Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study

Abstract

BackgroundDiet is a key modifiable risk factor for multiple chronic conditions, including type 2 diabetes (T2D). Consuming a range of foods from the five major food groups is advocated as critical to healthy eating, but the association of diversity across major food groups with T2D is not clear and the relationship of within-food-group diversity is unknown. In addition, there is a growing price gap between more and less healthy foods, which may limit the uptake of varied diets. The current study had two aims: first, to examine the association of reported diversity of intake of food groups as well as their subtypes with risk of developing T2D, and second, to estimate the monetary cost associated with dietary diversity.Methods and FindingsA prospective study of 23,238 participants in the population-based EPIC-Norfolk cohort completed a baseline Food Frequency Questionnaire in 1993–1997 and were followed up for a median of 10 y. We derived a total diet diversity score and additional scores for diversity within each food group (dairy products, fruits, vegetables, meat and alternatives, and grains). We used multivariable Cox regression analyses for incident diabetes (892 new cases), and multivariable linear regression for diet cost. Greater total diet diversity was associated with 30% lower risk of developing T2D (Hazard ratio [HR] 0.70 [95% CI 0.51 to 0.95]) comparing diets comprising all five food groups to those with three or fewer, adjusting for confounders including obesity and socioeconomic status. In analyses of diversity within each food group, greater diversity in dairy products (HR 0.61 [0.45 to 0.81]), fruits (HR 0.69 [0.52 to 0.90]), and vegetables (HR 0.67 [0.52 to 0.87]) were each associated with lower incident diabetes. The cost of consuming a diet covering all 5 food groups was 18% higher (£4.15/day [4.14 to 4.16]) than one comprising three or fewer groups. Key limitations are the self-reported dietary data and the binary scoring approach whereby some food groups contained both healthy and less healthy food items.ConclusionsA diet characterized by regular consumption of all five food groups and by greater variety of dairy, fruit, and vegetable subtypes, appears important for a reduced risk of diabetes. However, such a diet is more expensive. Public health efforts to prevent diabetes should include food price policies to promote healthier, more varied diets.

Dietary intake by food group of individuals with type 2 diabetes mellitus: A systematic review

“…around the diet quality of individuals with T2DM given the consumption of healthy diets is associated with a lower risk of developing the disease [35]. For example, a large prospective cohort study conducted in the United Kingdom showed individuals who reported consuming all five food groups had a 30% reduced incidence of T2DM [36]. Further research determining factors that impact long term adherence to dietary guidelines is needed [11].…”

EAACI position paper on diet diversity in pregnancy, infancy and childhood: Novel concepts and implications for studies in allergy and asthma

“…There is a nonexhaustive list of factors that may affect allergy outcomes, but potential confounders should be corrected for analysing associations between diet diversity and allergy outcomes Diet diversity can be measured by counting individual foods, 31,37,[42][43][44][45][46] food groups 30,[34][35][36]38,39,41,43,[47][48][49][50][51][52][53][54] or foods within a group, 32,33,55,56 and can be measured over a time period ranging from the previous 24 hours (24-hour recalls) [31][32][33][34][35]38,40,44,46,48 or over a 7day period 33,39,42,47,53,[55][56][57] to intake over one year. Food intake data may be collected once [32][33][34]…”

A prospective study of water intake and subsequent risk of all-cause mortality in a national cohort

“…The dietary diversity score (0-5) is a simple measure of the overall quality that indicates whether each of the 5 major food groups was mentioned in the recall (29,30). In previous published work, this measure has been shown to be related to health outcomes (31,32).…”