Food Intake Patterns Associated With Incident Type 2 Diabetes

The Insulin Resistance Atherosclerosis Study

  1. Angela D. Liese, PHD, MPH1,
  2. Kristina E. Weis, PHD, MPH1,
  3. Mandy Schulz, PHD, MSPH2 and
  4. Janet A. Tooze, PHD3
  1. 1Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
  2. 2Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
  3. 3Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  1. Corresponding author: Angela D. Liese, liese{at}sc.edu

Abstract

OBJECTIVE—Markers of hemostasis and inflammation such as plasminogen activator inhibitor-1 (PAI-1) and fibrinogen have been associated with risk of type 2 diabetes. We aimed to identify food intake patterns influencing this pathway and evaluate their association with incident diabetes.

RESEARCH DESIGN AND METHODS—The Insulin Resistance Atherosclerosis Study cohort included 880 middle-aged adults initially free of diabetes. At the 5-year follow-up, 144 individuals had developed diabetes. Usual dietary intake was ascertained with a 114-item food frequency questionnaire. Using reduced rank regression, we identified a food pattern maximizing the explained variation in PAI-1 and fibrinogen. Subsequently, the food pattern–diabetes association was evaluated using logistic regression.

RESULTS—High intake of the food groups red meat, low-fiber bread and cereal, dried beans, fried potatoes, tomato vegetables, eggs, cheese, and cottage cheese and low intake of wine characterized the pattern, which was positively associated with both biomarkers. With increasing pattern score, the odds of diabetes increased significantly (Ptrend < 0.01). After multivariate adjustment, the odds ratio comparing extreme quartiles was 4.3 (95% CI 1.7–10.8). Adjustment for insulin sensitivity and secretion and other metabolic factors had little impact (4.9, 1.8–13.7).

CONCLUSIONS—Our findings provide support for potential behavioral prevention strategies, as we identified a food intake pattern that was strongly related to PAI-1 and fibrinogen and independently predicted type 2 diabetes.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 25 November 2008.

    We dedicate this manuscript to our recently deceased friend and colleague Dr. Kurt Hoffmann from the German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany, who introduced RRR to nutritional epidemiology and spent countless hours educating us on this method with patience and humor.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted October 21, 2008.
    • Received July 16, 2008.
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  1. Published online before print November 25, 2008, doi: 10.2337/dc08-1325 Diabetes Care February 2009 vol. 32 no. 2 263-268
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