Dietary Patterns and 10-year (2002-2012) Incidence of Type 2 Diabetes: Results from the ATTICA Cohort Study

Rev Diabet Stud. Winter 2016;13(4):246-256. doi: 10.1900/RDS.2016.13.246. Epub 2017 Feb 10.

Abstract

Aim: To identify dietary patterns among apparently healthy individuals and to determine their long-term effect on diabetes incidence.

Methods: During 2001-2002, a random sample of 3,042 men and women (18-89 years old), living in greater Athens, was randomly selected to participate in the study. During 2011-2012, the 10-year follow-up was performed in 2,583 participants (15% drop-out rate). After excluding participants with diabetes at baseline and those for whom no information on diabetes status was available at follow-up, the working sample consisted of 1,485 participants. Dietary habits were assessed by means of a validated semi-quantitative, food frequency questionnaire. Factor analysis was performed to extract dietary patterns from 18 food groups.

Results: Diabetes diagnosis at follow-up was made in 191 participants, yielding an incidence rate of 12.9%. Six factors (i.e. dietary patterns) were identified that explained 54% of the variation in consumption. After adjusting for major confounders, and stratification by age-group, logistic regression revealed that the most healthful pattern consisted of the consumption of fruits, vegetables, legumes, bread, rusk, and pasta which reduced the 10-year diabetes risk by 40%, among participants aged 45-55 years. The association reached marginal statistical significance (95% CI: 0.34, 1.07), while no significant association was observed for the other age-groups. When the analysis was additionally adjusted for carbohydrate percentage, statistical significance was lost completely, suggesting a possibly mediating effect of this macronutrient.

Conclusions: The results confirm the potentially protective effect of a plant-based dietary pattern in the primary prevention of diabetes, in particular among middle-aged people. Carbohydrate content may be a specific factor in this relationship; other micronutrients found in plant-based food groups may also play a role.

MeSH terms

  • Adult
  • Age Factors
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diet / adverse effects
  • Diet / ethnology
  • Diet, Healthy* / ethnology
  • Factor Analysis, Statistical
  • Feeding Behavior* / ethnology
  • Female
  • Follow-Up Studies
  • Greece / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Patient Compliance* / ethnology
  • Prediabetic State / epidemiology
  • Prediabetic State / ethnology
  • Prediabetic State / etiology
  • Prediabetic State / prevention & control
  • Prospective Studies
  • Risk Factors
  • Urban Health* / ethnology