Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun 1;149(6):1047-1055.
doi: 10.1093/jn/nxz031.

Generalizability of a Diabetes-Associated Country-Specific Exploratory Dietary Pattern Is Feasible Across European Populations

Franziska Jannasch  1   2   3 , Janine Kröger  1   2 , Claudia Agnoli  4 , Aurelio Barricarte  5   6   7 , Heiner Boeing  8 , Valerie Cayssials  9 , Sandra Colorado-Yohar  5   10   11 , Christina C Dahm  12 , Courtney Dow  13 , Guy Fagherazzi  13 , Paul W Franks  14   15 , Heinz Freisling  16 , Marc J Gunter  16 , Nicola D Kerrison  17 , Timothy J Key  18 , Kay-Tee Khaw  19 , Tilman Kühn  20 , Cecilie Kyro  21 , Francesca Romana Mancini  13 , Olatz Mokoroa  5   22 , Peter Nilsson  14 , Kim Overvad  12   23 , Domenico Palli  24 , Salvatore Panico  25 , Jose Ramón Quirós García  26 , Olov Rolandsson  15 , Carlotta Sacerdote  27   28 , Mariá-José Sánchez  5   29 , Mohammad Sediq Sahrai  16 , Ruth Schübel  20 , Ivonne Sluijs  30 , Annemieke M W Spijkerman  31 , Anne Tjonneland  21 , Tammy Y N Tong  18 , Rosario Tumino  32   33 , Elio Riboli  34 , Claudia Langenberg  17 , Stephen J Sharp  17 , Nita G Forouhi  17 , Matthias B Schulze  1   2   35 , Nicholas J Wareham  17
Affiliations

Generalizability of a Diabetes-Associated Country-Specific Exploratory Dietary Pattern Is Feasible Across European Populations

Franziska Jannasch et al. J Nutr. .

Abstract

Background: Population-specificity of exploratory dietary patterns limits their generalizability in investigations with type 2 diabetes incidence.

Objective: The aim of this study was to derive country-specific exploratory dietary patterns, investigate their association with type 2 diabetes incidence, and replicate diabetes-associated dietary patterns in other countries.

Methods: Dietary intake data were used, assessed by country-specific questionnaires at baseline of 11,183 incident diabetes cases and 14,694 subcohort members (mean age 52.9 y) from 8 countries, nested within the European Prospective Investigation into Cancer and Nutrition study (mean follow-up time 6.9 y). Exploratory dietary patterns were derived by principal component analysis. HRs for incident type 2 diabetes were calculated by Prentice-weighted Cox proportional hazard regression models. Diabetes-associated dietary patterns were simplified or replicated to be applicable in other countries. A meta-analysis across all countries evaluated the generalizability of the diabetes-association.

Results: Two dietary patterns per country/UK-center, of which overall 3 dietary patterns were diabetes-associated, were identified. A risk-lowering French dietary pattern was not confirmed across other countries: pooled HRFrance per 1 SD: 1.00; 95% CI: 0.90, 1.10. Risk-increasing dietary patterns, derived in Spain and UK-Norfolk, were confirmed, but only the latter statistically significantly: HRSpain: 1.09; 95% CI: 0.97, 1.22 and HRUK-Norfolk: 1.12; 95% CI: 1.04, 1.20. Respectively, this dietary pattern was characterized by relatively high intakes of potatoes, processed meat, vegetable oils, sugar, cake and cookies, and tea.

Conclusions: Only few country/center-specific dietary patterns (3 of 18) were statistically significantly associated with diabetes incidence in this multicountry European study population. One pattern, whose association with diabetes was confirmed across other countries, showed overlaps in the food groups potatoes and processed meat with identified diabetes-associated dietary patterns from other studies. The study demonstrates that replication of associations of exploratory patterns with health outcomes is feasible and a necessary step to overcome population-specificity in associations from such analyses.

Keywords: diet-disease association; dietary patterns; meta-analysis; principal component analysis; replication; type 2 diabetes mellitus.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Scheme of the statistical steps to investigate the association between dietary patterns and type 2 diabetes risk. Subcohort in each country = randomly drawn subcohort in each country including noncases and cases of type 2 diabetes; whole case-cohort in each country = randomly drawn subcohort in each country and type 2 diabetes cases external to the subcohort; whole EPIC-InterAct case-cohort = sum of all randomly drawn subcohorts (n = 14,694) and external type 2 diabetes cases (n = 11,183), with an overlap of n = 719 verified incident type 2 diabetes cases in the subcohort, across all included EPIC-InterAct countries. *Sum of a reduced number (m < n) of standardized, unweighted food groups characterized by high factor loadings in the original dietary pattern score. **Sum of all 36 standardized food groups (Xn) multiplied by standardized scoring coefficients (βn). EPIC, European Prospective Investigation into Cancer and Nutrition.
FIGURE 2
FIGURE 2
Meta-analysis of HR and 95% CI for the risk of type 2 diabetes per 1 SD of the “Replicative Norfolk” score across all EPIC-InterAct countries. EPIC, European Prospective Investigation into Cancer and Nutrition.
See this image and copyright information in PMC

References

    1. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383:1999–2007. - PMC - PubMed
    1. InterAct Consortium, Bendinelli B, Palli D, Masala G, Sharp SJ, Schulze MB, Guevara M, van der A DL, Sera F, Amiano P et al. .. Association between dietary meat consumption and incident type 2 diabetes: the EPIC-InterAct study. Diabetologia. 2013;56:47–59. - PubMed
    1. InterAct Consortium, Romaguera D, Norat T, Wark PA, Vergnaud AC, Schulze MB, van Woudenbergh GJ, Drogan D, Amiano P, Molina-Montes E et al. .. Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Diabetologia. 2013;56:1520–30. - PubMed
    1. InterAct Consortium Dietary fibre and incidence of type 2 diabetes in eight European countries: the EPIC-InterAct Study and a meta-analysis of prospective studies. Diabetologia. 2015;58:1394–408. - PMC - PubMed
    1. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9. - PubMed

Publication types