Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study

doi:10.1136/bmj.39561.501007.BE

BMJ 2008;336:1348-1351 (14 June), doi:10.1136/bmj.39561.501007.BE (published 29 May 2008)

Research

Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study

M Á Martínez-González, professor of epidemiology and chair¹, C de la Fuente-Arrillaga, research assistant¹, J M Nunez-Cordoba, research fellow¹^,2, F J Basterra-Gortari, research fellow¹^,3, J J Beunza, assistant professor¹, Z Vazquez, research assistant¹, S Benito, research assistant¹, A Tortosa, research fellow¹, M Bes-Rastrollo, assistant professor¹

¹ Department of Preventive Medicine and Public Health, Medical School-Clinica Universitaria, University of Navarra, Pamplona, Spain, ² Department of Preventive Medicine and Quality Management, Hospital Virgen del Camino, Pamplona, Spain, ³ Department of Endocrinology, Hospital of Navarra, Pamplona, Spain

Correspondence to: M Á Martínez-González mamartinez{at}unav.es

Objective To assess the relation between adherence to a Mediterraneandiet and the incidence of diabetes among initially healthy participants.

Design Prospective cohort study with estimates of relative riskadjusted for sex, age, years of university education, totalenergy intake, body mass index, physical activity, sedentaryhabits, smoking, family history of diabetes, and personal historyof hypertension.

Setting Spanish university department.

Participants 13 380 Spanish university graduates without diabetesat baseline followed up for a median of 4.4 years.

Main outcome measures Dietary habits assessed at baseline witha validated 136 item food frequency questionnaire and scoredon a nine point index. New cases of diabetes confirmed throughmedical reports and an additional detailed questionnaire postedto those who self reported a new diagnosis of diabetes by adoctor during follow-up. Confirmed cases of type 2 diabetes.

Results Participants who adhered closely to a Mediterraneandiet had a lower risk of diabetes. The incidence rate ratiosadjusted for sex and age were 0.41 (95% confidence interval0.19 to 0.87) for those with moderate adherence (score 3-6)and 0.17 (0.04 to 0.75) for those with the highest adherence(score 7-9) compared with those with low adherence (score <3).In the fully adjusted analyses the results were similar. A twopoint increase in the score was associated with a 35% relativereduction in the risk of diabetes (incidence rate ratio 0.65,0.44 to 0.95), with a significant inverse linear trend (P=0.04)in the multivariate analysis.

Conclusion Adherence to a Mediterranean diet is associated witha reduced risk of diabetes.

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