title: Everything in Moderation--Dietary Diversity and Quality, Central Obesity and Risk of Diabetes.
abstract: Diet guidelines recommend increasing dietary diversity. Yet, metrics for dietary diversity have neither been well-defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown. We characterized and evaluated associations of diet diversity and quality with abdominal obesity and type II diabetes (T2D) in the Multi-Ethnic Study of Atherosclerosis. At baseline (2000-02), diet was assessed among 5,160 Whites, Hispanic, Blacks, and Chinese age 45-84 y and free of T2D, using a validated questionnaire. Three different aspects of diet diversity were characterized including count (number of different food items eaten more than once/week, a broad measure of diversity), evenness (Berry index, a measure of the spread of the diversity), and dissimilarity (Jaccard distance, a measure of the diversity of the attributes of the foods consumed). Diet quality was characterized using aHEI, DASH, and a priori pattern. Count and evenness were weakly positively correlated with diet quality (r with AHEI: 0.20, 0.04), while dissimilarity was moderately inversely correlated (r = -0.34). In multivariate models, neither count nor evenness was associated with change in waist circumference (WC) or incident T2D. Greater food dissimilarity was associated with higher gain in WC (p-trend<0.01), with 120% higher gain in participants in the highest quintile of dissimilarity scores. Diet diversity was not associated with incident T2D. Also, none of the diversity metrics were associated with change in WC or incident T2D when restricted to only healthier or less healthy foods. Higher diet quality was associated with lower risk of T2D. Our findings provide little evidence for benefits of diet diversity for either abdominal obesity or diabetes. Greater dissimilarity among foods was actually associated with gain in WC. These results do not support the notion that "eating everything in moderation" leads to greater diet quality or better metabolic health.
authors.affiliation: Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center, School of Public Health, Houston, Texas, United States of America.
authors.forename: Marcia C de Oliveira
authors.initials: MC
authors.lastname: Otto
authors.affiliation: Center for Nursing Research, The University of Texas Health Science Center, School of Nursing, Houston, Texas, United States of America.
authors.forename: Nikhil S
authors.initials: NS
authors.lastname: Padhye
authors.affiliation: Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, United States of America.
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004032:Diet; D004435:Eating; D005006:Ethnicity / Q000706:statistics & numerical data; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D056128:Obesity, Abdominal / Q000453:epidemiology*; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires; D014481:United States; D055105:Waist Circumference