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Arch Iran Med. 2025;28(11): 617-629.
doi: 10.34172/aim.34602
  Abstract View: 43
  PDF Download: 35

Original Article

Association between Five Established DASH Diet Indices and Risk of Type 2 Diabetes Mellitus: A Population-Based Prospective Cohort Study

Hanieh Malmir 1 ORCID logo, Somayeh Hosseinpour-Niazi 1* ORCID logo, Parvin Mirmiran 2* ORCID logo, Fereidoun Azizi 3 ORCID logo

1 Nutrition and Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
*Corresponding Authors: Somayeh Hosseinpour-Niazi, Email: s.hossainpour@yahoo.com; Parvin Mirmiran, Email: parvin.mirmiran@gmail.com

Abstract

Background: Type 2 diabetes mellitus (T2DM) represents a rising international health crisis, closely linked to changing eating habits and lifestyle choices. The Dietary Approaches to Stop Hypertension (DASH) diet has gained interest due to its potential to avert and control insulin resistance and T2DM. This research aims to investigate the association between five DASH diet indices and the risk of T2DM within the Tehran Lipid and Glucose Study (TLGS).

Methods: Individuals aged 21 years and older, who were free from T2DM at baseline, were included. Dietary habits were evaluated using a validated food frequency questionnaire; adherence to the DASH diet was assessed through five indices: Folsom, Dixon, Mellen, Fung, and Günther. To assess the association between the DASH diet and T2DM risk, Cox proportional hazards models, adjusted for demographic & lifestyle factors, were employed.

Results: Of the 2,188 participants, 989 (45.2%) were men. The mean (SD) age and BMI of the population were 40.6 (13.3) years and 27.0 (4.7) kg/m2 , respectively. During a median follow-up of 8.9 years, 234 new cases of T2DM were recorded. During a median follow-up period of 8.9 years, 234 new T2DM cases surfaced. Initially, no association was found in crude models; however, after adjustments for confounders, higher adherence to the Dixon index (HR=0.71; 95% CI: 0.52–0.98) and Günther index (HR=0.69; 95% CI: 0.50–0.96) were associated with a lower risk of T2DM. This association remained significant for the Günther index among those who were physically active (HR=0.70; 95% CI: 0.51–0.97).

Conclusion: High adherence to DASH diets, evaluated using the Dixon and Günther DASH indices, is associated with a lower risk of T2DM, particularly among individuals with low activity levels; therefore, the inclusion of the DASH diet, especially for those with low physical activity, is recommended as a component of public health strategies for T2DM prevention in Tehrani adults.



Cite this article as: Malmir H, Hosseinpour-Niazi S, Mirmiran P, Azizi F. Association between five established DASH diet indices and risk of type 2 diabetes mellitus: a population-based prospective cohort study. Arch Iran Med. 2025;28(11):617-629. doi: 10.34172/aim.34602
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Submitted: 31 May 2025
Revision: 29 Sep 2025
Accepted: 01 Oct 2025
ePublished: 01 Nov 2025
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