Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig- Maximilians University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
Pettenkofer School of Public Health, Ludwig-Maximilians University of Munich, Pettenkoferstr. 9A, 80336, Munich, Germany.
Eur J Nutr. 2024 Sep;63(6):2137-2148. doi: 10.1007/s00394-024-03411-0. Epub 2024 May 7.
We aimed to examine the association between dietary patterns and type 2 diabetes mellitus (T2DM) while considering the potential effect modification by metabolic phenotypes (metabotypes). Additionally, we aimed to explore the association between dietary scores and prediabetes.
A total of 1460 participants (11.8% with T2DM) from the cross-sectional population-based KORA FF4 study were included. Participants, classified into three metabotype subgroups, had both their FSAm-NPS dietary index (underpinning the Nutri-Score) and ultra-processed foods (UPF) intake (using NOVA classification) calculated. Glucose tolerance status was assessed via oral glucose tolerance tests (OGTT) in non-diabetic participants and was classified according to the American Diabetes Association criteria. Logistic regression models were used for both the overall and metabotype-stratified analyses of dietary scores' association with T2DM, and multinomial probit models for their association with prediabetes.
Participants who had a diet with a higher FSAm-NPS dietary index (i.e., a lower diet quality) or a greater percentage of UPF consumption showed a positive association with T2DM. Stratified analyses demonstrated a strengthened association between UPF consumption and T2DM specifically in the metabolically most unfavorable metabotype (Odds Ratio, OR 1.92; 95% Confidence Interval, CI 1.35, 2.73). A diet with a higher FSAm-NPS dietary index was also positively associated with prediabetes (OR 1.19; 95% CI 1.04, 1.35).
Our study suggests different associations between poorer diet quality and T2DM across individuals exhibiting diverse metabotypes, pointing to the option for stratified dietary interventions in diabetes prevention.
本研究旨在探讨饮食模式与 2 型糖尿病（T2DM）之间的关联，并考虑代谢表型（代谢类型）的潜在效应修饰作用。此外，我们还旨在探讨饮食评分与糖尿病前期之间的关联。
本研究共纳入了横断面人群基础 KORA FF4 研究中的 1460 名参与者（11.8%患有 T2DM）。根据三种代谢类型亚组对参与者进行分类，计算了他们的 FSAm-NPS 饮食指数（Nutri-Score 的基础）和超加工食品（UPF）的摄入量（采用 NOVA 分类）。非糖尿病参与者通过口服葡萄糖耐量试验（OGTT）评估葡萄糖耐量状况，并根据美国糖尿病协会标准进行分类。采用逻辑回归模型对饮食评分与 T2DM 的总体关联以及代谢类型分层分析进行分析，采用多项概率回归模型对饮食评分与糖尿病前期的关联进行分析。
FSAm-NPS 饮食指数较高（即饮食质量较低）或 UPF 消费比例较高的参与者与 T2DM 呈正相关。分层分析表明，UPF 消费与 T2DM 之间的关联在代谢最不利的代谢类型中更为强烈（优势比，OR 1.92；95%置信区间，CI 1.35，2.73）。FSAm-NPS 饮食指数较高的饮食也与糖尿病前期呈正相关（OR 1.19；95%置信区间，CI 1.04，1.35）。
我们的研究表明，在表现出不同代谢类型的个体中，较差的饮食质量与 T2DM 之间存在不同的关联，这为糖尿病预防中分层饮食干预提供了选择。
