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

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posted on 2020-09-01, 21:36 authored by Dong Hoon Lee, Jun Li, Yanping Li, Gang Liu, Kana Wu, Shilpa Bhupathiraju, Eric B. Rimm, Kathryn M. Rexrode, JoAnn E. Manson, Walter C. Willett, Frank B. Hu, Fred K. Tabung, Edward L. Giovannucci
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 2 (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 to those in the lowest quintile. Additional adjustment for body mass index (BMI) attenuated the associations (Hazard ratio, 1.95; 95% CI, 1.85-2.05 for EDIP; 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 to those in both lowest quintiles, after adjustment for BMI.

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


This work was supported by the National Institutes of Health (UM1 CA167552, UM1 CA186107, UM1 CA176726, K99 DK122128-01, and R00 CA207736) and the Boston Nutrition Obesity Research Center grant (2P30DK046200-26). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.