Genetics, Diet Quality, and Type 2 Diabetes Risk: An Observational Study

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It’s fairly well-known that family history and poor lifestyle play a role in developing type 2 diabetes, but how significant the combination of both can be is unknown. A recent study evaluated the link between hereditary risk and quality of diet with the incidence of type 2 diabetes.

Data from 35,759 men and women from the Nurse’s Health Study 1 and 2, and the Health Professionals Follow-up Study were evaluated. Genetic data on those who did not have diabetes, cardiovascular disease, or cancer at baseline was available. The hereditary risk was defined using a universal polygenic score encompassing overall genetic risk and additional scores representing pathophysiological mechanisms.

At the start of the study, subjects filled out questionnaires about their medical history, diet, and lifestyle. Diet quality was evaluated using the Alternate Healthy Eating Index (AHEI). Demographic background, study subjects’ health status, and genetic information were obtained as well. Researchers also gathered extensive genetic information.

Overall diet quality was measured by estimating the AHEI score of 11 foods and nutrients which focused on increased intake of fruits, vegetables, whole grains, beans and nuts, polyunsaturated fats, and long-chain fats. Each item was scored from zero (least healthy) to 10 (most healthy).

After adjusting for possible confounders, statistical analysis was used to measure hazard ratios for type 2 diabetes. Results showed that 4,433 participants were diagnosed with type 2 diabetes with more than 902,386 person-years of follow-up. The relative risk of type 2 increased as the AHEI score declined, which means that as diet quality decreased, rates of diabetes increased.

The link between low diet quality and increased family risk of type 2 diabetes was close to the combination of risks linked with each factor on its own. The researchers noted that self-reported diet information and possible bias from educated participants are limitations of the study. This study offers confirmation of the solo links of genetic risk and diet quality with the development of type 2 diabetes. A healthy diet is linked with lower rates of diabetes within all levels of hereditary risk.

So, what can you suggest to your clients who are at risk of diabetes? Here are a few ideas...

  • Swap refined grains with 100% whole-grain bread, cereal, and pasta.
  • Increase intake of leafy green vegetables and seasonal fruit.
  • Use brown rice in place of white rice.
  • Reduce consumption of sugary drinks and alcohol.
  • Choose lean meat and low-fat dairy products when possible.
  • Enjoy fruit with meals in place of heavy dessert.
  • Eat beans, potatoes, and other starchy vegetables in moderation.
  • Limit intake of high-sugar desserts and snacks.

By Lisa Andrews, MEd, RD, LD


Merino J, Guasch-Ferré M, Li J, Chung W, Hu Y, Ma B, et al. (2022) Polygenic scores, diet quality, and type 2 diabetes risk: An observational study among 35,759 adults from

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