Dietary Inflammatory and Insulinemic Potential and Risk of Type 2 Diabetes: Results From Three Prospective U.S. Cohort Studies

Diabetes Care. 2020 Nov;43(11):2675-2683. doi: 10.2337/dc20-0815. Epub 2020 Sep 1.


Objective: To examine whether proinflammatory and hyperinsulinemic diets are associated with increased risk of type 2 diabetes.

Research design and methods: We prospectively followed 74,767 women from the Nurses' Health Study (1984-2016), 90,786 women from the Nurses' Health Study II (1989-2017), and 39,442 men from the Health Professionals Follow-up Study (1986-2016). Using repeated measures of food-frequency questionnaires, we calculated empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores, which are food-based indices that characterize dietary inflammatory or insulinemic potential based on circulating biomarkers of inflammation or C-peptide. Diagnoses of type 2 diabetes were confirmed by validated supplementary questionnaires.

Results: We documented 19,666 incident type 2 diabetes cases over 4.9 million person-years of follow-up. In the pooled multivariable-adjusted analyses, individuals in the highest EDIP or EDIH quintile had 3.11 times (95% CI 2.96-3.27) and 3.40 times (95% CI 3.23-3.58) higher type 2 diabetes risk, respectively, compared with those in the lowest quintile. Additional adjustment for BMI attenuated the associations (hazard ratio 1.95 [95% CI 1.85-2.05] for EDIP and hazard ratio 1.87 [95% CI 1.78-1.98] for EDIH), suggesting adiposity partly mediates the observed associations. Moreover, individuals in both highest EDIP and EDIH quintiles had 2.34 times higher type 2 diabetes risk (95% CI 2.17-2.52), compared with those in both lowest quintiles, after adjustment for BMI.

Conclusions: Higher dietary inflammatory and insulinemic potential were associated with increased type 2 diabetes incidence. Findings suggest that inflammation and hyperinsulinemia are potential mechanisms linking dietary patterns and type 2 diabetes development.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • C-Peptide / blood
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / etiology*
  • Diet / adverse effects*
  • Female
  • Follow-Up Studies
  • Food / adverse effects*
  • Humans
  • Hyperinsulinism / complications*
  • Incidence
  • Inflammation / complications
  • Male
  • Middle Aged
  • Nurses
  • Obesity / complications
  • Proportional Hazards Models
  • Prospective Studies
  • Risk
  • Self Report
  • United States / epidemiology


  • Biomarkers
  • C-Peptide

Associated data

  • figshare/10.2337/figshare.12739601