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. 2018 Oct;61(10):2164-2173.
doi: 10.1007/s00125-018-4697-9. Epub 2018 Aug 3.

Gluten Intake and Risk of Type 2 Diabetes in Three Large Prospective Cohort Studies of US Men and Women

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Free PMC article

Gluten Intake and Risk of Type 2 Diabetes in Three Large Prospective Cohort Studies of US Men and Women

Geng Zong et al. Diabetologia. .
Free PMC article

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.

Keywords: Gluten; Type 2 diabetes.

Figures

Fig. 1
Fig. 1
Trends in gluten intake in three cohorts. Circles, NHS; diamonds, NHSII; squares, HPFS; solid lines, means; dashed lines show 95% CI
Fig. 2
Fig. 2
Restricted cubic spline analysis of the association between gluten intake (g/day) and risk of type 2 diabetes. Adjusted for age, ethnicity (white, African-American, Asian and other ethnicity), family history of diabetes (yes/no), smoking status (never, former, current [1–14, 15–24, or ≥ 25 cigarettes/day], or missing), alcohol intake (g/day: 0, 0.1– 4.9, 5.0–14.9, and ≥ 15.0 in women; 0, 0.1–4.9, 5.0–29.9, and ≥ 30.0 in men; or missing), physical activity (<3.0, 3.0–8.9, 9.0–17.9, 18.0–26.9, ≥ 27.0 METs, or missing), menopausal status and postmenopausal hormone use (pre-menopause, postmenopause [never, former, or current hormone use], or missing, for women), oral contraceptive use (yes, no, or missing, for NHSII), multivitamin use (yes/no), BMI (<23.0, 23.0–24.9, 25.0–29.9, 30.0–34.9, ≥ 35.0 kg/m2, or missing), total energy intake, AHEI, folic acid intake (in quintiles), and magnesium intake (in quintiles). Solid lines, point estimates; dashed lines, 95% CIs; black lines, estimates before further adjustment of cereal fibre; grey lines, estimates with further adjustment of cereal fibre
Fig. 3
Fig. 3
Joint analysis of gluten intake and other carbohydrate components on diabetes risk. HRs for type 2 diabetes by intake of: (a) bran; (b) added bran; (c) cereal fibre; and (d) whole grain. Adjusted for age, ethnicity (white, African-American, Asian, and other ethnicity), family history of diabetes (yes/no), smoking status (never, former, current [1– 14, 15–24, or ≥ 25 cigarettes/day], or missing), alcohol intake (g/day: 0, 0.1–4.9, 5.0–14.9, and ≥ 15.0 in women, 0, 0.1–4.9, 5.0–29.9 and ≥30.0 in men, or missing), physical activity (<3.0, 3.0–8.9, 9.0–17.9, 18.0–26.9, ≥ 27.0 METs, or missing), menopausal status and postmenopausal hormone use (pre-menopause, postmenopause [never, former, or current hormone use], or missing, for women), oral contraceptive use (yes, no, or missing, for NHSII), multivitamin use (yes/no), BMI (<23.0, 23.0–24.9, 25.0–29.9, 30.0–34.9, ≥ 35.0 kg/m2, or missing), total energy intake, AHEI (in quintiles), folic acid intake (in quintiles), magnesium intake (in quintiles), and cereal fibre intake where appropriate. Statistical significance of effect modification (p for interaction) was evaluated by likelihood ratio test comparing models with and without interaction terms between quintiles of gluten and the effect modifiers. The p values for interaction were p=0.12 for bran, p=0.02 for added bran, p=0.32 for cereal fibre and p=0.97 for whole grain. Light grey bars, lowest tertile of stratification variable; dark grey, medium tertile; and black, highest tertile. Error bars show standard errors

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