Increase Font Size Decrease Font Size View as PDF Print
Search Plan and Results


What is the relationship between adherence to dietary guidelines and recommendations or specific dietary patterns, assessed using an index or score, and risk of type 2 diabetes?

Are prevailing patterns of diet behavior in a population, assessed using factor or cluster analysis, related to risk of type 2 diabetes?

What is the relationship between adherence to dietary guidelines and recommendations or specific dietary patterns, assessed using reduced rank regression analysis, and risk of type 2 diabetes?

What is the relationship between adherence to dietary guidelines or recommendations or specific dietary patterns (assessed using methods other than index or score, cluster or factor, or reduced rank regression analyses) and risk of type 2 diabetes?

Date Searched

September 2012; November 2012; updated through August 2013

Inclusion Criteria

  • Human subjects
  • Subject populations from countries with high or very high human development, according to the Human Development Index [1]
  • Children, adolescents and adults aged two years and older
  • Subjects who were healthy or at elevated chronic disease risk
  • Randomized or non-randomized controlled trial with at least 30 subjects per study arm and a follow-up rate of at least 80%, or a prospective cohort study.
  • A description of the dietary pattern(s) consumed by subjects, for this review, were defined as:
    • The quantities, proportions, variety or combination of different foods, drinks, and nutrients (when available) in diets
    • The frequency with which they are habitually consumed.
In addition, articles were included if they were published in English in a peer-reviewed journal between January 1980 and August 2013 (see Appendices F–H for the date of the last search update for each question). If an author is included on more than one primary research article that is similar in content, the paper with the most pertinent data/endpoints was included. If data/endpoints from both papers are appropriate, it was made clear that results are from the same intervention.

Exclusion Criteria

  • Animals and in vitro models
  • Subject populations from countries with medium or low human development, according to the Human Development Index
  • Children under the age of two years
  • Subjects who were hospitalized, diagnosed with disease or receiving medical treatment
  • Low-calorie intervention (defined as less than 1, 600kcal per day for women and less than 2, 000kcal per day for men)
  • Systematic review, meta-analysis, narrative review, before-and-after study, cross-sectional study or case-control study.
Articles were excluded if they were not published in English, or were published before January 1980. Articles, abstracts and presentations not published in peer-reviewed journals (e.g., websites, magazine articles, Federal reports) were also excluded. Finally, if an author was included on more than one review article or primary research article that is similar in content, the paper with the most pertinent data/endpoints was included, and others were excluded.

Search Terms & Electronic Databases Used

Click to see Search Terms/Strategies & Electronic Databases Used.


Total hits from all electronic database searches: 4047

Total articles identified to review from electronic databases: 347

Articles identified via handsearch or other means: None.


Summary of Articles Identified to Review

Number of Primary Articles Identified: 37

Number of Review Articles Identified:

Total Number of Articles Identified: 37

Number of Articles Reviewed but Excluded: 4010


Figure H.1.     Flow chart of literature search results for studies examining the relationship between dietary patterns and risk of type 2 diabetes

List of Included Articles for Evidence Analysis

Index/Score (11)

  1. Abiemo EE, Alonso A, Nettleton JA, Steffen LM, Bertoni AG, Jain A, Lutsey PL. Relationships of the Mediterranean dietary pattern with insulin resistance and diabetes incidence in the Multi-Ethnic Study of Atherosclerosis (MESA). Br J Nutr. 2012 Aug 30:1-8. [Epub ahead of print] PubMed PMID: 22932232.
  2. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, Fiol M, Gómez-Gracia E, López-Sabater MC, Vinyoles E, Arós F, Conde M, Lahoz C, Lapetra J, Sáez G, Ros E; PREDIMED Study. Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006 Jul 4;145(1):1-11.  PMID: 16818923. (HAND SEARCH – Also in DP and BW/Obesity and CVD questions)
  3. Fung TT, McCullough M, van Dam RM, Hu FB. A prospective study of overall diet quality and risk of type 2 diabetes in women. Diabetes Care. 2007 Jul;30(7):1753-7. Epub 2007 Apr 11. PubMed PMID: 17429059.
  4. Gopinath B, Rochtchina E, Flood VM, Mitchell P. Diet quality is prospectively associated with incident impaired fasting glucose in older adults. Diabet Med. 2013 Jan 10. doi: 10.1111/dme.12109. [Epub ahead of print] PubMed PMID: 23301551.
  5. Jacobs DR Jr, Sluik D, Rokling-Andersen MH, Anderssen SA, Drevon CA. Association of 1-y changes in diet pattern with cardiovascular disease risk factors and adipokines: results from the 1-y randomized Oslo Diet and Exercise Study. Am J Clin Nutr. 2009 Feb;89(2):509-17. Epub 2008 Dec 30. PubMed PMID: 19116328. (Also in DP and BW/Obesity and CVD questions)
  6. Liese AD, Nichols M, Sun X, D'Agostino RB Jr, Haffner SM. Adherence to the DASH Diet is inversely associated with incidence of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes Care. 2009 Aug;32(8):1434-6. Epub 2009 Jun 1. PubMed PMID: 19487638; PubMed Central PMCID: PMC2713612.
  7. Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, Benito S, Tortosa A, Bes-Rastrollo M. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008 Jun 14;336(7657):1348-51. Epub 2008 May 29. PubMed PMID: 18511765; PubMed Central PMCID: PMC2427084.
  8. Rossi M, Turati F, Lagiou P, Trichopoulos D, Augustin LS, La Vecchia C, Trichopoulou A. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia. 2013 Aug 22. [Epub ahead of print] PMID: 23975324
  9. Rumawas ME, Meigs JB, Dwyer JT, McKeown NM, Jacques PF. Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort. Am J Clin Nutr. 2009 Dec;90(6):1608-14. Epub 2009 Oct 14. PubMed PMID: 19828705; PubMed Central PMCID: PMC3152203. (Also in DP and BW/Obesity and CVD questions)
  10. von Ruesten A, Illner AK, Buijsse B, Heidemann C, Boeing H. Adherence to recommendations of the German food pyramid and risk of chronic diseases: results from the EPIC-Potsdam study. Eur J Clin Nutr. 2010 Nov;64(11):1251-9. Epub 2010 Aug 18. PMID: 20717136. (Also in DP and CVD question)
  11. Zamora D, Gordon-Larsen P, He K, Jacobs DR Jr, Shikany JM, Popkin BM. Are the 2005 Dietary Guidelines for Americans Associated With reduced risk of type 2 diabetes and cardiometabolic risk factors? Twenty-year findings from the CARDIA study. Diabetes Care. 2011 May;34(5):1183-5. Epub 2011 Apr 8. PubMed PMID: 21478463; PubMed Central PMCID: PMC3114488. (Also in DP and BW/Obesity and CVD questions)
Factor Analysis (15)
  1. Bauer F, Beulens JW, van der A DL, Wijmenga C, Grobbee DE, Spijkerman AM, van der Schouw YT, Onland-Moret NC. Dietary patterns and the risk of type 2 diabetes in overweight and obese individuals. Eur J Nutr. 2012 Jul 28. [Epub ahead of print] PubMed PMID: 22972436.
  2. Brunner EJ, Mosdøl A, Witte DR, Martikainen P, Stafford M, Shipley MJ, Marmot MG. Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am J Clin Nutr. 2008 May;87(5):1414-21. PubMed PMID: 18469266.
  3. Duffey KJ, Steffen LM, Van Horn L, Jacobs DR Jr, Popkin BM. Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr. 2012 Apr;95(4):909-15. Epub 2012 Feb 29. PubMed PMID: 22378729; PubMed Central PMCID: PMC3302365.
  4. Erber E, Hopping BN, Grandinetti A, Park SY, Kolonel LN, Maskarinec G. Dietary patterns and risk for diabetes: the multiethnic cohort. Diabetes Care. 2010 Mar;33(3):532-8. Epub 2009 Dec 10. PubMed PMID: 20007939; PubMed Central PMCID: PMC2827503.
  5. Fung TT, Schulze M, Manson JE, Willett WC, Hu FB. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 2004 Nov 8;164(20):2235-40. PubMed PMID: 15534160.
  6. Hodge AM, English DR, O'Dea K, Giles GG. Dietary patterns and diabetes incidence in the Melbourne Collaborative Cohort Study. Am J Epidemiol. 2007 Mar 15;165(6):603-10. Epub 2007 Jan 12. PubMed PMID: 17220476.
  7. Kimokoti RW, Gona P, Zhu L, Newby PK, Millen BE, Brown LS, D'Agostino RB, Fung TT. Dietary patterns of women are associated with incident abdominal obesity but not metabolic syndrome. J Nutr. 2012 Sep;142(9):1720-7. doi: 10.3945/jn.112.162479. Epub 2012 Jul 25. PubMed PMID: 22833658; PubMed Central PMCID: PMC3417833.
  8. Lau C, Toft U, Tetens I, Carstensen B, Jørgensen T, Pedersen O, Borch-Johnsen K. Dietary patterns predict changes in two-hour post-oral glucose tolerance test plasma glucose concentrations in middle-aged adults. J Nutr. 2009 Mar;139(3):588-93. Epub 2009 Jan 21. PubMed PMID: 19158222.
  9. Malik VS, Fung TT, van Dam RM, Rimm EB, Rosner B, Hu FB. Dietary patterns during adolescence and risk of type 2 diabetes in middle-aged women. Diabetes Care. 2012 Jan;35(1):12-8. Epub 2011 Nov 10. PubMed PMID: 22074723; PubMed Central PMCID: PMC3241320.
  10. Montonen J, Knekt P, Härkänen T, Järvinen R, Heliövaara M, Aromaa A, Reunanen A. Dietary patterns and the incidence of type 2 diabetes. Am J Epidemiol. 2005 Feb 1;161(3):219-27. PubMed PMID: 15671254.
  11. Morimoto A, Ohno Y, Tatsumi Y, Mizuno S, Watanabe S. Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population. Asia Pac J Clin Nutr. 2012;21(4):601-8. PubMed PMID: 23017319.
  12. Nanri A, Shimazu T, Takachi R, Ishihara J, Mizoue T, Noda M, Inoue M, Tsugane S. Dietary patterns and type 2 diabetes in Japanese men and women: the Japan Public Health Center-based Prospective Study. Eur J Clin Nutr. 2013 Jan;67(1):18-24. doi: 10.1038/ejcn.2012.171. Epub 2012 Oct 24. PubMed PMID: 23093343.
  13. Nettleton JA, Steffen LM, Ni H, Liu K, Jacobs DR Jr. Dietary patterns and risk of incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2008 Sep;31(9):1777-82. Epub 2008 Jun 10. PubMed PMID: 18544792; PubMed Central PMCID: PMC2518344.
  14. van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med. 2002 Feb 5;136(3):201-9. PubMed PMID: 11827496.
  15. Yu R, Woo J, Chan R, Sham A, Ho S, Tso A, Cheung B, Lam TH, Lam K. Relationship between dietary intake and the development of type 2 diabetes in a Chinese population: the Hong Kong Dietary Survey. Public Health Nutr. 2011 Jul;14(7):1133-41. Epub 2011 Apr 5. PubMed PMID: 21466742.
Reduced Rank Regression (3)
  1. Imamura F, Lichtenstein AH, Dallal GE, Meigs JB, Jacques PF. Generalizability of dietary patterns associated with incidence of type 2 diabetes mellitus. Am J Clin Nutr. 2009 Oct;90(4):1075-83. Epub 2009 Aug 26. PubMed PMID: 19710193; PubMed Central PMCID: PMC2744626.
  2. Liese AD, Weis KE, Schulz M, Tooze JA. Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009 Feb;32(2):263-8. Epub 2008 Nov 25. PubMed PMID: 19033409; PubMed Central PMCID: PMC2628691.
  3. McNaughton SA, Mishra GD, Brunner EJ. Dietary patterns, insulin resistance, and incidence of type 2 diabetes in the Whitehall II Study. Diabetes Care. 2008 Jul;31(7):1343-8. Epub 2008 Apr 4. PubMed PMID: 18390803; PubMed Central PMCID: PMC2453656.
Other Methods (8)
  1. Adamsson V, Reumark A, Fredriksson IB, Hammarström E, Vessby B, Johansson G, Risérus U. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). J Intern Med. 2011 Feb;269(2):150-9. doi: 10.1111/j.1365-2796.2010.02290.x. Epub 2010 Oct 22. PubMed PMID: 20964740. (Also in DP-CVD Other Methods)
  2. Blumenthal JA, Babyak MA, Sherwood A, Craighead L, Lin PH, Johnson J, Watkins LL, Wang JT, Kuhn C, Feinglos M, Hinderliter A. Effects of the dietary approaches to stop hypertension diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids. Hypertension. 2010 May;55(5):1199-205. Epub 2010 Mar 8. PMID: 20212264. (Also in DP-BW+CVD- Other Methods)
  3. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004 Sep 22;292(12):1440-6. PubMed PMID: 15383514.
  4. Gadgil MD, Appel LJ, Yeung E, Anderson CA, Sacks FM, Miller ER 3rd. The effects of carbohydrate, unsaturated fat, and protein intake on measures of insulin sensitivity: results from the OmniHeart trial. Diabetes Care. 2013 May;36(5):1132-7. doi: 10.2337/dc12-0869. Epub 2012 Dec 5. PMID: 23223345
  5. Rallidis LS, Lekakis J, Kolomvotsou A, Zampelas A, Vamvakou G, Efstathiou S, Dimitriadis G, Raptis SA, Kremastinos DT. Close adherence to a Mediterranean diet improves endothelial function in subjects with abdominal obesity. Am J Clin Nutr. 2009 Aug;90(2):263-8. Epub 2009 Jun 10. PubMed PMID: 19515732.
  6. Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, Ibarrola-Jurado N, Basora J, Estruch R, Covas MI, Corella D, Arós F, Ruiz-Gutiérrez V, Ros E; PREDIMED Study Investigators. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011 Jan;34(1):14-9. Epub 2010 Oct 7. PubMed PMID: 20929998; PubMed Central PMCID: PMC3005482.
  7. Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R, Corella D, Fiol M, Gómez-Gracia E, Arós F, Flores G, Lapetra J, Lamuela-Raventós R, Ruiz-Gutiérrez V, Bulló M, Basora J, Covas MI; PREDIMED Study Investigators. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008 Dec 8;168(22):2449-58. PubMed PMID: 19064829.
  8. Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2011 Oct 7. [Epub ahead of print] PubMed PMID: 21983060.

List of Excluded Articles with Reason

Click here to see excluded citations list.