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Cited by 162Food composition and propertiesNutritional Studies and DietDiet, Metabolism, and Disease

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

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Bhavadharini, Balaji, Mohan, Viswanathan, Dehghan, Mahshid, Rangarajan, Sumathy, Swaminathan, Sumathi, Rosengren, Annika, Wielgosz, Andreas, Avezum, Alvaro +27 more·2020·Diabetes Care
DOI 10.2337/dc19-2335PMC PMC7576435

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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.

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  • Refined carbohydrates, including in sugar-sweetened beverages, increase the risk of diabetes.

    “whereas refined carbohydrates, including in sugar-sweetened beverages, increase this risk.41,45–47”

    From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [46]

    The Results and Conclusions report an association between higher white-rice intake and incident diabetes, particularly in South Asia. White rice is one refined carbohydrate, but the paper does not establish that refined carbohydrates generally increase diabetes risk or address sugar-sweetened beverages. The claim also states a causal effect more strongly than the reported association. (LLM, conf=0.86)

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Authors
Bhavadharini, B., Mohan, V., Dehghan, M., Rangarajan, S., Swaminathan, S., Rosengren, A., Wielgosz, A., Avezum, A., Lopez-Jaramillo, P., Lanas, F., Dans, A. L., Yeates, K., Poirier, P., Chifamba, J., Alhabib, K. F., Mohammadifard, N., Zatońska, K., Khatib, R., Vural Keskinler, M., Wei, L., Wang, C., Liu, X., Iqbal, R., Yusuf, R., Wentzel-Viljoen, E., Yusufali, A., Diaz, R., Keat, N. K., Lakshmi, P. V. M., Ismail, N., Gupta, R., Palileo-Villanueva, L. M., Sheridan, P., Mente, A., & Yusuf, S.
Affiliations
  • Population Health Research Institute (CA)
  • Madras Diabetes Research Foundation (IN)
  • St. John's Research Institute (IN)
  • Sahlgrenska University Hospital (SE)
  • University of Ottawa (CA)
  • Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
  • Instituto Masira, Medical School, Universidad de Santander, and Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
  • Universidad de La Frontera (CL)
  • University of the Philippines Manila (PH)
  • Queen's University (CA)
  • Institut universitaire de cardiologie et de pneumologie de Québec (CA)
  • University of Zimbabwe (ZW)
  • King Saud University (SA)
  • Isfahan University of Medical Sciences (IR)
  • Wroclaw Medical University (PL)
  • Northwestern University (US)
  • Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
  • 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
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • Aga Khan University (PK)
  • Independent University, Bangladesh (BD)
  • Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
  • Dubai Health Authority (AE)
  • Estudios Clínicos Latinoamerica, Rosario, Santa Fe, Argentina
  • Universiti Teknologi MARA (MY)
  • Post Graduate Institute of Medical Education and Research (IN)
  • University Kebangsaan Malaysia Medical Centre (MY)
  • Eternal Hospital (IN)
  • University of the Philippines College of Medicine, University of the Philippines Manila, Manila, Philippines
Corresponding author
Mohan, Viswanathan
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2020-09-01
Volume
43
Issue
11
Pages
2643-2650
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc19-2335
PMC
PMC7576435
OpenAlex
W3082673040
Cited by
162
References
3
Citations by year
2026: 33 · 2025: 34 · 2024: 33 · 2023: 19 · 2022: 28 · 2021: 12 · 2020: 3
FWCI
9.79
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor, 49 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
  • Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
  • Boloka Institutional Repository (North-west University) (submittedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
new-onset diabetes, rice consumption, diabetes risk, South Asia, regional variation, PURE study, dietary risk factors
MeSH terms
Adult, Africa, Aged, Asia, Canada, Diabetes Mellitus, Type 2, Diet, Eating, Europe, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Oryza, Risk Factors, Rural Population, South America, Incidence, Prevalence, Proportional Hazards Models

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