Association between a priori and a posteriori dietary patterns and the risk of type 2 diabetes: a representative cohort study in Taiwan

Abstract

The present study aimed to investigate the relationship between dietary patterns and the risk of type 2 diabetes mellitus (T2DM) among Taiwanese individuals. Data were collected using a nationwide cohort study (2001–15) from the Triple-High Database. Dietary intake was assessed using the twenty-group food frequency questionnaire and used to calculate alternate Mediterranean diet (aMED) and Dietary Approaches to Stop Hypertension (DASH) scores. Principal component analysis (PCA) and partial least-squares (PLS) regression were used to derive dietary patterns, with incident T2DM as the outcome. Multivariable-adjusted hazard ratios and 95 % confidence intervals were calculated using time-dependent Cox proportional hazards (Cox PH) regression analysis, and subgroup analyses were performed. A total of 4705 participants were enrolled in the study, and 995 had newly developed T2DM during the median 5⋅28-year follow-up period (30⋅7 per 1000 person-years). Six dietary patterns were extracted (PCA: Western, prudent, dairy and plant-based; PLS: health-conscious, fish-vegetable and fruit-seafood). The highest aMED score quartile had a 25 % (hazard ratio 0⋅75; 95 % CI 0⋅61, 0⋅92; P = 0⋅039) lower risk of T2DM than the lowest quartile. This association remained significant after adjustment (adjusted hazard ratio 0⋅74; 95 % CI 0⋅60, 0⋅91; P = 0⋅010), and no effect modifier was found for aMED. The DASH scores, PCA and PLS dietary patterns were not significant after adjustment. In conclusion, high adherence to a MED-type dietary pattern by Taiwanese foods was associated with a lower risk of T2DM in the Taiwanese population, regardless of unhealthy lifestyle habits.

Adherence to the Dietary Approaches to Stop Hypertension diet reduces the risk of diabetes mellitus: A systematic review and dose-response meta-analysis

“…Consistently, a previous meta-analysis of 10 prospective cohort studies including 404,528 participants, revealed that high adherence to "healthy" dietary patterns signi cantly decreased the risk of type 2 DM(RR:0.86; 95%CI:0.82-0.90) (40). However, in contrast to our ndings, found no signi cant association between adherence to the DASH diet and DM (35)(36). Although evidence associating DASH diet to DM remains inconsistent, some possible mechanisms have been reported to explain the observed negative association.…”

“…Accordingly, the remaining thirty-seven full-text articles were examined for eligibility, and 22 were excluded for the following reasons: 5 did not evaluated DM risk; 1 lacked su cient data and the corresponding author of this study could not be contacted; 16 did not mention DASH diet score. Finally, fteen studies(13 cohort and 2 case-control studies) with 557,475 participants and 57,064 cases of DM were included for this systematic review and meta-analysis(6-8, [19][20][21][22][23][24][25][26][34][35][36][37]. Figure 1.…”

“…For example, the DASH diet, as a priori dietary pattern, emphasizes high consumption of fruits, vegetables, whole grains, nuts and legumes, moderate consumption of low-fat dairy products, as well as low consumption of sodium, sweetened beverages and red and processed meats (14). To date, a substantial amount of epidemiological studies have been performed to examine the relationship between adherence to the DASH diet and DM risk (24)(25)(26)(34)(35)(36)(37), but these ndings remain inconsistent. In the Iran cohort study, Esfandiar and colleagues reported a 13% increased between adherence to DASH diet and the risk of DM (RR = 1.13, 95%CI: 0.88-1.46) (34).…”

“…Sample size ranged from 334 to 166500. Eight of the included studies were performed in United States (7-8, 19-21, 23-25), three in Iran(6, 26, 34), one in Taiwan China (35), one in Singapore (22), one in Brazil (36), and one study in Europe (37).…”

“…In addition, all included articles used methods designed by Fung et al ( (19-20, 35, 37) to extract DASH diet. Finally, based on the NOS scores, all of the included studies were considered to be of high-quality studies (6-8, [19][20][21][22][23][24][25][26][34][35][36][37].…”