Sylvia H Ley1,2, An Pan3, Yanping Li4, JoAnn E Manson5,6, Walter C Willett4,2,5, Qi Sun4,5, Frank B Hu1,2,5. 1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA sylvia.ley@channing.harvard.edu frank.hu@channing.harvard.edu. 2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. 3. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 4. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. 5. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. 6. Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: Recent public health recommendations emphasize adopting a healthful dietary pattern, but evidence is scarce on whether incremental diet quality changes have an impact on long-term diabetes prevention. We aim to evaluate diet quality changes during a 4-year period and subsequent 4-year type 2 diabetes incidence. RESEARCH DESIGN AND METHODS: Participants of prospective cohorts, the Nurses' Health Study (NHS), NHS II, and the Health Professionals Follow-up Study, who were free of diabetes at baseline (n = 124,607), were observed for ≥20 years. Diet quality, reflected by the Alternate Healthy Eating Index (AHEI) score, was assessed every 4 years to calculate changes. RESULTS: We documented 9,361 cases of type 2 diabetes during 2,093,416 person-years of follow-up. A >10% decrease in AHEI score over 4 years was associated with a higher subsequent diabetes risk (pooled hazard ratio 1.34 [95% CI 1.23-1.46]) with multiple adjustment, whereas a >10% increase in AHEI score was associated with a lower risk (0.84 [0.78-0.90]). Greater improvement in diet quality was associated with lower diabetes risk across baseline diet quality status (P for trend ≤ 0.001 for low, medium, or high initial diet quality) and baseline BMI (P for trend ≤ 0.01 for BMI <25, 25-29, or 30 kg/m2). Changes in body weight explained 32% (95% CI 24-41) of the association between AHEI changes (per 10% increase) and diabetes risk. CONCLUSIONS: Improvement in overall diet quality is associated with a lower risk of type 2 diabetes, whereas deterioration in diet quality is associated with a higher risk. The association between diet quality changes and diabetes risk is only partly explained by body weight changes.
OBJECTIVE: Recent public health recommendations emphasize adopting a healthful dietary pattern, but evidence is scarce on whether incremental diet quality changes have an impact on long-term diabetes prevention. We aim to evaluate diet quality changes during a 4-year period and subsequent 4-year type 2 diabetes incidence. RESEARCH DESIGN AND METHODS: Participants of prospective cohorts, the Nurses' Health Study (NHS), NHS II, and the Health Professionals Follow-up Study, who were free of diabetes at baseline (n = 124,607), were observed for ≥20 years. Diet quality, reflected by the Alternate Healthy Eating Index (AHEI) score, was assessed every 4 years to calculate changes. RESULTS: We documented 9,361 cases of type 2 diabetes during 2,093,416 person-years of follow-up. A >10% decrease in AHEI score over 4 years was associated with a higher subsequent diabetes risk (pooled hazard ratio 1.34 [95% CI 1.23-1.46]) with multiple adjustment, whereas a >10% increase in AHEI score was associated with a lower risk (0.84 [0.78-0.90]). Greater improvement in diet quality was associated with lower diabetes risk across baseline diet quality status (P for trend ≤ 0.001 for low, medium, or high initial diet quality) and baseline BMI (P for trend ≤ 0.01 for BMI <25, 25-29, or 30 kg/m2). Changes in body weight explained 32% (95% CI 24-41) of the association between AHEI changes (per 10% increase) and diabetes risk. CONCLUSIONS: Improvement in overall diet quality is associated with a lower risk of type 2 diabetes, whereas deterioration in diet quality is associated with a higher risk. The association between diet quality changes and diabetes risk is only partly explained by body weight changes.
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