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Diabetes Care. 2016 Nov;39(11):2011-2018. Epub 2016 Sep 15.

Changes in Overall Diet Quality and Subsequent Type 2 Diabetes Risk: Three U.S. Prospective Cohorts.

Ley SH1,2, Pan A3, Li Y4, Manson JE5,6, Willett WC4,2,5, Sun Q4,5, Hu FB1,2,5.

Author information

1
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA sylvia.ley@channing.harvard.edu frank.hu@channing.harvard.edu.
2
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
3
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
4
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
5
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
6
Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Abstract

OBJECTIVE:

Recent public health recommendations emphasize adopting a healthful dietary pattern, but evidence is scarce on whether incremental diet quality changes have an impact on long-term diabetes prevention. We aim to evaluate diet quality changes during a 4-year period and subsequent 4-year type 2 diabetes incidence.

RESEARCH DESIGN AND METHODS:

Participants of prospective cohorts, the Nurses' Health Study (NHS), NHS II, and the Health Professionals Follow-up Study, who were free of diabetes at baseline (n = 124,607), were observed for ≥20 years. Diet quality, reflected by the Alternate Healthy Eating Index (AHEI) score, was assessed every 4 years to calculate changes.

RESULTS:

We documented 9,361 cases of type 2 diabetes during 2,093,416 person-years of follow-up. A >10% decrease in AHEI score over 4 years was associated with a higher subsequent diabetes risk (pooled hazard ratio 1.34 [95% CI 1.23-1.46]) with multiple adjustment, whereas a >10% increase in AHEI score was associated with a lower risk (0.84 [0.78-0.90]). Greater improvement in diet quality was associated with lower diabetes risk across baseline diet quality status (P for trend ≤ 0.001 for low, medium, or high initial diet quality) and baseline BMI (P for trend ≤ 0.01 for BMI <25, 25-29, or 30 kg/m2). Changes in body weight explained 32% (95% CI 24-41) of the association between AHEI changes (per 10% increase) and diabetes risk.

CONCLUSIONS:

Improvement in overall diet quality is associated with a lower risk of type 2 diabetes, whereas deterioration in diet quality is associated with a higher risk. The association between diet quality changes and diabetes risk is only partly explained by body weight changes.

PMID:
27634391
PMCID:
PMC5079614
DOI:
10.2337/dc16-0574
[Indexed for MEDLINE]
Free PMC Article

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