Dietary patterns and risk for type 2 diabetes mellitus in US men

Background: The role of diet in the development of type 2 diabetes mellitus remains unsettled. Objective: To examine the association between major dietary patterns and risk for type 2 diabetes mellitus. Design: Prospective cohort study. Setting: United States. Participants: 42 504 male health professionals, 40 to 75 years of age, without diagnosed diabetes, cardiovascular disease, or cancer at baseline. Measurements: Using factor analysis based on data from food-frequency questionnaires, we identified and validated two major dietary patterns that we labeled "prudent" (characterized by higher consumption of vegetables, fruit, fish, poultry and whole grains) and "western" (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts). Relative risks and 95% CIs were adjusted for potential confounders, including body mass index (BMI), physical activity, and cigarette smoking. Results: During 12 years of follow-up (466508 person-years), we documented 1321 cases of type 2 diabetes. The prudent dietary pattern score was associated with a modestly lower risk for type 2 diabetes (relative risk for extreme quintiles, 0.84 [CI, 0.70 to 1.00]). In contrast, the western dietary pattern score was associated with an increased risk for type 2 diabetes (relative risk, 1.59 [CI, 1.32 to 1.93]; P < 0.001 for trend). A high score for the western dietary pattern combined with low physical activity (relative risk comparing extreme quintiles of dietary pattern score and physical activity, 1.96 [CI, 1.35 to 2.84]) or obesity (relative risk for BMI greater than or equal to 30 kg/m(2) vs. <25 kg/m(2), 11.2 [CI, 8.07 to 15.6]) was associated with a particularly high risk for type 2 diabetes. Conclusion: Our findings suggest that a western dietary pattern is associated with a substantially increased risk for type 2 diabetes in men.