Everything in moderation - Dietary diversity and quality, central obesity and risk of diabetes

Marcia C. De Oliveira Otto, Nikhil S. Padhye, Alain G. Bertoni, David R. Jacobs, Dariush Mozaffarian

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

Diet guidelines recommend increasing dietary diversity. Yet, metrics for dietary diversity have neither been well-defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown. We characterized and evaluated associations of diet diversity and quality with abdominal obesity and type II diabetes (T2D) in the Multi-Ethnic Study of Atherosclerosis. At baseline (2000-02), diet was assessed among 5,160 Whites, Hispanic, Blacks, and Chinese age 45-84 y and free of T2D, using a validated questionnaire. Three different aspects of diet diversity were characterized including count (number of different food items eaten more than once/week, a broad measure of diversity), evenness (Berry index, a measure of the spread of the diversity), and dissimilarity (Jaccard distance, a measure of the diversity of the attributes of the foods consumed). Diet quality was characterized using aHEI, DASH, and a priori pattern. Count and evenness were weakly positively correlated with diet quality (r with AHEI: 0.20, 0.04), while dissimilarity was moderately inversely correlated (r = -0.34). In multivariate models, neither count nor evenness was associated with change in waist circumference (WC) or incident T2D. Greater food dissimilarity was associated with higher gain in WC (p-trend<0.01), with 120% higher gain in participants in the highest quintile of dissimilarity scores. Diet diversity was not associated with incident T2D. Also, none of the diversity metrics were associated with change inWC or incident T2D when restricted to only healthier or less healthy foods. Higher diet quality was associated with lower risk of T2D. Our findings provide little evidence for benefits of diet diversity for either abdominal obesity or diabetes. Greater dissimilarity among foods was actually associated with gain in WC. These results do not support the notion that "eating everything in moderation" leads to greater diet quality or better metabolic health.

Original languageEnglish (US)
JournalPloS one
Volume10
Issue number10
DOIs
StatePublished - Oct 30 2015

Bibliographical note

Funding Information:
Dr. Otto was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under award number R01HL085710 and by unrestricted educational grants from Bunge LLC and from Swiss Re. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Mozaffarian reported receiving ad hoc honoraria or consulting from Bunge, Haas Avocado Board, Nutrition Impact, Amarin, Astra Zeneca, Boston Heart Diagnostics, GOED, and Life Sciences Research Organization; and scientific advisory boards, Unilever North America and Elysium Health. The other authors report no conflicts. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Publisher Copyright:
© 2015 de Oliveira Otto et al.This is an open access article distributed under the terms of the Creative Commons Attribution License ,which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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