European Journal of Nutrition

, Volume 52, Issue 3, pp 1127–1134 | Cite as

Dietary patterns and the risk of type 2 diabetes in overweight and obese individuals

  • Florianne Bauer
  • Joline W. J. Beulens
  • Daphne L. van der A
  • Cisca Wijmenga
  • Diederick E. Grobbee
  • Annemieke M. W. Spijkerman
  • Yvonne T. van der Schouw
  • N. Charlotte Onland-MoretEmail author
Original Contribution



Although overweight is an important determinant of diabetes risk, it remains unclear whether food choices can still influence the risk for type 2 diabetes in overweight persons. In this paper, we aim to clarify the role of dietary patterns in the development of type 2 diabetes in overweight and obese individuals.


We studied 20,835 overweight and obese participants in the Dutch part of the European Investigation into Cancer and Nutrition (EPIC-NL) study. Dietary intake was measured using a validated food frequency questionnaire, and dietary patterns were generated using factor analysis. Incident type 2 diabetes was verified against medical records. Cox proportional hazards models were used to assess the association between the dietary patterns (factor scores categorized in quartiles) and incident type 2 diabetes.


Scoring on Pattern 1, characterized by fish, wine, chicken, raw vegetables and fruit juices, was not associated with type 2 diabetes risk after confounder adjustment. A high score on Pattern 2, characterized by soft drinks, fries and snacks, was associated with higher risk of type 2 diabetes (HR Q4 vs. Q1 (95 % CI): 1.70 (1.31; 2.20), p trend ≤ 0.0001), particularly among less active individuals [less active: HR Q4 vs. Q1 (95 % CI): 2.14 (1.48; 3.09), p trend = 0.00004, more active: HR Q4 vs. Q1 (95 % CI): 1.35 (0.93; 1.97), p trend = 0.01; p interaction = 0.02].


A high score on a pattern high in soft drinks, fries and snacks and low in fruit and vegetables was associated with higher risk of type 2 diabetes in overweight and obese subjects especially among physically less active individuals.


Dietary pattern Type 2 diabetes Obesity Epidemiology 



This study was supported by SenterNovem (IOP Genomics IGE05012).

Conflict of interest

None of the authors had a conflict of interest.


  1. 1.
    Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i–xii, 1–253 (2000)Google Scholar
  2. 2.
    van Dam RM (2003) The epidemiology of lifestyle and risk for type 2 diabetes. Eur J Epidemiol 18:1115–1125Google Scholar
  3. 3.
    Fung TT, Schulze M, Manson JE, Willett WC, Hu FB (2004) Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med 164:2235–2240CrossRefGoogle Scholar
  4. 4.
    Montonen J, Knekt P, Harkanen T, Jarvinen R, Heliovaara M, Aromaa A, Reunanen A (2005) Dietary patterns and the incidence of type 2 diabetes. Am J Epidemiol 161:219–227CrossRefGoogle Scholar
  5. 5.
    van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB (2002) Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med 136:201–209Google Scholar
  6. 6.
    Sui X, Hooker SP, Lee IM, Church TS, Colabianchi N, Lee CD, Blair SN (2008) A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women. Diabetes Care 31:550–555CrossRefGoogle Scholar
  7. 7.
    Beulens JW, Monninkhof EM, Verschuren WM, van der Schouw YT, Smit J, Ocke MC, Jansen EH, van Dieren S, Grobbee DE, Peeters PH, Bueno-de-Mesquita HB (2010) Cohort profile: the EPIC-NL study. Int J Epidemiol 39:1170–1178CrossRefGoogle Scholar
  8. 8.
    Boker LK, van Noord PA, van der Schouw YT, Koot NV, Bueno de Mesquita HB, Riboli E, Grobbee DE, Peeters PH (2001) Prospect-EPIC Utrecht: study design and characteristics of the cohort population. European Prospective Investigation into Cancer and Nutrition. Eur J Epidemiol 17:1047–1053CrossRefGoogle Scholar
  9. 9.
    Blokstra A, Smit HA, Bueno de Mesquita HB, Seidell JC, Verschuren WMM (2005) Monitoring van Risicofactoren en Gezondheid in Nederland (MORGEN-project), 1993-1997, Leefstijl- en risicofactoren: prevalenties en trends [in Dutch]. Bilthoven: RIVM, Report nr: 26320008/2005Google Scholar
  10. 10.
    Sluijs I, van der A D, Beulens JW, Spijkerman AM, Ros MM, Grobbee DE, van der Schouw YT (2010) Ascertainment and verification of diabetes in the EPIC-NL study. Neth J Med 68:333–339Google Scholar
  11. 11.
    Ocke MC, Bueno-de-Mesquita HB, Goddijn HE, Jansen A, Pols MA, van Staveren WA, Kromhout D (1997) The Dutch EPIC food frequency questionnaire. I. Description of the questionnaire, and relative validity and reproducibility for food groups. Int J Epidemiol 26(Suppl 1):S37–S48CrossRefGoogle Scholar
  12. 12.
    Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124:17–27Google Scholar
  13. 13.
    NEVO-Table (1996) Dutch Food Composition Table 1996 Voorlichtingsbureau voor de Voeding, The HagueGoogle Scholar
  14. 14.
    Waijers PM, Ocke MC, van Rossum CT, Peeters PH, Bamia C, Chloptsios Y, van der Schouw YT, Slimani N, Bueno-de-Mesquita HB (2006) Dietary patterns and survival in older Dutch women. Am J Clin Nutr 83:1170–1176Google Scholar
  15. 15.
    Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45:569–581Google Scholar
  16. 16.
    Voorrips LE, Ravelli AC, Dongelmans PC, Deurenberg P, Van Staveren WA (1991) A physical activity questionnaire for the elderly. Med Sci Sports Exerc 23:974–979Google Scholar
  17. 17.
    Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, Day NE (2003) Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 6:407–413CrossRefGoogle Scholar
  18. 18.
    Kleinbaum DG, Kupper LL, Muller KE (1988) Factor Analysis. Applied Regression Analysis and Other Multivariable Methods. PWS-KENT Publishing Company, Boston, In, pp 601–641Google Scholar
  19. 19.
    Martinez ME, Marshall JR, Sechrest L (1998) Invited commentary: factor analysis and the search for objectivity. Am J Epidemiol 148:17–19CrossRefGoogle Scholar
  20. 20.
    Imamura F, Lichtenstein AH, Dallal GE, Meigs JB, Jacques PF (2009) Generalizability of dietary patterns associated with incidence of type 2 diabetes mellitus. Am J Clin Nutr 90:1075–1083CrossRefGoogle Scholar
  21. 21.
    Villegas R, Shu XO, Yang G, Matthews CE, Li H, Cai H, Gao Y, Zheng W (2009) Energy balance and type 2 diabetes: a report from the Shanghai Women’s Health Study. Nutr Metab Cardiovasc Dis 19:190–197CrossRefGoogle Scholar
  22. 22.
    Dunn CL, Hannan PJ, Jeffery RW, Sherwood NE, Pronk NP, Boyle R (2006) The comparative and cumulative effects of a dietary restriction and exercise on weight loss. Int J Obes (Lond) 30:112–121CrossRefGoogle Scholar
  23. 23.
    Koh-Banerjee P, Chu NF, Spiegelman D, Rosner B, Colditz G, Willett W, Rimm E (2003) Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men. Am J Clin Nutr 78:719–727Google Scholar
  24. 24.
    Leser MS, Yanovski SZ, Yanovski JA (2002) A low-fat intake and greater activity level are associated with lower weight regain 3 years after completing a very-low-calorie diet. J Am Diet Assoc 102:1252–1256CrossRefGoogle Scholar
  25. 25.
    Lissner L, Heitmann BL, Bengtsson C (1997) Low-fat diets may prevent weight gain in sedentary women: prospective observations from the population study of women in Gothenburg, Sweden. Obes Res 5:43–48CrossRefGoogle Scholar
  26. 26.
    Shepard TY, Weil KM, Sharp TA, Grunwald GK, Bell ML, Hill JO, Eckel RH (2001) Occasional physical inactivity combined with a high-fat diet may be important in the development and maintenance of obesity in human subjects. Am J Clin Nutr 73:703–708Google Scholar
  27. 27.
    Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, Hu FB (2001) Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr 73:61–67Google Scholar
  28. 28.
    Bassuk SS, Manson JE (2005) Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol 99:1193–1204CrossRefGoogle Scholar
  29. 29.
    Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, Hamalainen H, Harkonen P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Florianne Bauer
    • 1
    • 2
  • Joline W. J. Beulens
    • 1
  • Daphne L. van der A
    • 3
  • Cisca Wijmenga
    • 4
  • Diederick E. Grobbee
    • 1
    • 5
  • Annemieke M. W. Spijkerman
    • 6
  • Yvonne T. van der Schouw
    • 1
  • N. Charlotte Onland-Moret
    • 1
    • 2
    Email author
  1. 1.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Complex Genetics Section, Department of Medical Genetics-DBGUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Center for Nutrition and HealthNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
  4. 4.University of Groningen, University Medical Center Groningen, Department of GeneticsGroningenThe Netherlands
  5. 5.Julius CenterUniversity of Malaya Medical CenterKuala LumpurMalaysia
  6. 6.Center for Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands

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