title: Major dietary patterns, ethnicity, and prevalence of type 2 diabetes in rural Hawaii.
abstract: OBJECTIVE
  The association of type 2 diabetes (T2DM) with the overall dietary pattern and its relation with ethnicity was examined.
  
  
  METHODS
  A cross-sectional study with 1257 participants with four ethnicities (Caucasian, Filipino, Native Hawaiian, and Japanese) in the North Kohala region of Hawaii was conducted. Participants 18-95 y of age were surveyed for their ethnic and demographic backgrounds, dietary intakes, and biochemical indexes of glucose intolerance between 1997 and 2000.
  
  
  RESULTS
  Three dietary patterns from the food-frequency questionnaire were identified by factor analysis. Factor 1 was characterized by a healthy diet with a frequent intake of vegetables and fruits, and factor 2 was dominated by animal foods and local ethnic dishes. Factor 3 was characterized by a Western diet, which was dominated by French fries, fast-food hamburgers, pizza, and chips. Multivariate logistic regression model for T2DM prevalence included ethnicity and three dietary factors after adjustment for age, sex, income, physical activity, smoking status, and energy intake. Ethnicity was significantly associated with T2DM, with an odds ratio of 1.83 (95% confidence interval [CI] 1.12-3.00) for Native Hawaiians and 1.92 (95% CI 1.12-3.29) for Filipinos compared with Caucasians 1.92 (95% CI 1.12-3.29). Among the three dietary factors, factor 2 was positively associated with T2DM (odds ratio 1.30, 95% CI 1.03-1.68), but the significance disappeared after adjustment for energy intake.
  
  
  CONCLUSIONS
  The findings show that ethnicity is a stronger risk factor for T2DM than dietary patterns when energy intake is adjusted for. Reducing energy intake to prevent T2DM deserves more attention during health promotion for the multiethnic population of Hawaii.
authors.affiliation: Department of Food Science and Nutrition, Soonchunhyang University, Asan, Korea. hskim1@sch.ac.kr
authors.forename: Hee-Seon
authors.initials: HS
authors.lastname: Kim
authors.forename: Song-Yi
authors.initials: SY
authors.lastname: Park
authors.forename: Andrew
authors.initials: A
authors.lastname: Grandinetti
authors.forename: Peter S
authors.initials: PS
authors.lastname: Holck
authors.forename: Carol
authors.initials: C
authors.lastname: Waslien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology* / Q000209:etiology; D004032:Diet / Q000208:ethnology; D002149:Energy Intake / Q000502:physiology*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior / Q000208:ethnology / Q000523:psychology; D005260:Female; D006254:Hawaii; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult