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White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries

Bhavadharini B 1 , Mohan V 2 , Dehghan M 1 , Rangarajan S 1 , Swaminathan S 3 , Rosengren A 4 Show all authors , Wielgosz A 5 , Avezum A 6 , Lopez-Jaramillo P 7 , Lanas F 8 , Dans AL 9 , Yeates K 10 , Poirier P 11 , Chifamba J 12 , Alhabib KF 13 , Mohammadifard N 14 , Zatońska K 15 , Khatib R 16 , Vural Keskinler M 17 , Wei L 18 , Wang C 18 , Liu X 18 , Iqbal R 19 , Yusuf R 20 , Wentzel-Viljoen E 21 , Yusufali A 22 , Diaz R 23 , Keat NK 24 , Lakshmi PVM 25 , Ismail N 26 , Gupta R 27 , Palileo-Villanueva LM 28 , Sheridan P 1 , Mente A 1 , Yusuf S 1

Affiliations 

  • 1 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
  • 2 Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India drmohans@diabetes.ind.in
  • 3 Division of Nutrition, St. John's Research Institute, Bangalore, India
  • 4 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 5 University of Ottawa, Ottawa, Canada
  • 6 Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
  • 7 Instituto Masira, Medical School, Universidad de Santander, and Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
  • 8 Universidad de La Frontera, Temuco, Chile
  • 9 University of the Philippines College of Medicine, Manila, Philippines
  • 10 Department of Medicine, Queen's University, Kingston, Canada
  • 11 Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
  • 12 Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  • 13 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 14 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 15 Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
  • 16 Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
  • 17 Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
  • 18 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  • 19 Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  • 20 Independent University, Dhaka, Bangladesh
  • 21 Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
  • 22 Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates
  • 23 Estudios Clínicos Latinoamerica, Rosario, Santa Fe, Argentina
  • 24 Universiti Teknologi MARA, Sungai Buloh, Malaysia
  • 25 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 26 Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 27 Eternal Heart Care Centre and Research Institute, Jaipur, India
  • 28 University of the Philippines College of Medicine, University of the Philippines Manila, Manila, Philippines
Diabetes Care, 2020 11;43(11):2643-2650.
PMID: 32873587 DOI: 10.2337/dc19-2335

Abstract

OBJECTIVE: Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study.

RESEARCH DESIGN AND METHODS: Data on 132,373 individuals aged 35-70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as <150, ≥150 to <300, ≥300 to <450, and ≥450 g/day, based on one cup of cooked rice = 150 g. The primary outcome was incident diabetes. Hazard ratios (HRs) were calculated using a multivariable Cox frailty model.

RESULTS: During a mean follow-up period of 9.5 years, 6,129 individuals without baseline diabetes developed incident diabetes. In the overall cohort, higher intake of white rice (≥450 g/day compared with <150 g/day) was associated with increased risk of diabetes (HR 1.20; 95% CI 1.02-1.40; P for trend = 0.003). However, the highest risk was seen in South Asia (HR 1.61; 95% CI 1.13-2.30; P for trend = 0.02), followed by other regions of the world (which included South East Asia, Middle East, South America, North America, Europe, and Africa) (HR 1.41; 95% CI 1.08-1.86; P for trend = 0.01), while in China there was no significant association (HR 1.04; 95% CI 0.77-1.40; P for trend = 0.38).

CONCLUSIONS: Higher consumption of white rice is associated with an increased risk of incident diabetes with the strongest association being observed in South Asia, while in other regions, a modest, nonsignificant association was seen.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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