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Disclosures: The authors report no relevant financial disclosures.
March 18, 2021
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Insulinemic and inflammatory diets increase type 2 diabetes risk for postmenopausal women

Disclosures: The authors report no relevant financial disclosures.
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Postmenopausal women consuming a high proinflammatory or hyperinsulinemic diet have an increased risk for developing type 2 diabetes, according to data from the Women’s Health Initiative published in Diabetes Care.

Fred Tabung

“Our findings suggest that while the ability of the dietary pattern to raise blood sugar levels may be important for type 2 diabetes prevention, focusing only on foods that contribute to blood sugar levels may not be an optimal approach because there are other foods and beverages that may not contribute to sugar levels, but may be potent regulators of inflammation and insulin hypersecretion,” Fred Tabung, PhD, MSPH, an assistant professor at The Ohio State University College of Medicine and Comprehensive Cancer Center, told Healio. “Inflammation and insulin response are normal ways our bodies use to keep us healthy, but when these processes go into overdrive, they become harmful to the body. One way they may go into overdrive is through a habitual dietary pattern that promotes chronic systemic inflammation or insulin hypersecretion.”

High hyperinsulinemic and high proinflammatory diets were associated with an increased risk for type 2 diabetes in postmenopausal women. Data were derived from Jin Q, et al. Diabetes Care. 2021;doi:10.2337/dc20-2216.  

Tabung and colleagues analyzed data from 73,495 postmenopausal women aged 50 to 79 years without type 2 diabetes at baseline who participated in WHI. Dietary indices were calculated using baseline dietary data from a self-administered food frequency questionnaire conducted at baseline. Hyperinsulinemia index scores were calculated to assess the insulinemic potential of a diet, and empirical dietary inflammatory pattern scores were calculated to assess inflammatory potential. Women received a higher hyperinsulinemia index score if they consumed more processed and red meat, sugar-sweetened beverages, nonfatty fish, eggs and poultry, and less green leafy vegetables, fruit, high-fat dairy, coffee and wine. High inflammatory diets were those with more meats, refined grain and high-energy beverages and less vegetables, coffee, tea, wine and beer. Glycemic index and glycemic load were calculated to assess the glycemic potential of a diet based on carbohydrate content. Participants were defined as having new-onset type 2 diabetes if they reported treatment or hospitalization for diabetes.

Hyperinsulinemic, proinflammatory diets increase risk for diabetes

During a median 13.3 years of follow-up, 11,009 incident cases of type 2 diabetes were reported in the study cohort. After adjusting for variables, women in the highest hyperinsulinemic diet quintile had a higher risk for type 2 diabetes compared with participants in the lowest hyperinsulinemic diet quintile (adjusted HR = 1.49; 95% CI, 1.32-1.68; P < .0001). Similarly, women in the highest empirical dietary inflammatory pattern quintile had a higher risk for type 2 diabetes compared with participants in the lowest quintile (aHR = 1.45; 95% CI, 1.29-1.63; P < .0001). Glycemic index and glycemic load were not associated with type 2 diabetes risk.

Women consuming a high hyperinsulinemic diet had 220 excess type 2 diabetes cases per 100,000 person-years, and proinflammatory diets were associated with 271 excess type 2 diabetes cases per 100,000 person-years. Hyperglycemic diets were not associated with excess type 2 diabetes cases.

“We expected there would be a difference between the insulinemic/inflammatory potential of the diet and the glycemic potential of the diet because dietary glycemic potential is a narrower concept, especially acute glycemia,” Tabung said. “But we did not expect that the difference would be that large, in terms of absolute excess risk that may be due to consuming a hyperinsulinemic or proinflammatory dietary pattern vs. a hyperglycemic dietary pattern.”

In subgroup analysis, women with overweight or obesity consuming a high hyperinsulinemic or proinflammatory diet had a higher risk for type 2 diabetes compared with women with normal weight and a low hyperinsulinemic or proinflammatory diet. High hyperinsulinemic and proinflammatory diets were also associated with a higher type 2 diabetes risk among white and Hispanic women.

New focus on dietary patterns

Focusing on only glycemic content in food is not an optimal approach for preventing diabetes, according to Tabung. He said providers should instead look at a woman’s overall dietary pattern and how it could directly affect insulin levels.

“Picking out certain foods and consuming them will not work as well as consuming the entire dietary pattern, except the foods that some people may be allergic or intolerant to,” Tabung said. “Furthermore, we may get a higher yield on our type 2 diabetes prevention efforts if we target specific racial and ethnic subgroups, such as African American women or Hispanic/Latina women rather than the general population with the same message.”

For more information:

Fred Tabung, PhD, MSPH, can be reached at fred.tabung@osumc.edu.