The association of dietary macronutrients composition with the incidence of type 2 diabetes, using iso-energetic substitution models: Tehran Lipid and Glucose Study

Published:October 08, 2021DOI:


      • Whole grain at the expense of carbohydrate from non-whole grain, protein, and fats is associated with decreased risk of T2D.
      • The substitution of protein and fats was not associated with T2D.
      • Trans-fatty acid intake increase risk of T2D.



      There is still controversy on optimal percentage of macronutrient intakes especially carbohydrate on prevention of type 2 diabetes (T2D). The aim of the current study was to evaluate the iso-energetic substitution of dietary macronutrients in relation to incidence of T2D.


      This prospective study was conducted on 6547 subjects who were followed for 3.0 ± 1.6 years. Dietary intakes were evaluated using a valid and reliable semi-quantitative food frequency questionnaire. Biochemical variables and anthropometrics were evaluated at baseline and follow-up examinations. Multivariate Cox proportional hazard regression models were used to estimate the hazards ratio (HR) of T2D.


      A one unit higher proportion of carbohydrate from whole grain at the expense of carbohydrate from non-whole grain (HR = 0.82, 95% CI = 0.71–0.95), protein (HR = 0.75, 95% CI = 0.60–0.94), total fat (HR = 0.79, 95% CI = 0.67–0.93), saturated fatty acid (HR = 0.79, 95% CI = 0.65–0.96), poly-unsaturated fatty acid (HR = 0.81, 95% CI = 0.68–0.96) and mono-unsaturated fatty acid (HR = 0.75, 95% CI = 0.60–0.94) was associated with decreased risk of T2D. The substitution of protein and fats was not associated with diabetes. Risk of T2D increased from quartiles 1–4 for trans-fatty acid (HR: 1.00, 1.27, 0.95, 1.97, Ptrend = 0.01).


      A higher proportion of carbohydrate from whole grain in replacement of refined grain, and other macronutrients was associated with decreased risk of T2D. Also our study suggests a positive association between trans-fatty acid intake and risk of T2D.


      T2D (type 2 diabetes), TLGS (Tehran Lipid and Glucose Study), FCT (Iranian food composition table), SFA (saturated fatty acids), PUFA (poly-unsaturated fatty acid), MUFA (mono-unsaturated fatty acid), WC (waist circumference), FBG (fasting blood glucose), HR (hazards ratio)


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