Dietary Factors Determining Diabetes and Impaired Glucose Tolerance: A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study

Edith J Feskens; Suvi M Virtanen; Leena Räsänen; Jaakko Tuomilehto; Jari Stengård; Juha Pekkanen; Aulikki Nissinen; Daan Kromhout

doi:10.2337/diacare.18.8.1104

Original Articles

Dietary Factors Determining Diabetes and Impaired Glucose Tolerance: A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study

Edith J Feskens, PHD,
Suvi M Virtanen, PHD, MD ,
Leena Räsänen, PHD,
Jaakko Tuomilehto, PHD, MD,
Jari Stengård, PHD, MD,
Juha Pekkanen, PHD, MD,
Aulikki Nissinen, PHD, MD and
Daan Kromhout, PHD, MPH

Department of Chronic Diseases and Environmental Epidemiology, University of Kuopio Kuopio, Finland
National Institute of Public Health and Environmental Protection, Bilthoven, and the Department of Epidemiology and Public Health, University of Kuopio Kuopio, Finland
Agricultural University Wageningen, the Netherlands; and the Department of Applied Chemistry and Microbiology, University of Kuopio Kuopio, Finland
Division of Nutrition, University of Helsinki, and the Department of Epidemiology and Health Promotion, University of Kuopio Kuopio, Finland
National Public Health Institute Helsinki, and the Department of Environmental Epidemiology, University of Kuopio Kuopio, Finland
National Public Health Institute, and the Department of Community Health and General Practice, University of Kuopio Kuopio, Finland

Address correspondence and reprint requests to E.J.M. Feskens, PhD, Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and Environmental Protection, P.O. Box 1, NL-3720 BA Bilthoven, the Netherlands. E-mail: Ejm.Feskens{at}rivm.nl.

Diabetes Care 1995 Aug; 18(8): 1104-1112. https://doi.org/10.2337/diacare.18.8.1104

Abstract

OBJECTIVE To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses.

RESULTS Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level (P < 0.05). An independent inverse association with the past intake of vitamin C was observed (P < 0.05). These associations were independent of changes in the intake of fat and vitamin C during the 20-year follow-up. An increase in the consumption of vegetables and legumes, potatoes, and fish during the 20-year follow-up was inversely related with 2-h glucose level (P < 0.05).

CONCLUSIONS Although the regression coefficients were in general not very large, these results indicate that a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and NIDDM. Foods such as fish, potatoes, vegetables, and legumes may have a protective effect. In addition, the observed inverse association between vitamin C and glucose intolerance suggests that antioxidants may also play a role in the development of derangements in glucose metabolism.