title: Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS).
abstract: BACKGROUND
  Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN ("Seguimiento Universidad de Navarra") longitudinal study.
  
  
  METHODS
  We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM.
  
  
  RESULTS
  We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25-39 points) vs. low (11-24) category 0.43 [95% confidence interval (CI) 0.21, 0.89]; and for high (40-60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019).
  
  
  CONCLUSIONS
  The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM and also as an educational tool for laypeople to help them in self-assessing their future risk for developing diabetes.
authors.affiliation: Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
authors.forename: Ligia J
authors.initials: LJ
authors.lastname: Dominguez
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, Pamplona, Spain and CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, Pamplona, Spain and CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.|Department of Internal Medicine (Endocrinology), Hospital Reina Sofia, Osasunbidea-IDISNA, Tudela, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Basterra-Gortari
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, Pamplona, Spain and CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gea
authors.affiliation: Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Barbagallo
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, Pamplona, Spain and CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004032:Diet; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012306:Risk