title: A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and meta-analysis.
abstract: Our review and meta-analysis examined the association between a posteriori-derived dietary patterns (DPs) and risk of type 2 diabetes mellitus. MEDLINE and EMBASE were searched for articles published up to July 2012 and data were extracted by two independent reviewers. Overall, 19 cross-sectional, 12 prospective cohort, and two nested case-control studies were eligible for inclusion. Results from cross-sectional studies reported an inconsistent association between DPs and measures of insulin resistance and/or glucose abnormalities, or prevalence of type 2 diabetes. A meta-analysis was carried out on nine prospective cohort studies that had examined DPs derived by principle component/factor analysis and incidence of type 2 diabetes risk (totaling 309,430 participants and 16,644 incident cases). Multivariate-adjusted odds ratios were combined using a random-effects meta-analysis. Two broad DPs (Healthy/Prudent and Unhealthy/Western) were identified based on food factor loadings published in original studies. Pooled results indicated a 15% lower type 2 diabetes risk for those in the highest category of Healthy/Prudent pattern compared with those in the lowest category (95% CI 0.80 to 0.91; P<0.0001). Compared with the lowest category of Unhealthy/Western DP, those in the highest category had a 41% increased risk of type 2 diabetes (95% CI 1.32 to 1.52; P<0.0001). These results provide evidence that DPs are consistently associated with risk of type 2 diabetes even when other lifestyle factors are controlled for. Thus, greater adherence to a DP characterized by high intakes of fruit, vegetables, and complex carbohydrate and low intakes of refined carbohydrate, processed meat, and fried food may be one strategy that could have a positive influence on the global public health burden of type 2 diabetes.
authors.forename: Claire T
authors.initials: CT
authors.lastname: McEvoy
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cardwell
authors.forename: Jayne V
authors.initials: JV
authors.lastname: Woodside
authors.forename: Ian S
authors.initials: IS
authors.lastname: Young
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hunter
authors.forename: Michelle C
authors.initials: MC
authors.lastname: McKinley
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004032:Diet / Q000009:adverse effects*; D066273:Diet, Western / Q000009:adverse effects*; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D004043:Dietary Fiber / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005511:Food Handling; D057141:Food, Preserved / Q000009:adverse effects*; D005638:Fruit; D006293:Health Promotion; D006801:Humans; D007333:Insulin Resistance; D008461:Meat Products / Q000009:adverse effects*; D018673:Nutrition Policy; D012307:Risk Factors; D014675:Vegetables
chemical_list: D004040:Dietary Carbohydrates; D004043:Dietary Fiber
keywords: Diabetes; Dietary patterns; Insulin resistance; Meta-analysis