Dietary intake of carbohydrates and risk of type 2 diabetes: the European Prospective Investigation into Cancer-Norfolk study
Open accessAbstract
In the present study, we investigated the association between dietary intake of carbohydrates and the risk of type 2 diabetes. Incident cases of diabetes (n 749) were identified and compared with a randomly selected subcohort of 3496 participants aged 40–79 years. For dietary assessment, we used 7 d food diaries administered at baseline. We carried out modified Cox proportional hazards regression analyses and compared results obtained from the different methods of adjustment for total energy intake. Dietary intakes of total carbohydrates, starch, sucrose, lactose or maltose were not significantly related to diabetes risk after adjustment for confounders. However, in the residual method for energy adjustment, intakes of fructose and glucose were inversely related to diabetes risk. The multivariable-adjusted hazard ratios (HR) of diabetes comparing the extreme quintiles of intake were 0·79 (95 % CI 0·59, 1·07; P for trend = 0·03) for glucose and 0·62 (95 % CI 0·46, 0·83; P for trend = 0·01) for fructose. In the nutrient density method, only fructose was inversely related to diabetes risk (HR 0·65, 95 % CI 0·48, 0·88). The replacement of 5 % energy intake from SFA with an isoenergetic amount of fructose was associated with a 30 % lower diabetes risk (HR 0·69, 95 % CI 0·50, 0·96). Results of the standard and energy partition methods were similar to those of the residual method. These prospective findings suggest that the intakes of starch and sucrose are not associated, but that those of fructose and glucose are inversely associated with diabetes risk. Whether the inverse associations with fructose and glucose reflect the effect of substitution of these carbohydrate subtypes with other nutrients (i.e. SFA), their net higher intake or other nutrients associated with their intake remains to be established through further investigation.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The association between the use of GLP-1 receptor agonists and the risk of acute pancreatitis is negative.
“The association between the use of GLP‐1 receptor agonists and the risk of acute pancreatitis has been shown to be negative 25 , 26 , 27 , 28 , 29 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [27]
Coffee or tea intake is a preventive factor against type 2 diabetes.
“Coffee or tea intake is shown to be a preventive factor against type 2 diabetes 26 , 27 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [27]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Willett, W. C. (1998) · doi:10.1093/acprof:oso/9780195122978.001.0001 · Cited by 4,541 · see citing works
Adjustment for total energy intake in epidemiologic studies
Willett, W. C., Howe, G., & Kushi, L. H. (1997) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/65.4.1220s · Cited by 3,747 · see citing works
A Case-Cohort Design for Epidemiologic Cohort Studies and Disease Prevention Trials
Prentice, R. L. (1986) · Biometrika · doi:10.1093/biomet/73.1.1 · Cited by 1,444 · see citing works
Carbohydrates, dietary fiber, and incident type 2 diabetes in older women
Meyer, K. A., Kushi, L. H., Jacobs, D. R., Slavin, J., Sellers, T. A., & Folsom, A. R. (2000) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/71.4.921 · Cited by 1,271 · see citing works
Gillies, C. L., Abrams, K. R., Lambert, P. C., Cooper, N. J., Sutton, A. J., Hsu, R. T., & Khunti, K. (2007) · BMJ · doi:10.1136/bmj.39063.689375.55 · Cited by 1,171 · see citing works
Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies
Barclay, A. W., Petocz, P., McMillan-Price, J., Flood, V. M., Prvan, T., Mitchell, P., & Brand-Miller, J. C. (2008) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.3.627 · Cited by 1,061 · see citing works
Ajala, O., English, P., & Pinkney, J. (2013) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.112.042457 · Cited by 821 · see citing works
Day, N., Oakes, S., Luben, R., Khaw, K., Bingham, S., Welch, A., & Wareham, N. (1999) · Nature · doi:10.17863/cam.89388 · Cited by 780 · see citing works
Self-citationSchulze, M. B., Liu, S., Rimm, E. B., Manson, J. E., Willett, W. C., & Hu, F. B. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.2.348 · Cited by 772 · see citing works
Analysis of Case-Cohort Designs
Barlow, W. E., Ichikawa, L., Rosner, D., & Izumi, S. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(99)00102-x · Cited by 682 · see citing works
Saturated fat, carbohydrate, and cardiovascular disease
Siri-Tarino, P. W., Sun, Q., Hu, F. B., & Krauss, R. M. (2010) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.26285 · Cited by 636 · see citing works
Micha, R., & Mozaffarian, D. (2010) · Lipids · doi:10.1007/s11745-010-3393-4 · Cited by 543 · see citing works
Glycemic Index and Dietary Fiber and the Risk of Type 2 Diabetes
Hodge, A. M., English, D. R., O’Dea, K., & Giles, G. G. (2004) · Diabetes Care · doi:10.2337/diacare.27.11.2701 · Cited by 434 · see citing works
Villegas, R., Liu, S., Gao, Y.-T., Yang, G., Li, H., Zheng, W., & Shu, X. O. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.21.2310 · Cited by 431 · see citing works
Nutritional methods in the European Prospective Investigation of Cancer in Norfolk
Bingham, S. A., Welch, A. A., McTaggart, A., Mulligan, A. A., Runswick, S. A., Luben, R., Oakes, S., Khaw, K., Wareham, N. J., & Day, N. (2001) · Public Health Nutrition · doi:10.1079/phn2000102 · Cited by 421 · see citing works
Self-citationSluijs, I., Beulens, J. W. J., van der A, D. L., Spijkerman, A. M. W., Grobbee, D. E., & van der Schouw, Y. T. (2010) · Diabetes Care · doi:10.2337/dc09-1321 · Cited by 335 · see citing works
Harding, A.-H. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.14.1493 · Cited by 322 · see citing works
Montonen, J., Järvinen, R., Knekt, P., Heliövaara, M., & Reunanen, A. (2007) · Journal of Nutrition · doi:10.1093/jn/137.6.1447 · Cited by 260 · see citing works
Effect of Fructose on Glycemic Control in Diabetes
Cozma, A., Sievenpiper, J., de Souza, R., Chiavaroli, L., Ha, V., Wang, D., Mirrahimi, A., Yu, M. E., Carleton, A., Buono, M. D., et al. (2012) · Diabetes Care · doi:10.2337/dc12-0073 · Cited by 202 · see citing works
A prospective study of sugar intake and risk of type 2 diabetes in women.
Janket, S.-J., Manson, J., Sesso, H., Buring, J., & Liu, S.-M. (2003) · Diabetes Care · doi:10.2337/diacare.26.4.1008 · Cited by 158 · see citing works
Sluijs, I., van der Schouw, Y. T., van der A, D. L., Spijkerman, A. M. W., Hu, F. B., Grobbee, D. E., & Beulens, J. W. J. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2010.29620 · Cited by 151 · see citing works
Welch, A., McTaggart, A., Mulligan, A. A., Luben, R., Walker, N., Khaw, K., Day, N., & Bingham, S. (2001) · Public Health Nutrition · doi:10.1079/phn2001196 · Cited by 138 · see citing works
Self-citationHallfrisch, J. G., Ellwood, K. C., Michaelis, O. E., Reiser, S., O’Dorisio, T. M., & Prather, E. S. (1983) · Journal of Nutrition · doi:10.1093/jn/113.9.1819 · Cited by 122 · see citing works
Interpretation of Energy Adjustment Models for Nutritional Epidemiology
Kipnis, V., Freedman, L. S., Brown, C., Hartman, A. M., Schatzkin, A. G., & Wacholder, S. (1993) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116647 · Cited by 117 · see citing works
Reiser, S., Handler, H., Gardner, L., Hallfrisch, J., Michaelis, O., & Prather, E. (1979) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/32.11.2206 · Cited by 117 · see citing works
Sugars, insulin sensitivity, and the postprandial state
Daly, M. E. (2003) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/78.4.865s · Cited by 111 · see citing works
Schulze, M. B., Schulz, M., Heidemann, C., Schienkiewitz, A., Hoffmann, K., & Boeing, H. (2007) · British Journal Of Nutrition · doi:10.1017/s0007114507853360 · Cited by 108 · see citing works
Postprandial glycemia, glycemic index, and the prevention of type 2 diabetes
Brand-Miller, J. C. (2004) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.2.243 · Cited by 107 · see citing works
Serum insulin and glucose in hyperinsulinemic subjects fed three different levels of sucrose
Reiser, S., Bohn, E., Hallfrisch, J., Michaelis, O. E., Keeney, M., & Prather, E. S. (1981) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/34.11.2348 · Cited by 102 · see citing works
Metabolic Consequence of Two-Week Fructose Feeding in Diabetic Subjects
Crapo, P. A., Kolterman, O., & Henry, R. R. (1986) · Diabetes Care · doi:10.2337/diacare.9.2.111 · Cited by 97 · see citing works
Diabetes, insulin resistance and sugars
Laville, M., & Nazare, J. (2009) · Obesity Reviews · doi:10.1111/j.1467-789x.2008.00562.x · Cited by 90 · see citing works
Bingham, S., Luben, R., Welch, A., Tasevska, N., Wareham, N., & Khaw, K. T. (2007) · Cancer Epidemiology, Biomarkers & Prevention · doi:10.1158/1055-9965.epi-06-1050 · Cited by 88 · see citing works
Self-citationFructose and insulin sensitivity in patients with type 2 diabetes
Koivisto, V. A., & Yki-Järvinen, H. (1993) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1993.tb00667.x · Cited by 82 · see citing works
Sugars and starch in the nutritional management of diabetes mellitus
Kelley, D. E. (2003) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/78.4.858s · Cited by 81 · see citing works
Glycemic Index, Dietary Fiber, and Risk of Type 2 Diabetes in a Cohort of Older Australians
Barclay, A. W., Flood, V. M., Rochtchina, E., Mitchell, P. L. R., & Brand-Miller, J. C. (2007) · Diabetes Care · doi:10.2337/dc07-0784 · Cited by 81 · see citing works
Effect of Measurement Error on Energy-Adjustment Models in Nutritional Epidemiology
Kipnis, V., Freedman, L. S., Brown, C. C., Hartman, A. M., Schatzkin, A. G., & Wacholder, S. (1997) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009202 · Cited by 78 · see citing works
Diabetes induced by a high fructose diet
Cohen, A. M., Teitelbaum, A., & Rosenman, E. (1977) · Metabolism · doi:10.1016/0026-0495(77)90123-8 · Cited by 54 · see citing works
Carbohydrate and diabetes: Is the source or the amount of more importance?
Franz, M. J. (2001) · Current Diabetes Reports · doi:10.1007/s11892-001-0031-9 · Cited by 29 · see citing works
Goda, T., Yamada, K., Sugiyama, M., et al. (1982) · Journal of Nutritional Science and Vitaminology · doi:10.3177/jnsv.28.41 · Cited by 25 · see citing works
Kim, H. S., Paik, H. Y., Lee, K., et al. (1988) · Diabetes Research and Clinical Practice · doi:10.1016/s0168-8227(88)80030-5 · Cited by 22 · see citing works
Ahmadi‐Abhari, S., & Chowdhury, R. (2011) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2011.142976h.41 · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Rothman K, Greenland S & Timothy L (2008) Modern Epide- miology, 3rd ed. Philadelphia, PA: Wolters Kluwer Lippincott Williams and Wilkins.
Cited by
Sorted by citations
Japanese clinical practice guideline for diabetes 2019
Araki, E., Goto, A., Kondo, T., Noda, M., Noto, H., Origasa, H., Osawa, H., Taguchi, A., Tanizawa, Y., Tobe, K., et al. (2020) · Diabetology International · doi:10.1007/s13340-020-00439-5 · Cited by 545 · see citing works
Tsilas, C. S., de Souza, R. J., Mejia, S. B., Mirrahimi, A., Cozma, A. I., Jayalath, V. H., Ha, V., Tawfik, R., Di Buono, M., Jenkins, A. L., et al. (2017) · Canadian Medical Association Journal · doi:10.1503/cmaj.160706 · Cited by 109 · see citing works
Althuis, M. D., Weed, D. L., & Frankenfeld, C. L. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-80 · Cited by 30 · see citing works
Noto, H., Goto, A., Tsujimoto, T., & Noda, M. (2016) · Journal of General and Family Medicine · doi:10.14442/jgfm.17.1_60 · Cited by 12 · see citing works
- Authors
- Ahmadi-Abhari, S., Luben, R. N., Powell, N., Bhaniani, A., Chowdhury, R., Wareham, N. J., Forouhi, N. G., & Khaw, K.-T.
- Affiliations
- University of Cambridge (GB)
- Wellcome/MRC Institute of Metabolic Science (GB)
- ORCID
- Venue
- British Journal of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-07-23
- Volume
- 111
- Issue
- 2
- Pages
- 342-352
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W1998838608
- Cited by
- 42
- References
- 41
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 4 · 2014: 3
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cancer Research UK
- National Institute for Health and Care Research (NF-SI-0512-10165)
- British Heart Foundation (RG/08/014/24067)
- Stroke Association
- University of Cambridge
- Medical Research Council (MC_UU_12015/5, MR/L003120/1, MC_UU_12015/1)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Keywords
- type 2 diabetes, dietary carbohydrates, fructose, glucose, starch, sucrose, saturated fatty acids, dietary intake, food diary, residual method, incident diabetes risk
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Diet, Dietary Carbohydrates, England, Feeding Behavior, Female, Humans, Male, Middle Aged
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
