title: Dietary Patterns and 10-year (2002-2012) Incidence of Type 2 Diabetes: Results from the ATTICA Cohort Study.
abstract: OBJECTIVE
  To identify dietary patterns among apparently healthy individuals and to determine their long-term effect on diabetes incidence.
  
  
  METHODS
  During 2001-2002, a random sample of 3,042 men and women (18-89 years old), living in greater Athens, was randomly selected to participate in the study. During 2011-2012, the 10-year follow-up was performed in 2,583 participants (15% drop-out rate). After excluding participants with diabetes at baseline and those for whom no information on diabetes status was available at follow-up, the working sample consisted of 1,485 participants. Dietary habits were assessed by means of a validated semi-quantitative, food frequency questionnaire. Factor analysis was performed to extract dietary patterns from 18 food groups.
  
  
  RESULTS
  Diabetes diagnosis at follow-up was made in 191 participants, yielding an incidence rate of 12.9%. Six factors (i.e. dietary patterns) were identified that explained 54% of the variation in consumption. After adjusting for major confounders, and stratification by age-group, logistic regression revealed that the most healthful pattern consisted of the consumption of fruits, vegetables, legumes, bread, rusk, and pasta which reduced the 10-year diabetes risk by 40%, among participants aged 45-55 years. The association reached marginal statistical significance (95% CI: 0.34, 1.07), while no significant association was observed for the other age-groups. When the analysis was additionally adjusted for carbohydrate percentage, statistical significance was lost completely, suggesting a possibly mediating effect of this macronutrient.
  
  
  CONCLUSIONS
  The results confirm the potentially protective effect of a plant-based dietary pattern in the primary prevention of diabetes, in particular among middle-aged people. Carbohydrate content may be a specific factor in this relationship; other micronutrients found in plant-based food groups may also play a role.
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Efi
authors.initials: E
authors.lastname: Koloverou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Ekavi N
authors.initials: EN
authors.lastname: Georgousopoulou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Grekas
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Aimilia
authors.initials: A
authors.lastname: Christou
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Chatzigeorgiou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D004032:Diet / Q000009:adverse effects / Q000208:ethnology; D000072001:Diet, Healthy / Q000208:ethnology; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010349:Patient Compliance / Q000208:ethnology; D011236:Prediabetic State / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D014504:Urban Health / Q000208:ethnology