Journal article
Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study
PLoS medicine, Vol.13(7), pp.e1002085-e1002085
07/2016
Handle:
https://hdl.handle.net/2376/114357
PMCID: PMC4951147
PMID: 27433799
Abstract
Diet is a key modifiable risk factor for multiple chronic conditions, including type 2 diabetes (T2D). Consuming a range of foods from the five major food groups is advocated as critical to healthy eating, but the association of diversity across major food groups with T2D is not clear and the relationship of within-food-group diversity is unknown. In addition, there is a growing price gap between more and less healthy foods, which may limit the uptake of varied diets. The current study had two aims: first, to examine the association of reported diversity of intake of food groups as well as their subtypes with risk of developing T2D, and second, to estimate the monetary cost associated with dietary diversity.
A prospective study of 23,238 participants in the population-based EPIC-Norfolk cohort completed a baseline Food Frequency Questionnaire in 1993-1997 and were followed up for a median of 10 y. We derived a total diet diversity score and additional scores for diversity within each food group (dairy products, fruits, vegetables, meat and alternatives, and grains). We used multivariable Cox regression analyses for incident diabetes (892 new cases), and multivariable linear regression for diet cost. Greater total diet diversity was associated with 30% lower risk of developing T2D (Hazard ratio [HR] 0.70 [95% CI 0.51 to 0.95]) comparing diets comprising all five food groups to those with three or fewer, adjusting for confounders including obesity and socioeconomic status. In analyses of diversity within each food group, greater diversity in dairy products (HR 0.61 [0.45 to 0.81]), fruits (HR 0.69 [0.52 to 0.90]), and vegetables (HR 0.67 [0.52 to 0.87]) were each associated with lower incident diabetes. The cost of consuming a diet covering all 5 food groups was 18% higher (£4.15/day [4.14 to 4.16]) than one comprising three or fewer groups. Key limitations are the self-reported dietary data and the binary scoring approach whereby some food groups contained both healthy and less healthy food items.
A diet characterized by regular consumption of all five food groups and by greater variety of dairy, fruit, and vegetable subtypes, appears important for a reduced risk of diabetes. However, such a diet is more expensive. Public health efforts to prevent diabetes should include food price policies to promote healthier, more varied diets.
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Details
- Title
- Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study
- Creators
- Annalijn I Conklin - WORLD Policy Analysis Center, UCLA Fielding School of Public Health, Los Angeles, California, United States of AmericaPablo Monsivais - Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United KingdomKay-Tee Khaw - Department of Public Health and Primary Care, University of Cambridge, Cambridge, United KingdomNicholas J Wareham - Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United KingdomNita G Forouhi - Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Publication Details
- PLoS medicine, Vol.13(7), pp.e1002085-e1002085
- Academic Unit
- Nutrition and Exercise Physiology, Department of
- Publisher
- United States
- Grant note
- G0401527 / Medical Research Council Cancer Research UK Wellcome Trust MR/N003284/1 / Medical Research Council 087636/Z/08/Z / Wellcome Trust MC_UU_12015/1 / Medical Research Council MC_UU_12015/5 / Medical Research Council MR/K023187/1 / Medical Research Council British Heart Foundation G1000143 / Medical Research Council MFE-135520 / CIHR
- Identifiers
- 99900548357601842
- Language
- English
- Resource Type
- Journal article