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Epidemiology/Health Services Research

Dietary Patterns and Risk of Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)

  1. Jennifer A. Nettleton, PHD1,
  2. Lyn M. Steffen, PHD, MPH, RD2,
  3. Hanyu Ni, PHD, MPH3,
  4. Kiang Liu, PHD4 and
  5. David R. Jacobs, Jr., PHD25
  1. 1Division of Epidemiology and Disease Control, University of Texas Health Sciences Center, Houston, Texas
  2. 2Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
  3. 3National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  4. 4Northwestern University Medical School, Chicago, Illinois
  5. 5Department of Nutrition, University of Oslo, Oslo, Norway
  1. Corresponding author: Jennifer Nettleton, jennifer.a.nettleton{at}uth.tmc.edu
Diabetes Care 2008 Sep; 31(9): 1777-1782. https://doi.org/10.2337/dc08-0760
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Article Figures & Tables

Tables

  • Table 1—

    Demographic, lifestyle, clinical, and dietary characteristics of 5,011 participants in MESA stratified by type 2 diabetes status

    Free of type 2 diabetes through follow-upType 2 diabetes diagnosed at one of three follow-up examsP
    n4,598413
    Age (years)61.7 ± 0.261.5 ± 0.50.69
    Sex (% male)47.349.40.41
    Race/ethnicity (%)<0.001
        White44.433.2
        Black19.627.6
        Hispanic23.727.9
        Chinese12.311.4
    High school degree (%)85.079.90.006
    Active leisure activity (MET min/week)2,522 ± 452,345 ± 1510.26
    Inactive leisure activity (MET min/week)1,664 ± 161,815 ± 550.008
    Current smokers (%)14.313.80.79
    Weekly supplement use (%)58.356.40.54
    BMI (kg/m2)27.6 ± 0.131.2 ± 0.3<0.001
    Waist circumference (cm)96.1 ± 0.2106 ± 0.7<0.001
    Systolic blood pressure (mmHg)125 ± 0.3130 ± 1<0.001
    LDL cholesterol118 ± 0.5117 ± 20.52
    HDL cholesterol52.1 ± 0.246.6 ± 0.7<0.001
    Triglycerides (mg/dl)125 ± 1149 ± 4<0.001
    Fasting insulin (mg/dl)6.1 ± 0.19.7 ± 0.2<0.001
    Fasting glucose (mg/dl)88.3 ± 0.1103 ± 0.5<0.001
    Total energy intake (kcal)1,676 ± 111,802 ± 380.001
    Protein (% of total kcal)16 ± 0.116 ± 0.20.49
    Total fat (% of total kcal)34 ± 0.135 ± 0.30.01
    Saturated fat (% of total kcal)11 ± 0.0411 ± 0.10.44
    Monounsaturated fat (% of total kcal)12 ± 0.0413 ± 0.10.01
    Polyunsaturated fat (% of total kcal)7.7 ± 0.038.0 ± 0.10.07
    Carbohydrate (% of total kcal)50 ± 0.149 ± 0.40.06
    Fiber (g/day)18 ± 0.118 ± 0.30.36
    Whole grains (servings/day)0.60 ± 0.010.54 ± 0.030.02
    Vegetables (servings/day)*2.3 ± 0.022.2 ± 0.070.25
    Nuts/seeds (servings/day)0.29 ± 0.010.25 ± 0.020.04
    Low-fat dairy (servings/day)0.79 ± 0.020.68 ± 0.050.07
    Coffee (servings/day)1.2 ± 0.021.1 ± 0.10.17
    Red meat (servings/day)0.38 ± 0.0040.39 ± 0.010.22
    Processed meat (servings/day)0.17 ± 0.0040.18 ± 0.010.34
    High-fat dairy (servings/day)†0.50 ± 0.010.57 ± 0.030.05
    White potatoes (servings/day)‡0.20 ± 0.0030.20 ± 0.010.84
    Regular soda (servings/day)§0.40 ± 0.010.45 ± 0.040.22
    • Data are means ± SE. Except for total energy intake, dietary variables are adjusted for energy intake (kcal/day). P for difference by F test from linear regression (continuous variables) or χ2 (categorical variables).

    • ↵* Vegetables include green leafy vegetables, cruciferous vegetables, dark-yellow vegetables, other vegetables, and tomatoes (food groups used in the principal components analyses were combined).

    • ↵† High-fat dairy combines whole milk and high-fat cheese/cream sauces (food groups used in the principal components analyses were combined).

    • ↵‡ White potatoes include white potatoes (baked, boiled, or mashed) and fried potatoes (food groups used in the principal components analyses were combined).

    • ↵§ Regular soda includes nondiet soda, sweetened mineral water, and nonalcoholic beer (participant response to single question listing these three beverages).

  • Table 2—

    Risk of type 2 diabetes according to two dietary patterns derived by principal components analysis and one a priori–defined low-risk food pattern in 5,011 men and women from MESA

    Incident diabetes per person-years of follow-upQuintile 1Quintile 2Quintile 3Quintile 4Quintile 5PtrendHR (95% CI) per 1-score SD*
    “Beans, tomatoes, and refined grains”78/4,31168/3,39475/4,43383/4,446109/4,344
        Model 1†1.000.92 (0.66–1.28)1.02 (0.74–1.41)1.07 (0.77–1.48)1.25 (0.87–1.81)0.0041.18 (1.06–1.32)
        Model 2‡1.000.92 (0.66–1.28)1.02 (0.74–1.41)1.06 (0.76–1.47)1.23 (0.85–1.78)0.0041.18 (1.06–1.32)
        Model 3§1.000.99 (0.71–1.38)1.09 (0.78–1.51)1.09 (0.78–1.52)1.28 (0.88–1.84)0.0031.19 (1.06–1.33)
    “Whole grains and fruit”108/4,32882/4,34176/4,43576/4,41071/4,414
        Model 1†1.000.76 (0.56–1.02)0.71 (0.52–0.97)0.71 (0.52–0.98)0.63 (0.45–0.89)0.0020.84 (0.75–0.94)
        Model 2‡1.000.76 (0.56–1.02)0.73 (0.53–1.99)0.72 (0.52–0.99)0.66 (0.47–0.93)0.0050.85 (0.76–0.95)
        Model 3§1.000.74 (0.54–1.99)0.76 (0.55–1.03)0.77 (0.56–1.07)0.73 (0.52–1.04)0.050.89 (0.79–1.00)
    A priori, low-risk food pattern‖106/4,26384/4,401101/4,33668/4,45154/4,477
        Model 1†1.000.88 (0.65–1.20)1.16 (0.86–1.57)0.79 (0.57–1.10)0.59 (0.42–0.84)0.020.88 (0.80–0.98)
        Model 2‡1.000.93 (0.69–1.26)1.22 (0.90–1.66)0.83 (0.60–1.16)0.62 (0.44–0.88)0.040.87 (0.81–0.99)
        Model 3§1.001.00 (0.73–1.33)1.31 (0.94–1.74)0.92 (0.66–1.29)0.72 (0.51–1.03)0.180.93 (0.84–1.03)
    • Data are n or HR (95% CI). Ptrend calculated with dietary pattern modeled as a continuous variable (score units).

    • ↵* For incident type 2 diabetes per 1-SD change in dietary pattern score. For the “beans, tomatoes, and refined grains” and “whole grains and fruit” dietary patterns, SD was 1.00. For the a priori, low-risk food pattern, SD was 3.8.

    • ↵† For incident type 2 diabetes with quintile 1 as the reference category adjusted for energy intake (kcal/day), study center (California, Minnesota, Maryland, New York, Illinois, or North Carolina), age (years), sex, and race/ethnicity (white, black, Chinese, or Hispanic).

    • ↵‡ For incident type 2 diabetes with quintile 1 as the reference category adjusted for the above plus education (less than a high school degree, a high school degree, and more than a high school degree), active leisure-time physical activity (MET minutes per week), inactive leisure-time physical activity (MET minutes per week), current smoking status (yes or no), smoking pack-years, and current weekly supplement use (yes or no).

    • ↵§ For incident type 2 diabetes with quintile 1 as the reference category adjusted for the above plus waist circumference (cm).

    • ↵‖ The a priori, low type 2 diabetes–risk food pattern is the sum of servings per day from 10 food groups (standardized to mean 0.00, SD 1.00). Positive (+1) weights were assigned to whole grains, fruit, vegetables, nuts/seeds, low-fat dairy, and coffee. Negative (−1) weights were assigned to red meat, processed meat, high-fat dairy, and regular soda.

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Dietary Patterns and Risk of Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Jennifer A. Nettleton, Lyn M. Steffen, Hanyu Ni, Kiang Liu, David R. Jacobs
Diabetes Care Sep 2008, 31 (9) 1777-1782; DOI: 10.2337/dc08-0760

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Dietary Patterns and Risk of Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Jennifer A. Nettleton, Lyn M. Steffen, Hanyu Ni, Kiang Liu, David R. Jacobs
Diabetes Care Sep 2008, 31 (9) 1777-1782; DOI: 10.2337/dc08-0760
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