Geng Zong1,2, Benjamin Lebwohl3, Frank B Hu2,4,5, Laura Sampson2, Lauren W Dougherty2, Walter C Willett2,4,5, Andrew T Chan6,7,8,9, Qi Sun10,11,12. 1. CAS Key Laboratory of Nutrition, Metabolism and Food safety, Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China. 2. Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA. 3. Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. 4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 5. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 6. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. ACHAN@mgh.harvard.edu. 7. Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. ACHAN@mgh.harvard.edu. 8. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA. ACHAN@mgh.harvard.edu. 9. Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA. ACHAN@mgh.harvard.edu. 10. Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA. qisun@hsph.harvard.edu. 11. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. qisun@hsph.harvard.edu. 12. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. qisun@hsph.harvard.edu.
Abstract
AIMS/HYPOTHESIS: We investigated the association between gluten intake and long-term type 2 diabetes risk among Americans. METHODS: We followed women from the Nurses' Health Study (NHS, n = 71,602, 1984-2012) and NHS II (n = 88,604, 1991-2013) and men from the Health Professionals Follow-Up Study (HPFS, n = 41,908, 1986-2012). Gluten intake was estimated using a validated food frequency questionnaire every 2-4 years. Incident type 2 diabetes was defined as self-reported physician-diagnosed diabetes confirmed using a supplementary questionnaire. RESULT: Gluten intake was strongly correlated with intakes of carbohydrate components, especially refined grains, starch and cereal fibre (Spearman correlation coefficients >0.6). During 4.24 million years of follow-up, 15,947 people were confirmed to have type 2 diabetes. After multivariate adjustment, pooled HRs and 95% CIs for type 2 diabetes, from low to high gluten quintiles, were (ptrend < 0.001): 1 (reference); 0.89 (0.85, 0.93); 0.84 (0.80, 0.88); 0.78 (0.74, 0.82) and 0.80 (0.76, 0.84). The association was slightly weakened after further adjusting for cereal fibre, with pooled HRs (95% CIs) of (ptrend < 0.001): 1 (reference); 0.91 (0.87, 0.96); 0.88 (0.83, 0.93); 0.83 (0.78, 0.88) and 0.87 (0.81, 0.93). Dose-response analysis supported a largely linear inverse relationship between gluten intake up to 12 g/day and type 2 diabetes. The association between gluten intake and type 2 diabetes was stronger when intake of added bran was also higher (pinteraction = 0.02). CONCLUSIONS/ INTERPRETATION: Gluten intake is inversely associated with type 2 diabetes risk among largely healthy US men and women. Limiting gluten in the diet is associated with lower intake of cereal fibre and possibly other beneficial nutrients that contribute to good health.
AIMS/HYPOTHESIS: We investigated the association between gluten intake and long-term type 2 diabetes risk among Americans. METHODS: We followed women from the Nurses' Health Study (NHS, n = 71,602, 1984-2012) and NHS II (n = 88,604, 1991-2013) and men from the Health Professionals Follow-Up Study (HPFS, n = 41,908, 1986-2012). Gluten intake was estimated using a validated food frequency questionnaire every 2-4 years. Incident type 2 diabetes was defined as self-reported physician-diagnosed diabetes confirmed using a supplementary questionnaire. RESULT: Gluten intake was strongly correlated with intakes of carbohydrate components, especially refined grains, starch and cereal fibre (Spearman correlation coefficients >0.6). During 4.24 million years of follow-up, 15,947 people were confirmed to have type 2 diabetes. After multivariate adjustment, pooled HRs and 95% CIs for type 2 diabetes, from low to high gluten quintiles, were (ptrend < 0.001): 1 (reference); 0.89 (0.85, 0.93); 0.84 (0.80, 0.88); 0.78 (0.74, 0.82) and 0.80 (0.76, 0.84). The association was slightly weakened after further adjusting for cereal fibre, with pooled HRs (95% CIs) of (ptrend < 0.001): 1 (reference); 0.91 (0.87, 0.96); 0.88 (0.83, 0.93); 0.83 (0.78, 0.88) and 0.87 (0.81, 0.93). Dose-response analysis supported a largely linear inverse relationship between gluten intake up to 12 g/day and type 2 diabetes. The association between gluten intake and type 2 diabetes was stronger when intake of added bran was also higher (pinteraction = 0.02). CONCLUSIONS/ INTERPRETATION: Gluten intake is inversely associated with type 2 diabetes risk among largely healthy US men and women. Limiting gluten in the diet is associated with lower intake of cereal fibre and possibly other beneficial nutrients that contribute to good health.
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