Prevention of Non Communicable Diseases

Adherence to the Danish food-based dietary guidelines and risk of type 2 diabetes: the Danish diet, cancer, and health cohort



We evaluated the association between adherence to the 2013 Danish dietary guidelines and the risk of type 2 diabetes (T2D) in a Danish cohort.


We used data from the Danish Diet, Cancer, and Health cohort. Participants aged 50–64 years were included from 1993–1997. Information on diet and covariates was collected at baseline using questionnaires and physical assessments. A diet index was developed to assess adherence to the Danish dietary guidelines. T2D cases were identified using the Danish National Diabetes Register. Cox proportional hazards regression was used to estimate hazard ratios (HR), and the pseudo-observation method was used to estimate risk differences, and 95% confidence intervals (CI).


A total of 54,305 subject were included. During a median follow-up of 15 years, 7136 participants were diagnosed with T2D. After multivariable adjustment, the HR for high versus low adherence to the index was 0.57 (95 % CI: 0.48, 0.69) in men, and 0.71 (95% CI: 0.60, 0.83) in women. Compared with the lowest adherence to the index, high adherence was associated with a 6.58% (95% CI: −8.69; −4.47%) or 3.17% (95% CI: −4.90, −1.44%) lower risk of T2D in men and women, respectively.


High adherence to the Danish food-based dietary guidelines was associated with lower risk of T2D in a Danish cohort, both on a relative and an absolute scale. Shifting from low to high adherence to the dietary guidelines may provide public health benefit.

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Fig. 1: Hazard ratio of type 2 diabetes across the Danish Dietary guidelines Index, among men (n = 25,748) and women (n = 28,557) in the Danish Diet, Cancer and Health cohort.
Fig. 2: Association between adherence to the Danish Dietary guidelines Index and absolute risk of type 2 diabetes in the Danish Diet, Cancer and Health cohort (Cohort: n = 54,305, n cases=7136; Men: n = 25,748, n cases=3962; Women: n = 28,557, n cases = 3174).


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We thank the participants and the staff at the Danish Cancer Society for their invaluable contribution to this study.

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The authors’ responsibilities were as follows: LM, DBI, AT, KO, CCD: Designed the study; LM, CCD, DBI performed the statistical analyses; LM, CCD, DBI wrote the manuscript and had final responsibility for the final content of the manuscript; AT, KO collected data; AT, KO supplied valuable knowledge and scientific input throughout the study; all authors read and approved the final manuscript. The study was supported by Aarhus University and the study protocol was registered internally at the Danish Cancer Society.

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Correspondence to Christina C. Dahm.

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Markanti, L., Ibsen, D.B., Tjønneland, A. et al. Adherence to the Danish food-based dietary guidelines and risk of type 2 diabetes: the Danish diet, cancer, and health cohort. Eur J Clin Nutr (2020).

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