Insulinemic and inflammatory dietary patterns show enhanced predictive potential for type 2 diabetes risk in postmenopausal women

Qi Jin, Ni Shi, Desmond Aroke, Dong Hoon Lee, Joshua J. Joseph, Macarius Donneyong, Darwin L. Conwell, Phil A. Hart, Xuehong Zhang, Steven K. Clinton, Zobeida Cruz-Monserrate, Theodore M. Brasky, Rebecca Jackson, Lesley F. Tinker, Simin Liu, Lawrence S. Phillips, Aladdin H. Shadyab, Rami Nassir, Wei Bao, Fred K. Tabung

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


OBJECTIVE The empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP) scores assess the insulinemic and inflammatory potentials of habitual dietary patterns, irrespective of the macronutrient content, and are based on plasma insulin response or inflammatory biomarkers, respec-tively. The glycemic index (GI) and glycemic load (GL) assess postprandial glycemic potential based on dietary carbohydrate content. We tested the hypothesis that dietary patterns promoting hyperinsulinemia, chronic inflammation, or hypergly-cemia may influence type 2 diabetes risk. RESEARCH DESIGN AND METHODS We calculated dietary scores from baseline (1993–1998) food frequency ques-tionnaires among 73,495 postmenopausal women in the Women’s Health Initiative, followed through March 2019. We used multivariable-adjusted Cox regression to estimate hazard ratios (HRs) and 95% CIs for type 2 diabetes risk. We also estimated multivariable-adjusted absolute risk of type 2 diabetes. RESULTS During a median 13.3 years of follow-up, 11,009 incident cases of type 2 diabetes were diagnosed. Participants consuming the most hyperinsulinemic or proinflam-matory dietary patterns experienced greater risk of type 2 diabetes; HRs (95% CI) comparing highest to lowest dietary index quintiles were EDIH 1.49 (1.32–1.68; Ptrend < 0.0001) and EDIP 1.45 (1.29–1.63; Ptrend < 0.0001). The absolute excess incidence for the same comparison was 220 (EDIH) and 271 (EDIP) cases per 100,000 person-years. GI and GL were not associated with type 2 diabetes risk: GI 0.99 (0.88– 1.12; Ptrend = 0.46) and GL 1.01 (0.89–1.16; Ptrend = 0.30). CONCLUSIONS Our findings in this diverse cohort of postmenopausal women suggest that lowering the insulinemic and inflammatory potentials of the diet may be more effective in preventing type 2 diabetes than focusing on glycemic foods.

Original languageEnglish
Pages (from-to)707-714
Number of pages8
JournalDiabetes Care
Issue number3
StatePublished - Mar 2021

Bibliographical note

Funding Information:
Funding. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. F.K.T. was responsible for concept and design. All of the authors were responsible for acquisition, analysis, or interpretation of data. Q.J. wrote the original manuscript draft. All authors contributed to the critical revision of the manuscript. Q.J. was responsible for statistical analysis. F.K.T. supervised the project. Q.J. and F.K.T. are the guarantors of this work and, as such, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. This study was presented in abstract form at the Nutrition 2020 Conference, 1–4 June 2020.

Publisher Copyright:
© 2021 by the American Diabetes Association.

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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