American Diabetes Association
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White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries

Version 3 2020-10-23, 18:19
Version 2 2020-10-07, 22:06
Version 1 2020-09-01, 19:42
posted on 2020-10-23, 18:19 authored by Balaji Bhavadharini, Viswanathan Mohan, Mahshid Dehghan, Sumathy Rangarajan, Sumathi Swaminathan, Annika Rosengren, Andreas Wielgosz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Antonio L Dans, Karen Yeates, Paul Poirier, Jephat Chifamba, Khalid F Alhabib, Noushin Mohammadifard, Katarzyna Zatońska, Rasha Khatib, Mirac Vural Keskinler, Li Wei, Chuangshi Wang, Xiaoyun Liu, Romaina Iqbal, Rita Yusuf, Edelweiss Wentzel-Viljoen, Afzal Hussein Yusufali, Rafael Diaz, NG Kien Keat, PVM Lakshmi, Noorhassim Ismail, Rajeev Gupta, Lia M Palileo-Villanueva, Patrick Sheridan, Andrew Mente, Salim Yusuf
Objective: Previous prospective studies on association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study.

Research design and methods: Data on 132,373 individuals aged 35-70 years, from 21 countries. were analysed. White rice consumption (cooked) was categorised as <150, ≥150 to <300, ≥300 to <450 and ≥450 grams/day, based on 1 cup of cooked rice = 150 grams. The primary outcome was incident diabetes. Hazards ratios were calculated using multivariable Cox frailty model.

Results: During a mean follow up period of 9.5 years, 6,129 individuals without baseline diabetes developed incident diabetes. In the overall cohort, higher intake of white rice (≥450g/d compared with <150g/d) was associated with increased risk of diabetes (HR: 1.20; 95% CI: 1.03-1.41 p for trend=0.003). However, the highest risk was seen in South Asia (HR: 1.65; 95% CI: 1.17-2.34, p for trend=0.02), followed by other regions of the world (which included South East Asia, Middle East, South America, North America/Europe and Africa) (HR: 1.41; 95% CI: 1.08-1.85, p for trend =0.01), while in China there was no significant association (HR: 1.05; 95% CI: 0.78-1.41, p for trend = 0.38).

Conclusions: Higher consumption of white rice is associated with an increased risk of incident diabetes with the strongest association being observed in South Asia, while in other regions, a modest, non-significant association was seen.


Dr S Yusuf is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. The PURE study is an investigator-initiated study that is funded by the Population Health Research Institute, Hamilton Health Sciences Research Institute (HHSRI), the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Support from Canadian Institutes of Health Research’s Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies [with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithKline], and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries. These include: Argentina: Fundacion ECLA (Estudios Clínicos Latino America) ; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: This study was supported by an unrestricted grant Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; Chile: Universidad de La Frontera [DI13-PE11]; China: National Center for Cardiovascular Diseases and ThinkTank Research Center for Health Development; Colombia: Colciencias (grant 6566-04-18062 and grant 6517-777-58228); India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia (grant number: 100-IRDC/BIOTEK 16/6/21 [13/2007], and 07-05-IFN-BPH 010), Ministry of Higher Education of Malaysia (grant number: 600-RMI/LRGS/5/3 [2/2011]), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010); occupied Palestinian territory: the United Nations Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory; Internationa


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