The Association Between Dietary Patterns and Insulin Resistance: A Systematic Review

Abstract

Background: Insulin resistance (IR (is associated with multiple metabolic disorders, increasing thereby the risk of type 2 diabetes. The systematic review was performed to study the association between dietary patterns and insulin resistance. Method: The study was carried out in database of PubMed, Scopus, Iran Medex and Magiran for the main keywords including diet, insulin, insulin resistance, dietary pattern. Finding: Articles used collected for reviewwere publications until March 2015.Prospective cohort studies and cross sectional studies were selected based on their title, abstract and full text of the materials. After excluding experimental surveys and studies focused on children and randomized clinical trials, required information were extracted. The results show that “Western” dietary patterns rich in red meat, fried and processed dishes, refined cereals and carbohydrate with high glycemic index has statistically significant effects in incidence of insulin resistance. Conclusion: The results of this systematic review indicate that unhealthy food habits rich in trans fatty acids and saturated fatty acids, refined carbohydrate with high glycemic index are related to the insulin resistance, hyperglycemia and risk of type 2 diabetes.

Full text

International Journal of Nutrition and Food Sciences
2016; 5(1-2): 14-18
Published online January 12, 2016 (http://www.sciencepublishinggroup.com/j/ijnfs)
doi: 10.11648/j.ijnfs.s.2016050102.13
ISSN: 2327-2694 (Print); ISSN: 2327-2716 (Online)
The Association Between Dietary Patterns and Insulin
Resistance: A Systematic Review
Tayebeh Doostvandi
1
, Hassan Mozaffari-Khosravi
2
, Parvin Mirmiran
3, *
, Zahra Bahadoran
3
1
International Campuse, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2
Department of Nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3
Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, ShahidBehesh ti University of Medical Sciences,
Tehran, Iran
Email address:
mirmiran@endocrine.ac.ir (P. Mirmiran)
To cite this article:
Tayebeh Doostvandi, Hassan Mozaffari-Khosravi, Parvin Mirmiran, Zahra Bahadoran. The association Between Dietary Patterns and Insulin
Resistance: A Systematic Review. International Journal of Nutrition and Food Sciences. Special Issue: Nutrition and Cardiometabolic Risk
Factors. Vol. 5, No. 1-2, 2016, pp. 14-18. doi: 10.11648/j.ijnfs.s.2016050102.13
Abstract:
Background: Insulin resistance (IR ) is associated with multiple metabolic disorders, increasing thereby the risk of
type 2 diabetes. The systematic review was performed to study the association between dietary patterns and insulin resistance.
Method: The study was carried out in database of PubMed, Scopus, Iran Medex and Magiran for the main keywords including
diet, insulin, insulin resistance, dietary pattern. Finding: Articles used collected for reviewwere publications until March
2015.Prospective cohort studies and cross sectional studies were selected based on their title, abstract and full text of the
materials. After excluding experimental surveys and studies focused on children and randomized clinical trials, required
information were extracted. The results show that “Western” dietary patterns rich in red meat, fried and processed dishes,
refined cereals and carbohydrate with high glycemic index has statistically significant effects in incidence of insulin resistance.
Conclusion: The results of this systematic review indicate that unhealthy food habits rich in trans fatty acids and saturated fatty
acids, refined carbohydrate with high glycemic index are related to the insulin resistance, hyperglycemia and risk of type 2
diabetes.
Keywords:
Diet, Insulin, Insulin Resistance, Dietary Pattern
1. Introduction
Insulin resistance (IR) is a patho-physiological condition
where the insulin reporter is less sensitive and therefore
insulin in a natural dose is not enough to produce normal
biological effects. Insulin resistance is a major risk factor for
the development of type 2 diabetes, cardiovascular disease
and metabolic syndrome [1].
In the USA, the National Health and Nutrition
Examination Survey found that 52.1% obese adolescents had
IR [2]. The obesity-associated increase in fatty acids can
trigger insulin resistance through intracellular metabolites
that activate protein kinas C (PKC), leading to the activation
of serine/threonine kinases that inhibit insulin signaling [3].
Diet seems to play an important role in IR. Nowadays,
various aspects of diet, such as fat, carbohydrate, fiber, whole
grain and glyscemic index and glycemic load have been
related to IR [2]. Traditionally, nutritional epidemiology has
examined the relationship between diet and disease by
evaluating the effects of single nutrient or specific foods [4].
However in daily life, people consume a variety of foods
with complex combinations of nutrients. To carry out
nutritional epidemiological research with more closely
models on human experience, researchers have proposed
studying dietary patterns rather than isolated foods. This
approach can help us to more accurately understand the links
between food consumption and the spread or prevention of
chronic disease [1].
Therefore, the aim of this review is to study of the
association between dietary pattern and insulin resistance.
2. Material and Methods
2.1. Search Strategy
This paper reviews the articles including cohort and cross
sectional studies that published until 2015 in all journals,

International Journal of Nutrition and Food Sciences 2016; 5(1-2): 14-18 15
using scientific database, including PubMed, Scopus, Iran
Medex and Magiran, using keywords which included:
insulin, insulin resistance, dietary pattern, diet and other
related key words.
2.2. Inclusion and Exclusion Criteria
All studies were selected based on their title, abstract and
full text of the materials. The experimental and children studies,
case control, clinical trial and duplicate article were excluded.
Information obtained from different studies (Table 1) is based
on following item respectively: a authors, country, sex, age,
sample size, follow up period, dietary intake assess, dietary
pattern, result and adjustment variable and primary results of
data base search revealed over390 papers in pubmed regarding
insulin resistance and dietary pattern. From 2749 articles in
scientific data bases, there were 1087on the subject of diets
and insulin resistance. After comprehensive review of title,
abstracts and the main objectives of studies 12 article were
included in this study (Fig. 1).
Figure 1. Flow chart of the study.
Table 1. Description of studies of dietary patterns identified via the systematic review.
Author Country
(year) Sex Age
(year)
Sample
size
Follow
up
period
Dietary
intake
assess
Dietary pattern Result adjustment variable
Arisawa et
al 2014
Japan
(2008)
Male
and
females
35-70
513 Cross-
sectional
FFQ
PrudentHigh
fat/westernBread and
dairy productsSeafood
High fat/western dietary
pattern was positively
correlated with insulin
resistance in Japanese
population.
Age, sex, smoking,
drinking, physical
activity, total energy
intake
Batis et
al., 2014
China
(2009)
Male
and
females
27-68
4096 15 years
24- hour
recalls,Hou
sehold
food
inventory
High in
wheatproducts and
soy milk and low in
rice, legumes, poultry,
eggs, and fish
Dietary pattern trajectories
with healthier scores
Longitudinally had a lower
HbA1c compared to those
with unhealthier scores.
Age, sex, geographic
city, physical activity,
BMI smoking
Abiemo et
al., 2013
USA
(2000)
Male
and
females
45-84
5390
Cross-
sectional
6 yr
follow
up
FFQ 127
items Mediterraneandiet
Mediterranean-style diet,
reflected by a higher a
prioriMediterranean diet
score, was cross-sectional
associated with lower insulin
levels among non-
diabetics,and lower blood
glucose prior to adjustment
for obesity, but not with
lower incidence ofDiabetes.
Age, sex, smoking,
physical activity,
family income,
education level, race,
waist circumference
Zuo et al.,
2013
China
(2006)
Male
and
females
>18 1070
Open
ongoing
cohort
from
2006
Semi-
quantitativ
eFFQ
WesternHigh wheat,
Traditional,Hedonic
Dietary pattern were
significantly associated with
insulin resistance
Age, sex, BMI,
smoking, physical
activity, total energy
Song et
al., 2012
South
Korea
(2007)
Male
and
females
30-65
3871 1 year FFQ
Diverse diet, western
diet, whole grain and
beans,white rice and
kimchi,alcohol and
coffee
Whole grains and beans
patterns were inversely
associated with insulin
resistance.
Age, sex, education,
income, BMI,
smoking, alcohol use,
physical activity
McNaught
on et al.,
2008
UK
(1988)
Male
and
females
35-55
items 7339 19 years
127 item
FFQ
low calorie/diet soft
drinks, onions, sugar-
sweetened beverages,
burgers and sausages,
crisps andother
snacks, and white
bread and low
consumption of
medium-/high-fiber
breakfast cereals,jam,
Dietary pattern associated
with insulin resistance
Age, sex, energy,
ethnicity,
employment grade,
smoking, alcohol,
physical activity,
BMI, blood pressure

16 Tayebeh Doostvandi et al.: The association Between Dietary Patterns and Insulin Resistance: A Systematic Review
Author Country
(year) Sex Age
(year)
Sample
size
Follow
up
period
Dietary
intake
assess
Dietary pattern Result adjustment variable
French
dressing/vinaigrette,
and whole meal bread
Lie et
al,2009 USA
Male
and
females
2875 FFQ 126
items
FruitsReduce fat dairy
and whole
grainsRefined grains
and sweetsBeer and
soda
consumption of a diet rich in
fruits, vegetables, whole
grains and reduced fatdairy
protects against insulin-
resistant phenotypes and
displacing these healthy
choices with refined grains,
high-fat dairy, sweet
bakedfoods, candy and
sugar-sweetened soda may
promote insulin-resistant
phenotypes.
Age, sex, total energy
Esmaillza
deh et al
Iran
(2007)
Females
teachers
40-60
486 Cross-
sectional
Semi-
quantitativ
eFFQ 168
item
Western
Healthy Traditional
High consumption of fruit,
vegetables and legumes is
associated with reduce risk
of insulin resistance and
metabolic syndrome in
tehrani female teachers.
Age,anthropomtry,ph
ysical activity,total
energy,smoking,curre
nt esterogen use and
menopausal staus
Isharwal
et
al(2008)
India
2008
Male
and
females
18>18
352 24-hour
food recall
For prevention and
amelioration of insulin
resistancein Asian Indian
adolescents and young
adults, it is prudentto have
normal BMI and low intake
of _ –6 PUFAs.
Sex,BMI,total fat
Desmond
E. M.
2000
UK2000
Male
and
females
40-65
802 Cross-
sectional
35 item
FFQ
healthy balanced
dietlow intake of fried
foods
dietary pattern which
includes increased fruit
and vegetable consumption
and a reduction in the intake
offatty foods and processed
meat for protection against
theoccurrence of the
metabolic syndrome and
glucoseintolerance.
Sex, age, Socio-
economic group,
BMI, Smoking
status, Alcohol intake
category
Villegas
r2004 Irish
Meal
and
females
adults
1473 Cross
sectional
FFQ
Traditional Irish
dietPrudent diet
Alcohol and
convenience food
A prudent diet may be
associated with
enhancedinsulin sensitivity
and a lower risk of type 2
diabetes
Sex, age, smoking
statues
Tzima
n2007 Athens
Meal
and
female
20-87
3042 cohort FFQ Mediterranean diet
Adherence to Mediterranean
diet is modeslty associated
with a better
insulinsensitivity, lower
levels of total cholesterol
and lower levels of systolic
blood pressure inOverweight
and obese subjects. This may
Sex, age, BMI,
current
smoking,physical
activity, waist, waist
to hip
3. Results and Discussion
In study by Arisawa et al, 513 subjects without treatment
for diabetes participated in the baseline survey of cohort
study in Tokushima, Japan. Four dietary patterns extracted
were: 1- prudent diet (high intake of vegetables and fruits), 2-
high fat/western (high intake of fried food, fried dish and
meat), 3- bread and dairy products, 4- seafood patterns.
Statistical analysis showed that a high fat/western dietary
patternsmay be positively associated with insulin resistance
in the Japanese population [2].
Inanother study of4096adults by Batis et al, with three to
six waves of diet data and biomarkers measured in the China
health and nutrition surveys, diet was assessed with three 24-
hour recalls and a household food inventory. A dietary pattern
previously identified with reduced rank regression that
positively predicted diabetes in 2006 (high in wheat products
and soy milk and low in rice, legumes, poultry, eggs, and
fish). Findings suggest that dietary pattern trajectories with
healthier scores longitudinally had a lower HbA1c compared
to those with unhealthier scores, even when trajectories had
similar scores in the end point [5]. Abiemo et al, studied 5390
men and women age, 45-48 years with 6 years follow up in

International Journal of Nutrition and Food Sciences 2016; 5(1-2): 14-18 17
MESA; dietary intake was assessed as FFQ. A MeDiet score
was created based on intake of 10 food components,
vegetables, whole grains, nuts, legumes, fruits, ratio of
monounsaturated to saturated fat, red and processed meat,
dairy, fish and alcohol. MeDiet was not significantly related
to risk of incident diabetes. Greater consistency with a
Mediterranean-style diet, reflected by a higher a priori
Mediterranean diet score, was cross-sectionally associated
with lower insulin levels among non-diabetics, and lower
blood glucose prior to adjustment for obesity, but not with
lower incidence of diabetes [6]. Zuo et al, studied 1070 men
and women, aged>18 years who participated in the 2006
phase of the China health and nutrition survey. Dietary intake
assessed using a validated FFQ and four dietary patterns
were identified: the Western (characterized by animal food,
milk, cake, etc), high wheat (high in wheat instead of rice,
wholegrain and beef/lamb), traditional (high in eggs, tofu,
organ meat, pickled, vegetables, etc) and the hedonic pattern
(high in beer, wine and alcohols and fresh vegetables).
Statistical analysis showed that western pattern was
associated with greater odds of insulinresistant;in contrast,
the Hedonic patternwas negatively associated with insulin
resistance in Chinese adults[1]. In the Song et al, 3871 men
and women 30 - 65 years participated in the Korea National
Health and Nutrition Examination Survey, using dietary
intake to assess was a validated FFQ, and 5 dietary patterns
were identified: Diverse diet, western diet, whole grain and
beans, white rice and kimchi (traditional fermented cabbage),
alcohol and coffee. A dietary pattern, characterized by high
consumption of whole grains, beans and fruits was found to
inversely associated with insulin resistance in healthy Korean
adults [7]. McNaughton et al, assessed 7,339 participants of
the Whitehall II study, measuring dietary intake using a 127-
item food frequency questionnaire, and the reduced rank
regression method to determine dietary patterns, using the
homeostasis model assessment of insulin resistance as the
intermediate or response variable; the association between
the dietary pattern identified and incidence of type 2 diabetes
was investigated using Cox proportional hazard regression
models. The authors identified a dietary pattern characterized
by high consumption of low calorie diet, soft drinks, onions,
sugar-sweetened beverages, burgers and sausages, crisps and
other snacks, and white bread and low consumption of
medium-/high-fiber breakfast cereals, jam, French
dressing/vinaigrette, and whole meal bread. Higher dietary
pattern scores were associated with increased risk of type 2
diabetes. Result demonstrated that a dietary pattern
associated with insulin resistance predicts type 2 diabetes risk
after adjustment for a range of confounders [8].
Lieet al used data from the fifth examination cycle of the
Framingham Offspring Study. Among 2875 participants
without diabetes, they identified four dietary patterns based
on the predominant sources of energy: ‘Fruits, Reduced Fat
Dairy and Whole Grains’, ‘Refined Grains and Sweets’,
‘Beer’ and ‘Soda’. These findings indicatedthat consumption
of a diet rich in fruits, vegetables, whole grains and reduced
fat dairy protects against insulin-resistant phenotypes and
displacing these healthy choices with refined grains, high-fat
dairy, sweet baked foods, candy and sugar-sweetened soda
may promote insulin-resistant phenotypes[9]. In a cross-
sectional study by Esmaillzadeh et al, 486 Tehrani female
teachers, aged 40–60 y were assessed, and 3 major dietary
patterns were identified by factor analysis, the healthy dietary
pattern, the Western dietary pattern, and the traditional
dietary pattern. These findings indicate that a dietary pattern
characterized by high consumption of fruit, vegetables,
poultry, and legumes is associated with reduced risk of
insulin resistance and the metabolic syndrome in Tehranian
female teachers. In contrast, a dietary pattern with high
amounts of refined grains, red meat, butter, processed meat,
and high-fat dairy products and low amounts of vegetables
and low-fat dairy products is associated with a greater risk of
the metabolic syndrome [4].
Ishrawe et al, investigated the relationship between dietary
nutrients and insulin resistance in352 Asian Indian adolescents
and young adults, dietary nutrient intake was (24-hour dietary
recall and monthly consumption data) result showed that for
prevention and amelioration of insulin resistance in Asian
Indian adolescents and young adults, it is prudent to have
normal BMI and low intakes of 6 PUFAs [10].
In a cross-sectional study by Desmond E. M, 802 subjects
aged 40–65 years were randomly selected, and principal
component analysis was used to identify four dietary patterns
explaining 31×7% of the dietary variation in the study cohort.
Component 1 was characterized by a healthy balanced diet
with a frequent intake of raw and salad vegetables, fruits in
summer and winter, fish, pasta and rice and low intake of
fried foods, sausages, fried fish, and potatoes. this component
was negatively correlated with central obesity, fasting plasma
glucose, 120 min non-esterifiesfatty acid and triacylglycerol,
and was positively correlated with HDL-cholesterol. It
therefore appears to be protective against metabolic
syndrome; this component was also negatively associated
with the risk of having undiagnosed diabetes, an association
independent of age, sex, smoking and obesity. These findings
support the hypothesis that dietary patterns are associated
with other lifestyle factors and with glucose intolerance and
other features of the metabolic syndrome [11].
In a cross-sectional study by Villegas et al, 1018 men and
women sampled from 17 general practice lists in the south of
Ireland. Three dietary patterns were identified by cluster
analysis;traditional Irish diet including white breadand refine
cereals, chips, butter, whole milk and dairy products, deserts
and sweets and lowest intake of poultry, fish, pasta and rice,
prudent diet including high intake of pasta and rice, brown
and unrefined cereals, spreads, poultry, fish, low fat and
dairyproducts, salad dressing, fruit and vegetables and lowest
intake of chips, white bread and refine cereals, butter, high
fat dairy, meat, meat products and sweet and Alcohol and
convenience pattern including high intake of alcohol, meat,
meat products, chips and snacks and the lowest intake, of
dessert, fruits, vegetable, brown bread and refined cereal, low
fat, dairy products and drink; the results showed that prudent
diet may be associated with enhanced insulin sensitivity and

18 Tayebeh Doostvandi et al.: The association Between Dietary Patterns and Insulin Resistance: A Systematic Review
lower risk of type 2 diabetes [12]. Another study indicated
that adherence to Mediterranean diet, high intakes of non-
refined cereals and products, vegetables,legumes, fruits, olive
oil, dairy products, fish,pulses, nuts, potatoes, eggs, sweets,
poultry, red meat andmeat products, was modestly associated
with a better insulin sensitivity, lower levels of total
cholesterol and lower levels of systolic blood pressure in
overweight and obese subjects. This may suggest that
compared to general population, the beneficial effect of this
diet in cardiovascular system of excess body weight people is
limited [13].
In conclusion, results of this systematic review indicate
that unhealthy food habits which is rich in trans fatty acids
and saturated fatty acids, refined carbohydrate with high
glycemic index is related to the insulin resistance,
hyperglycemia and risk of diabetes type 2.
Acknowledgement
We would like to acknowledge Ms N Shiva for critical
editing of the English grammar and syntax of the manuscript.
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