European Journal of Nutrition

, Volume 58, Issue 8, pp 3349–3360 | Cite as

Rice intake and risk of type 2 diabetes: the Singapore Chinese Health Study

  • Jowy Y. H. Seah
  • Woon-Puay KohEmail author
  • Jian-Min Yuan
  • Rob M. van DamEmail author
Original Contribution



The prevalence of type 2 diabetes (T2D) is increasing in Asian populations. White rice is a common staple food in these populations and results from several studies suggest that high white rice consumption increases T2D risk. We assessed whether rice, noodles and bread intake was associated with T2D risk in an ethnic Chinese population.


We included data from 45,411 male and female Chinese participants of the Singapore Chinese Health Study cohort aged 45–74 years at baseline. Usual diet at baseline was evaluated by a validated 165-item semi-quantitative food frequency questionnaire. Physician-diagnosed T2D was self-reported during two follow-up interviews. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).


During a mean follow-up of 11 years, 5207 incident cases of T2D were documented. Rice intake was not associated with higher T2D risk [HR for extreme quintiles, 0.98 (95% CI 0.90, 1.08)] despite the large variation in intake levels (median intake for extreme quintiles: 236.5 g/day vs. 649.3 g/day), although the precise risk estimate depended greatly on the substitute food. Replacing one daily serving of rice with noodles [HR 1.14 (95% CI 1.07, 1.22)], red meat [HR 1.40 (95% CI 1.23, 1.60)] and poultry [HR 1.37 (95% CI 1.18, 1.59)] was associated with higher T2D risk, whereas the replacement of rice with white bread [HR 0.90 (95% CI 0.85, 0.94)] or wholemeal bread [HR 0.82 (95% CI 0.75, 0.90)] was associated with lower T2D risk.


Higher rice consumption was not substantially associated with a higher risk of T2D in this Chinese population. Recommendations to reduce high white rice consumption in Asian populations for the prevention of T2D may only be effective if substitute foods are considered carefully.

Clinical Trial Registry number and website



Rice Noodles Bread Type 2 diabetes Grains Refined grains 



Type 2 diabetes mellitus


Hazard ratio


Confidence interval


Glycemic index


Glycemic load



We are grateful to Siew-Hong Low of the National University of Singapore for supervising the fieldwork in the Singapore Chinese Health Study and Renwei Wang for the maintenance of the cohort study database. We also thank the founding principal investigator of the Singapore Chinese Health Study, Mimi C. Yu.

Author contributions

The authors’ responsibilities were as follows—JYHS: performed statistical analysis, wrote paper and had primary responsibility for final content; W-PK and RMvD: developed the analytical plan, co-wrote and reviewed the manuscript, and directed the work; all authors: reviewed and edited the manuscript and approved the final version of the manuscript.


This study was supported by the National Institutes of Health, USA (R01 CA144034 and UM1 CA182876). JYHS is supported by the NGS Scholarship. W-PK is supported by the National Medical Research Council, Singapore (NMRC/CSA/0055/2013).

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest.

Supplementary material

394_2018_1879_MOESM1_ESM.docx (40 kb)
Supplementary material 1 (DOCX 39 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Saw Swee Hock School of Public HealthNational University of Singapore (NUS)SingaporeSingapore
  2. 2.NUS Graduate School for Integrative Sciences and EngineeringNUSSingaporeSingapore
  3. 3.Health Services and Systems ResearchDuke-NUS Medical SchoolSingaporeSingapore
  4. 4.Division of Cancer Control and Population Sciences, UPMC Hillman Cancer CenterUniversity of PittsburghPittsburghUSA
  5. 5.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  6. 6.Department of Medicine, Yong Loo Lin School of MedicineNUS and National University Health SystemSingaporeSingapore
  7. 7.Department of NutritionHarvard School of Public HealthBostonUSA

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