Table 3.
Prospective association of the Portfolio, DASH, and aMED dietary patterns with risk of type 2 diabetes among 145,299 participants in the WHI (CT + OS) (1993–2021)
| Q1 | Q2 | Q3 | Q4 | Q5 | Per 1 SD increase | P trend | |
|---|---|---|---|---|---|---|---|
| Portfolio | |||||||
| Median score | 12.0 | 15.0 | 17.0 | 19.5 | 22.5 | ||
| Cases/person-years | 3,221/452,805 | 3,473/537,932 | 2,609/438,987 | 2,289/425,443 | 2,351/466,426 | ||
| Model 1* | 1.00 (ref) | 0.92 (0.88, 0.96) | 0.87 (0.83, 0.92) | 0.80 (0.75, 0.84) | 0.74 (0.70, 0.78) | 0.89 (0.88, 0.91) | <0.001 |
| Model 2† | 1.00 (ref) | 0.95 (0.90, 1.00) | 0.90 (0.85, 0.95) | 0.82 (0.77, 0.87) | 0.77 (0.72, 0.82) | 0.90 (0.88, 0.92) | <0.001 |
| Model 3‡ | 1.00 (ref) | 0.99 (0.94, 1.04) | 0.94 (0.89, 0.99) | 0.88 (0.83, 0.94) | 0.87 (0.82, 0.93) | 0.94 (0.93, 0.96) | <0.001 |
| DASH | |||||||
| Median score | 18.0 | 22.0 | 25.0 | 27.5 | 30.5 | ||
| Cases/person-years | 3,854/436,408 | 3,164/471,119 | 3,244/570,836 | 1,834/390,032 | 1,847/453,197 | ||
| Model 1* | 1.00 (ref) | 0.80 (0.77, 0.83) | 0.69 (0.64, 0.73) | 0.59 (0.56, 0.62) | 0.51 (0.48, 0.54) | 0.79 (0.77, 0.80) | <0.001 |
| Model 2† | 1.00 (ref) | 0.90 (0.86, 0.95) | 0.83 (0.79, 0.88) | 0.75 (0.71, 0.80) | 0.69 (0.64, 0.73) | 0.88 (0.86, 0.90) | <0.001 |
| Model 3‡ | 1.00 (ref) | 0.93 (0.88, 0.98) | 0.88 (0.84, 0.93) | 0.81 (0.77, 0.86) | 0.78 (0.72, 0.83) | 0.92 (0.90, 0.93) | <0.001 |
| aMED | |||||||
| Median score | 2.0 | 3.0 | 4.0 | 5.0 | 6.5 | ||
| Cases/person-years | 2,957/406,039 | 2,951/446,685 | 3,106/509,383 | 2,518/460,847 | 2,411/498,638 | ||
| Model 1* | 1.00 (ref) | 0.93 (0.89, 0.98) | 0.89 (0.83, 0.92) | 0.80 (0.76, 0.84) | 0.71 (0.68, 0.75) | 0.88 (0.86, 0.89) | <0.001 |
| Model 2† | 1.00 (ref) | 0.96 (0.90, 1.01) | 0.92 (0.87, 0.97) | 0.87 (0.82, 0.92) | 0.78 (0.74, 0.83) | 0.90 (0.89, 0.93) | <0.001 |
| Model 3‡ | 1.00 (ref) | 0.99 (0.94, 1.05) | 0.97 (0.92, 1.02) | 0.93 (0.88, 0.99) | 0.88 (0.83, 0.94) | 0.94 (0.93, 0.96) | <0.001 |
Data are HR (95% CI) unless otherwise indicated. Q1 represents the least adherent to the dietary patterns, whereas Q5 represents the most adherent. Association between dietary patterns and diabetes was determined by Cox proportional hazards models. Under/over–energy reporters and those with baseline diabetes were excluded from the analysis.
Model 1 adjustments include age (continuous), region (Northeast, South, Midwest, West), smoking (never, past, current) and study arm (HRT, DM, CaD).
Model 2 adjustments include model 1 adjustments plus self-identified race and ethnicity (White, African American, Hispanic, Asian), education (college or above, below college), marital status (presently married, other), hysterectomy history (yes, no), physical activity (continuous), alcohol intake (≥7 drinks/week, <7 drinks/week [excluded from aMED analysis, as alcohol intake is included in the score]), energy intake (continuous), hypertension status (yes, no), family history of diabetes (yes, no), HT use (never, past, current), cholesterol-lowering medication use (yes, no).
Model 3 adjustments include model 2 adjustments plus BMI (continuous).