American Diabetes Association
DC_Online-Only_Supplemental_Material_11Nov2020.pdf (766.46 kB)

Insulinemic and Inflammatory Dietary Patterns Show Enhanced Predictive Potential for Type 2 Diabetes Risk in Postmenopausal Women

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posted on 2021-01-08, 19:35 authored by Qi Jin, Ni Shi, Desmond Aroke, Dong Hoon Lee, Joshua J. Joseph, Macarius Donneyong, Darwin L. Conwell, Phil A. Hart, Xuehong Zhang, Steven K. Clinton, Zobeida Cruz-Monserrate, Theodore M. Brasky, Rebecca Jackson, Lesley F. Tinker, Simin Liu, Lawrence S. Phillips, Aladdin H. Shadyab, Rami Nassir, Wei Bao, Fred K. Tabung
Objective: The empirical dietary index for hyperinsulinemia(EDIH) and empirical dietary inflammatory pattern(EDIP) scores assess the insulinemic and inflammatory potentials of habitual dietary patterns, irrespective of the macronutrient content, and are based on plasma insulin response or inflammatory biomarkers, respectively. The glycemic index (GI) and glycemic load (GL) assess postprandial glycemic potential based on dietary carbohydrate content. We tested the hypothesis that dietary patterns promoting hyperinsulinemia, chronic inflammation, or hyperglycemia may influence type 2 diabetes risk.

Research Design and Methods: We calculated dietary scores from baseline (1993-1998) food frequency questionnaires among 73,495 postmenopausal women in the Women’s Health Initiative, followed through March 2019. We used multivariable-adjusted Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for type 2 diabetes risk. We also estimated multivariable-adjusted absolute risk of type 2 diabetes.

Results: During a median 13.3 years of follow-up, 11,009 incident type 2 diabetes cases were diagnosed. Participants consuming the most hyperinsulinemic or proinflammatory dietary patterns experienced greater risk of type 2 diabetes: HRs(95%CI) comparing highest to lowest dietary index quintiles were: EDIH: 1.49 (1.32-1.68),Ptrend<.0001; EDIP: 1.45 (1.29-1.63),Ptrend<.0001). The absolute excess incidence for the same comparison was +220 (EDIH) and +271 (EDIP) cases per 100,000 person-years. GI and GL were not associated with type 2 diabetes risk: GI: 0.99 (0.88-1.12),Ptrend=0.46; GL: 1.01 (0.89, 1.16),Ptrend=0.30.

Conclusions: Our findings in this diverse cohort of postmenopausal women, suggest that lowering the insulinemic and inflammatory potentials of the diet may be more effective in preventing type 2 diabetes than focusing on glycemic foods.


The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.


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