Diet Quality Indices and Risk of Type 2 Diabetes: The Singapore Chinese Health Study

Abstract

We aimed to test whether predefined dietary patterns inversely relating to risk of type 2 diabetes (T2D) in Western populations were similarly associated with lower T2D risk in an Asian population. We included 45,411 middle aged and older participants of the Singapore Chinese Health Study free of diabetes, cancer or cardiovascular disease at baseline (1993–1998). Participants were followed up for T2D diagnosis through 2010. Dietary information was collected using a validated food frequency questionnaire. Dietary pattern scores were calculated for the alternate Mediterranean diet, alternative Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension diet, an overall plant-based diet index, and a healthful plant-based diet index. During a median 11.2 years of follow-up, 5,207 incident cases of T2D occurred. After the adjustment for multiple potential confounders, the 5 dietary pattern scores were significantly associated with 16% (for alternate Mediterranean diet) to 29% (for Dietary Approaches to Stop Hypertension diet) lower risk of T2D when comparing the highest with the lowest score quintiles (all P for trend <0.001). These associations did not vary substantially by baseline age, sex, body mass index or hypertension status, but were limited to non-smokers (P for interaction <0.001 for alternate Mediterranean diet and 0.03 for alternative Healthy Eating Index-2010). Adherence to a high-quality diet, as reflected by several predefined diet quality indices derived in Western populations, was significantly associated with lower risk of T2D in an Asian population.