Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Nutr Diabetes. 2020 Mar 20;10(1):8. doi: 10.1038/s41387-020-0113-x.
A Mediterranean-style eating pattern is consistently associated with a decreased diabetes risk in Mediterranean and European populations. However, results in U.S. populations are inconsistent. The objective of this study was to assess whether a Mediterranean-style eating pattern would be associated with diabetes risk in a large, nationally representative U.S. cohort of black and white men and women.
Participants from the Atherosclerosis Risk in Communities study prospective cohort without diabetes, cardiovascular disease, or cancer at baseline (visit 1, 1987-1989; n = 11,991) were included (mean age 54 years, 56% female, 75% white). Alternate Mediterranean Diet scores (aMed) were calculated using the mean dietary intake self-reported at visit 1 and visit 3 (1993-1995) or visit 1 only for participants censored before visit 3. Participants were followed from visit 1 through 31 December 2016 for incident diabetes. We used Cox regression models to characterize associations of aMed (quintiles as well as per 1-point higher) with incident diabetes adjusted for energy intake, age, sex, race and study center, and education (Model 1) for all participants then stratified by race and body mass index (BMI). Model 2 included potential mediating behavioral and clinical measures associated with diabetes. Results are presented as hazard ratios and 95% confidence intervals.
Over a median follow-up of 22 years, there were 4024 incident cases of diabetes. Higher aMed scores were associated with lower diabetes risk [Model 1: 0.83 (0.73-0.94) for Q5 vs Q1 (p-trend < 0.001) and 0.96 (0.95-0.98) for 1-point higher]. Associations were stronger for black vs white participants (interaction p < 0.001) and weaker for obese vs normal BMI (interaction p < 0.01). Associations were attenuated but statistically significant in Model 2.
An eating pattern high in fruits, vegetables, whole grains, legumes, nuts, and fish, and moderate in alcohol was associated with a lower risk of diabetes in a community-based U.S.
在地中海地区和欧洲人群中，地中海式饮食模式与降低糖尿病风险之间存在一致性关联。然而，美国人群的研究结果并不一致。本研究的目的是评估在地中海饮食模式与美国大型、具有代表性的黑人和白人人群的糖尿病风险之间是否存在关联。
该研究纳入了 Atherosclerosis Risk in Communities 研究前瞻性队列中无糖尿病、心血管疾病或癌症的参与者（基线时，即 1987-1989 年第 1 次访视；n=11991；平均年龄 54 岁，56%为女性，75%为白人）。采用第 1 次和第 3 次（1993-1995 年）或仅第 1 次访视时报告的平均饮食摄入量计算交替地中海饮食评分（aMed）。对于在第 3 次访视之前被排除的参与者，从第 1 次访视开始至 2016 年 12 月 31 日进行糖尿病发病的随访。我们使用 Cox 回归模型来描述 aMed（五分位数和每增加 1 分）与调整了能量摄入、年龄、性别、种族和研究中心以及教育水平后的糖尿病发病风险之间的关联（模型 1），然后根据种族和体重指数（BMI）对所有参与者进行分层（模型 2）。模型 2纳入了与糖尿病相关的潜在中介行为和临床措施。结果以风险比（HR）和 95%置信区间（CI）表示。
中位随访 22 年期间，共发生 4024 例糖尿病发病事件。较高的 aMed 评分与较低的糖尿病发病风险相关[模型 1：五分位数 Q5 与 Q1 相比，0.83（0.73-0.94）（p 趋势＜0.001），每增加 1 分，0.96（0.95-0.98）]。与白种人相比，这种关联在黑种人中更强（交互作用 p＜0.001），在肥胖者与正常 BMI 者相比，这种关联更弱（交互作用 p＜0.01）。在模型 2 中，这种关联减弱但仍具有统计学意义。
以水果、蔬菜、全谷物、豆类、坚果和鱼类为主，适量饮酒的饮食模式与美国社区人群的糖尿病发病风险降低相关。
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