Abstract
Background
Dietary energy density, or energy available in relation to gram intake, can inform
disease risk.
Objective
The objective of this study was to investigate the association between baseline dietary
energy density and risk of incident type 2 diabetes in postmenopausal women.
Design
Dietary energy density, weight status, and type 2 diabetes incidence were prospectively
characterized in a large cohort of postmenopausal women participating in one or more
clinical trials or an observational study.
Participants/setting
The study involved 161,808 postmenopausal women recruited to the Women's Health Initiative
observational study or clinical trials at 40 centers across the United States between
1993 and 1998.
Main outcome measures
The primary outcome was incident type 2 diabetes.
Statistical analyses performed
The association between dietary energy density quintiles and incident diabetes was
tested using Cox proportional hazards regression.
Results
A total of 143,204 participants without self-reported diabetes at enrollment completed
baseline dietary assessment and were followed for 12.7±4.6 years. Risk of diabetes
developing was 24% greater for women in the highest dietary energy density quintile
compared with the lowest after adjusting for confounders (95% CI 1.17 to 1.32). Body
mass index (calculated as kg/m2) and waist circumference mediated the relationship between dietary energy density
and diabetes. In waist circumference−stratified analysis, women in dietary energy
density quintiles 2 to 5 with waist circumferences >88 cm were at 9% to 12% greater
risk of diabetes developing compared with women with waist circumference ≤88 cm.
Conclusions
In this prospective study, a higher baseline dietary energy density was associated
with higher incidence of type 2 diabetes among postmenopausal women, both overall,
and in women with elevated waist circumference.
Keywords
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Biography
M. D. Hingle is an assistant professor, Department of Nutritional Sciences, The University of Arizona, Tucson.
Biography
B. C. Wertheim is an assistant scientific investigator, The University of Arizona Cancer Center, Tucson.
Biography
M. L. Neuhouser is principal staff scientist, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Biography
L. F. Tinker is a nutrition scientist, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Biography
B. V. Howard is a senior scientist, MedStar Health Research Institute, Hyattsville, MD, and a professor, Department of Medicine, Georgetown/Howard Universities Center for Clinical and Translational Sciences, Washington, DC.
Biography
K. Johnson is a professor, Department of Preventive Medicine, University of Tennessee, Health Science Center, College of Medicine, Memphis.
Biography
S. Liu is a professor of epidemiology and medicine, Department of Epidemiology, Brown University, School of Public Health, Providence, RI.
Biography
L. S. Phillips is a site principal investigator, Atlanta VA Medical Center, Decatur, GA, and a professor of medicine, Division of Endocrinology and Metabolism, Department of Medicine, Emory University, Atlanta, GA.
Biography
L. Qi is an associate professor, Department of Public Health Sciences, University of California Davis, School of Medicine, Davis.
Biography
G. Sarto is professor emeritus, Department of Obstetrics and Gynecology, University of Wisconsin Madison, School of Medicine and Public Health, Madison.
Biography
T. Turner is a postdoctoral associate, Department of Nutritional Sciences, The University of Arizona, Tucson.
Biography
M. E. Waring is an assistant professor, Departments of Quantitative Health Science and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester.
Biography
C. A. Thomson is a professor, Health Promotion Sciences Department, The University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson.
Article info
Publication history
Published online: January 05, 2017
Accepted:
November 16,
2016
Received:
June 2,
2016
Footnotes
Supplementary materials: Table 2 is available at www.andjrnl.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST Lawrence S. Phillips declares that there is no duality of interest associated with this manuscript. With regard to potential conflicts of interest, within the past several years, Dr Phillips has served on Scientific Advisory Boards for Boehringer Ingelheim, Janssen, and the Profil Institute for Clinical Research, and has or had research support from Merck, Amylin, Eli Lilly, Novo Nordisk, Sanofi, PhaseBio, Roche, Abbvie, Vascular Pharmaceuticals, Janssen, Glaxo SmithKline, and the Cystic Fibrosis Foundation. In the past, he was a speaker for Novartis and Merck, but not for the last 5 years. Dr Phillips is also supported in part by the Veterans Health Administration (VA). This work is not intended to reflect the official opinion of the VA or the US government. No potential conflicts of interest were reported by the remaining authors.
FUNDING/SUPPORT The WHI program is funded by the National Heart, Lung, and Blood Institute; National Institutes of Health; and US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. Lawrence S. Phillips is supported in part by Food and Drug Administration (FDA) award RO1FD003527; VA awards HSR&D IIR 07-138 and I01-CX001025; National Institutes of Health (NIH) awards R21DK099716, DK066204, U01 DK091958, and U01 DK098246; and a Cystic Fibrosis Foundation award PHILLI12A0. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr Phillips is also supported in part by the Veterans Health Administration (VA). This work is not intended to reflect the official opinion of the VA or the US government.
Identification
Copyright
© 2017 by the Academy of Nutrition and Dietetics.
