title: Multiple Healthful Dietary Patterns and Type 2 Diabetes in the Women's Health Initiative.
abstract: The relationship between various diet quality indices and risk of type 2 diabetes (T2D) remains unsettled. We compared associations of 4 diet quality indices--the Alternate Mediterranean Diet Index, Healthy Eating Index 2010, Alternate Healthy Eating Index 2010, and the Dietary Approaches to Stop Hypertension (DASH) Index--with reported T2D in the Women's Health Initiative, overall, by race/ethnicity, and with/without adjustment for overweight/obesity at enrollment (a potential mediator). This cohort (n = 101,504) included postmenopausal women without T2D who completed a baseline food frequency questionnaire from which the 4 diet quality index scores were derived. Higher scores on the indices indicated a better diet. Cox regression was used to estimate multivariate hazard ratios for T2D. Pearson coefficients for correlation among the indices ranged from 0.55 to 0.74. Follow-up took place from 1993 to 2013. During a median 15 years of follow-up, 10,815 incident cases of T2D occurred. For each diet quality index, a 1-standard-deviation higher score was associated with 10%-14% lower T2D risk (P < 0.001). Adjusting for overweight/obesity at enrollment attenuated but did not eliminate associations to 5%-10% lower risk per 1-standard-deviation higher score (P < 0.001). For all 4 dietary indices examined, higher scores were inversely associated with T2D overall and across racial/ethnic groups. Multiple forms of a healthful diet were inversely associated with T2D in these postmenopausal women.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Cespedes
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Lesley
authors.initials: L
authors.lastname: Tinker
authors.forename: Bernard
authors.initials: B
authors.lastname: Rosner
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Lorena
authors.initials: L
authors.lastname: Garcia
authors.forename: Melanie
authors.initials: M
authors.lastname: Hingle
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.forename: Jinnie J
authors.initials: JJ
authors.lastname: Rhee
authors.forename: Molly E
authors.initials: ME
authors.lastname: Waring
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004032:Diet / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D014481:United States / Q000453:epidemiology
keywords: Alternate Healthy Eating Index; Alternate Mediterranean Diet Index; Dietary Approaches to Stop Hypertension Index; Healthy Eating Index; dietary patterns; health disparities; type 2 diabetes; women's health