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Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Conklin, Annalijn I 
Monsivais, Pablo 
Khaw, Kay-Tee 
Wareham, Nicholas J  ORCID logo  https://orcid.org/0000-0003-1422-2993
Forouhi, Nita G 

Abstract

BACKGROUND: 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.

Description

Keywords

Adult, Aged, Costs and Cost Analysis, Diabetes Mellitus, Type 2, Diet, Female, Food, Humans, Incidence, Male, Middle Aged, Prospective Studies, Risk Factors, Surveys and Questionnaires, United Kingdom

Journal Title

PLoS Med

Conference Name

Journal ISSN

1549-1277
1549-1676

Volume Title

13

Publisher

Public Library of Science (PLoS)
Sponsorship
Wellcome Trust (087636/Z/08/Z)
Economic and Social Research Council (ES/G007462/1)
Medical Research Council (MR/K023187/1)
Medical Research Council (MC_UU_12015/5)
Medical Research Council (MC_UU_12015/1)
MRC (MC_PC_13048)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
Medical Research Council (MR/N003284/1)
Medical Research Council (G1000143)
Medical Research Council (G0401527)
Medical Research Council (G0401527/1)
This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research of Excellence which is funded by the British Heart Foundation, Economic and Social Research Council, Medical Research Council, Cancer Research UK, National Institute for Health Research (ES/G007462/1 and MR/K023187/1) and the Wellcome Trust (087636/Z/08/Z), and by the Medical Research Council Epidemiology Unit core support (MC_UU_12015/5 and MC_UU_12015/1). AIC was supported by the Gates Cambridge Trust and by the Canadian Institute for Health Research Postdoctoral Fellowship Award (MFE-135520).