Dietary energy density predicts the risk of clinically incident type 2 diabetes: The EPIC-Norfolk study

Abstract

Objective: Accumulating evidence suggests that energy dense foods predispose to obesity, and such foods may also be associated with increased risk of type 2 diabetes, but there is limited evidence. Our aim was to investigate whether there is an independent association between dietary energy density and incidence of diabetes.

Research Design and Methods: Population-based prospective study, the EPIC (European Prospective Investigation of Cancer)-Norfolk Cohort Study of persons aged 40-79 years at baseline. We calculated energy density for overall diet (all solids and drinks) using food frequency questionnaire. During 12 years of follow-up, we documented 725 clinically incident cases of diabetes among 21,919 participants without diabetes, cancer or cardiovascular disease at baseline.

Results: Baseline energy density (age, sex, baseline BMI adjusted) was higher in those who developed type 2 diabetes (Mean 3.08 kJ/g, 95% CI 3.03-3.13) than those who remained non-diabetic (3.01 kJ/g, 3.00-3.02) (P=0.012). Energy density was positively associated with incident diabetes (odds ratio, OR, 1.21 per unit increase, 95% CI 1.06-1.38) adjusted for known risk factors. There was a 60% higher risk of diabetes (OR 1.60, 95% CI 1.19-2.16) in the highest quintile of energy density (range 3.55-7.97 kJ/g) compared with the lowest quintile (range 1.04-2.43 kJ/g) in adjusted analysis.

Conclusions: This is the first large population-based prospective study to report that an energy dense diet may be associated with increased risk of developing diabetes, independently of baseline obesity. The potential public health impact of a low energy dense diet on reducing the risk of diabetes deserves further study.