TY - JOUR
T1 - The Association between Dietary Energy Density and Type 2 Diabetes in Europe
T2 - Results from the EPIC-InterAct Study
AU - van den Berg, Saskia W.
AU - van der A, Daphne L.
AU - Spijkerman, Annemieke M.W.
AU - van Woudenbergh, Geertruida J.
AU - Tijhuis, Mariken J.
AU - Amiano, Pilar
AU - Ardanaz, Eva
AU - Beulens, Joline W.J.
AU - Boeing, Heiner
AU - Clavel-Chapelon, Françoise
AU - Crowe, Francesca L.
AU - de Lauzon-Guillain, Blandine
AU - Fagherazzi, Guy
AU - Franks, Paul W.
AU - Freisling, Heinz
AU - Gonzalez, Carlos
AU - Grioni, Sara
AU - Halkjaer, Jytte
AU - Huerta, José María
AU - Huybrechts, Inge
AU - Kaaks, Rudolf
AU - Khaw, Kay Tee
AU - Masala, Giovanna
AU - Nilsson, Peter M.
AU - Overvad, Kim
AU - Panico, Salvatore
AU - Quirós, J. Ramón
AU - Rolandsson, Olov
AU - Sacerdote, Carlotta
AU - Sánchez, María José
AU - Schulze, Matthias B.
AU - Slimani, Nadia
AU - Struijk, Ellen A.
AU - Tjonneland, Anne
AU - Tumino, Rosario
AU - Sharp, Stephen J.
AU - Langenberg, Claudia
AU - Forouhi, Nita G.
AU - Feskens, Edith J.M.
AU - Riboli, Elio
AU - Wareham, Nicholas J.
PY - 2013/5/16
Y1 - 2013/5/16
N2 - Background:Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake.Methodology/Principal Findings:A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4-1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93-1.13), which was consistent across countries (I2 = 2.9%).Conclusions/Significance:In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases.
AB - Background:Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake.Methodology/Principal Findings:A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4-1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93-1.13), which was consistent across countries (I2 = 2.9%).Conclusions/Significance:In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases.
UR - http://www.scopus.com/inward/record.url?scp=84877833999&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0059947
DO - 10.1371/journal.pone.0059947
M3 - Article
C2 - 23696784
AN - SCOPUS:84877833999
VL - 8
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 5
M1 - e59947
ER -