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Dietary Insulinemic Potential and Risk of Total and Cause-Specific Mortality in the Nurses' Health Study and the Health Professionals Follow-up Study

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posted on 29.11.2021, 22:38 by Yi Wan, Fred K. Tabung, Dong Hoon Lee, Teresa T. Fung, Walter C. Willett, Edward L. Giovannucci
Objective: Insulin response is related to overall health. Diet modulates insulin response. We aimed to investigate whether insulinemic potential of diet are associated with risk of all-cause and cause-specific mortality.

Research Design and Methods: We prospectively followed 63,464 women from the Nurses’ Health Study (1986-2016) and 42,880 men from the Health Professionals Follow-up Study (1986-2016). Diet was assessed by food frequency questionnaires every 4 years. The insulinemic potential of diet was evaluated using a food-based empirical dietary index for hyperinsulinemia (EDIH), which was pre-defined based on predicting circulating C-peptide concentrations.

Results: During 2,792,550 person-years of follow-up, 38,329 deaths occurred. In the pooled multivariable-adjusted analyses, a higher dietary insulinemic potential was associated with an increased risk of mortality from all-cause (hazard ratio [HR] comparing extreme quintiles: 1.33; 95% confidence interval [CI]: 1.29, 1.38; P-trend<0.001), cardiovascular disease (CVD) (HR: 1.37; 95% CI: 1.27, 1.46; P-trend<0.001), and cancers (HR: 1,20; 95% CI: 1.13, 1.28; P-trend<0.001). These associations were independent of body mass index and remained significant after further adjustment for other well-known dietary indices. Furthermore, compared with participants whose EDIH scores were stable over an 8-year period, those with the greatest increases had a higher subsequent risk of all-cause (HR: 1.13; 95%CI: 1.09, 1.18; P-trend<0.001) and CVD (HR: 1.10; 95% CI: 1.01, 1.21; P-trend=0.006) mortality.

Conclusions: Higher insulinemic potential of diet was associated with increased risk of all-cause, CVD, and cancer mortality. Adopting a diet with low insulinemic potential might be an effective approach to improve overall health and prevent premature death.


This work was supported by grants from the National Institutes of Health (UM1 CA186107, P01 CA87969, and U01 CA167552). Dr. Wan was supported by funding from the Friends of FACES Foundation. The sponsors had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or in the decision to submit the article for publication.