A high-fat, high-glycaemic index, low-fibre dietary pattern is prospectively associated with type 2 diabetes in a British birth cohort

Abstract

The combined association of dietary fat, glycaemic index (GI) and fibre with type 2 diabetes has rarely been investigated. The objective was to examine the relationship between a high-fat, high-GI, low-fibre dietary pattern across adult life and type 2 diabetes risk using reduced rank regression. Data were from the MRC National Survey of Health and Development. Repeated measures of dietary intake estimated using 5-d diet diaries were available at the age of 36, 43 and 53 years for 1180 study members. Associations between dietary pattern scores at each age, as well as longitudinal changes in dietary pattern z-scores, and type 2 diabetes incidence (n 106) from 53 to 60-64 years were analysed. The high-fat, high-GI, low-fibre dietary pattern was characterised by low intakes of fruit, vegetables, low-fat dairy products and whole-grain cereals, and high intakes of white bread, fried potatoes, processed meat and animal fats. There was an increasing trend in OR for type 2 diabetes with increasing quintile of dietary pattern z-scores at the age of 43 years among women but not among men. Women in the highest z-score quintile at the age of 43 years had an OR for type 2 diabetes of 5·45 (95 % CI 2·01, 14·79). Long-term increases in this dietary pattern, independently of BMI and waist circumference, were also detrimental among women: for each 1 sd unit increase in dietary pattern z-score between 36 and 53 years, the OR for type 2 diabetes was 1·67 (95 % CI 1·20, 2·43) independently of changes in BMI and waist circumference in the same periods. A high-fat, high-GI, low-fibre dietary pattern was associated with increased type 2 diabetes risk in middle-aged British women but not in men.

Keywords: Dietary fibre; Dietary patterns; EER estimated energy requirement; EI energy intake; GI glycaemic index; Glycaemic index; NSHD National Survey of Health and Development; RRR reduced rank regression; Type 2 diabetes; WC waist circumference.

Figure 1

Factor loadings for the high-fat, high-GI, low-fibre dietary pattern in the NSHD used in confirmatory dietary pattern analyses

Figure 2

Mean change in dietary pattern z-score across the adult life course (36-53 years) by type 2 diabetes diagnosis (diagnosed between age 53 to 60-64 years) and sex. Student t-test was used to test for differences in z-score changes; age 36-43: P=0.50 for men and <0.01 for women; age 43-53: P=0.39 for men and <0.01 for women; age 36-53: P=0.29 for men and <0.001 for women.