Socio-economic disparities in the association of diet quality and type 2 diabetes incidence in the Dutch Lifelines cohort

Abstract

A B S T R A C TBackground: It is unknown whether a socio-economic difference exists in the association of diet quality with type 2 diabetes incidence, nor how diet influences the socioeconomic inequality in diabetes burden. Methods: In 91,025 participants of the population-based Lifelines Cohort (aged 30, no diabetes or cardiovascular diseases at baseline), type 2 diabetes incidence was based on self-report, fasting glucose 7¢0 mmol/l and/or HbA1c 6¢5%. The evidence-based Lifelines Diet Score was calculated with data of a 110-item food frequency questionnaire. Socio-economic status (SES) was defined by educational level. Cox proportional hazards models were adjusted for age, gender, smoking, energy intake, alcohol intake and physical activity. Findings: In 279,796 person-years of follow-up, 1045 diabetes cases were identified. Incidence rate was 5¢7, 3¢2 and 2¢4 cases/1000 person-years in low, middle and high SES, respectively. Diet was associated with greater diabetes risk (HR(95%CI) in Q1 (poor diet quality) vs. Q5 (high diet quality) = 2¢11 (1¢70À2¢62)). SES was a moderator of the association(p INTERACTION = 0¢038). HRs for Q1 vs. Q5 were 1¢66 (1¢22À2¢.27) in low, 2¢76 (1¢86À4¢08) in middle and 2¢46 (1¢53À3¢97) in high SES. With population attributable fractions of 14¢8%, 40¢1% and 37¢3%, the expected number of cases/1000 person-years preventable by diet quality improvement was 0¢85 in low, 1¢28 in middle and 0¢90 in high SES.Interpretation: Diet quality improvement can potentially prevent one in three cases of type 2 diabetes, but because of a smaller impact in low SES, it will not narrow the socioeconomic health gap in diabetes burden. Funding: None.

Uncovering the mechanisms underlying the social patterning of diabetes

“…Risk of diabetes is higher in socially disadvantaged groups [3,4]. Data presented by Vinke, et al [5] in this article of EClinicalMedicine are informative with regard to the mechanism by which social position might impact diabetes risk. The differential exposure explanation is that socially disadvantaged groups have greater risk of diabetes because they are more likely to eat poor quality diets, an important risk factor for diabetes.…”

Applying Behavioral Insights to Real-World Letter Invitations: A Randomized Controlled Trial Testing for the Effect of Personalization and Risk Frame Messaging on NHS Diabetes Prevention Programme Uptake

“…Patients at high risk of developing diabetes are often in low socioeconomic status (SES) groups (Vinke et al, 2020), so if this intervention helps, it especially helps people of low SES, and thus contributes to reducing health inequality…”

Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study

“…In addition, emerging lifestyle risk factors, such as excessive TV watching (Llavero-Valero et al, 2021;Patterson et al, 2018) and unhealthy sleep duration (Cappuccio et al, 2010), have potential as new type 2 diabetes prevention targets. After controlling for the aforementioned risk factors, socioeconomic status, such as low education and insufficient income, has been found to be associated with higher risk of type 2 diabetes (Foster et al, 2018;Maty et al, 2005;Vinke et al, 2020). We present a more extensive summary of evidence in Supplementary Table 1.…”