A dietary pattern score and risk of developing type 2 diabetes in the sun project

Abstract

Introduction: Numerous diabetes risk models and scores have been developed, but most are rarely used or are not focused on diet or do not fully capture the overall dietary pattern. Objectives: To develop a friendly, plausible, self-administered, and complete diabetes dietary score (DDS), emphasizing the powerful role of optimal food patterns to decrease the risk of developing type 2 diabetes (T2DM). Method / Design: We assessed 17,292 participants of the prospective SUN cohort initially free of diabetes. They were followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Vegetables, fruit, whole-cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts were positively weighted (assumed to be beneficial to decrease the incidence of T2DM). Red meat, processed meat and sugar-sweetened beverages were negatively weighted (assumed to be detrimental). Energy-adjusted quintiles of each of the 12 items were used to build the score (range: 12–60 points). Incident T2DM was confirmed by the medical doctors of the research team through an additional detailed questionnaire mailed to participants who self-reported a new diagnosis of T2DM by a doctor during follow-up using blind revision of clinical records. Results: We observed 143 cases of incident T2DM during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (26-40 points) vs. low (<26) category 0.45 [95%CI:0.22-0.93]; and for high (>40) vs. low category 0.34 [0.15-0.75]; p for linear trend: 0.032). Conclusions: A simple score exclusively based on dietary components, may be applicable in clinical practice and/or be self-administered. It may well be an educational tool for laypeople while self-assessing their risk of diabetes.