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

Balaji Bhavadharini, Viswanathan Mohan, Mahshid Dehghan, Sumathy Rangarajan, Sumathi Swaminathan, Annika Rosengren, Andreas Wielgosz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Antonio L. Dans, Karen Yeates, Paul Poirier, Jephat Chifamba, Khalid F. Alhabib, Noushin Mohammadifard, Katarzyna Zatońska, Rasha Khatib, Mirac Vural Keskinler, Li WeiChuangshi Wang, Xiaoyun Liu, Romaina Iqbal, Rita Yusuf, Edelweiss Wentzel-Viljoen, Afzalhussein Yusufali, Rafael Diaz, Ng Kien Keat, P. V.M. Lakshmi, Noorhassim Ismail, Rajeev Gupta, Lia M. Palileo-Villanueva, Patrick Sheridan, Andrew Mente, Salim Yusuf

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)


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 5 150 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 5 0.003). However, the highest risk was seen in South Asia (HR 1.61; 95% CI 1.13–2.30; P for trend 5 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 5 0.01), while in China there was no significant association (HR 1.04; 95% CI 0.77–1.40; P for trend 5 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.

Original languageEnglish
Pages (from-to)2643-2650
Number of pages8
JournalDiabetes Care
Issue number11
Publication statusPublished - Nov 2020


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