Mediterranean diet lowers risk of new-onset diabetes: a nationwide cohort study in China

Abstract

Background: The Mediterranean diet (MD) has shown promising results in preventing type 2 diabetes, particularly in Mediterranean and European populations. However, the applicability of these benefits to non-Mediterranean populations is unclear, with contradictory findings in the literature.

Methods: In this study, we included 12,575 participants without diabetes at baseline from the China Health and Nutrition Survey (CHNS). Dietary intake was measured by three consecutive 24-h dietary recalls. The Mediterranean diet adherence (MDA) was measured by a score scale that included nine components of vegetables, legumes, fruits, nuts, cereals, fish, red meat, dairy products, and alcohol. New-onset diabetes was defined as self-reported physician-diagnosed diabetes during the follow-up.

Results: During a median follow-up of 9.0 years, 445 (3.5%) subjects developed diabetes. Overall, there was an inverse association between the MDA score and new-onset diabetes (per score increment, HR 0.83, 95% CI 0.76-0.90). Moreover, age, sex, BMI, and energy intake significantly modified the association between the MDA score and the risk of new-onset diabetes (all P interactions < 0.05). Greater fruit, fish, and nut intake was significantly associated with a lower risk of new-onset diabetes.

Conclusion: There was an inverse association between Mediterranean diet adherence and new-onset diabetes in the Chinese population.

Keywords: Chinese; Health; Mediterranean diet; New-onset diabetes.

Fig. 1

Flow chart of the study participants

Fig. 2

The association between the MDA score and new-onset diabetes. Adjusted for age, sex, BMI, occupation, education level, region, smoking status, urban or rural residence status, income, physical activity (low, moderate, high) at baseline, and cumulative average total energy intake. Overall P = 0.0002; Nonlinearity P = 0.9096

Fig. 3

The association between the MDA score and new-onset diabetes in different subgroups. Adjusted for age, sex, BMI, occupation, education level, region, smoking status, urban or rural residence status, income, physical activity (low, moderate, high) at baseline, and cumulative average total energy intake. a Male: overall P = 0.0076; nonlinearity P = 0.3544; b female: overall P = 0.0170; nonlinearity P = 0.3528; c age < 60: overall P = 0.0107; nonlinearity P = 0.8596; d age ≥ 60: overall P = 0.0115; nonlinearity P = 0.7829; d BMI < 24 kg/m²: overall P = 0.0047; nonlinearity P = 0.3841; d BMI ≥ 24 kg/m.²: overall P = 0.0160; nonlinearity P = 0.1940; g energy intake < 2220 kcal/d: overall P = 0.0183; nonlinearity P = 0.3235; d energy ≥ 2220 kcal/d: overall P = 0.0023; nonlinearity P = 0.2545

Fig. 4

Forest plot of Cox regression analysis of Mediterranean diet components and new-onset diabetes