(P13-069-25) Healthful Dietary Patterns and Mortality Among Adults Living With Type 2 Diabetes

Objectives: To prospectively assess 11empirical or pre-defined healthy dietary patterns in relation to all-cause and cause-specific mortality (i.e., cardiovascular disease [CVD], cancer, and others) and life expectancy among individuals living with type 2 diabetes (T2D).

Methods: We included 7,795 participants with incident T2D from the Nurses’ Health Study (1984–2016) and Health Professionals Follow-Up Study (1986–2020), free of CVD and cancer at diagnosis. Diet was assessed using a validated food frequency questionnaire and updated every four years. We calculated cumulatively-averaged dietary pattern scores after the diagnosis and assessed scores changes from pre- to post-diagnosis. Multivariable-adjusted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Over an average of 24.0 years of follow-up, 3509 deaths were confirmed, including 1079 from CVD and 649 from cancer. Adherence to any healthy dietary pattern after diagnosis (comparing the 90th with the 10th percentile of dietary pattern scores) was consistently associated with a 10%-27% lower all-cause mortality, or 0.02-3.4 years gain in life expectancy at age 60. Furthermore, individuals who improved adherence to most dietary patterns from pre- to post-diagnosis were also associated with an 8%-37% lower all-cause mortality risk. In particular, the Alternative Healthy Eating Index (AHEI) and Planetary Health Diet (PHD) was associated with the greatest risk reduction in all-cause mortality (HR = 0.73 and 0.78 for post-diagnosis diet, and HR = 0.63 and 0.72 for improved adherence, respectively) and CVD mortality (HR = 0.68 and 0.73 for post-diagnosis diet, and HR = 0.57 and 0.68 for improved adherence, respectively). Additionally, the reversed Empirical Dietary Index for Hyperinsulinemia (rEDIH) was specifically associated with a 28% and 25% reduction in cancer mortality risk for post-diagnosis diet and improved adherence, respectively. Findings remained consistent across various demographic and lifestyle subgroups.

Conclusions: Adherence to any healthy dietary patterns is likely associated with better survival in individuals with T2D, with AHEI and PHD showing the strongest associations for all-cause and CVD mortality and rEDIH specifically predicting a lower cancer mortality among these patients.

Funding Sources: The analyses were supported by NIH.