Dietary patterns and risk for type 2 diabetes mellitus in U.S. men.
BACKGROUND
The role of diet in the development of type 2 diabetes mellitus remains unsettled.


OBJECTIVE
To examine the association between major dietary patterns and risk for type 2 diabetes mellitus.


METHODS
Prospective cohort study.


METHODS
United States.


METHODS
42 504 male health professionals, 40 to 75 years of age, without diagnosed diabetes, cardiovascular disease, or cancer at baseline.


METHODS
Using factor analysis based on data from food-frequency questionnaires, we identified and validated two major dietary patterns that we labeled "prudent" (characterized by higher consumption of vegetables, fruit, fish, poultry and whole grains) and "western" (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts). Relative risks and 95% CIs were adjusted for potential confounders, including body mass index (BMI), physical activity, and cigarette smoking.


RESULTS
During 12 years of follow-up (466 508 person-years), we documented 1321 cases of type 2 diabetes. The prudent dietary pattern score was associated with a modestly lower risk for type 2 diabetes (relative risk for extreme quintiles, 0.84 [CI, 0.70 to 1.00]). In contrast, the western dietary pattern score was associated with an increased risk for type 2 diabetes (relative risk, 1.59 [CI, 1.32 to 1.93]; P < 0.001 for trend). A high score for the western dietary pattern combined with low physical activity (relative risk comparing extreme quintiles of dietary pattern score and physical activity, 1.96 [CI, 1.35 to 2.84]) or obesity (relative risk for BMI > or = 30 kg/m2 vs. <25 kg/m2, 11.2 [CI, 8.07 to 15.6]) was associated with a particularly high risk for type 2 diabetes.


CONCLUSIONS
Our findings suggest that a western dietary pattern is associated with a substantially increased risk for type 2 diabetes in men.
van Dam
Rob M
RM
Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
Rimm
Eric B
EB
Willett
Walter C
WC
Stampfer
Meir J
MJ
Hu
Frank B
FB
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D004032:Diet; D015444:Exercise; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires