Types of diet, obesity, and incident type 2 diabetes: Findings from the UK Biobank prospective cohort study

Abstract

Aim: To investigate the associations between types of diet and incident type 2 diabetes and whether adiposity mediated these associations.

Materials and methods: In total, 203 790 participants from UK Biobank (mean age 55.2 years; 55.8% women) without diabetes at baseline were included in this prospective study. Using the dietary intake data self-reported at baseline, participants were categorized as vegetarians (n = 3237), fish eaters (n = 4405), fish and poultry eaters (n = 2217), meat eaters (n = 178 004) and varied diet (n = 15 927). The association between type of diet and incident type 2 diabetes was investigated using Cox-proportional hazards models with a 2-year landmark analysis. The mediation role of adiposity was tested under a counterfactual framework.

Results: After excluding the first 2 years of follow-up, the median follow-up was 5.4 (IQR: 4.8-6.3) years, during which 5067 (2.5%) participants were diagnosed with type 2 diabetes. After adjusting for lifestyle factors, fish eaters (HR 0.52 [95% CI: 0.39-0.69]) and fish and poultry eaters (HR 0.62 [95% CI: 0.45-0.88]) had a lower risk of incident type 2 diabetes compared with meat eaters. The association for vegetarians was not significant. Varied diet had a higher risk of type 2 diabetes. Obesity partially mediated the association of fish (30.6%), fish and poultry (49.8%) and varied (55.2%) diets.

Conclusions: Fish eaters, as well as fish and poultry eaters, were at a lower risk of incident type 2 diabetes than meat eaters, partially attributable to lower obesity risk.

Keywords: fish; lacto-ovo diet; meat; poultry; type 2 diabetes; vegetarian.

FIGURE 1

Association between types of diet and incidence of type 2 diabetes. Data are presented as hazard ratio (HR) and 95% CI. Meat eaters was a reference group (Ref.). Model 1 (sociodemographics) was adjusted for age, sex and deprivation; model 2 (lifestyle) was adjusted for all covariates included in model 1 plus lifestyle variables (alcohol, smoking, sedentary time, sleep time and type of physical activity); model 3 (body mass index [BMI]) was adjusted for all covariates included in model 2 plus BMI; and model 4 (waist circumference [WC]) was adjusted for all covariates included in model 2 plus WC. All analyses were conducted using 2‐year landmark analyses and excluding participants with type 1 diabetes, type 2 diabetes or unknown diabetes at baseline