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dc.contributor.authorConklin, Annalijn Ien
dc.contributor.authorMonsivais, Pabloen
dc.contributor.authorKhaw, Kay-Teeen
dc.contributor.authorWareham, Nicholasen
dc.contributor.authorForouhi, Nitaen
dc.date.accessioned2016-09-07T10:30:43Z
dc.date.available2016-09-07T10:30:43Z
dc.date.issued2016-07-19en
dc.identifier.issn1549-1277
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/259992
dc.description.abstractBACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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.
dc.format.mediumElectronic-eCollectionen
dc.languageengen
dc.language.isoenen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectHumansen
dc.subjectDiabetes Mellitus, Type 2en
dc.subjectDieten
dc.subjectIncidenceen
dc.subjectRisk Factorsen
dc.subjectProspective Studiesen
dc.subjectFooden
dc.subjectAdulten
dc.subjectAgeden
dc.subjectMiddle Ageden
dc.subjectCosts and Cost Analysisen
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectSurveys and Questionnairesen
dc.subjectUnited Kingdomen
dc.titleDietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study.en
dc.typeArticle
prism.publicationDate2016en
prism.publicationNamePLoS Medicineen
prism.startingPagee1002085
prism.volume13en
dc.identifier.doi10.17863/CAM.4219
dcterms.dateAccepted2016-06-10en
rioxxterms.versionofrecord10.1371/journal.pmed.1002085en
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2016-07-19en
dc.contributor.orcidMonsivais, Pablo [0000-0002-7088-6674]
dc.contributor.orcidKhaw, Kay-Tee [0000-0002-8802-2903]
dc.contributor.orcidWareham, Nicholas [0000-0003-1422-2993]
dc.contributor.orcidForouhi, Nita [0000-0002-5041-248X]
dc.identifier.eissn1549-1676
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMRC (MC_UU_12015/5)
pubs.funder-project-idMRC (MC_UU_12015/1)
pubs.funder-project-idMRC (MC_PC_13048)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
pubs.funder-project-idMEDICAL RESEARCH COUNCIL (MR/N003284/1)
pubs.funder-project-idMRC (G1000143)
pubs.funder-project-idMRC (G0401527)
pubs.funder-project-idMRC (MR/K023187/1)
pubs.funder-project-idESRC (ES/G007462/1)
pubs.funder-project-idWellcome Trust (087636/Z/08/Z)


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International