The association between dietary energy density and type 2 diabetes in Europe: results from the EPIC-InterAct Study.

• Main Authors: InterAct Consortium, Saskia W van den Berg, Daphne L van der A, Annemieke M W Spijkerman, Geertruida J van Woudenbergh, Mariken J Tijhuis, Pilar Amiano, Eva Ardanaz, Joline W J Beulens, Heiner Boeing, Françoise Clavel-Chapelon, Francesca L Crowe, Blandine de Lauzon-Guillain, Guy Fagherazzi, Paul W Franks, Heinz Freisling, Carlos Gonzalez, Sara Grioni, Jytte Halkjaer, José María Huerta, Inge Huybrechts, Rudolf Kaaks, Kay Tee Khaw, Giovanna Masala, Peter M Nilsson, Kim Overvad, Salvatore Panico, J Ramón Quirós, Olov Rolandsson, Carlotta Sacerdote, María-José Sánchez, Matthias B Schulze, Nadia Slimani, Ellen A Struijk, Anne Tjonneland, Rosario Tumino, Stephen J Sharp, Claudia Langenberg, Nita G Forouhi, Edith J M Feskens, Elio Riboli, Nicholas J Wareham
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2013-01-01
• Series: PLoS ONE
• Online Access: http://europepmc.org/articles/PMC3655954?pdf=render

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 (I(2) = 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.