Insulinemic and inflammatory dietary patterns show enhanced predictive potential for gestational diabetes mellitus risk

CONTEXT

The putative association between proinflammatory and hyperinsulinemic dietary patterns and susceptibility to gestational diabetes mellitus (GDM) remains unclear.

OBJECTIVE

We aimed to compare the risk associated with the Mediterranean diet, as well as insulinemic and proinflammatory dietary patterns, in relation to the occurrence of GDM, and evaluate their predictive value.

METHODS

We prospectively followed 8, 495 women from the Maternal and Infant Health cohort in Hefei, China (2015-2021). Using a food frequency questionnaire, we calculated the Empirical Dietary Inflammatory Pattern (EDIP), the Empirical Dietary Index for Hyperinsulinemia (EDIH) score, and the Mediterranean diet (MD) score. GDM was diagnosed based on a 2-hour 75-gram oral glucose tolerance test conducted between 24 to 28 weeks of gestation. Logistic regression was used to estimate the risk of GDM, while Receiver Operating Characteristic (ROC) curves were constructed to evaluate the predictive performance of the empirical dietary index for GDM.

RESULTS

Participants who followed hyperinsulinemic or proinflammatory dietary patterns to the greatest extent had a higher risk of developing GDM. The OR for the highest quartile compared to the lowest quartile were 1.39 (95% CI: 1.30-1.49) for EDIH and 2.40 (95% CI: 1.88-3.01) for EDIP. The OR for the lowest quartile compared to the highest quartile was 1.33 (95% CI:1.14-1.55)for MD. The ROC curve analysis indicated that the combination of EDIP and EDIH (AUC = 0.81, 95% CI: 0.78-0.82, P = 0.003) can effectively predict the occurrence of GDM.

CONCLUSIONS

Utilizing both empirical dietary indexes, EDIP and EDIH, might offer a potentially more effective approach in preventing GDM when compared to solely focusing on adherence to the Mediterranean diet pattern.

Association of dietary insulinemic and inflammatory potential with risk of liver cancer and chronic liver disease mortality in postmenopausal women: a prospective cohort study

BACKGROUND

Low diet quality, diabetes, and chronic inflammation are risk factors of liver cancer and chronic liver disease (CLD), but the extent to which insulinemic and inflammatory diets are independently associated with risk of liver cancer and CLD mortality is unknown.

METHODS

We conducted a prospective cohort analysis among 78,356 postmenopausal women in the Women's Health Initiative Observational Study. Two validated dietary indices, the empirical dietary index for hyperinsulinemia (EDIH) and the empirical dietary inflammation pattern (EDIP), were estimated from a food-frequency questionnaire. Incident cases of liver cancer and CLD mortality were adjudicated via review of medical records and linkage to National Death Index. Multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, adjusted for age, diabetes, body mass index, and other covariates.

RESULTS

During a median 22.1 y of follow-up, we documented 176 primary liver cancer cases and 156 CLD mortality cases. EDIH was positively associated with incident liver cancer (HRQuartile 4 vs. Quartile 1 = 1.68; 95% CI: 1.00, 2.83; P-trend = 0.05) and CLD mortality (HRQ4 vs. Q1 = 2.28; 95% CI: 1.25, 4.15; P-trend = 0.02) in the multivariable model. EDIP was also positively associated with liver cancer (HRQ4 vs. Q1 = 1.88; 95% CI: 1.17, 3.03; P-trend = 0.009) and CLD mortality (HRQ4 vs. Q1 = 1.85; 95% CI: 1.09, 3.15; P-trend = 0.007). Estimates remained significant and robust in sensitivity analyses. Further analyses indicated positive associations for refined grains, processed meat, sugary beverages, and eggs, and inverse associations for coffee/tea and poultry.

CONCLUSIONS

Dietary insulinemic and inflammatory potentials were independently associated with higher risk of liver cancer and CLD mortality in U.S. postmenopausal women. These findings suggest a potential role for diet modification to reduce risk of liver cancer and CLD.

The relationship between the insulinemic potential of diet and lifestyle and risk of breast cancer: a case-control study among iranian adult women

BACKGROUND

Breast cancer (BC) is the most prevalent cancer, with a higher mortality rate in women worldwide. We aimed to investigate the association of the insulinemic potential of diet and lifestyle with the odds of BC using empirical indices, including the empirical dietary index for hyperinsulinemia (EDIH), empirical lifestyle index for hyperinsulinemia (ELIH), the empirical dietary index for insulin resistance (EDIR), and empirical lifestyle index for insulin resistance (ELIR).

METHODS

This hospital-based case-control study was conducted among Tehranian adult women aged≥30 years. The final analysis was performed on 134 women newly diagnosed with histologically confirmed BC as a case and 267 healthy women of the same age as control. A 168-food item food frequency questionnaire was used for assessing dietary intakes at baseline. The odds ratios (ORs) and 95% confidence intervals (CIs) of BC across tertiles of EDIH, ELIH, EDIR, and ELIR were determined using multivariable-adjusted logistic regression.

RESULTS

The mean ± SD of age and BMI of participants were 47.9±10.3 years and 29.4±5.5 kg/m2, respectively. EDIH score was related to the higher risk of BC based on fully adjusted models (OR:2.24;95%CI:1.21-4.12, P_trend=0.016). Furthermore, subgroup analysis showed a higher BC risk with increasing EDIH score in postmenopausal women (OR:1.74, 95%CI:1.13-2.69) and those without a history of the oral contraceptive pill (OCP) use (OR:1.44;95%CI:1.02-2.04). Moreover, ELIH scores were positively associated with an increased risk of BC in postmenopausal women (OR; 1.98; 95% CI: 1.35 - 2.89), those with a family history of cancer (OR:1.94;95%CI:1.10-3.42), and in individuals who did not use OCP (OR:1.46; 95% CI:1.00-2.12).

CONCLUSION

Our results showed a possible link between EDIH and higher BC risk. Also, higher EDIH and ELIH scores were strongly associated with a higher risk of BC in postmenopausal women, those with a family history of BC, and those who do not use OCP.

The association of insulinemic potential of diet and lifestyle with the risk of insulin-related disorders: a prospective cohort study among participants of Tehran Lipid and Glucose Study

BACKGROUND

We aim to assess the association of empirical dietary (EDIH) and lifestyle (ELIH) index for hyperinsulinemia with the risk of insulin resistance, hyperinsulinemia, insulin sensitivity, and β-cell dysfunction in Iranian adults.

METHODS

In this prospective study, a total of 1244 men and women aged ≥ 20 years were selected among participants of the Tehran lipid and glucose study and followed for 3.2 years. Dietary intakes were assessed using a valid semi-quantitative food frequency questionnaire. Dietary and lifestyle insulinemic potential indices were calculated using dietary intake, body mass index, and physical activity information. Multivariable logistic regression was used to estimate the associated risk of a 3-year incidence of insulin-related disorders.

RESULTS

The mean ± SD age and BMI of all eligible participants (42.7% males) were 43.0 ± 13.0 and 27.4 ± 4.9 in the study's baseline. After adjusting for all potential confounders, participants in the highest tertile of ELIH score had a greater risk of developing hyperinsulinemia (OR:2.42, 95%CI:1.52-3.86, P for trend =  < 0.001), insulin resistance (OR:2.71, 95%CI:1.75-4.18, P for trend =  < 0.001) and insulin insensitivity (OR:2.65, 95%CI: 1.72-4.10, P for trend =  < 0.001) compared with those in the lowest tertile. However, the risk of incident β-cell dysfunction was lower in individuals with a higher score of ELIH in comparison to those with the lowest score (OR:0.30, 95%CI:0.19-0.45, P for trend =  < 0.001).

CONCLUSIONS

Empirical lifestyle index for hyperinsulinemia was directly associated with insulin resistance, insulin insensitivity, and hyperinsulinemia and was inversely associated with β-cells dysfunction.