title: Dietary patterns and the risk of type 2 diabetes in overweight and obese individuals.
abstract: OBJECTIVE
  Although overweight is an important determinant of diabetes risk, it remains unclear whether food choices can still influence the risk for type 2 diabetes in overweight persons. In this paper, we aim to clarify the role of dietary patterns in the development of type 2 diabetes in overweight and obese individuals.
  
  
  METHODS
  We studied 20,835 overweight and obese participants in the Dutch part of the European Investigation into Cancer and Nutrition (EPIC-NL) study. Dietary intake was measured using a validated food frequency questionnaire, and dietary patterns were generated using factor analysis. Incident type 2 diabetes was verified against medical records. Cox proportional hazards models were used to assess the association between the dietary patterns (factor scores categorized in quartiles) and incident type 2 diabetes.
  
  
  RESULTS
  Scoring on Pattern 1, characterized by fish, wine, chicken, raw vegetables and fruit juices, was not associated with type 2 diabetes risk after confounder adjustment. A high score on Pattern 2, characterized by soft drinks, fries and snacks, was associated with higher risk of type 2 diabetes (HR Q4 vs. Q1 (95 % CI): 1.70 (1.31; 2.20), P(trend) ≤ 0.0001), particularly among less active individuals [less active: HR Q4 vs. Q1 (95 % CI): 2.14 (1.48; 3.09), P(trend) = 0.00004, more active: HR Q4 vs. Q1 (95 % CI): 1.35 (0.93; 1.97), P(trend) = 0.01; P(interaction) = 0.02].
  
  
  CONCLUSIONS
  A high score on a pattern high in soft drinks, fries and snacks and low in fruit and vegetables was associated with higher risk of type 2 diabetes in overweight and obese subjects especially among physically less active individuals.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Mailbox: Str. 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Florianne
authors.initials: F
authors.lastname: Bauer
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Cisca
authors.initials: C
authors.lastname: Wijmenga
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: N Charlotte
authors.initials: NC
authors.lastname: Onland-Moret
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002253:Carbonated Beverages / Q000009:adverse effects; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D004032:Diet / Q000009:adverse effects*; D057140:Fast Foods / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000503:physiopathology*; D050177:Overweight / Q000503:physiopathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D057185:Sedentary Behavior; D062410:Snacks