White rice intake and incident diabetes: A study of 132,373 participants in 21 countries


Balaji Bhavadharini, Hamilton Health Sciences
Viswanathan Mohan, Madras Diabetes Research Foundation
Mahshid Dehghan, Hamilton Health Sciences
Sumathy Rangarajan, Hamilton Health Sciences
Sumathi Swaminathan, St. John's Research Institute
Annika Rosengren, Göteborg University, Sahlgrenska Academy
Andreas Wielgosz, University of Ottawa, Canada
Alvaro Avezum, Hospital Alemao Oswaldo Cruz
Patricio Lopez-Jaramillo, Fundación Oftalmológica de Santander
Fernando Lanas, Universidad de la Frontera
Antonio L. Dans, University of the Philippines College of Medicine
Karen Yeates, Queen's University, Kingston
Paul Poirier, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval
Jephat Chifamba, University of Zimbabwe
Khalid F. Alhabib, King Khalid University Hospital
Noushin Mohammadifard, Isfahan Cardiovascular Research Center, Isfahan UMS
Katarzyna Zatońska, Wroclaw Medical University
Rasha Khatib, Advocate Aurora Health
Mirac Vural Keskinler, Istanbul Medeniyet University
Li Wei, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
Chuangshi Wang, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
Xiaoyun Liu, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
Romaina Iqbal, The Aga Khan University
Rita Yusuf, Independent University, Bangladesh
Edelweiss Wentzel-Viljoen, North-West University
Afzalhussein Yusufali, Dubai Health Authority
Rafael Diaz, Estudios Clinicos Latinoamerica
Ng Kien Keat, Universiti Teknologi MARA
P. V.M. Lakshmi, Postgraduate Institute of Medical Education & Research, Chandigarh
Noorhassim Ismail, Universiti Kebangsaan Malaysia
Rajeev Gupta, Eternal Heart Care Centre and Research Institute
Lia M. Palileo-Villanueva, University of the Philippines College of Medicine


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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