Type 2 Diabetes–Prevention Diet and All-Cause and Cause-Specific Mortality

A Prospective Study

Chun-Rui Wang; Tian-Yang Hu; Fa-Bao Hao; Nan Chen; Yang Peng; Jing-Jing Wu; Peng-Fei Yang; Guo-Chao Zhong


Am J Epidemiol. 2022;191(3):472-486. 

In This Article

Abstract and Introduction


We aimed to examine whether type 2 diabetes–prevention diet, a dietary pattern previously developed for reducing type 2 diabetes risk, was associated with mortality in a US population. A population-based cohort of 86,633 subjects was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993–2015). Dietary information was collected with a food frequency questionnaire. A dietary diabetes risk-reduction score was calculated to reflect adherence to this dietary pattern, with higher scores representing better adherence. Hazard ratios (HRs) and absolute risk differences (ARDs) in mortality rates per 10,000 person-years were calculated. After a mean follow-up of 13.6 years, 17,532 all-cause deaths were observed. Participants with the highest versus the lowest quintiles of dietary diabetes risk-reduction score were observed to have decreased risks of death from all causes (HR = 0.76, 95% CI: 0.72, 0.80; ARD: −81.94, 95% CI: −93.76, −71.12), cardiovascular disease (HR = 0.73, 95% CI: 0.66, 0.81; ARD: −17.82, 95% CI: −24.81, −11.30), and cancer (HR = 0.85, 95% CI: 0.78, 0.94; ARD: −9.92, 95% CI: −15.86, −3.59), which were modified by sex, smoking status, or alcohol consumption in subgroup analyses (P for interaction < 0.05 for all). In conclusion, a type 2 diabetes–prevention diet confers reduced risks of death from all causes, cardiovascular disease, and cancer in this US population.


Type 2 diabetes is a major public health concern worldwide and is a well-established predisposing factor for cardiovascular disease[1] and cancer,[2] which represent 2 leading global causes of death. Dietary behaviors play a critical role in public health; unhealthy diet is ranked as the most common cause of death in the US population.[3] Hence, it is essential to investigate the potential associations of dietary behaviors with health outcomes.

A type 2 diabetes–prevention diet was proposed by Rhee et al. in 2015[4] and features high intakes of cereal fiber, polyunsaturated fatty acids, coffee, and nuts and low intakes of carbohydrates, trans-fatty acids, red and processed meat, and sugar-sweetened beverages.[4] Compared with other established dietary patterns (e.g., the Mediterranean diet), the type 2 diabetes–prevention diet captures key dietary elements closely related to the risk of type 2 diabetes and is developed primarily for facilitating the prevention of this disease,[4] resulting in inclusion of some components that are not part of other established dietary patterns (e.g., coffee and glycemic index); moreover, adherence to the type 2 diabetes–prevention diet could improve insulin sensitivity and reduce inflammation levels.[4–6] Recently, the type 2 diabetes–prevention diet was found to be associated with reduced risks of hepatocellular carcinoma,[7] breast cancer,[8] and pancreatic cancer.[9] However, whether the type 2 diabetes–prevention diet is associated with mortality remains unknown. Some studies have investigated the associations between individual components of the type 2 diabetes–prevention diet with the risk of mortality,[10–16] but they fail to consider the potential interactions among dietary components. Therefore, assessment of dietary patterns, which include multiple foods or nutrients simultaneously and thus can capture the potential interactions among them, may provide a more accurate estimate for diet-disease associations.

Hence, in this study, we aimed to examine the hypothesis that adherence to the type 2 diabetes–prevention diet is associated with all-cause and cause-specific mortality in the US population.