Cross-sectional association of dietary patterns with insulin-resistant phenotypes among adults without diabetes in the Framingham Offspring Study

Cluster analysis is a valuable tool for exploring the health consequences of consuming different dietary patterns. We used this approach to examine the cross-sectional relationship between dietary patterns and insulin-resistant phenotypes, including waist circumference, BMI, fasting insulin, 2h post-challenge insulin, insulin sensitivity index (ISI0,120), HDL-cholesterol, TAG and blood pressure, using data from the fifth examination cycle of the Framingham Offspring Study. Among 2875 participants without diabetes, we identified four dietary patterns based on the predominant sources of energy: Fruits, Reduced Fat Dairy and Whole Grains, Refined Grains and Sweets, Beer and Soda. After adjusting for multiple comparisons and potential confounders, compared with the Fruits, Reduced Fat Dairy and Whole Grains pattern, the Refined Grains and Sweets pattern had significantly higher mean waist circumference (924 v. 905cm; P=0008) and BMI (27.3 v. 26.6kg/m ²; P=0.02); the Soda pattern had significantly higher mean fasting insulin concentration (31.3 v. 28.0 μU/ml; P ≤0.001);the Beer pattern had significantly higher mean HDL-cholesterol concentration (1.46 v. 13.1mmol/l; P<0.001). No associations were observed between dietary patterns and ISI0,120, TAG, and systolic or diastolic blood pressure. Our findings suggest that consumption of a diet rich in fruits, vegetables, whole grains and reduced-fat dairy protects against insulin-resistant phenotypes and displacing these healthy choices with refined grains, high-fat dairy, sweet baked foods, candy and sugar-sweetened soda may promote insulin-resistant phenotypes.