British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Relationships of the Mediterranean dietary pattern with insulin resistance and diabetes incidence in the Multi-Ethnic Study of Atherosclerosis (MESA)

Eunice E. Abiemoa1, Alvaro Alonsoa1, Jennifer A. Nettletona2, Lyn M. Steffena1, Alain G. Bertonia3, Aditya Jaina4 and Pamela L. Lutseya1 c1

a1 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN 55454, USA

a2 Division of Epidemiology and Disease Control, University of Texas Health Science Center, Houston, TX, USA

a3 Divisions of Public Health Sciences and Internal Medicine, Wake Forest University, Winston-Salem, NC, USA

a4 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA


Type 2 diabetes (T2D) is a highly prevalent but preventable disorder. We assessed the association between an a priori Mediterranean diet (MeDiet) score and fasting glucose and insulin at baseline and incident T2D after a 6-year follow-up in the Multi-Ethnic Study of Atherosclerosis. Dietary intake was measured at baseline using a 127-item FFQ in 5390 men and women aged 45–84 years free of prevalent diabetes and clinical CVD. A MeDiet score was created based on the intake of ten food components: vegetables; whole grains; nuts; legumes; fruits; ratio of monounsaturated:saturated fat; red and processed meat; dairy products; fish; alcohol. Multivariable linear and proportional hazards models were used to estimate the association of the MeDiet, categorised in quintiles, with baseline insulin and glucose, and incident diabetes, respectively. The models were adjusted for demographic, physiological and behavioural characteristics. After multivariable adjustment, individuals with a higher MeDiet score had lower baseline mean insulin levels (Q1: 5·8 (95 % CI 5·6, 6·0) μmol/l; Q5: 4·8 (95 % CI 4·6, 5·0) μmol/l; P for trend < 0·0001). A higher MeDiet score was also associated with significantly lower glucose levels after basic adjustment, but was attenuated after adjustment for waist circumference. During the follow-up, 412 incident diabetes events accrued. The MeDiet was not significantly related to the risk of incident diabetes (P for trend = 0·64). In summary, greater consistency with a Mediterranean-style diet, reflected by a higher a priori MeDiet score, was cross-sectionally associated with lower insulin levels among non-diabetics, and with lower blood glucose before adjustment for obesity, but not with a lower incidence of diabetes.

(Received March 25 2012)

(Revised June 20 2012)

(Accepted June 25 2012)

(Online publication August 30 2012)

Key Words:

  • Mediterranean diet;
  • Insulin;
  • Glucose;
  • Diabetes;
  • Multi-Ethnic Study of Atherosclerosis (MESA)


c1 Corresponding author: P. L. Lutsey, fax +1 612 624-0315, email


  Abbreviations: IFG, impaired fasting glucose; MeDiet, Mediterranean diet; MESA, Multi-Ethnic Study of Atherosclerosis; T2D, type 2 diabetes