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Rev Diabet Stud, 2016, 13(4):246-256 DOI 10.1900/RDS.2016.13.246

Dietary Patterns and 10-year (2002-2012) Incidence of Type 2 Diabetes: Results from the ATTICA Cohort Study

Efi Koloverou1, Demosthenes B. Panagiotakos1, Ekavi N. Georgousopoulou1, Athanasios Grekas1, Aimilia Christou1, Michail Chatzigeorgiou1, Christina Chrysohoou2, Dimitrios Tousoulis2, Christodoulos Stefanadis2, Christos Pitsavos2, ATTICA Study Group

1Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
2First Cardiology Clinic, School of Medicine, University of Athens, Greece
Address correspondence to: Demosthenes B. Panagiotakos, Department of Nutrition and Dietetics, School of Health Science and Education, 70 Eleftheriou Venizelou Ave., 17671 Athens, Greece, e-mail: dbpanag@hua.gr

Manuscript submitted December 26, 2016; resubmitted January 11, 2017; accepted January 31, 2017.

Keywords: type 2 diabetes, Mediterranean diet, dietary pattern, prediabetes, diabetes incidence, factor analysis


AIM: To identify dietary patterns among apparently healthy individuals and to determine their long-term effect on diabetes incidence. METHODS: During 2001-2002, a random sample of 3,042 men and women (18-89 years old), living in greater Athens, was randomly selected to participate in the study. During 2011-2012, the 10-year follow-up was performed in 2,583 participants (15% drop-out rate). After excluding participants with diabetes at baseline and those for whom no information on diabetes status was available at follow-up, the working sample consisted of 1,485 participants. Dietary habits were assessed by means of a validated semi-quantitative, food frequency questionnaire. Factor analysis was performed to extract dietary patterns from 18 food groups. RESULTS: Diabetes diagnosis at follow-up was made in 191 participants, yielding an incidence rate of 12.9%. Six factors (i.e. dietary patterns) were identified that explained 54% of the variation in consumption. After adjusting for major confounders, and stratification by age-group, logistic regression revealed that the most healthful pattern consisted of the consumption of fruits, vegetables, legumes, bread, rusk, and pasta which reduced the 10-year diabetes risk by 40%, among participants aged 45-55 years. The association reached marginal statistical significance (95% CI: 0.34, 1.07), while no significant association was observed for the other age-groups. When the analysis was additionally adjusted for carbohydrate percentage, statistical significance was lost completely, suggesting a possibly mediating effect of this macronutrient. CONCLUSIONS: The results confirm the potentially protective effect of a plant-based dietary pattern in the primary prevention of diabetes, in particular among middle-aged people. Carbohydrate content may be a specific factor in this relationship; other micronutrients found in plant-based food groups may also play a role.

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