Multiple healthful dietary patterns and type 2 diabetes in the women's health initiative

Elizabeth M. Cespedes, Frank B. Hu, Lesley Tinker, Bernard Rosner, Susan Redline, Lorena Garcia, Melanie Hingle, Linda Van Horn, Barbara V. Howard, Emily B. Levitan, Wenjun Li, Jo Ann E. Manson, Lawrence S. Phillips, Jinnie J. Rhee, Molly E. Waring, Marian L. Neuhouser

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


The relationship between various diet quality indices and risk of type 2 diabetes (T2D) remains unsettled. We compared associations of 4 diet quality indices - the Alternate Mediterranean Diet Index, Healthy Eating Index 2010, Alternate Healthy Eating Index 2010, and the Dietary Approaches to Stop Hypertension (DASH) Index - with reported T2D in the Women's Health Initiative, overall, by race/ethnicity, and with/without adjustment for overweight/obesity at enrollment (a potential mediator). This cohort (n = 101,504) included postmenopausal women without T2D who completed a baseline food frequency questionnaire from which the 4 diet quality index scores were derived. Higher scores on the indices indicated a better diet. Cox regression was used to estimate multivariate hazard ratios for T2D. Pearson coefficients for correlation among the indices ranged from 0.55 to 0.74. Follow-up took place from 1993 to 2013. During a median 15 years of follow-up, 10,815 incident cases of T2D occurred. For each diet quality index, a 1-standard-deviation higher score was associated with 10%-14% lower T2D risk (P < 0.001). Adjusting for overweight/obesity at enrollment attenuated but did not eliminate associations to 5%-10% lower risk per 1-standard-deviation higher score (P < 0.001). For all 4 dietary indices examined, higher scores were inversely associated with T2D overall and across racial/ethnic groups. Multiple forms of a healthful diet were inversely associated with T2D in these postmenopausal women.

Original languageEnglish (US)
Pages (from-to)622-633
Number of pages12
JournalAmerican journal of epidemiology
Issue number7
StatePublished - Apr 1 2016


  • Alternate Healthy Eating Index
  • Alternate Mediterranean Diet Index
  • Dietary Approaches to Stop Hypertension Index
  • Healthy Eating Index
  • dietary patterns
  • health disparities
  • type 2 diabetes
  • women's health

ASJC Scopus subject areas

  • General Medicine


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