Abstract
Purpose
Patterns of change from the traditional Palaeolithic lifestyle to the modern lifestyle may partly explain the epidemic proportions of non-communicable diseases (NCDs). We investigated to what extent adherence to the Palaeolithic diet (PD) and the Palaeolithic-like lifestyle was associated with type 2 diabetes (T2D) and hypertension risks.
Methods
A study of 70,991 women from the E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale) cohort, followed up for nearly 20 years. There were 3292 incident T2D and 12,504 incident hypertension cases that were validated. Dietary data were collected at baseline in 1993 via a food frequency questionnaire. The PD score and the Palaeolithic-like lifestyle score (PD, physical activity, smoking status, and body mass index [BMI]) were derived and considered in quintiles. Multivariable Cox regression models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident T2D and hypertension.
Results
In the fully adjusted models, a 1-SD increase of the PD score was associated with 4% and 3% lower risks of T2D and hypertension, respectively. Those in the highest versus the lowest quintile of the score had HR (95% CI) of 0.88 (0.79, 0.98) and 0.91 (0.86, 0.96) for T2D and hypertension, respectively (P-trend < 0.0001). Associations were stronger for the Palaeolithic-like lifestyle score; in the fully adjusted model, a 1-SD increase of the score was associated with 19% and 6% lower risks of T2D and hypertension, respectively. Risks lowered successively with each increase in quintile; those in the highest versus the lowest quintile had HR (95% CI) of 0.58 (0.52, 0.65) and 0.85 (0.80, 0.90) for T2D and hypertension, respectively (P-trend < 0.0001).
Conclusions
Our data suggest that adhering to a PD based on fruit, vegetables, lean meats, fish, and nuts, and incorporating a Palaeolithic-like lifestyle could be promising options to prevent T2D and hypertension.
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Availability of data and material
The datasets generated during and/or analysed for the current study are not publicly available, but are available from the corresponding author on reasonable request.
Abbreviations
- AHA:
-
American Heart Association
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- DASH:
-
Dietary Approach to Stop Hypertension
- E3N:
-
Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale
- HDL:
-
High-density lipoproteins
- HR:
-
Hazard ratio
- LDL:
-
Low-density lipoproteins
- MGEN:
-
Mutuelle Générale de l’Education Nationale
- mg/dL:
-
Milligrams per decilitre
- mmol/L:
-
Millimoles per litre
- NCDs:
-
Non-communicable diseases
- PD:
-
Palaeolithic diet
- SD:
-
Standard deviation
- T2D:
-
Type 2 diabetes
- WHO:
-
World Health Organization
- US:
-
United States
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Acknowledgements
The research was carried out using data from Inserm (French National Institutes for Health and Medical Research) E3N cohort, which was established and maintained with the support of the Mutuelle Générale de l’Education Nationale (MGEN), Gustave Roussy, and the French League against Cancer (LNCC). E3N-E4N is also supported by the French National Research Agency (ANR) under the Investment for the Future Program (PIA) (ANR-10-COHO-0006) and by the French Ministry of Higher Education, Research and Innovation (subsidy for public service charges #2102 918823). The authors are indebted to all participants for their continued participation. They are also grateful to all members of the E3N study group and contribution by Emmanuelle Correia for insights on the dietary data.
Funding
This work was supported by a grant for the Nutriperso Project (IDEX Paris Saclay). This research was carried out using data from Inserm’s E3N cohort with the support of the MGEN, the Institut GUSTAVE ROUSSY and the Ligue contre le Cancer for the constitution and maintenance of the E3N cohort. This work has also benefited from State aid managed by the National Research Agency under the program “Investissement d’avenir” under the reference ANR-10-COHO-0006 as well as a subsidy from the “Ministère de l’enseignement supérieur, de la recherche et de l’innovation” for public service charges under the reference n°2102 918823.
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SS, NL MCBR and GS conceived and designed the study. SS performed the statistical analysis and drafted the original manuscript. All authors contributed to the interpretation of data discussed in the manuscript, revised the manuscript and approved its final version to be published. NL is the guarantor of this work and, as such, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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The study received ethical approval from the French National Commission for Data Protection and Privacy (Commission Nationale Informatique et Libertés). The protocol is registered at clinicaltrials.gov as NCT03285230.
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All participants signed informed consent in compliance with the rules of the French National Commission for Computed Data and Individual Freedom (Commission Nationale Informatique et Libertés).
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Shah, S., MacDonald, CJ., El Fatouhi, D. et al. The associations of the Palaeolithic diet alone and in combination with lifestyle factors with type 2 diabetes and hypertension risks in women in the E3N prospective cohort. Eur J Nutr 60, 3935–3945 (2021). https://doi.org/10.1007/s00394-021-02565-5
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DOI: https://doi.org/10.1007/s00394-021-02565-5