Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study

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.

Figure 1

Risk of type 2 diabetes by quartile of simplified food pattern score and obesity status at baseline. Adjusted for age, sex, race/clinic, family history of diabetes, glucose tolerance status at baseline, energy expenditure, smoking, and energy intake (n = 878). All ORs for BMI <30 kg/m² are statistically significant.