A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort
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Dietary patterns have been associated with the incidence of type 2 diabetes, but little is known about the impact of ethnicity on this relationship. This study evaluated the association between four a priori dietary quality indexes and risk of type 2 diabetes among white individuals, Japanese-Americans and Native Hawaiians in the Hawaii component of the Multiethnic Cohort.
After excluding participants with prevalent diabetes and missing values, the analysis included 89,185 participants (11,217 cases of type 2 diabetes). Dietary intake was assessed at baseline with a quantitative food frequency questionnaire designed for use in the relevant ethnic populations. Sex- and ethnicity-specific HRs were calculated for the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the Alternate Mediterranean Diet Score (aMED) and the Dietary Approaches to Stop Hypertension (DASH).
We observed significant inverse associations between higher DASH index scores and risk of type 2 diabetes in white men and women, as well as in Japanese-American women and Native Hawaiian men, with respective risk reductions of 37%, 31%, 19% and 21% (in the highest compared with the lowest index category). A higher adherence to the AHEI-2010 and aMED diet was related to a 13–28% lower risk of type 2 diabetes in white participants but not in other ethnic groups. No significant associations with risk of type 2 diabetes were observed for the HEI-2010 index.
The small ethnic differences in risk of type 2 diabetes associated with scores of a priori-defined dietary patterns may be due to a different consumption pattern of food components and the fact that the original indexes were not based on diets typical for Asians and Pacific Islanders.
KeywordsAlternate Mediterranean Diet Score Alternative Healthy Eating Index Dietary Approaches to Stop Hypertension Dietary patterns Healthy Eating Index Multiethnic Cohort Type 2 diabetes
Alternative Healthy Eating Index
Alternate Mediterranean Diet Score
Coronary Artery Risk Development in Young Adults
Dietary Approaches to Stop Hypertension
Healthy Eating Index
Health Professionals Follow-Up Study
MyPyramid Equivalents Database
Proportion of exposure effect
Quantitative food frequency questionnaire
The MEC has been supported by NCI grant R37 CA54281 (PI: LNK) and by UM1 CA164973 (PI: LL, BEH, LRW). The recruitment of Native Hawaiians was funded by grant DAMD 17-94-T-4184 (principal investigator: A. Nomura). The diabetes project was funded by R21 DK073816 (PI: GM).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
SJ analysed the data and drafted the manuscript. All authors qualify for authorship according to Diabetologia criteria. They have all contributed to the conception and design of the study, the interpretation of the data, the critical revision of the article for important intellectual content, and the final approval of the version to be published. GM is responsible for the integrity of the work as a whole.
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