Objective-The association of type 2 diabetes (T2DM) with the overall dietary pattern and its relation with ethnicity were examined.Methods-A cross-sectional study with 1257 participants with four ethnicities (Caucasian, Filipino, Native Hawaiian and Japanese) in the North Kohala region of Hawaii was conducted. Participants aged 18-95 years were surveyed for their ethnic and demographic backgrounds, dietary intakes and biochemical indexes of glucose intolerance between 1997 and 2000.Results-Three dietary patterns from the food frequency questionnaire were identified by factor analysis. Factor 1 was characterized by a healthy diet with a frequent intake of vegetables and fruits, and factor 2 was dominated by animal foods and local ethnic dishes. Factor 3 was characterized by a Western diet, which was dominated by French fries, fast-food hamburgers, pizza, and chips. Multivariate logistic regression model for the T2DM prevalence included ethnicity and 3 dietary factors after adjustment for age, sex, BMI, income, physical activity, smoking status and energy intake. Ethnicity was significantly associated with T2DM showing odds ratios (OR's) for Native Hawaiians and Filipinos compared to Caucasians are 1.83 (95% CI 1.12-3.00) and 1.92 (95% CI 1.12-3.29), respectively. Among the three dietary factors, factor 2 HSK prepared the draft of the manuscript; HSK and CW contributed to the conception and design of the study; AG and CW contributed to the generation, collection and assembly of data; SYP, AG and PSH contributed to analysis and interpretation of data; All coauthors contributed to the revision of the manuscript and approved the final version of the manuscript.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Author ManuscriptAuthor Manuscript was positively associated with T2DM (OR=1.30, 95% CI of 1.03-1.68), but the significance disappeared after adjustment for energy intake.Conclusions-The findings show that ethnicity is a stronger risk factor for T2DM than dietary patterns when energy intake is adjusted for. Reducing energy intake to prevent T2DM deserves more attention during health promotion for the multiethnic population of Hawaii.