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Generalizability of a Diabetes-Associated Country-Specific Exploratory Dietary Pattern Is Feasible Across European Populations.

Accepted version
Peer-reviewed

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Authors

Jannasch, Franziska 
Kröger, Janine 
Agnoli, Claudia 
Barricarte, Aurelio 
Boeing, Heiner 

Abstract

BACKGROUND: Population-specificity of exploratory dietary patterns limits their generalizability in investigations with type 2 diabetes incidence. OBJECTIVE: The aim of this study was to derive country-specific exploratory dietary patterns, investigate their association with type 2 diabetes incidence, and replicate diabetes-associated dietary patterns in other countries. METHODS: Dietary intake data were used, assessed by country-specific questionnaires at baseline of 11,183 incident diabetes cases and 14,694 subcohort members (mean age 52.9 y) from 8 countries, nested within the European Prospective Investigation into Cancer and Nutrition study (mean follow-up time 6.9 y). Exploratory dietary patterns were derived by principal component analysis. HRs for incident type 2 diabetes were calculated by Prentice-weighted Cox proportional hazard regression models. Diabetes-associated dietary patterns were simplified or replicated to be applicable in other countries. A meta-analysis across all countries evaluated the generalizability of the diabetes-association. RESULTS: Two dietary patterns per country/UK-center, of which overall 3 dietary patterns were diabetes-associated, were identified. A risk-lowering French dietary pattern was not confirmed across other countries: pooled HRFrance per 1 SD: 1.00; 95% CI: 0.90, 1.10. Risk-increasing dietary patterns, derived in Spain and UK-Norfolk, were confirmed, but only the latter statistically significantly: HRSpain: 1.09; 95% CI: 0.97, 1.22 and HRUK-Norfolk: 1.12; 95% CI: 1.04, 1.20. Respectively, this dietary pattern was characterized by relatively high intakes of potatoes, processed meat, vegetable oils, sugar, cake and cookies, and tea. CONCLUSIONS: Only few country/center-specific dietary patterns (3 of 18) were statistically significantly associated with diabetes incidence in this multicountry European study population. One pattern, whose association with diabetes was confirmed across other countries, showed overlaps in the food groups potatoes and processed meat with identified diabetes-associated dietary patterns from other studies. The study demonstrates that replication of associations of exploratory patterns with health outcomes is feasible and a necessary step to overcome population-specificity in associations from such analyses.

Description

Keywords

diet-disease association, dietary patterns, meta-analysis, principal component analysis, replication, type 2 diabetes mellitus, Adult, Aged, Case-Control Studies, Cohort Studies, Diabetes Mellitus, Type 2, Diet, Disease Susceptibility, Europe, Feasibility Studies, Female, Humans, Incidence, Male, Middle Aged, Principal Component Analysis, Risk Factors

Journal Title

J Nutr

Conference Name

Journal ISSN

0022-3166
1541-6100

Volume Title

149

Publisher

Elsevier BV
Sponsorship
Medical Research Council (MC_UU_12015/5)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Medical Research Council (MC_UU_12015/1)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
European Commission (37197)
Medical Research Council (G0401527)
Medical Research Council (MR/N003284/1)
Medical Research Council (G1000143)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (G0401527/1)
NJW, CL and NGF acknowledge MRC Epidemiology Unit support through Programmes MC_UU_12015/1 and MC_UU_12015/5, and in addition NGF and NJW acknowledge NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215-20014).