Diet Quality Based on NRF 9.3 Assessment is Associated with Lower Incidence of Type 2 Diabetes

by | May 21, 2024 | 2024, Diabetes, Nutrition and Dieting, Recent Articles

Written by Chrystal Moulton, Science Writer. Patients who developed type 2 diabetes after five years had significantly lower change in NRF 9.3 score compared to those who did not develop type 2 diabetes (P= 0.01).

diabetesChronic diseases such as type 2 diabetes can be prevented by maintaining a proper diet and exercise routine1-3. Various indices measuring diet quality have been created to measure the association between dietary intakes of certain foods and the incidence of type 2 diabetes. However, a new diet quality index called the Nutrient Rich Food Index 9.3 [NRF 9.3] was recently created to establish the association between diet and the incidence of certain diseases4,5. In the current study, researchers evaluated dietary quality based on the Nutrient Rich Food Index 9.3 [NRF 9.3] assessment in association with the risk of type 2 diabetes in patients with coronary heart disease6.

This evaluation was done within the CORDIOPREV study. The CORDIOPREV study is a randomized controlled trial containing 1002 patients with coronary heart disease following either a Mediterranean diet or a low-fat diet for seven years7. Patients in the CORDIOPREV study were included if they had established coronary heart disease without clinical events six months prior to inclusion, had no other serious illnesses, were between the ages of 20 and 75 years old, and were willing to follow a long-term monitoring study. All patients within the CORDIOPREV study did not present with type 2 diabetes at baseline. Patients were excluded from this sub-analysis if dietary data was not present at baseline or follow up; individuals presented with extreme baseline values; they discontinued the study or died. Dietary intake at baseline and at one year follow up was included in this sub-analysis. Diet quality was assessed using the NRF 9.3 and the Alternative Healthy Eating Index- 2010 [AHEI-2010]. Evaluators assessed scores using both diet quality indices at baseline and after one year a follow up. They also calculated the change in diet score based on the 2 assessments. During the CORDIOPREV study, venous blood samples are also collected from each participant along with anthropometric measures. Samples were used to test markers of diabetes including HbA1C, serum insulin, HOMA-IR, and insulin sensitivity along with blood lipids and plasma glucose.

A total of 422 patients were included in this sub-analysis and 106 developed type 2 diabetes after five years. Waist circumference, HOMA- IR, BMI, fasting insulin and glucose levels, as well as HbA1C were significantly higher in patients that developed type 2 diabetes (P< 0.05). No significant differences were observed at baseline in diet quality index scores between those who developed type 2 diabetes and those who did not. Furthermore, patients who developed type 2 diabetes after five years had significantly lower change in NRF 9.3 score compared to those who did not develop type 2 diabetes (P= 0.01). No significant difference was observed between those who developed type 2 diabetes and those who did not based on the change in diet quality according to the Alternative Healthy Eating Index [AHEI-2010]. Also, researchers saw no significant difference in the change of NRF 9.3 scores between the low-fat diet versus the Mediterranean diet group. Regression analysis showed that patients with greater improvement in NRF 9.3 scores [tertile 3] had a significantly lower probability of developing type 2 diabetes compared to those with the lowest change in NRF 9.3 score [tertile 1] even after adjusting for confounders (smoking habits, HDL-C, triglycerides, age, sex, statin therapy, IGI, ISI, HOMA-IR, DI, LDL-C and BMI) [HR= 2.10, P= 0.006].

Ultimately, this analysis showed that a change in NRF 9.3 scores was significantly associated with the incidence of type 2 diabetes. Also, since the NRF 9.3 values were similar for both the low-fat diet and the Mediterranean diet, both diets were associated with a lower probability of developing type 2 diabetes. Additional studies will be needed to verify these results.

Source: Rivas-Garcia, Lorenzo, Gracia M. Quintana-Navarro, Juan F. Alcala-Díaz, Jose D. Torres-Peña, Antonio P. Arenas-de Larriva, Oriol Alberto Rangel-Zuñiga, Alejandro López-Moreno et al. “Association between Diet Quality and Risk of Type 2 Diabetes Mellitus in Patients with Coronary Heart Disease: Findings from the CORDIOPREV Study.” Nutrients 16, no. 8 (2024): 1249.

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/license
s/by/4.0/).

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Posted May 21, 2024.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

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