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
(2023) In PLoS Medicine 20(4).- Abstract
Background AU Self-reported: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly 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. Methods and findings 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... (More)
Background AU Self-reported: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly 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. Methods and findings 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. Conclusions 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.
(Less)
- author
- organization
- publishing date
- 2023-04
- type
- Contribution to journal
- publication status
- published
- subject
- in
- PLoS Medicine
- volume
- 20
- issue
- 4
- article number
- e1004221
- publisher
- Public Library of Science (PLoS)
- external identifiers
-
- pmid:37104291
- scopus:85159241898
- ISSN
- 1549-1277
- DOI
- 10.1371/journal.pmed.1004221
- language
- English
- LU publication?
- yes
- id
- cb616248-023c-466d-a966-2ef59ac06047
- date added to LUP
- 2023-08-11 13:39:06
- date last changed
- 2025-04-07 14:10:01
@article{cb616248-023c-466d-a966-2ef59ac06047,
abstract = {{<p>Background AU Self-reported: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly 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. Methods and findings 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. Conclusions 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.</p>}},
author = {{Sobiecki, Jakub G. and Imamura, Fumiaki and Davis, Courtney R. and Sharp, Stephen J. and Koulman, Albert and Hodgson, Jonathan M. and Guevara, Marcela and Schulze, Matthias B. and Zheng, Ju Sheng and Agnoli, Claudia and Bonet, Catalina and Colorado-Yohar, Sandra M. and Fagherazzi, Guy and Franks, Paul W. and Gundersen, Thomas E. and Jannasch, Franziska and Kaaks, Rudolf and Katzke, Verena and Molina-Montes, Esther and Nilsson, Peter M. and Palli, Domenico and Panico, Salvatore and Papier, Keren and Rolandsson, Olov and Sacerdote, Carlotta and Tjønneland, Anne and Tong, Tammy Y.N. and van der Schouw, Yvonne T. and Danesh, John and Butterworth, Adam S. and Riboli, Elio and Murphy, Karen J. and Wareham, Nicholas J. and Forouhi, Nita G.}},
issn = {{1549-1277}},
language = {{eng}},
number = {{4}},
publisher = {{Public Library of Science (PLoS)}},
series = {{PLoS Medicine}},
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}},
url = {{http://dx.doi.org/10.1371/journal.pmed.1004221}},
doi = {{10.1371/journal.pmed.1004221}},
volume = {{20}},
year = {{2023}},
}