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Carbohydrates, glycemic index and diabetes mellitus

Midlife susceptibility to the effects of poor diet on diabetes risk



Type 2 diabetes mellitus (T2D) prevalence continues to increase, and age of incidence continues to decrease. More information is needed to target interventions to the ages where they can be most effective. The objective of this study was to explore the degree to which the association between diet and T2D incidence changes through adulthood.


Participants were a large number (N = 2818) of community living adults in Canberra and Queanbeyan, Australia across three cohorts; young (20–24 followed to 32–36), mid-life (40–44 followed to 52–56) and late-life (60–64 followed to 72–76). Self-report dietary pattern scores at baseline and diabetes incidence across 12 years follow-up were measured, alongside confounders of caloric intake, sex, smoking status, years of education, hypertension, BMI and physical activity.


Cox proportional hazards indicated that neither Western nor Prudent dietary pattern scores were significantly associated with T2D incidence when confounders were included in the model. Unadjusted estimates suggested a positive association between Western dietary pattern scores and subsequent diabetes incidence (HR = 1.40, 95% CI [1.18, 1.64]). Compared with the mid-life cohort, a higher Western dietary pattern score posed a lower risk for incident T2D in the young cohort (unadjusted HR = 0.46, 95% CI [0.22, 0.96]), who also had significantly lower BMI and higher physical activity. No such significant effects were found for the late-life cohort.


Our findings indicate that mid-life may be a period of heightened vulnerability to the effects of an unhealthy diet on diabetes risk, but this effect is attenuated when risk factors related to diet, such as adiposity, are taken into account.

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Fig. 1: Cox survival hazard model results.


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The authors are grateful to Anthony Jorm, Helen Christensen, Bryan Rogers, Keith Dear, Simon Easteal, Chantal Reglade Meslin, Jerome Maller, Patricia Jacomb, Karen Maxwell, Kristine Kuh and the PATH project interviewers.


This work was supported the National Health and Medical Research Council [grant numbers 973302, 179805, 157125, 1063907 and 1100579]. At the time of writing, NC’s Fellowship was funded by the Australian Research Council [grant number 120100227]. PB’s Research Fellowship was funded by the Australian Research Council [FT13101444]], KJA’s NHMRC Fellowship #1102694. FNJ was supported by an NHMRC Career Development Fellowship (2) [1108125].

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Authors and Affiliations



EW contributed to the design of the study, provided methodological input, conducted the statistical analyses and contributed to all aspects of manuscript preparation and submission. FNJ and PB generated the dietary patterns, provided methodological input and contributed to writing and editing of the manuscript. KJA contributed to the design of the study, provided methodological input and contributed to writing and editing of the manuscript. NC contributed to the design of the study, provided methodological input and theoretical expertise and contributed to all aspects of manuscript preparation and submission.

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Correspondence to Erin I. Walsh.

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The authors declare that they have no conflict of interest.

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This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the Australian National University Human Research Ethics Committee. Written informed consent was obtained from all participants.

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Walsh, E.I., Jacka, F.N., Butterworth, P. et al. Midlife susceptibility to the effects of poor diet on diabetes risk. Eur J Clin Nutr 75, 85–90 (2021).

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