Prediction Of Dietary Patterns On The Incidence Of Type 2 Diabetes Mellitus In The Adult Population

Objective: With the development of modern society,the prevalence of type 2 diabetes,which is a common metabolic disease,is increasing.Moreover,due to its serious complications,it brings a huge medical burden,and has become a public health issue of common concern all over the world.Numerous studies have demonstrated that dietary patterns are related with T2 DM,but very few prospective cohort studies are available on the relationship between dietary patterns with T2 DM among Chinese general adults.Hence,the aims of the present study were to explore the predictive value of dietary patterns for T2 DM in a large sample of adults,and to provide theoretical evidence for nutritional dietary intervention of glucose-metabolic disorders.Methods: We designed this population-based cohort study.Participants began to participate in the “TCLSIH” cohort study from 2013,and were followed up until 2018,with an average follow-up of 4.17 years and a follow-up rate of 83.0 percent.A total of 26,425 general adults were enrolled.All participants volunteered to participate and had signed the informed consent.T2 DM was diagnosed according to the standard criteria that established by America Diabetes Association.The dietary nutrition was assessed by validated food frequency questionnaire(FFQ),which comprised 100 food items.Three major dietary patterns were identified by explanatory factor analysis:(1)The plant-based dietary pattern: characterized by strawberry,grape,pineapple,pear,leek,onion,seaweeds,and beans;(2)The animal foods dietary pattern: characterized by animal offal,processed meat,and various kinds of fish;(3)The traditional eastern dietary pattern: characterized by a variety of vegetables,cereals,meats,and staple food.The three dietary patterns accounted for 11.3%,9.5% and 8.9% of the variance of food intake,respectively(29.7% in total).Other confounding factors were obtained through questionnaire,physical examination and laboratory inspection.All statistical analyses were performed using the Statistical Analysis System 9.3 edition for Windows.When comparing the baseline characteristics of the T2 DM group and the non-T2 DM group,analysis of covariance and logistic regression analysis were used to analyze continuous variables and categorical variables,respectively.Multiple Cox proportional hazards regression models were used to assess the relationship of dietary patterns with T2 DM,and the gender stratification analysis and the analysis by BMI stratification in the population of different genders were conducted.Results: The mean age of all participants were 41.0(standard deviation: 11.5),and the cumulative incidence was 3.84% for T2DM.The cumulative incidence of T2DM in male population was 5.29%,while that in female population was 2.16%.There were significant differences in the incidence of T2DM among different genders(P <0.0001).The multivariable-adjusted hazard ratios and corresponding 95% confidence intervals of T2DM across the plant-based dietary pattern score were: 1.00,1.09(0.91,1.31),0.80(0.66,0.97),and 0.76(0.62,0.94)(P for trend <0.01).Compared with the lowest quintile,the hazard ratios and corresponding 95% confidence intervals for the male participants in the 2,3 and 4 quartiles of the plant-based dietary pattern were 1.12(0.91,1.39),0.81(0.65,1.02),and 0.75(0.59,0.95)(P for trend <0.01),respectively.No similar association was observed in female participants.Compared with the lowest quintile,the hazard ratios and corresponding 95% confidence intervals for the female participants in the 2,3 and 4 quartiles of the plant-based dietary pattern were 1.02(0.70,1.48),0.78(0.51,1.19),and 0.81(0.52,1.27)(P for trend =0.25),respectively.Moreover,no statistically significant differences were observed between the other two dietary patterns and the incidence of T2DM.Conclusions: The plant-based dietary pattern was closely related with lower incidence of T2 DM in all population and males.However,no significant associations between other two dietary patterns and T2DM were observed.The results indicated that the plant-based dietary pattern which was characterized by high intake of various fruits,leek,onion,seaweeds,and beans,may be beneficial for prevention and control of abnormal glucose metabolism.More experimental studies are needed to confirm the results and explore the mechanisms of association between plant-based dietary pattern and T2 DM,so as to provide strategies for the nutritional prevention of T2DM.