Background
Dietary energy density (DED), or energy available in relation to gram intake, may inform disease risk.
Objective
The objective of this study was to investigate the association between baseline DED and risk of incident type 2 diabetes in postmenopausal women.
Design
DED, 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 (WHI) observational study or clinical trials at forty centers across the U.S. between 1993 and 1998.
Main Outcome Measures
The primary outcome was incident type 2 diabetes.
Statistical Analyses Performed
The association between DED 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 developing diabetes was 24% greater for women in the highest DED quintile compared with the lowest after adjusting for confounders (95% confidence interval: 1.17, 1.32). BMI and waist circumference mediated the relationship between DED and diabetes. In waist circumference-stratified analysis, women in DED quintiles 2–5 with waist circumferences >88 cm were at 9–12% greater risk of developing diabetes compared to women with waist circumference ≤ 88 cm.
Conclusions
In this prospective study, a higher baseline DED was associated with higher incidence of type 2 diabetes among postmenopausal women, both overall, and in women with elevated waist circumference.