A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study
Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated us...
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| Veröffentlicht in: | PLoS medicine 2023-04, Vol.20 (4), p.e1004221-e1004221 |
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| creator | Sobiecki, Jakub G Imamura, Fumiaki Davis, Courtney R Sharp, Stephen J Koulman, Albert Hodgson, Jonathan M Guevara, Marcela Schulze, Matthias B Zheng, Ju-Sheng Agnoli, Claudia Bonet, Catalina Colorado-Yohar, Sandra M Fagherazzi, Guy Franks, Paul W Gundersen, Thomas E Jannasch, Franziska Kaaks, Rudolf Katzke, Verena Molina-Montes, Esther Nilsson, Peter M Palli, Domenico Panico, Salvatore Papier, Keren Rolandsson, Olov Sacerdote, Carlotta Tjønneland, Anne Tong, Tammy Y N van der Schouw, Yvonne T Danesh, John Butterworth, Adam S Riboli, Elio Murphy, Karen J Wareham, Nicholas J Forouhi, Nita G |
| description | Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet.
We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants sampled from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding.
These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.
Australian New Zealand Clinical Trials Registry ( |
| doi_str_mv | 10.1371/journal.pmed.1004221 |
| format | Article |
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We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants sampled from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding.
These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000602729 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363860.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1004221</identifier><identifier>PMID: 37104291</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adipose tissue ; Adult ; Analysis ; Australia ; Biological markers ; Biology and Life Sciences ; Biomarkers ; Cancer ; Care and treatment ; Carotenoids ; Chromatography ; Clinical trials ; Cohort analysis ; Cohort Studies ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - prevention & control ; Diabetes therapy ; Diagnosis ; Diet ; Diet therapy ; Diet, Mediterranean ; Fatty acids ; Health Sciences ; Humans ; Hälsovetenskap ; Intervention ; Laboratories ; Legumes ; Life Sciences ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Medicine and Health Sciences ; Neoplasms - complications ; Nutrition and Dietetics ; Nutrition research ; Nuts ; Näringslära ; Olive oil ; Oncology, Experimental ; Physical Sciences ; Questionnaires ; Research and Analysis Methods ; Risk Factors ; Santé publique et épidémiologie ; Self report ; Standard deviation ; Type 2 diabetes</subject><ispartof>PLoS medicine, 2023-04, Vol.20 (4), p.e1004221-e1004221</ispartof><rights>Copyright: © 2023 Sobiecki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Sobiecki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><rights>2023 Sobiecki et al 2023 Sobiecki et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c906t-472757236be7203a34489d69e4594de7f968e307d7e7b8690f63d9fc07cd6a0f3</citedby><cites>FETCH-LOGICAL-c906t-472757236be7203a34489d69e4594de7f968e307d7e7b8690f63d9fc07cd6a0f3</cites><orcidid>0000-0003-2641-2313 ; 0000-0003-3478-4758 ; 0000-0001-5033-5966 ; 0000-0001-6184-7764 ; 0000-0002-5652-8459 ; 0000-0001-9242-6364 ; 0000-0002-0428-2426 ; 0000-0002-6700-0780 ; 0000-0001-6560-4890 ; 0000-0001-6795-6080 ; 0000-0002-3866-2603 ; 0000-0003-4385-2097 ; 0000-0002-6509-6555 ; 0000-0002-4102-6835 ; 0000-0002-4605-435X ; 0000-0002-8008-5096 ; 0000-0002-5041-248X ; 0000-0002-0830-5277 ; 0000-0003-2375-1440 ; 0000-0002-6915-9015 ; 0000-0002-6841-8396 ; 0000-0002-0284-8959 ; 0000-0003-4472-1179 ; 0000-0003-1422-2993 ; 0000-0002-0520-7604 ; 0000-0001-9998-051X ; 0000-0002-5498-8312 ; 0000-0002-8015-9411 ; 0000-0002-2589-1319</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10138823/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10138823/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37104291$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04233250$$DView record in HAL$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-209120$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/cb616248-023c-466d-a966-2ef59ac06047$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><contributor>Popkin, Barry M.</contributor><creatorcontrib>Sobiecki, Jakub G</creatorcontrib><creatorcontrib>Imamura, Fumiaki</creatorcontrib><creatorcontrib>Davis, Courtney R</creatorcontrib><creatorcontrib>Sharp, Stephen J</creatorcontrib><creatorcontrib>Koulman, Albert</creatorcontrib><creatorcontrib>Hodgson, Jonathan M</creatorcontrib><creatorcontrib>Guevara, Marcela</creatorcontrib><creatorcontrib>Schulze, Matthias B</creatorcontrib><creatorcontrib>Zheng, Ju-Sheng</creatorcontrib><creatorcontrib>Agnoli, Claudia</creatorcontrib><creatorcontrib>Bonet, Catalina</creatorcontrib><creatorcontrib>Colorado-Yohar, Sandra M</creatorcontrib><creatorcontrib>Fagherazzi, Guy</creatorcontrib><creatorcontrib>Franks, Paul W</creatorcontrib><creatorcontrib>Gundersen, Thomas E</creatorcontrib><creatorcontrib>Jannasch, Franziska</creatorcontrib><creatorcontrib>Kaaks, Rudolf</creatorcontrib><creatorcontrib>Katzke, Verena</creatorcontrib><creatorcontrib>Molina-Montes, Esther</creatorcontrib><creatorcontrib>Nilsson, Peter M</creatorcontrib><creatorcontrib>Palli, Domenico</creatorcontrib><creatorcontrib>Panico, Salvatore</creatorcontrib><creatorcontrib>Papier, Keren</creatorcontrib><creatorcontrib>Rolandsson, Olov</creatorcontrib><creatorcontrib>Sacerdote, Carlotta</creatorcontrib><creatorcontrib>Tjønneland, Anne</creatorcontrib><creatorcontrib>Tong, Tammy Y N</creatorcontrib><creatorcontrib>van der Schouw, Yvonne T</creatorcontrib><creatorcontrib>Danesh, John</creatorcontrib><creatorcontrib>Butterworth, Adam S</creatorcontrib><creatorcontrib>Riboli, Elio</creatorcontrib><creatorcontrib>Murphy, Karen J</creatorcontrib><creatorcontrib>Wareham, Nicholas J</creatorcontrib><creatorcontrib>Forouhi, Nita G</creatorcontrib><title>A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet.
We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants sampled from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding.
These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000602729 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363860.</description><subject>Adipose tissue</subject><subject>Adult</subject><subject>Analysis</subject><subject>Australia</subject><subject>Biological markers</subject><subject>Biology and Life Sciences</subject><subject>Biomarkers</subject><subject>Cancer</subject><subject>Care and treatment</subject><subject>Carotenoids</subject><subject>Chromatography</subject><subject>Clinical trials</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - prevention & control</subject><subject>Diabetes therapy</subject><subject>Diagnosis</subject><subject>Diet</subject><subject>Diet therapy</subject><subject>Diet, Mediterranean</subject><subject>Fatty acids</subject><subject>Health Sciences</subject><subject>Humans</subject><subject>Hälsovetenskap</subject><subject>Intervention</subject><subject>Laboratories</subject><subject>Legumes</subject><subject>Life Sciences</subject><subject>Medical and Health Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine and Health Sciences</subject><subject>Neoplasms - complications</subject><subject>Nutrition and Dietetics</subject><subject>Nutrition research</subject><subject>Nuts</subject><subject>Näringslära</subject><subject>Olive oil</subject><subject>Oncology, Experimental</subject><subject>Physical Sciences</subject><subject>Questionnaires</subject><subject>Research and Analysis Methods</subject><subject>Risk Factors</subject><subject>Santé publique et épidémiologie</subject><subject>Self report</subject><subject>Standard deviation</subject><subject>Type 2 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nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study</title><author>Sobiecki, Jakub G ; Imamura, Fumiaki ; Davis, Courtney R ; Sharp, Stephen J ; Koulman, Albert ; Hodgson, Jonathan M ; Guevara, Marcela ; Schulze, Matthias B ; Zheng, Ju-Sheng ; Agnoli, Claudia ; Bonet, Catalina ; Colorado-Yohar, Sandra M ; Fagherazzi, Guy ; Franks, Paul W ; Gundersen, Thomas E ; Jannasch, Franziska ; Kaaks, Rudolf ; Katzke, Verena ; Molina-Montes, Esther ; Nilsson, Peter M ; Palli, Domenico ; Panico, Salvatore ; Papier, Keren ; Rolandsson, Olov ; Sacerdote, Carlotta ; Tjønneland, Anne ; Tong, Tammy Y N ; van der Schouw, Yvonne T ; Danesh, John ; Butterworth, Adam S ; Riboli, Elio ; Murphy, Karen J ; Wareham, Nicholas J ; Forouhi, Nita G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c906t-472757236be7203a34489d69e4594de7f968e307d7e7b8690f63d9fc07cd6a0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adipose tissue</topic><topic>Adult</topic><topic>Analysis</topic><topic>Australia</topic><topic>Biological markers</topic><topic>Biology and Life Sciences</topic><topic>Biomarkers</topic><topic>Cancer</topic><topic>Care and treatment</topic><topic>Carotenoids</topic><topic>Chromatography</topic><topic>Clinical trials</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - diagnosis</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - prevention & control</topic><topic>Diabetes therapy</topic><topic>Diagnosis</topic><topic>Diet</topic><topic>Diet therapy</topic><topic>Diet, Mediterranean</topic><topic>Fatty acids</topic><topic>Health Sciences</topic><topic>Humans</topic><topic>Hälsovetenskap</topic><topic>Intervention</topic><topic>Laboratories</topic><topic>Legumes</topic><topic>Life Sciences</topic><topic>Medical and Health Sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine and Health Sciences</topic><topic>Neoplasms - complications</topic><topic>Nutrition and Dietetics</topic><topic>Nutrition research</topic><topic>Nuts</topic><topic>Näringslära</topic><topic>Olive oil</topic><topic>Oncology, Experimental</topic><topic>Physical Sciences</topic><topic>Questionnaires</topic><topic>Research and Analysis Methods</topic><topic>Risk Factors</topic><topic>Santé publique et épidémiologie</topic><topic>Self report</topic><topic>Standard deviation</topic><topic>Type 2 diabetes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sobiecki, Jakub G</creatorcontrib><creatorcontrib>Imamura, Fumiaki</creatorcontrib><creatorcontrib>Davis, Courtney R</creatorcontrib><creatorcontrib>Sharp, Stephen J</creatorcontrib><creatorcontrib>Koulman, Albert</creatorcontrib><creatorcontrib>Hodgson, Jonathan M</creatorcontrib><creatorcontrib>Guevara, Marcela</creatorcontrib><creatorcontrib>Schulze, Matthias B</creatorcontrib><creatorcontrib>Zheng, Ju-Sheng</creatorcontrib><creatorcontrib>Agnoli, Claudia</creatorcontrib><creatorcontrib>Bonet, Catalina</creatorcontrib><creatorcontrib>Colorado-Yohar, Sandra M</creatorcontrib><creatorcontrib>Fagherazzi, Guy</creatorcontrib><creatorcontrib>Franks, Paul W</creatorcontrib><creatorcontrib>Gundersen, Thomas E</creatorcontrib><creatorcontrib>Jannasch, Franziska</creatorcontrib><creatorcontrib>Kaaks, Rudolf</creatorcontrib><creatorcontrib>Katzke, 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Franziska</au><au>Kaaks, Rudolf</au><au>Katzke, Verena</au><au>Molina-Montes, Esther</au><au>Nilsson, Peter M</au><au>Palli, Domenico</au><au>Panico, Salvatore</au><au>Papier, Keren</au><au>Rolandsson, Olov</au><au>Sacerdote, Carlotta</au><au>Tjønneland, Anne</au><au>Tong, Tammy Y N</au><au>van der Schouw, Yvonne T</au><au>Danesh, John</au><au>Butterworth, Adam S</au><au>Riboli, Elio</au><au>Murphy, Karen J</au><au>Wareham, Nicholas J</au><au>Forouhi, Nita G</au><au>Popkin, Barry M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2023-04-27</date><risdate>2023</risdate><volume>20</volume><issue>4</issue><spage>e1004221</spage><epage>e1004221</epage><pages>e1004221-e1004221</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet.
We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants sampled from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding.
These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.
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| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2023-04, Vol.20 (4), p.e1004221-e1004221 |
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| source | PubMed Central Free; MEDLINE; DOAJ Directory of Open Access Journals; SWEPUB Freely available online; Public Library of Science; EZB Electronic Journals Library |
| subjects | Adipose tissue Adult Analysis Australia Biological markers Biology and Life Sciences Biomarkers Cancer Care and treatment Carotenoids Chromatography Clinical trials Cohort analysis Cohort Studies Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - prevention & control Diabetes therapy Diagnosis Diet Diet therapy Diet, Mediterranean Fatty acids Health Sciences Humans Hälsovetenskap Intervention Laboratories Legumes Life Sciences Medical and Health Sciences Medicin och hälsovetenskap Medicine and Health Sciences Neoplasms - complications Nutrition and Dietetics Nutrition research Nuts Näringslära Olive oil Oncology, Experimental Physical Sciences Questionnaires Research and Analysis Methods Risk Factors Santé publique et épidémiologie Self report Standard deviation Type 2 diabetes |
| title | A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study |
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