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Teresa T. Fung, ScD; Matthias Schulze, DrPH; JoAnn E. Manson, MD, DrPH; Walter C. Willett, MD, DrPH; Frank B. Hu, MD, PhD

Arch Intern Med. 2004;164:2235-2240.

Background  Although obesity is the most important risk factor for type 2 diabetes, evidence is emerging that certain foods and dietary factors may be associated with diabetes. To examine the association between major dietary patterns and risk of type 2 diabetes mellitus in a cohort of women.

Methods  We prospectively assessed the associations between major dietary patterns and risk of type 2 diabetes in women. Dietary information was collected in 1984, 1986, 1990, and 1994 from 69 554 women aged 38 to 63 years without a history of diabetes, cardiovascular disease, or cancer in 1984. We conducted factor analysis and identified 2 major dietary patterns: "prudent" and "Western." We then calculated pattern scores for each participant and examined prospectively the associations between dietary pattern scores and type 2 diabetes risks.

Results  The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, while the Western pattern included higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. During 14 years of follow-up, we identified 2699 incident cases of type 2 diabetes. After adjusting for potential confounders, we observed a relative risk for diabetes of 1.49 (95% confidence interval [CI], 1.26-1.76, P for trend, <.001) when comparing the highest to lowest quintiles of the Western pattern. Positive associations were also observed between type 2 diabetes and red meat and other processed meats. The relative risk for diabetes for every 1-serving increase in intake is 1.26 (95% CI, 1.21-1.42) for red meat, 1.38 (95% CI, 1.23-1.56) for total processed meats, 1.73 (95% CI, 1.39-2.16) for bacon, 1.49 (95% CI, 1.04-2.11) for hot dogs, and 1.43 (95% CI, 1.22-1.69) for processed meats.

Conclusion  The Western pattern, especially a diet higher in processed meats, may increase the risk of type 2 diabetes in women.

Author Affiliations: Department of Nutrition, Simmons College (Dr Fung); Departments of Nutrition (Drs Fung, Schulze, Willett, and Hu) and Epidemiology (Drs Manson, Willett, and Hu), Harvard School of Public Health; Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital (Drs Manson, Willett, and Hu), and Division of Preventive Medicine (Dr Manson), Harvard Medical School, Boston, Mass.

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