Waist circumference (WC) is a simple and reliable measure of fat distribution that may add to the prediction of type 2 diabetes (T2D), but previous studies have been too small to reliably quantify ...the relative and absolute risk of future diabetes by WC at different levels of body mass index (BMI).
The prospective InterAct case-cohort study was conducted in 26 centres in eight European countries and consists of 12,403 incident T2D cases and a stratified subcohort of 16,154 individuals from a total cohort of 340,234 participants with 3.99 million person-years of follow-up. We used Prentice-weighted Cox regression and random effects meta-analysis methods to estimate hazard ratios for T2D. Kaplan-Meier estimates of the cumulative incidence of T2D were calculated. BMI and WC were each independently associated with T2D, with WC being a stronger risk factor in women than in men. Risk increased across groups defined by BMI and WC; compared to low normal weight individuals (BMI 18.5-22.4 kg/m(2)) with a low WC (<94/80 cm in men/women), the hazard ratio of T2D was 22.0 (95% confidence interval 14.3; 33.8) in men and 31.8 (25.2; 40.2) in women with grade 2 obesity (BMI≥35 kg/m(2)) and a high WC (>102/88 cm). Among the large group of overweight individuals, WC measurement was highly informative and facilitated the identification of a subgroup of overweight people with high WC whose 10-y T2D cumulative incidence (men, 70 per 1,000 person-years; women, 44 per 1,000 person-years) was comparable to that of the obese group (50-103 per 1,000 person-years in men and 28-74 per 1,000 person-years in women).
WC is independently and strongly associated with T2D, particularly in women, and should be more widely measured for risk stratification. If targeted measurement is necessary for reasons of resource scarcity, measuring WC in overweight individuals may be an effective strategy, since it identifies a high-risk subgroup of individuals who could benefit from individualised preventive action.
Carbohydrate quantity and quality may play an important role in the development of type 2 diabetes.
We investigated the associations of dietary glycemic load (GL), glycemic index (GI), carbohydrate, ...and fiber intake with the incidence of type 2 diabetes.
A prospective cohort study was conducted in 37,846 participants of the EPIC-NL (European Prospective Investigation into Cancer and Nutrition-Netherlands) study, aged 21-70 y at baseline and free of diabetes. Dietary intake was assessed with the use of a validated food-frequency questionnaire. Incident diabetes cases were mainly self-reported and verified against general practitioner records.
During a mean follow-up of 10 y, 915 incident diabetes cases were documented. Dietary GL was associated with an increased diabetes risk after adjustment for age, sex, established diabetes risk factors, and dietary factors hazard ratio (HR) per SD increase: 1.27; 95% CI: 1.11, 1.44; P < 0.001 corrected. GI tended to increase diabetes risk (HR: 1.08; 95% CI: 1.00, 1.17; P = 0.05). Dietary fiber was inversely associated with diabetes risk (HR: 0.92; 95% CI: 0.85, 0.99; P < 0.05), whereas carbohydrate intake was associated with increased diabetes risk (HR: 1.15; 95% CI: 1.01, 1.32; P < 0.05). Of the carbohydrate subtypes, only starch was related to increased diabetes risk HR: 1.25 (1.07, 1.46), P < 0.05. All associations became slightly stronger after exclusion of energy misreporters.
Diets high in GL, GI, and starch and low in fiber were associated with an increased diabetes risk. Both carbohydrate quantity and quality seem to be important factors in diabetes prevention. Energy misreporting contributed to a slight attenuation of associations.
Current evidence suggests a direct association of uric acid with diabetes risk, but it is still unclear whether this is independent of risk factors such as obesity and diet. We aimed to investigate ...whether plasma uric acid concentrations are independently associated with incident type 2 diabetes and to investigate the role of a uric acid–related dietary pattern in this association. We used a case-cohort nested in the European Prospective Investigation into Cancer and Nutrition-Netherlands study. The study included 2318 subcohort members and 845 incident diabetes cases, with a mean follow-up of 10 y. At baseline, blood samples were taken and diet was assessed using a validated FFQ. A uric acid–related dietary pattern was derived with reduced rank regression. Diabetes was mainly self-reported and verified against general practitioner records. Plasma uric acid was (mean ± SD) 231 ± 54.6 μmol/L in the subcohort. After adjustment for established diabetes risk factors such as age, the HR (highest vs. lowest quartile of uric acid) for diabetes was 4.36 (95% CI: 3.22, 5.90). Further adjustment for adiposity attenuated the HR to 1.86 (95% CI: 1.32, 2.62). Additional adjustment for hypertension and biochemical markers, such as TG, slightly attenuated the association HR = 1.43 (95% CI: 0.97, 2.10). A uric acid–related dietary pattern did not confound the association. In conclusion, this study supports that high uric acid concentrations are associated with increased diabetes risk, although a large part of the association can be explained by the degree of adiposity.
To estimate the causal association between intake of dairy products and incident type 2 diabetes.
The analysis included 21,820 European individuals (9,686 diabetes cases) of the European Prospective ...Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study. Participants were genotyped, and rs4988235 (LCT-12910C>T), a single nucleotide polymorphism (SNP) for lactase persistence (LP) that enables digestion of dairy sugar, i.e., lactose, was imputed. Baseline dietary intakes were assessed with diet questionnaires. We investigated the associations between imputed SNP dosage for rs4988235 and intake of dairy products and other foods through linear regression. Mendelian randomization (MR) estimates for the milk-diabetes relationship were obtained through a two-stage least squares regression.
Each additional LP allele was associated with a higher intake of milk (β 17.1 g/day, 95% CI 10.6-23.6) and milk beverages (β 2.8 g/day, 95% CI 1.0-4.5) but not with intake of other dairy products. Other dietary intakes associated with rs4988235 included fruits (β -7.0 g/day, 95% CI -12.4 to -1.7 per additional LP allele), nonalcoholic beverages (β -18.0 g/day, 95% CI -34.4 to -1.6), and wine (β -4.8 g/day, 95% CI -9.1 to -0.6). In instrumental variable analysis, LP-associated milk intake was not associated with diabetes (hazard ratio
0.99, 95% CI 0.93-1.05).
rs4988235 was associated with milk intake but not with intake of other dairy products. This MR study does not suggest that milk intake is associated with diabetes, which is consistent with previous observational and genetic associations. LP may be associated with intake of other foods as well, but owing to the modest associations, we consider it unlikely that this caused the observed null result.
Carotenoids have antioxidant properties. Little is known about the relation of dietary carotenoid intake on metabolic syndrome risk. We examined whether dietary carotenoid intake was associated with ...metabolic syndrome and metabolic syndrome risk factors. We conducted a population-based, cross-sectional study in 374 men aged 40-80 y. Intakes of β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein, and zeaxanthin were estimated using a validated FFQ. Presence of metabolic syndrome was determined using fasting serum glucose, triglyceride, and HDL-cholesterol concentrations, waist circumference, and systolic and diastolic blood pressure. Metabolic syndrome was present in 22% of the men. After adjustment for confounders, total carotenoid and lycopene intakes were inversely associated with presence of metabolic syndrome relative risk (RR) quartile 4 vs. quartile 1 (95% CI) 0.42 (0.20-0.87), P-trend 0.02; and 0.55 (0.28-1.11), P-trend 0.01, respectively. For β-carotene, a decreased risk was observed for each quartile of intake compared with the first RR quartile 4 vs. quartile 1 (95% CI) 0.58 (0.33-1.02). Higher total carotenoid, β-carotene, α-carotene, and lycopene intakes were associated with lower waist circumferences and visceral and subcutaneous fat mass. Higher lycopene intake was related to lower serum triglyceride concentrations. In conclusion, higher total carotenoid intakes, mainly those of β-carotene and lycopene, were associated with a lower prevalence of metabolic syndrome and with lower measures of adiposity and serum triglyceride concentrations in middle-aged and elderly men.
Gene-diet interactions have been reported to contribute to the development of type 2 diabetes (T2D). However, to our knowledge, few examples have been consistently replicated to date.
We aimed to ...identify existing evidence for gene-macronutrient interactions and T2D and to examine the reported interactions in a large-scale study.
We systematically reviewed studies reporting gene-macronutrient interactions and T2D. We searched the MEDLINE, Human Genome Epidemiology Network, and WHO International Clinical Trials Registry Platform electronic databases to identify studies published up to October 2015. Eligibility criteria included assessment of macronutrient quantity (e.g., total carbohydrate) or indicators of quality (e.g., dietary fiber) by use of self-report or objective biomarkers of intake. Interactions identified in the review were subsequently examined in the EPIC (European Prospective Investigation into Cancer)-InterAct case-cohort study (
= 21,148, with 9403 T2D cases; 8 European countries). Prentice-weighted Cox regression was used to estimate country-specific HRs, 95% CIs, and
-interaction values, which were then pooled by random-effects meta-analysis. A primary model was fitted by using the same covariates as reported in the published studies, and a second model adjusted for additional covariates and estimated the effects of isocaloric macronutrient substitution.
Thirteen observational studies met the eligibility criteria (
< 1700 cases). Eight unique interactions were reported to be significant between macronutrients carbohydrate, fat, saturated fat, dietary fiber, and glycemic load derived from self-report of dietary intake and circulating n-3 (ω-3) polyunsaturated fatty acids and genetic variants in or near transcription factor 7-like 2 (
), gastric inhibitory polypeptide receptor (
), caveolin 2 (
), and peptidase D (
) (
-interaction < 0.05). We found no evidence of interaction when we tried to replicate previously reported interactions. In addition, no interactions were detected in models with additional covariates.
Eight gene-macronutrient interactions were identified for the risk of T2D from the literature. These interactions were not replicated in the EPIC-InterAct study, which mirrored the analyses undertaken in the original reports. Our findings highlight the importance of independent replication of reported interactions.
Abstract
Background
Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and ...vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC).
Methods
We conducted a prospective analysis of 490 311 men and women without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases = 8504), in 10 European countries. Dietary intake was assessed using validated questionnaires, calibrated with 24-h recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD.
Results
There was a lower risk of IHD with a higher intake of fruit and vegetables combined HR per 200 g/day higher intake 0.94, 95% confidence interval (CI): 0.90–0.99, P-trend = 0.009, and with total fruits (per 100 g/day 0.97, 0.95–1.00, P-trend = 0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10 g/day 0.90, 0.82–0.98, P-trend = 0.020), total fibre (per 10 g/day 0.91, 0.85–0.98, P-trend = 0.015), fruit and vegetable fibre (per 4 g/day 0.95, 0.91–0.99, P-trend = 0.022) and fruit fibre (per 2 g/day 0.97, 0.95–1.00, P-trend = 0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk.
Conclusions
In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear.
Background There is controversy about associations between total dietary fatty acids, their classes (saturated fatty acids SFAs, monounsaturated fatty acids, and polyunsaturated fatty acids), and ...risk of coronary heart disease (CHD). Specifically, the relevance of food sources of SFAs to CHD associations is uncertain. Methods and Results We conducted a case-cohort study involving 10 529 incident CHD cases and a random subcohort of 16 730 adults selected from a cohort of 385 747 participants in 9 countries of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. We estimated multivariable adjusted country-specific hazard ratios (HRs) and 95% CIs per 5% of energy intake from dietary fatty acids, with and without isocaloric macronutrient substitutions, using Prentice-weighted Cox regression models and pooled results using random-effects meta-analysis. We found no evidence for associations of the consumption of total or fatty acid classes with CHD, regardless of macronutrient substitutions. In analyses considering food sources, CHD incidence was lower per 1% higher energy intake of SFAs from yogurt (HR, 0.93 95% CI, 0.88-0.99), cheese (HR, 0.98 95% CI, 0.96-1.00), and fish (HR, 0.87 95% CI, 0.75-1.00), but higher for SFAs from red meat (HR, 1.07 95% CI, 1.02-1.12) and butter (HR, 1.02 95% CI, 1.00-1.04). Conclusions This observational study found no strong associations of total fatty acids, SFAs, monounsaturated fatty acids, and polyunsaturated fatty acids, with incident CHD. By contrast, we found associations of SFAs with CHD in opposite directions dependent on the food source. These findings should be further confirmed, but support public health recommendations to consider food sources alongside the macronutrients they contain, and suggest the importance of the overall food matrix.
To identify differences in dietary quality, dietary greenhouse gas (GHG) emissions and food consumption over 20 years in a Dutch cohort.
Participants (n 8932) filled out an FFQ in 1993-1997 and in ...2015. The Dutch Healthy Diet index 2015 (DHD15-index) score, GHG emissions and consumption of food groups (g/4184 kJ (1000 kcal)) were compared between the time points with paired t tests.
The Netherlands.
European Prospective Investigation into Cancer and Nutrition - Netherlands (EPIC-NL) cohort, aged 18-65 years at baseline.
Total energy intake decreased by -678 (95 % CI -4908, 3377) kJ/d (-162 (95 % CI -1173, 807) kcal/d) for men and -372 (95 % CI -3820, 3130) kJ/d (-89 (95 % CI -913, 748) kcal/d) for women. DHD15-index scores increased by 11 % (from 64·8 to 71·9 points) and 13 % (from 65·2 to 73·6 points) in men and women, respectively (P < 0·0001), mainly due to an increased (shell)fish and nuts/seeds/nut paste consumption. After energy intake adjustment, dietary-related GHG emissions increased by 5 % in men (2·48-2·61 kg CO2-eq/4184 kJ (1000 kcal), P < 0·0001) and were similar in women (0·4 %, 2·70-2·71 kg CO2-eq/4184 kJ (1000 kcal), P = 0·3930) due to the increased consumption of (shell)fish, nuts/seeds/nut paste, poultry and higher GHG-intensive red meats such as beef.
This Dutch cohort analyses showed more healthy diets without mitigated GHG emissions over a 20-year period, at similar energy intakes. Higher consumption of (shell)fish and poultry was not yet at the expense of red and processed meat. Lower consumption of animal-based foods is needed to achieve healthier as well as environmentally friendly diets.
The aim of this study is to determine whether combinations of specific Life's Simple 7 (LS7) components are associated with reduced risk for heart failure (HF).
The American Heart Association ...recommends the concept of LS7: healthy behaviors that have been shown to reduce cardiovascular disease.
A total of 37,803 participants from the EPIC-NL (European Prospective Investigation Into Cancer and Nutrition-Netherlands) cohort were included (mean age: 49.4 ± 11.9 years, 74.7% women). The LS7 score ranged from 0 to 14 and was calculated by assigning 0, 1, or 2 points for smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose. An overall ideal score (11 to 14 points) was present in 23.2% of participants, an intermediate score (9 or 10 points) in 35.3%, and an inadequate score (0 to 8 points) in 41.5%.
Over a median follow-up period of 15.2 years (interquartile range: 14.1 to 16.5 years), 690 participants (1.8%) developed HF. In Cox proportional hazards models, ideal and intermediate LS7 scores were associated with reduced risk for HF compared with the inadequate category (hazard ratio: 0.45 95% confidence interval (CI): 0.34 to 0.60 and hazard ratio: 0.53 95% CI: 0.44 to 0.64, respectively). Our analyses show that combinations with specific LS7 components, notably glucose, body mass index, smoking, and blood pressure, are associated with a lower incidence of HF.
A healthy lifestyle, as reflected in an ideal LS7 score, was associated with a 55% lower risk for HF compared with an inadequate LS7 score. Preventive strategies that target combinations of specific LS7 components could have a significant impact on decreasing incident HF in the population at large.
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