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Diets with Higher Insulinemic Potential Are Associated with Increased Risk of Overall and Cardiovascular Disease-specific Mortality

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Research Article

Diets with Higher Insulinemic Potential Are Associated with Increased Risk of Overall and Cardiovascular Disease-specific Mortality

Yingying Wang1,2,3,4*, Bo Chen5*, Jiawei Zhang5*, Hairong Li1, Xufen Zeng1, Zhuang Zhang1, Yu Zhu1, Xiude Li1, Anla Hu1, Qihong Zhao1, Wanshui Yang1,2,

This peer-reviewed article has been accepted for publication but not yet copyedited or typeset, and so may be subject to change during the production process. The article is considered published and may be cited using its DOI 10.1017/S0007114521004815 The British Journal of Nutrition is published by Cambridge University Press on behalf of The Nutrition Society Downloaded from https://www.cambridge.org/core. IP address: 107.3.144.178, on 08 Dec 2021 at 00:56:44, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0007114521004815

Accepted manuscript Abstract

Hyperinsulinemia and insulin resistance have been proposed to be associated with mortality risk, and diet can modulate insulin response. However, whether dietary patterns with high insulinemic potential are associated with mortality remains unknown. We prospectively examined the associations between hyperinsulinemic diets and the risk of total and cause-specific mortality in a large nationally representative population. Dietary factors were assessed by 24-hour recalls. Two empirical dietary indices for hyperinsulinemia (EDIH) and insulin resistance (EDIR) were developed to identify food groups most predictive of biomarkers for hyperinsulinemia (C-peptide and insulin) and insulin resistance (homeostatic model assessment for insulin resistance), respectively. Deaths from date of the first dietary interview until December 31, 2015 were identified by the National Death Index. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models. During a median follow-up of 7.8 years, 4,904 deaths were documented among 40,074 participants. For EDIH, the multivariable-adjusted HRs (comparing extreme quintiles) were 1.20 (95% CI: 1.09-1.32, P-trend<0.001) for overall mortality, and 1.41 (95% CI: 1.15-1.74, P-trend=0.002) for cardiovascular disease (CVD) mortality. Similar associations were observed for EDIR with HRs of 1.18 (95% CI: 1.07-1.29, P-trend<0.001) for total and 1.35 (95% CI: 1.09-1.67, P-trend=0.005) for CVD mortality. After further adjustments for body mass index and diabetes, these positive associations were somewhat attenuated, but most remained statistically significant. Our findings suggested that diets with higher insulinemic potential are associated with increased risk of overall and CVD-specific mortality. Strategies to avoid hyperinsulinemic dietary patterns may potentially promote health and longevity.