Association between adherence to the French dietary guidelines and the risk of type 2 diabetes

Abstract Objective : French food-based dietary guidelines (FBDG) have been updated in 2017. The objective of this prospective study was to estimate the associations between the PNNS-GS2 (Programme National Nutrition Sante - guidelines score 2), reflecting the level of adherence to the 2017 FBDG, and the risk of type 2-diabetes (T2D). Methods : A total of 79,205 French adult participants (mean age: 41.5 years (SD=14.5) 78.5% women, 65% were postgraduate) from the NutriNet-Sante cohort (2009-2019) were included. Dietary intakes were collected using repeated 24-hour dietary records. The PNNS-GS2 (theorical range: -∞ to 14.25), including 6 adequacy components and 7 moderation components as well as a penalization on energy intake, was computed. The association between the PNNS-GS2 (as quintiles (Q)) and T2D risk was estimated using multivariable Cox proportional hazard models accounting for sociodemographic, anthropometric, lifestyle and health-related factors. Results : During an average follow-up of 6.7y (536,679 person-years), 676 T2D cases occurred. In the multi-adjusted model, participants with the highest PNNS-GS2 (higher adherence to the 2017 FBDG), compared to those with the lowest (lower adherence to FBDG), exhibited a 49% reduction in risk of T2D (HRQ5 vs Q1: 0.51, 95%CI: 0.37, 0.69). Body mass index accounted for up to 27% of the main association. The healthy profiles of cohort's participants may have reduced statistical power. Conclusions : In this large prospective cohort study, a higher adherence to the French 2017 FBDG was strongly and inversely associated with the risk of developing type 2 diabetes. Such analysis should be confirmed in other settings but in terms of public health and nutritional policy, this study supports the relevance of the 2017 French food-based dietary guidelines.