# Association between Five Established DASH Diet Indices and Risk of Type 2 Diabetes Mellitus: A Population-Based Prospective Cohort Study

## TL;DR

Following a DASH diet, especially using specific indices, may lower the risk of developing type 2 diabetes, particularly in people with low physical activity.

## Contribution

This study identifies specific DASH diet indices associated with reduced T2DM risk in a population-based cohort.

## Key findings

- Higher adherence to the Dixon and Günther DASH indices was linked to lower T2DM risk after adjusting for confounders.
- The protective effect of the Günther index was stronger among physically active individuals.
- DASH diet adherence could be a public health strategy for T2DM prevention in low-activity populations.

## Abstract

Type 2 diabetes mellitus (T2DM) represents a rising international health crisis, closely linked to changing eating habits and lifestyle choices. The Dietary Approaches to Stop Hypertension (DASH) diet has gained interest due to its potential to avert and control insulin resistance and T2DM. This research aims to investigate the association between five DASH diet indices and the risk of T2DM within the Tehran Lipid and Glucose Study (TLGS).

Individuals aged 21 years and older, who were free from T2DM at baseline, were included. Dietary habits were evaluated using a validated food frequency questionnaire; adherence to the DASH diet was assessed through five indices: Folsom, Dixon, Mellen, Fung, and Günther. To assess the association between the DASH diet and T2DM risk, Cox proportional hazards models, adjusted for demographic & lifestyle factors, were employed.

Of the 2,188 participants, 989 (45.2%) were men. The mean (SD) age and BMI of the population were 40.6 (13.3) years and 27.0 (4.7) kg/m2, respectively. During a median follow-up of 8.9 years, 234 new cases of T2DM were recorded. During a median follow-up period of 8.9 years, 234 new T2DM cases surfaced. Initially, no association was found in crude models; however, after adjustments for confounders, higher adherence to the Dixon index (HR=0.71; 95% CI: 0.52–0.98) and Günther index (HR=0.69; 95% CI: 0.50–0.96) were associated with a lower risk of T2DM. This association remained significant for the Günther index among those who were physically active (HR=0.70; 95% CI: 0.51–0.97).

High adherence to DASH diets, evaluated using the Dixon and Günther DASH indices, is associated with a lower risk of T2DM, particularly among individuals with low activity levels; therefore, the inclusion of the DASH diet, especially for those with low physical activity, is recommended as a component of public health strategies for T2DM prevention in Tehrani adults.