A Posteriori Dietary Patterns Are Related to Risk of Type 2 Diabetes: Findings from a Systematic Review and Meta-Analysis

• Published in: Journal of the Academy of Nutrition and Dietetics Vol. 114; no. 11; pp. 1759 - 1775.e4
• Main Authors: McEvoy, Claire T., PhD, RD, Cardwell, Christopher R., PhD, Woodside, Jayne V., PhD, Young, Ian S., MD, MB, BCh, FRCP, Hunter, Steven J., MD, MB, BCh, FRCP, McKinley, Michelle C., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01-11-2014
• Subjects: Biological and medical sciences; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Diabetes Mellitus, Type 2 - prevention & control; Diabetes. Impaired glucose tolerance; Diet - adverse effects; Diet, Western - adverse effects; Dietary Carbohydrates - adverse effects; Dietary Fiber - therapeutic use; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Evidence-Based Medicine; Feeding. Feeding behavior; Food Handling; Food, Preserved - adverse effects; Fruit; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Health Promotion; Humans; Insulin Resistance; Internal Medicine; Meat Products - adverse effects; Medical sciences; Nutrition Policy; Risk Factors; Vegetables; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Insulin resistance; Dietary patterns; Diabetes; Meta-analysis; Endocrinopathy; Type 2 diabetes; Diet; Evidence-based practice; Risk factor; Metabolic diseases; Systematic review; Risk; Evidence-based medicine; Feeding; Metaanalysis
• ISSN: 2212-2672; 2212-2680
• DOI: 10.1016/j.jand.2014.05.001

Abstract Our review and meta-analysis examined the association between a posteriori –derived dietary patterns (DPs) and risk of type 2 diabetes mellitus. MEDLINE and EMBASE were searched for articles published up to July 2012 and data were extracted by two independent reviewers. Overall, 19 cross-sectional, 12 prospective cohort, and two nested case-control studies were eligible for inclusion. Results from cross-sectional studies reported an inconsistent association between DPs and measures of insulin resistance and/or glucose abnormalities, or prevalence of type 2 diabetes. A meta-analysis was carried out on nine prospective cohort studies that had examined DPs derived by principle component/factor analysis and incidence of type 2 diabetes risk (totaling 309,430 participants and 16,644 incident cases). Multivariate-adjusted odds ratios were combined using a random-effects meta-analysis. Two broad DPs (Healthy/Prudent and Unhealthy/Western) were identified based on food factor loadings published in original studies. Pooled results indicated a 15% lower type 2 diabetes risk for those in the highest category of Healthy/Prudent pattern compared with those in the lowest category (95% CI 0.80 to 0.91; P <0.0001). Compared with the lowest category of Unhealthy/Western DP, those in the highest category had a 41% increased risk of type 2 diabetes (95% CI 1.32 to 1.52; P <0.0001). These results provide evidence that DPs are consistently associated with risk of type 2 diabetes even when other lifestyle factors are controlled for. Thus, greater adherence to a DP characterized by high intakes of fruit, vegetables, and complex carbohydrate and low intakes of refined carbohydrate, processed meat, and fried food may be one strategy that could have a positive influence on the global public health burden of type 2 diabetes.