rich diet. IntroductionThe relationship between diet and health is an ancient interest, and nutritional epidemiology is one of the important branches of epidemiology. 1 In the study of circulatory disease since World War II, "associations between food and disease" has become one of the major research topics, yielding important study results such as the over consumption of salt and saturated fatty acids being risk factors for arteriosclerosis. [2][3][4] According to the Vital Statistics Survey, and the National Health and Nutrition Survey by the Japanese Ministry of Health, Labor and Welfare, the disease frequency patterns of modern Japanese are becoming similar to that of Europe and the USA, with the Westernization of diet characterized by increased meat and fat consumption. Studies on Japanese immigrants who moved to the USA and other countries showed that in the younger generat...

Effects of total and green vegetable intakes on glycated hemoglobin A1c and triglycerides in elderly patients with type 2 diabetes mellitus: The Japanese Elderly Intervention Trial

“…The fact that groups with high intake of vegetables showed a dietary pattern similar to the “ prudent” dietary pattern suggests that “prudent” dietary patterns leads to improved HbA1c levels, even in elderly patients with type 2 diabetes mellitus. These results are in good agreement with results of Iimuro et al 29 . in this supplement.…”

“…27,28 The fact that groups with high intake of vegetables showed a dietary pattern similar to the " prudent" dietary pattern suggests that "prudent" dietary patterns leads to improved HbA1c levels, even in elderly patients with type 2 diabetes mellitus. These results are in good agreement with results of Iimuro et al 29 in this supplement. They showed a lower mortality rate in elderly type 2 diabetic patients with a dietary pattern of high intakes of vegetable and fish using elderly type 2 diabetic patients registered to J-EDIT.…”

Assessment of Daily Food and Nutrient Intake in Japanese Type 2 Diabetes Mellitus Patients Using Dietary Reference Intakes

“…The results of cohort studies showed that a sufficient intake of vegetables and fruit reduced the frequency of developing diabetes [16,17], and a diet high in dietary fiber containing vegetables might improve glycemic control [18,19]. Several studies conducted with elderly Japanese participants with T2DM demonstrated that diets rich in vegetables were correlated with improved HbA1c, serum triglyceride levels [20], and life prognosis [21]. Therefore, it is important to educate Japanese T2DM patients about the health advantages of consuming vegetables.…”

Empirically derived dietary patterns: interpretability and construct validity according to different factor rotation methods

“…The factor rotation selected for this research was the same as those reported in previous studies on dietary pattern analysis that used factor analysis or principal component analysis: the orthogonal varimax 34,5,6,37,38,39,40 , the oblique promax 11,12,13,14,15 and direct oblimin 16,17 . In brief, the varimax is a type of orthogonal rotation that attempts to maximize the variance of squared loadings on a factor, i.e., to reduce the cross-loadings of the variables, leading to uncorrelated simple factor structures 41 .…”

“…Orthogonal rotation leads to uncorrelated factors that are considered simpler and easier to interpret 8,10 , whereas nonorthogonal (oblique) rotation, such as promax and oblimin, allow producing correlated factors which are considered harder to interpret and, for this reason, have been used less in studies involving dietary pattern analysis 11,12,13,14,15,16,17 .…”