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<b>Objective:</b> 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.
<p><b>Research Design and Methods</b><b>:</b>
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. </p>
<p><b>Results:</b> 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),P<sub>trend</sub><.0001;
EDIP: 1.45 (1.29-1.63),P<sub>trend</sub><.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),P<sub>trend</sub>=0.46;
GL: 1.01 (0.89, 1.16),P<sub>trend</sub>=0.30. </p>
<p><b>Conclusions:</b> <a>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.</a> </p>
Funding
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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