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A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort

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Abstract

Aims/hypothesis

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.

Methods

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).

Results

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.

Conclusions/interpretation

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.

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Abbreviations

AHEI:

Alternative Healthy Eating Index

aMED:

Alternate Mediterranean Diet Score

CARDIA:

Coronary Artery Risk Development in Young Adults

DASH:

Dietary Approaches to Stop Hypertension

HEI:

Healthy Eating Index

HPFS:

Health Professionals Follow-Up Study

MEC:

Multiethnic Cohort

MPED:

MyPyramid Equivalents Database

PEE:

Proportion of exposure effect

QFFQ:

Quantitative food frequency questionnaire

SSB:

Sugar-sweetened beverage

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Funding

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.

Contribution statement

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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Authors and Affiliations

  1. Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany

    Simone Jacobs, Janine Kröger & Matthias B. Schulze

  2. School of Public Health, University of Memphis, Memphis, TN, 38152, USA

    Brook E. Harmon

  3. Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA

    Carol J. Boushey, Yukiko Morimoto, Lynne R. Wilkens, Loic Le Marchand, Laurence N. Kolonel & Gertraud Maskarinec

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  1. Simone Jacobs
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  2. Brook E. Harmon
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  3. Carol J. Boushey
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  4. Yukiko Morimoto
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  5. Lynne R. Wilkens
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  7. Janine Kröger
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  8. Matthias B. Schulze
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  9. Laurence N. Kolonel
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  10. Gertraud Maskarinec
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Corresponding author

Correspondence to Gertraud Maskarinec.

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Jacobs, S., Harmon, B.E., Boushey, C.J. et al. A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort. Diabetologia 58, 98–112 (2015). https://doi.org/10.1007/s00125-014-3404-8

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  • DOI: https://doi.org/10.1007/s00125-014-3404-8

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