Dietary patterns, inflammation and diabetes

Accumulating evidence supports the hypothesis that chronic low-grade inflammation and activation of the innate immune system are closely involved in the pathogenesis of the type 2 diabetes. Dietary factors may have effects on inflammation and endothelial function independent of smoking, hypercholesterolemia, and hypertension. However, dietary exposures that lead to inflammation and diabetes are largely unknown. Therefore, a recent study in the American Journal of Clinical Nutrition investigated the relationship between a dietary pattern associated with biomarkers of inflammation and the incidence of type 2 diabetes.

A nested case-control study was performed of 656 cases of type 2 diabetes and 694 controls among women in the Nurses' Health Study (NHS) and two prospective cohort studies of 35,340 women in the Nurses' Health Study and 89,311 women in the Nurses' Health Study II (NHS-II), who were followed for incident diabetes. Dietary intake was assessed through semiquantitative FFQs. Information on age, weight, smoking status, contraceptive use and postmenopausal hormone therapy was collected through biennial questionnaires.

The dietary pattern that was strongly related to inflammatory markers was high in sugar-sweetened soft drinks, refined grains, diet soft drinks, and processed meat. It was low in wine, coffee, cruciferous vegetables and yellow vegetables and was associated with an increased risk of diabetes. One thousand five hundred and seventeen incident cases of confirmed type 2 diabetes were identified from the NHS and 724 cases from the NHS-II.

The NHS and NHS-II cohorts are study populations of US female nurses and therefore not representative of the general US female population. Therefore, these results should be replicated in other populations. However, this pattern strongly predicted risk of type 2 diabetes in a nested case-control analysis, independent of BMI and other diabetes risk factors. This association was subsequently confirmed in 2 separate cohorts of women. These findings provide evidence that the association between dietary factors and risk of type 2 diabetes may be mediated in part by inflammation and endothelial dysfunction.

Matthias B. Schulze, Kurt Hoffman, JoAnn E. Manson, et al. Dietary Pattern, Inflammation, and Incidence of Type 2 Diabetes in Women. AJCN; 82:675-684 (September 2005) [Reprints not available. Correspondence: M. B. Schulze, German Institute of Human Nutrition Potsdam-Rehbruecke, Department of Epidemiology, Arthur-Scheunert-Allee 114-116,14558 Nuthetal, Germany. E-mail: mschulze@mail.dife.de].

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