Dietary Patterns and Risk of Diabetes and Mortality: Impact of Cardiorespiratory Fitness
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The primary objective of this study was to assess the relationship between dietary patterns with diabetes and mortality risk from all-cause and cardiovascular disease while controlling for the confounding effects of fitness. The secondary objective was to examine the combined effects of dietary patterns and fitness on chronic disease and mortality risk. Participants consisted of 13,621 men and women from the Aerobics Center Longitudinal Study who completed a standardized medical examination and 3-day diet record between 1987 and 1999. Reduced rank regression was used to identify dietary patterns that were predictive of unfavorable profiles of cholesterol, white blood cell count, glucose, mean arterial pressure, HDL-cholesterol, uric acid, triglycerides, and body mass index. One primary dietary pattern emerged, which was labeled the “Unhealthy Eating Index”. This pattern was characterized by a large consumption of processed meat, red meat, white potato products, non-whole grains, added fat, and a small consumption of non-citrus fruits. After adjustment for covariates, the odds ratio for diabetes and the hazard ratio for all-cause mortality were 2.55 (95% confidence interval: 1.81-3.58) and 1.40 (1.02-1.91) in the highest quintile of the Unhealthy Eating Index when compared to the lowest quintile, respectively. After controlling for fitness, these risk estimates were reduced by 51.6% and 55.0%. The Unhealthy Eating Index was not a significant predictor of cardiovascular disease mortality before or after controlling for fitness. Examining the combined effects of dietary patterns and fitness revealed that both variables were independent predictors of diabetes (Ptrend <0.0001), while fitness (Ptrend <0.0001) but not unhealthy eating (Ptrend=0.071) significantly predicted all-cause mortality risk. These results suggest that both diet and fitness must be considered when studying disease.