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5 February 2002 | Volume 136 Issue 3 | Pages 201-209
Background: The role of diet in the development of type 2 diabetes mellitus remains unsettled.
Objective: To examine the association between major dietary patterns and risk for type 2 diabetes mellitus.
Design: Prospective cohort study.
Setting: United States.
Participants: 42 504 male health professionals, 40 to 75 years of age, without diagnosed diabetes, cardiovascular disease, or cancer at baseline.
Measurements: Using factor analysis based on data from food-frequency questionnaires, we identified and validated two major dietary patterns that we labeled "prudent" (characterized by higher consumption of vegetables, fruit, fish, poultry and whole grains) and "western" (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts). Relative risks and 95% CIs were adjusted for potential confounders, including body mass index (BMI), physical activity, and cigarette smoking.
Results: During 12 years of follow-up (466 508 person-years), we documented 1321 cases of type 2 diabetes. The prudent dietary pattern score was associated with a modestly lower risk for type 2 diabetes (relative risk for extreme quintiles, 0.84 [CI, 0.70 to 1.00]). In contrast, the western dietary pattern score was associated with an increased risk for type 2 diabetes (relative risk, 1.59 [CI, 1.32 to 1.93]; P < 0.001 for trend). A high score for the western dietary pattern combined with low physical activity (relative risk comparing extreme quintiles of dietary pattern score and physical activity, 1.96 [CI, 1.35 to 2.84]) or obesity (relative risk for BMI
Conclusion: Our findings suggest that a western dietary pattern is associated with a substantially increased risk for type 2 diabetes in men.
Author and Article Information
From Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, and National Institute for Public Health and the Environment, the Netherlands.
Grant Support: By CA 55075 and HL 35464 from the U.S. National Institutes of Health. Dr. Hu was supported in part by a Research Award from the American Diabetes Association.
Requests for Single Reprints: Frank B. Hu, MD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115; e-mail, frank.hu{at}channing.harvard.edu.
Current Author Addresses: Mr. Van Dam: Department of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment, Box 1, 3720 BA Bilthoven, the Netherlands.
Drs. Rimm, Willett, Hu, and Stampfer: Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.
Author Contributions: Conception and design: R.M. van Dam, E.B. Rimm, W.C. Willett, F.B. Hu.
Analysis and interpretation of the data: R.M. van Dam, E.B. Rimm, W.C. Willett, M.J. Stampfer, F.B. Hu.
Drafting of the article: R.M. van Dam, F.B. Hu.
Critical revision of the article for important intellectual content: R.M. van Dam, E.B. Rimm, W.C. Willett, M.J. Stampfer, F.B. Hu.
Final approval of the article: R.M. van Dam, E.B. Rimm, W.C. Willett, M.J. Stampfer, F.B. Hu.
Provision of study materials or patients: W.C. Willett.
Statistical expertise: R.M. van Dam, W.C. Willett, F.B. Hu.
Obtaining of funding: E.B. Rimm, W.C. Willett, F.B. Hu.
Administrative, technical, or logistic support: E.B. Rimm, W.C. Willett, F.B. Hu.
Collection and assembly of data: E.B. Rimm, W.C. Willett. ARTICLE
Dietary Patterns and Risk for Type 2 Diabetes Mellitus in U.S. Men
30 kg/m2 vs. <25 kg/m2, 11.2 [CI, 8.07 to 15.6]) was associated with a particularly high risk for type 2 diabetes.
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