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Diabetologia

, Volume 62, Issue 12, pp 2233–2244 | Cite as

Cumulative average dietary pattern scores in young adulthood and risk of incident type 2 diabetes: the CARDIA study

  • Kristin M. Hirahatake
  • David R. JacobsJr
  • James M. Shikany
  • Luohua Jiang
  • Nathan D. Wong
  • Andrew O. OdegaardEmail author
Article

Abstract

Aims/hypothesis

The evidence for the role of contemporary dietary patterns, trends and predominant aspects of energy intake in a typical American diet and in type 2 diabetes risk is limited. Therefore, we examined the association between dietary pattern scores created to reflect the 2015 Dietary Guidelines for Americans (DGA) Scientific Report, a Palaeolithic (Palaeo) diet, a diet high in ‘empty calories’, and the A Priori Diet Quality Score (APDQS) (cohort reference) and type 2 diabetes risk over time.

Methods

We carried out a prospective analysis of 4719 young adult black and white men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) study with repeated dietary histories collected at study years 0, 7 and 20. Using multivariable Cox proportional hazards regression models, we examined the association between time-dependent cumulative average dietary pattern scores and incident type 2 diabetes.

Results

During the 30 year follow-up period, 680 (14.4%) incident cases of type 2 diabetes occurred. There was no association between the 2015 DGA, Palaeo or empty calorie scores and type 2 diabetes risk in the overall population. Participants in the fourth quartile of the APDQS, reflecting a more healthful dietary pattern, had a 45% lower risk of type 2 diabetes compared with those in the lowest quartile (HR 0.55 [95% CI 0.41, 0.74]). In stratified analyses there was an inverse association for the 2015 DGA in non-smokers per SD (HR 0.86 [95% CI 0.74, 0.99]) and an inverse association for the empty calorie score in white women (HR 0.76 [95% CI 0.60, 0.96]) as well as in a subgroup analysis of the Palaeo index of participants who maintained a high score over 20 years (per SD, HR 0.59 [95% CI 0.39, 0.88]).

Conclusions/interpretation

Higher levels of the APDQS, which largely aligns with the 2015 DGA, were strongly inversely associated with 30 year type 2 diabetes risk in the CARDIA cohort; the results from the other patterns were nuanced and need to be considered in the context of the study and potential biases.

Keywords

Dietary guidelines Dietary patterns Epidemiology Palaeolithic Type 2 diabetes 

Abbreviations

APDQS

A Priori Diet Quality Score

CARDIA

Coronary Artery Risk Development in Young Adults

DGA

Dietary Guidelines for Americans

EC

Empty calorie

EU

Exercise units

NCC

Nutrition Coordinating Center

Palaeo

Palaeolithic

Notes

Contribution statement

KH and AO are responsible for the concept and design of the study, analysis and interpretation and writing of the manuscript. KH, AO and DJ are responsible for data acquisition. DJ, LJ, NW, and JS contributed to the analysis and interpretation of the data and provided a critical review of the manuscript. All authors have read and approved the final version of the manuscript. KH and AO are the guarantors of this work and, as such, had full access to the data provided by the CARDIA study and take responsibility for the integrity and accuracy of the data analysis.

Funding

The CARDIA study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I and HHSN268201800007I from the National Heart, Lung, and Blood Institute (NHLBI).

Duality of interest

DJ declares consultancy fees and honoraria received from the California Walnut Commission. All other authors declare no duality of interest associated with their involvement with this manuscript.

Supplementary material

125_2019_4989_MOESM1_ESM.pdf (291 kb)
ESM Tables (PDF 290 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Kristin M. Hirahatake
    • 1
  • David R. JacobsJr
    • 2
  • James M. Shikany
    • 3
  • Luohua Jiang
    • 1
  • Nathan D. Wong
    • 1
  • Andrew O. Odegaard
    • 1
    Email author
  1. 1.Department of Epidemiology, School of MedicineUniversity of CaliforniaIrvineUSA
  2. 2.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  3. 3.Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA

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