Lee Dong Hoon, Li Jun, Li Yanping, Liu Gang, Wu Kana, Bhupathiraju Shilpa, Rimm Eric B, Rexrode Kathryn M, Manson JoAnn E, Willett Walter C, Hu Frank B, Tabung Fred K, Giovannucci Edward L
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Diabetes Care. 2020 Nov;43(11):2675-2683. doi: 10.2337/dc20-0815. Epub 2020 Sep 1.
To examine whether proinflammatory and hyperinsulinemic diets are associated with increased risk of type 2 diabetes.
We prospectively followed 74,767 women from the Nurses' Health Study (1984-2016), 90,786 women from the Nurses' Health Study II (1989-2017), and 39,442 men from the Health Professionals Follow-up Study (1986-2016). Using repeated measures of food-frequency questionnaires, we calculated empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores, which are food-based indices that characterize dietary inflammatory or insulinemic potential based on circulating biomarkers of inflammation or C-peptide. Diagnoses of type 2 diabetes were confirmed by validated supplementary questionnaires.
We documented 19,666 incident type 2 diabetes cases over 4.9 million person-years of follow-up. In the pooled multivariable-adjusted analyses, individuals in the highest EDIP or EDIH quintile had 3.11 times (95% CI 2.96-3.27) and 3.40 times (95% CI 3.23-3.58) higher type 2 diabetes risk, respectively, compared with those in the lowest quintile. Additional adjustment for BMI attenuated the associations (hazard ratio 1.95 [95% CI 1.85-2.05] for EDIP and hazard ratio 1.87 [95% CI 1.78-1.98] for EDIH), suggesting adiposity partly mediates the observed associations. Moreover, individuals in both highest EDIP and EDIH quintiles had 2.34 times higher type 2 diabetes risk (95% CI 2.17-2.52), compared with those in both lowest quintiles, after adjustment for BMI.
Higher dietary inflammatory and insulinemic potential were associated with increased type 2 diabetes incidence. Findings suggest that inflammation and hyperinsulinemia are potential mechanisms linking dietary patterns and type 2 diabetes development.
研究促炎饮食和高胰岛素血症饮食是否与2型糖尿病风险增加相关。
我们对护士健康研究（1984 - 2016年）中的74,767名女性、护士健康研究II（1989 - 2017年）中的90,786名女性以及健康专业人员随访研究（1986 - 2016年）中的39,442名男性进行了前瞻性跟踪。通过重复测量食物频率问卷，我们计算了经验性饮食炎症模式（EDIP）和高胰岛素血症经验性饮食指数（EDIH）得分，这两个基于食物的指数根据炎症循环生物标志物或C肽来表征饮食的炎症或胰岛素血症潜力。2型糖尿病的诊断通过经过验证的补充问卷得以确认。
在超过490万人年的随访中，我们记录了19,666例2型糖尿病新发病例。在汇总的多变量调整分析中，与处于最低五分位数的个体相比，处于最高EDIP或EDIH五分位数的个体患2型糖尿病的风险分别高出3.11倍（95%置信区间2.96 - 3.27）和3.40倍（95%置信区间3.23 - 3.58）。对体重指数（BMI）进行额外调整后，这种关联有所减弱（EDIP的风险比为1.95 [95%置信区间1.85 - 2.05]，EDIH的风险比为1.87 [95%置信区间1.78 - 1.98]），这表明肥胖在一定程度上介导了所观察到的关联。此外，在调整BMI后，与处于两个最低五分位数的个体相比，同时处于最高EDIP和EDIH五分位数的个体患2型糖尿病的风险高出2.34倍（95%置信区间2.17 - 2.52）。
更高的饮食炎症和胰岛素血症潜力与2型糖尿病发病率增加相关。研究结果表明，炎症和高胰岛素血症是将饮食模式与2型糖尿病发展联系起来的潜在机制。
