Reducing consumption of foods with insulinemic and inflammatory potentials may be most effective at preventing type 2 diabetes (T2D) among prediabetic women who are postmenopausal, according results from a study published in Diabetes Care.

Women (N=73,495) aged 50 to 79 years between 1993 and 1995 were recruited at 40 clinical centers in the United States to participate in the Women’s Health Initiative (WHI), which was a combinatory observational study and clinical trial.

Participants responded to the food frequency questionnaire and were assessed for T2D through March 1, 2019. Foods were scored by the empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP). Higher EDIH scores predicted increased circulatory of C-peptide, and EDIP scores predicted elevated circulation of inflammatory biomarkers.

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Stratified by quintiles of EDIH and EDIP scores, women in the highest quintiles had increased body mass indexes (mean, 28.7 vs 25.6 kg/m2; 28.1 vs 26.1 kg/m2), lower physical activity (mean, 9.6 vs 18.1 h/week; 10.8 vs 16.6 h/week), and were less likely to be White (79% vs 90%; 71% vs 93%) compared with women in the lowest quintiles, respectively.

At the study conclusion, 11,009 women were diagnosed with T2D. For every 1 standard deviation increase of EDIH or EDIP scores, risk for T2D was increased (adjusted hazard ratio [aHR], 1.12; 95% CI, 1.07-1.17; P <.0001; aHR, 1.14; 95% CI, 1.09-1.19; P <.0001, respectively).

In the fully adjusted multivariate models, T2D risk was not associated with diets that had a high glycemic index (aHR, 0.97; 95% CI, 0.92-1.03; P =.31) or glycemic load (aHR, 0.99; 95% CI, 0.94-1.05; P =.71).

The risk for T2D among women in the highest compared with the lowest quintiles for each dietary measure was higher among those consuming more EDIH (excess incidence [EI], 220 per 100,000 person-years [py]) or EDIP (EI, 271 per 100,000 py) foods and lower among those consuming more glycemic index (EI, -19 per 100,000 py) or glycemic load (EI, -41 per 100,000 py) foods.

The patterns of excess incidence were amplified among Hispanic women (EDIH: EI, 743 per 100,00 py; EDIP: EI, 786 per 100,000 py) followed by Black women (EDIH: EI, 582 per 100,00 py; EDIP: EI, 420 per 100,000 py), and lowest among White women (EDIH: EI, 168 per 100,00 py; EDIP: EI, 194 per 100,000 py).

Stratified by characteristics of weight, a significant interaction was observed between waist-to-hip ratio with EDIH (P <.0001) and EDIP (P <.0001), and obese or overweight women consuming more hyperinsulinemic or inflammatory foods had a 72% to 73% increased risk for T2D. No significant interactions were observed between weight characteristics and glycemic index or load.

This study was limited in that it did not include data on blood glucose, which likely contributed to the development of T2D.

These data indicated increased consumption of hyperinsulinemic or inflammatory potential foods increased risk for T2D among women who were postmenopausal, especially among those who were Black, Hispanic, obese, or overweight.


Jin Q, Shi N, Aroke D, et al. Insulinemic and inflammatory dietary patterns show enhanced predictive potential for type 2 diabetes risk in postmenopausal women. Diabetes Care. 2021;44(3):707-714. doi:10.2337/dc20-2216