A balanced diet is an important factor in preventing type 2 diabetes. But do all people benefit equally from a healthy lifestyle? Or does the protective effect also depend on an individual’s susceptibility to the disease?
Researchers led by Christine El-Khoury and Matthias Schulze from DIfE and DZD investigated this question. In their study, they examined both genetic predisposition to type 2 diabetes—as assessed using polygenic risk scores—and diabetes-related epigenetic factors based on DNA methylation patterns.
A healthy diet provides protection regardless of genetic risk
For their analyses, the researchers used data from the EPIC-Potsdam study*, a long-term population-based study involving more than 27,000 participants who have been scientifically monitored since the 1990s. The study utilized genetic data from 2,204 individuals in a randomly selected subcohort, as well as from 750 people with newly diagnosed type 2 diabetes. The DNA methylation analyses included 1,065 participants from the subcohort and 676 cases of diabetes.
To assess diet quality, the researchers used various scientifically established methods. Among other things, these measures assess how balanced the diet is and to what extent it exhibits pro-inflammatory or health-promoting properties.
The analysis showed no evidence that genetic predisposition to type 2 diabetes modifies the association between diet quality and the risk of type 2 diabetes.
Evidence suggesting a role for epigenetic factors
The results were different for epigenetic factors. These are chemical changes (methylation) in DNA that can impact gene activity without altering the genetic information itself. Such changes are influenced by factors such as age, lifestyle, and environmental exposures.
The authors combined methylation patterns that had been associated with an increased risk of type 2 diabetes in previous studies into a methylation risk score (MRS). “EPIC-Potsdam also demonstrated that the higher this score was, the greater the risk of developing type 2 diabetes later in life,” says lead author El-Khoury.
In addition, the researchers found evidence suggesting that these epigenetic changes could modify the association between diet quality and diabetes risk. The analyses suggested that the effects of different diets might vary depending on an individual’s epigenetic risk profile. A diet rich in vegetables, fruit, whole grains, legumes, nuts, fish, and plant-based fats—and low in red and processed meat and sugar-sweetened beverages—was associated with a lower risk of diabetes, particularly among study participants with a lower epigenetic risk (lower MRS). In contrast, study participants with a higher MRS did not appear to benefit.
Prospects for personalized diabetes prevention
The study opens up new prospects for more personalized diabetes prevention. In the long term, epigenetic factors could help tailor prevention strategies more specifically to individual people.
However, further research is needed before individual dietary recommendations can be derived. “We view our findings as an important indication of which biological factors might be relevant for future precision prevention,” says Schulze. “The next step is to verify these associations in independent studies.”
*Background: EPIC-Potsdam
The EPIC-Potsdam Study is part of the European Prospective Investigation into Cancer and Nutrition (EPIC). Between 1994 and 1998, 27,548 women and men between the ages of 35 and 65 from the Potsdam population were enrolled in the cohort. In addition to dietary and lifestyle data, blood samples and anthropometric measurements, among other things, were collected. Participants were then followed up regularly.
For the current study, the researchers analyzed a case-cohort sample. New cases of type 2 diabetes were medically confirmed.
Original publication:
El-Khoury C, Eichelmann F, Jannasch F, Schulze MB: Epigenetic and Genetic Factors Modifying the Association between Diet Quality and Incident Type 2 Diabetes: The EPIC-Potsdam Cohort. Cardiovascular Diabetology, DOI: 10.1186/s12933-026-03356-0
Scientific contact:
Prof. Dr. Matthias Schulze
German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE)
Head of the Department of Molecular Epidemiology
Arthur-Scheunert-Allee 114-116
14558 Nuthetal
Phone: + 49 33 200 88 - 2434
E-Mail: mschulze@dife.de
Christine El-Khoury
PhD student at the Department of Molecular Epidemiology
Phone: +49 33 200 88 - 2435
E-Mail: christine.el-khoury@dife.de
Press contact:
Press and Public Relations at DIfE
Phone: +49 33200 88 - 2335
E-Mail: presse@dife.de
The German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) is a member of the Leibniz Association. It investigates the causes of nutrition-associated diseases in order to develop new strategies for prevention, treatment and nutritional recommendations. Its research interests include the causes and consequences of the metabolic syndrome, a combination of obesity, hypertension (high blood pressure), insulin resistance and lipid metabolism disorder, the role of nutrition for healthy aging and the mechanisms of food choice and precision nutrition. DIfE is also a partner of the German Center for Diabetes Research (DZD), which has been funded by the Federal Ministry of Research, Technology and Space (BMFTR) since 2009. www.dife.de/en
The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en
