{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:47:21Z","timestamp":1792057641528,"version":"4.4.0"},"reference-count":52,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Nutr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Although consuming a diverse diet is generally considered beneficial for chronic disease prevention, its relationship with type 2 diabetes (T2D) remains unclear. This study investigated the associations of overall and within-group dietary diversity scores (DDS) with T2D incidence in the Korean Genome and Epidemiology Study\u2013CVD Association Study. A total of 16\u00a0666 participants aged 40 years and older without T2D at baseline were followed for 96\u00a0609 person-years, during which 953 incident T2D cases were identified. Cumulative average overall DDS and within-group DDS were derived from repeated FFQ administered at each visit. Modified Poisson regression with a robust error variance estimator was used to estimate incidence rate ratios (IRR) and 95 % CI. A significant inverse linear trend was observed between overall DDS and T2D risk (IRR = 0\u00b756, 95 % CI = 0\u00b740\u20130\u00b779 for men; IRR = 0\u00b773, 95 % CI = 0\u00b754\u20130\u00b798 for women). Among the five within-group DDS, those for \u2018Milk and Dairy products\u2019 in both sexes, \u2018Fruits\u2019 in men and \u2018Vegetables\/Seaweeds\/Mushrooms\u2019 in women were inversely associated with T2D (Q4\n                    <jats:italic>v<\/jats:italic>\n                    . Q1). No significant sex-related interactions were observed (all\n                    <jats:italic>p<\/jats:italic>\n                    for interaction &gt; 0\u00b705). Higher overall DDS and greater within-group diversity in \u2018Milk and Dairy products,\u2019 \u2018Fruits\u2019 and \u2018Vegetables\/Seaweeds\/Mushrooms\u2019 were associated with lower T2D risk. These findings suggest that maintaining overall dietary diversity \u2013 particularly emphasising non-energy-dense food groups such as fruits, vegetables, and dairy \u2013 may help prevent T2D.\n                  <\/jats:p>","DOI":"10.1017\/s0007114526108733","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:12:44Z","timestamp":1792055564000},"page":"1-10","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Dietary diversity and type 2 diabetes risk: evidence from a prospective Korean cohort study"],"prefix":"10.1017","author":[{"given":"Min-Ji","family":"Kim","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046865y68","id-type":"ROR","asserted-by":"publisher"}],"name":"Hanyang University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Won","family":"Woo","sequence":"additional","affiliation":[{"name":"Hanyang University"},{"name":"Hanyang University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Ho","family":"Shin","sequence":"additional","affiliation":[{"name":"Chonnam National University Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Baek","family":"Koh","sequence":"additional","affiliation":[{"name":"Yonsei University Wonju College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeon Chang","family":"Kim","sequence":"additional","affiliation":[{"name":"Yonsei University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Mi","family":"Kim","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046865y68","id-type":"ROR","asserted-by":"publisher"}],"name":"Hanyang University"},{"name":"Hanyang University"},{"name":"Hanyang University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8503-2631","authenticated-orcid":false,"given":"Mi Kyung","family":"Kim","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046865y68","id-type":"ROR","asserted-by":"publisher"}],"name":"Hanyang University"},{"name":"Hanyang University"},{"name":"Hanyang University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"S0007114526108733_ref4","volume-title":"US Department of Agriculture. 2015\u20132020 Dietary Guidelines for Americans","year":"2015"},{"key":"S0007114526108733_ref27","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.clnu.2020.04.035","article-title":"Sex-specific associations of habitual intake of soy protein and isoflavones with risk of type 2 diabetes","volume":"40","author":"Woo","year":"2021","journal-title":"Clin Nutr"},{"key":"S0007114526108733_ref44","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1038\/nature11319","article-title":"Gut microbiota composition correlates with diet and health in the elderly","volume":"488","author":"Claesson","year":"2012","journal-title":"Nature"},{"key":"S0007114526108733_ref52","doi-asserted-by":"crossref","first-page":"3911s","DOI":"10.1093\/jn\/133.11.3911S","article-title":"Operationalizing dietary diversity: a review of measurement issues and research priorities","volume":"133","author":"Ruel","year":"2003","journal-title":"J Nutr"},{"key":"S0007114526108733_ref41","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1001\/archinte.168.14.1493","article-title":"Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus: the European prospective investigation of cancer--Norfolk prospective study","volume":"168","author":"Harding","year":"2008","journal-title":"Arch Intern Med"},{"key":"S0007114526108733_ref31","doi-asserted-by":"crossref","first-page":"e0195103","DOI":"10.1371\/journal.pone.0195103","article-title":"Evaluating pre-pregnancy dietary diversity vs. dietary quality scores as predictors of gestational diabetes and hypertensive disorders of pregnancy","volume":"13","author":"Gicevic","year":"2018","journal-title":"PLOS ONE"},{"key":"S0007114526108733_ref12","doi-asserted-by":"crossref","first-page":"e13174","DOI":"10.1111\/obr.13174","article-title":"The role of dietary diversity in preventing metabolic-related outcomes: findings from a systematic review","volume":"22","author":"Mozaffari","year":"2021","journal-title":"Obes Rev"},{"key":"S0007114526108733_ref10","unstructured":"10. Division NaFS (2016) Influencing food environments for healthy diets."},{"key":"S0007114526108733_ref43","doi-asserted-by":"crossref","first-page":"269","DOI":"10.3390\/nu16020269","article-title":"Nutrition at the intersection between gut microbiota eubiosis and effective management of Type 2 diabetes","volume":"16","author":"Hamamah","year":"2024","journal-title":"Nutrients"},{"key":"S0007114526108733_ref49","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.foodchem.2017.09.149","article-title":"Anti-inflammatory properties of edible mushrooms: a review","volume":"243","author":"Muszynska","year":"2018","journal-title":"Food Chem"},{"key":"S0007114526108733_ref20","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.2337\/dc20-S002","article-title":"2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020","volume":"43","year":"2020","journal-title":"Diabetes Care"},{"key":"S0007114526108733_ref32","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.2337\/dc11-2388","article-title":"A prospective study of the association between quantity and variety of fruit and vegetable intake and incident type 2 diabetes","volume":"35","author":"Cooper","year":"2012","journal-title":"Diabetes Care"},{"key":"S0007114526108733_ref47","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1093\/advances\/nmab009","article-title":"Dietary diversity indicators and their associations with dietary adequacy and health outcomes: a systematic scoping review","volume":"12","author":"Verger","year":"2021","journal-title":"Adv Nutr"},{"key":"S0007114526108733_ref42","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1093\/aje\/kwj136","article-title":"Associations of serum carotenoid concentrations with the development of diabetes and with insulin concentration: interaction with smoking: the Coronary Artery Risk Development in Young Adults (CARDIA) Study","volume":"163","author":"Hozawa","year":"2006","journal-title":"Am J Epidemiol"},{"key":"S0007114526108733_ref13","doi-asserted-by":"crossref","first-page":"e1002085","DOI":"10.1371\/journal.pmed.1002085","article-title":"Dietary diversity, diet cost, and incidence of Type 2 diabetes in the United Kingdom: a prospective cohort study","volume":"13","author":"Conklin","year":"2016","journal-title":"PLOS MED"},{"key":"S0007114526108733_ref8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1146\/annurev-nutr-071715-051004","article-title":"Nature, nurture, and cancer risks: genetic and nutritional contributions to cancer","volume":"37","author":"Theodoratou","year":"2017","journal-title":"Annu Rev Nutr"},{"key":"S0007114526108733_ref14","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1017\/S000711451500094X","article-title":"Can nutrient profiling help to identify foods which diet variety should be encouraged? Results from the Whitehall II cohort","volume":"113","author":"Masset","year":"2015","journal-title":"Br J Nutr"},{"key":"S0007114526108733_ref1","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2991\/jegh.k.191028.001","article-title":"Epidemiology of type 2 diabetes - global burden of disease and forecasted trends","volume":"10","author":"Khan","year":"2020","journal-title":"J Epidemiol Glob Health"},{"key":"S0007114526108733_ref19","unstructured":"19. 360 FaF (2016) Minimum Dietary Diversity for Women: A Guide for Measurement, Rome: FAO: FAO and FHI 360."},{"key":"S0007114526108733_ref3","doi-asserted-by":"crossref","unstructured":"3. Uusitupa, M , Khan, TA , Viguiliouk, E , et al. (2019) Prevention of type 2 diabetes by lifestyle changes: a systematic review and meta-analysis. Nutrients 11, article no. 2611.","DOI":"10.3390\/nu11112611"},{"key":"S0007114526108733_ref35","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.cofs.2017.04.002","article-title":"The beneficial role of edible mushrooms in human health","volume":"14","author":"Roncero-Ramos","year":"2017","journal-title":"Curr Opin Food Sci"},{"key":"S0007114526108733_ref11","first-page":"395","article-title":"Dietary guidelines for Americans, 2020\u20132025","volume":"69","author":"Phillips","year":"2021","journal-title":"WHS"},{"key":"S0007114526108733_ref29","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780199754038.001.0001","volume-title":"Nutritional Epidemiology","author":"Willett","year":"2012"},{"key":"S0007114526108733_ref9","doi-asserted-by":"crossref","first-page":"8120","DOI":"10.1080\/10408398.2021.1925630","article-title":"Is eating a mixed diet better for health and survival? A systematic review and meta-analysis of longitudinal observational studies","volume":"62","author":"Mozaffari","year":"2022","journal-title":"Crit Rev Food Sci Nutr"},{"key":"S0007114526108733_ref45","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1093\/ajcn\/nqac178","article-title":"Associations of dietary diversity with the gut microbiome, fecal metabolites, and host metabolism: results from 2 prospective Chinese cohorts","volume":"116","author":"Xiao","year":"2022","journal-title":"Am J Clin Nutr"},{"key":"S0007114526108733_ref17","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1093\/ije\/dyv316","article-title":"Cohort profile: the Korean Genome and Epidemiology Study (KoGES) consortium","volume":"46","author":"Kim","year":"2017","journal-title":"Int J Epidemiol"},{"key":"S0007114526108733_ref22","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/(SICI)1097-0274(199801)33:1<33::AID-AJIM5>3.0.CO;2-X","article-title":"Empirical comparisons of proportional hazards, Poisson, and logistic regression modeling of occupational cohort data","volume":"33","author":"Callas","year":"1998","journal-title":"Am J Ind Med"},{"key":"S0007114526108733_ref46","doi-asserted-by":"crossref","first-page":"108212","DOI":"10.1016\/j.celrep.2020.108212","article-title":"Genetic and microbial associations to plasma and fecal bile acids in obesity relate to plasma lipids and liver fat content","volume":"33","author":"Chen","year":"2020","journal-title":"Cell Rep"},{"key":"S0007114526108733_ref25","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/j.numecd.2017.10.005","article-title":"Dietary total, animal, vegetable calcium and type 2 diabetes incidence among Korean adults: the Korean Multi-Rural Communities Cohort (MRCohort)","volume":"27","author":"Oh","year":"2017","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"S0007114526108733_ref48","doi-asserted-by":"crossref","first-page":"652","DOI":"10.3390\/nu2070652","article-title":"Health benefits of nut consumption","volume":"2","author":"Ros","year":"2010","journal-title":"Nutrients"},{"key":"S0007114526108733_ref18","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1038\/sj.ejcn.1602657","article-title":"Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study","volume":"61","author":"Ahn","year":"2007","journal-title":"Eur J Clin Nutr"},{"key":"S0007114526108733_ref50","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1161\/CIR.0000000000000595","article-title":"Dietary diversity: implications for obesity prevention in adult populations: a science advisory from the American Heart Association","volume":"138","author":"de Oliveira Otto","year":"2018","journal-title":"Circulation"},{"key":"S0007114526108733_ref15","doi-asserted-by":"crossref","first-page":"e0141341","DOI":"10.1371\/journal.pone.0141341","article-title":"Everything in moderation--dietary diversity and quality, central obesity and risk of diabetes","volume":"10","author":"Otto","year":"2015","journal-title":"PLOS ONE"},{"key":"S0007114526108733_ref33","doi-asserted-by":"crossref","DOI":"10.1093\/nutrit\/nuaf310","article-title":"Mapping definitions, measures, and methodologies for assessing dietary diversity in the nutrition literature: results of a systematic scoping review","author":"Conklin","year":"2026","journal-title":"Nutr Rev"},{"key":"S0007114526108733_ref39","doi-asserted-by":"crossref","DOI":"10.1016\/j.tifs.2024.104741","article-title":"Impact of dairy food products on type 2 diabetes: gut-pancreas axis for lower glucose level","volume":"153","author":"Agag\u00fcnd\u00fcz","year":"2024","journal-title":"Trends Food Sci Tech"},{"key":"S0007114526108733_ref30","doi-asserted-by":"crossref","DOI":"10.1093\/ije\/dyaf057","article-title":"Protein diversity, type 2 diabetes, and effect modifiers: a multi-country prospective study","volume":"54","author":"Mozaffari","year":"2025","journal-title":"Int J Epidemiol"},{"key":"S0007114526108733_ref40","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/S0002-8223(02)90246-4","article-title":"Higher dietary variety is associated with better nutritional status in frail elderly people","volume":"102","author":"Bernstein","year":"2002","journal-title":"J Am Diet Assoc"},{"key":"S0007114526108733_ref28","doi-asserted-by":"crossref","first-page":"134","DOI":"10.2337\/diacare.27.1.134","article-title":"Magnesium intake and risk of type 2 diabetes in men and women","volume":"27","author":"Lopez-Ridaura","year":"2004","journal-title":"Diabetes Care"},{"key":"S0007114526108733_ref7","volume-title":"Dietary Reference Intakes for Koreans 2020","year":"2020"},{"key":"S0007114526108733_ref16","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1093\/oxfordjournals.aje.a009849","article-title":"Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements","volume":"149","author":"Hu","year":"1999","journal-title":"Am J Epidemiol"},{"key":"S0007114526108733_ref24","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1017\/S0007114517003087","article-title":"A prospective association between dietary folate intake and type 2 diabetes risk among Korean adults aged 40 years or older: the Korean Multi-Rural Communities Cohort (MRCohort) Study","volume":"118","author":"Hong","year":"2017","journal-title":"Br J Nutr"},{"key":"S0007114526108733_ref36","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/nure.12091","article-title":"Seaweed and human health","volume":"72","author":"Brown","year":"2014","journal-title":"Nutr Rev"},{"key":"S0007114526108733_ref38","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00394-020-02225-0","article-title":"Dietary iodine, seaweed consumption, and incidence risk of metabolic syndrome among postmenopausal women: A prospective analysis of the Korean Multi-Rural Communities Cohort Study (MRCohort)","volume":"60","author":"Park","year":"2021","journal-title":"Eur J Nutr"},{"key":"S0007114526108733_ref21","doi-asserted-by":"crossref","DOI":"10.1201\/b16343","volume-title":"Epidemiology: Study Design and Data Analysis","author":"Woodward","year":"2013"},{"key":"S0007114526108733_ref51","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/00041433-200202000-00002","article-title":"Dietary pattern analysis: a new direction in nutritional epidemiology","volume":"13","author":"Hu","year":"2002","journal-title":"Curr Opin Lipidol"},{"key":"S0007114526108733_ref6","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1631\/jzus.B1600341","article-title":"Dietary guidelines for Chinese residents (2016): comments and comparisons","volume":"17","author":"Wang","year":"2016","journal-title":"J Zhejiang Univ Sci B"},{"key":"S0007114526108733_ref2","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1056\/NEJMoa010492","article-title":"Diet, lifestyle, and the risk of type 2 diabetes mellitus in women","volume":"345","author":"Hu","year":"2001","journal-title":"N Engl J Med"},{"key":"S0007114526108733_ref5","volume-title":"Food-based dietary guidelines in the WHO European Region","year":"2003"},{"key":"S0007114526108733_ref23","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"S0007114526108733_ref34","doi-asserted-by":"crossref","first-page":"1752s","DOI":"10.1093\/jn\/138.9.1752S","article-title":"Possible benefit of nuts in type 2 diabetes","volume":"138","author":"Jenkins","year":"2008","journal-title":"J Nutr"},{"key":"S0007114526108733_ref26","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1001\/archinte.167.21.2304","article-title":"Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in US black women","volume":"167","author":"Krishnan","year":"2007","journal-title":"Arch Intern Med"},{"key":"S0007114526108733_ref37","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2024017","article-title":"A prospective association between dietary mushroom intake and the risk of type 2 diabetes: the Korean Genome and Epidemiology Study\u2013Cardiovascular Disease Association Study","volume":"46","author":"Kim","year":"2024","journal-title":"Epidemiol Health"}],"container-title":["British Journal of Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007114526108733","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:12:53Z","timestamp":1792055573000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007114526108733\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":52,"alternative-id":["S0007114526108733"],"URL":"https:\/\/doi.org\/10.1017\/s0007114526108733","relation":{},"ISSN":["0007-1145","1475-2662"],"issn-type":[{"value":"0007-1145","type":"print"},{"value":"1475-2662","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of The Nutrition Society","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}