A case-control study of diet in newly diagnosed NIDDM in the Wanigela people of Papua New Guinea

OBJECTIVE - To study the association between diet and newly diagnosed NIDDM in the Wanigela people of Papua New Guinea, a population with an extraordinary susceptibility for NIDDM. RESEARCH DESIGN AND METHODS - We performed a case- control study of Wanigela people from an urban settlement (Koki). Case patients (n = 145) were asymptomatic subjects in whom NIDDM was newly diagnosed using a 2-h 75-g oral glucose tolerance test. Control subjects with normal glucose tolerance (n = 140) were group-matched on the basis of age and sex. A detailed food frequency questionnaire was used to determine energy and nutrient intakes. Nutrient intakes were compared directly and after calculation of residuals to correct for energy intake. Odds ratios for NIDDM were compared in relation to total energy and specific nutrient intakes, adjusting for age, sex, BMI, waist- to-hip ratio, and physical activity. RESULTS - There were no differences between case patients and control subjects in mean values of total or energy-adjusted nutrient intakes. In logistic regression models, neither total neither nor any of the specific nutrients were associated with increased risk of NIDDM. When models were repeated with nutrients categorized by tertiles, there were marginally significant associations with intakes of fiber (positive) and cholesterol, protein, and sugar (negative). CONCLUSIONS - This study does not support the hypothesis that saturated fat is an independent risk factor for NIDDM. The weak associations of intakes of fiber and cholesterol with newly diagnosed NIDDM were in the opposite directions to those expected and are probably due to chance. Relative homogeneity of diet within a community, such as that found in Koki, makes it difficult to demonstrate risk factor-disease associations. However, changes in diet and reduced levels of physical activity accompanying urbanization undoubtedly contribute to the high prevalence of obesity observed in this community and hence diet is likely to contribute to NIDDM risk at least by indirect means.