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Table 4—

RR of type 2 diabetes according to quintiles of nutrient intake in the WHS

Quintile of intake
1 (lowest)2345 (highest)P for trend
Saturated fat       
    Median intake (g/day) 13.8 17.1 19.4 21.8 25.8  
    Cases/person-years 231/65,587 268/65,503 301/65,758 337/65,285 421/64,743  
    Age, energy adjusted 1.00 1.17 (0.98–1.39) 1.31 (1.10–1.55) 1.48 (1.26–1.76) 1.90 (1.62–2.23) <0.0001 
    Multivariate model 1* 1.00 0.96 (0.80–1.14) 1.04 (0.87–1.24) 1.01 (0.85–1.20) 1.10 (0.93–1.31) 0.14 
    Multivariate model 2 1.00 0.95 (0.76–1.18) 0.94 (0.73–1.21) 0.85 (0.64–1.13) 0.89 (0.66–1.21) 0.49 
Monounsaturated fat       
    Median intake (g/day) 15.1 18.9 21.4 24.0 27.9  
    Cases/person-years 242/65,355 242/65,631 305/65,635 343/65,275 426/64,980  
    Age, energy adjusted 1.00 0.99 (0.83–1.18) 1.25 (1.06–1.48) 1.41 (1.20–1.67) 1.79 (1.52–2.09) <0.0001 
    Multivariate model 1* 1.00 0.91 (0.76–1.09) 1.06 (0.89–1.26) 1.10 (0.93–1.30) 1.14 (0.97–1.35) 0.02 
    Multivariate model 2 1.00 1.01 (0.77–1.32) 1.11 (0.80–1.55) 1.17 (0.81–1.70) 1.27 (0.85–1.91) 0.20 
n-3 polyunsaturated fat§       
    Median intake (g/day) 0.95 1.17 1.34 1.54 1.88  
    Cases/person-years 283/66,108 299/63,856 301/66,863 322/63,488 353/66,562  
    Age, energy adjusted 1.00 1.08 (0.92–1.27) 1.03 (0.88–1.21) 1.16 (0.99–1.36) 1.21 (1.04–1.42) 0.009 
    Multivariate model 1* 1.00 1.08 (0.92–1.28) 1.04 (0.88–1.23) 1.11 (0.95–1.31) 1.09 (0.93–1.28) 0.28 
    Multivariate model 2 1.00 1.09 (0.92–1.29) 1.06 (0.89–1.25) 1.13 (0.96–1.34) 1.10 (0.93–1.30) 0.30 
n-6 polyunsaturated fat       
    Median intake (g/day) 7.35 9.12 10.5 12.0 14.5  
    Cases/person-years 260/64,953 302/65,430 315/65,293 331/65,409 350/65,791  
    Age, energy adjusted 1.00 1.14 (0.97–1.35) 1.19 (1.01–1.40) 1.24 (1.06–1.46) 1.31 (1.12–1.54) 0.001 
    Multivariate model 1* 1.00 1.06 (0.90–1.26) 1.12 (0.95–1.32) 1.09 (0.92–1.28) 1.03 (0.87–1.21) 0.90 
    Multivariate model 2 1.00 1.06 (0.89–1.26) 1.09 (0.91–1.31) 1.04 (0.86–1.25) 0.95 (0.78–1.16) 0.39 
trans fatty acid       
    Median intake (g/day) 1.12 1.64 2.09 2.65 3.66  
    Cases/person-years 226/65,788 294/64,637 306/65,305 347/66,054 385/65,093  
    Age, energy adjusted 1.00 1.34 (1.13–1.59) 1.38 (1.16–1.63) 1.54 (1.31–1.83) 1.76 (1.49–2.08) <0.001 
    Multivariate model 1* 1.00 1.21 (1.01–1.44) 1.13 (0.95–1.35) 1.15 (0.96–1.37) 1.14 (0.96–1.35) 0.47 
    Multivariate model 2 1.00 1.21 (1.00–1.46) 1.09 (0.89–1.33) 1.07 (0.87–1.32) 1.03 (0.83–1.28) 0.44 
Cholesterol       
    Median intake (mg/day) 147 188 219 253 309  
    Cases/person-years 219/65,594 258/65,688 303/65,546 333/65,315 445/64,733  
    Age, energy adjusted 1.00 1.19 (0.99–1.42) 1.39 (1.17–1.66) 1.54 (1.30–1.83) 2.13 (1.81–2.51) <0.0001 
    Multivariate model 1* 1.00 1.06 (0.89–1.28) 1.18 (0.99–1.41) 1.13 (0.95–1.34) 1.33 (1.12–1.57) 0.001 
    Multivariate model 2 1.00 1.09 (0.90–1.31) 1.21 (1.00–1.47) 1.15 (0.95–1.40) 1.35 (1.11–1.64) 0.003 
Animal fat       
    Median intake (g/day) 19.7 26.0 30.4 35.2 43.1  
    Cases/person-years 238/65,645 237/65,740 304/65,547 346/65,228 433/64,715  
    Age, energy adjusted 1.00 1.00 (0.84–1.20) 1.30 (1.10–1.54) 1.49 (1.27–1.76) 1.90 (1.62–2.23) <0.0001 
    Multivariate model 1* 1.00 0.93 (0.77–1.11) 1.03 (0.87–1.23) 1.08 (0.91–1.28) 1.17 (0.99–1.38) 0.01 
    Multivariate model 2 1.00 0.94 (0.78–1.15) 1.05 (0.86–1.29) 1.08 (0.87–1.34) 1.13 (0.90–1.43) 0.16 
Vegetable fat       
    Median intake (g/day) 16.9 22.0 25.9 30.2 37.3  
    Cases/person-years 286/64,927 294/65,311 326/65,460 317/65,535 335/65,644  
    Age, energy adjusted 1.00 1.01 (0.86–1.19) 1.12 (0.95–1.31) 1.08 (0.92–1.27) 1.14 (0.98–1.34) 0.07 
    Multivariate model 1* 1.00 0.97 (0.83–1.15) 1.10 (0.94–1.30) 1.04 (0.89–1.23) 0.94 (0.80–1.11) 0.59 
    Multivariate model 2 1.00 0.98 (0.82–1.16) 1.08 (0.90–1.28) 0.98 (0.81–1.18) 0.85 (0.70–1.03) 0.08 
Animal protein       
    Median intake (g/day) 39.8 50.5 57.8 65.3 77.3  
    Cases/person-years 233/65,541 290/65,512 306/65,415 352/65,274 377/65,133  
    Age, energy adjusted 1.00 1.25 (1.05–1.48) 1.33 (1.12–1.58) 1.55 (1.31–1.83) 1.70 (1.44–2.00) <0.0001 
    Multivariate model 1* 1.00 1.19 (1.00–1.42) 1.24 (1.04–1.48) 1.34 (1.13–1.59) 1.27 (1.08–1.51) 0.004 
    Multivariate model 2 1.00 1.24 (1.03–1.48) 1.33 (1.10–1.60) 1.48 (1.21–1.79) 1.44 (1.16–1.78) 0.001 
Vegetable protein       
    Median intake (g/day) 17.1 20.2 22.5 24.9 29.2  
    Cases/person-years 393/64,754 284/65,550 320/65,746 314/65,403 247/65,423  
    Age, energy adjusted 1.00 0.70 (0.60–0.82) 0.79 (0.68–0.92) 0.77 (0.66–0.89) 0.61 (0.52–0.71) <0.0001 
    Multivariate model 1* 1.00 0.80 (0.68–0.93) 0.95 (0.82–1.11) 0.92 (0.79–1.07) 0.82 (0.69–0.97) 0.10 
    Multivariate model 2 1.00 0.84 (0.71–0.99) 1.03 (0.86–1.23) 1.01 (0.83–1.23) 0.91 (0.73–1.14) 0.83 
Heme iron       
    Median intake (mg/day) 0.59 0.84 1.02 1.22 1.55  
    Cases/person-years 216/65,859 265/63,533 290/67,652 349/65,284 438/64,548  
    Age, energy adjusted 1.00 1.29 (1.07–1.54) 1.33 (1.12–1.59) 1.67 (1.41–1.98) 2.17 (1.84–2.55) <0.0001 
    Multivariate model 1* 1.00 1.18 (0.98–1.42) 1.13 (0.95–1.36) 1.30 (1.09–1.55) 1.41 (1.19–1.67) <0.0001 
    Multivariate model 2 1.00 1.20 (1.00–1.45) 1.17 (0.97–1.41) 1.35 (1.12–1.63) 1.46 (1.20–1.78) <0.0001 
Total iron       
    Median intake (mg/day) 10.0 11.8 13.7 18.0 33.8  
    Cases/person-years 304/65,405 365/65,431 353/65,076 267/65,450 269/65,514  
    Age, energy adjusted 1.00 1.17 (1.00–1.36) 1.11 (0.95–1.30) 0.83 (0.70–0.98) 0.86 (0.73–1.02) 0.001 
    Multivariate model 1* 1.00 1.18 (1.01–1.38) 1.14 (0.97–1.34) 0.99 (0.83–1.17) 1.03 (0.87–1.22) 0.37 
    Multivariate model 2 1.00 1.24 (1.05–1.45) 1.23 (1.04–1.46) 1.09 (0.90–1.31) 1.13 (0.93–1.37) 0.94 
Quintile of intake
1 (lowest)2345 (highest)P for trend
Saturated fat       
    Median intake (g/day) 13.8 17.1 19.4 21.8 25.8  
    Cases/person-years 231/65,587 268/65,503 301/65,758 337/65,285 421/64,743  
    Age, energy adjusted 1.00 1.17 (0.98–1.39) 1.31 (1.10–1.55) 1.48 (1.26–1.76) 1.90 (1.62–2.23) <0.0001 
    Multivariate model 1* 1.00 0.96 (0.80–1.14) 1.04 (0.87–1.24) 1.01 (0.85–1.20) 1.10 (0.93–1.31) 0.14 
    Multivariate model 2 1.00 0.95 (0.76–1.18) 0.94 (0.73–1.21) 0.85 (0.64–1.13) 0.89 (0.66–1.21) 0.49 
Monounsaturated fat       
    Median intake (g/day) 15.1 18.9 21.4 24.0 27.9  
    Cases/person-years 242/65,355 242/65,631 305/65,635 343/65,275 426/64,980  
    Age, energy adjusted 1.00 0.99 (0.83–1.18) 1.25 (1.06–1.48) 1.41 (1.20–1.67) 1.79 (1.52–2.09) <0.0001 
    Multivariate model 1* 1.00 0.91 (0.76–1.09) 1.06 (0.89–1.26) 1.10 (0.93–1.30) 1.14 (0.97–1.35) 0.02 
    Multivariate model 2 1.00 1.01 (0.77–1.32) 1.11 (0.80–1.55) 1.17 (0.81–1.70) 1.27 (0.85–1.91) 0.20 
n-3 polyunsaturated fat§       
    Median intake (g/day) 0.95 1.17 1.34 1.54 1.88  
    Cases/person-years 283/66,108 299/63,856 301/66,863 322/63,488 353/66,562  
    Age, energy adjusted 1.00 1.08 (0.92–1.27) 1.03 (0.88–1.21) 1.16 (0.99–1.36) 1.21 (1.04–1.42) 0.009 
    Multivariate model 1* 1.00 1.08 (0.92–1.28) 1.04 (0.88–1.23) 1.11 (0.95–1.31) 1.09 (0.93–1.28) 0.28 
    Multivariate model 2 1.00 1.09 (0.92–1.29) 1.06 (0.89–1.25) 1.13 (0.96–1.34) 1.10 (0.93–1.30) 0.30 
n-6 polyunsaturated fat       
    Median intake (g/day) 7.35 9.12 10.5 12.0 14.5  
    Cases/person-years 260/64,953 302/65,430 315/65,293 331/65,409 350/65,791  
    Age, energy adjusted 1.00 1.14 (0.97–1.35) 1.19 (1.01–1.40) 1.24 (1.06–1.46) 1.31 (1.12–1.54) 0.001 
    Multivariate model 1* 1.00 1.06 (0.90–1.26) 1.12 (0.95–1.32) 1.09 (0.92–1.28) 1.03 (0.87–1.21) 0.90 
    Multivariate model 2 1.00 1.06 (0.89–1.26) 1.09 (0.91–1.31) 1.04 (0.86–1.25) 0.95 (0.78–1.16) 0.39 
trans fatty acid       
    Median intake (g/day) 1.12 1.64 2.09 2.65 3.66  
    Cases/person-years 226/65,788 294/64,637 306/65,305 347/66,054 385/65,093  
    Age, energy adjusted 1.00 1.34 (1.13–1.59) 1.38 (1.16–1.63) 1.54 (1.31–1.83) 1.76 (1.49–2.08) <0.001 
    Multivariate model 1* 1.00 1.21 (1.01–1.44) 1.13 (0.95–1.35) 1.15 (0.96–1.37) 1.14 (0.96–1.35) 0.47 
    Multivariate model 2 1.00 1.21 (1.00–1.46) 1.09 (0.89–1.33) 1.07 (0.87–1.32) 1.03 (0.83–1.28) 0.44 
Cholesterol       
    Median intake (mg/day) 147 188 219 253 309  
    Cases/person-years 219/65,594 258/65,688 303/65,546 333/65,315 445/64,733  
    Age, energy adjusted 1.00 1.19 (0.99–1.42) 1.39 (1.17–1.66) 1.54 (1.30–1.83) 2.13 (1.81–2.51) <0.0001 
    Multivariate model 1* 1.00 1.06 (0.89–1.28) 1.18 (0.99–1.41) 1.13 (0.95–1.34) 1.33 (1.12–1.57) 0.001 
    Multivariate model 2 1.00 1.09 (0.90–1.31) 1.21 (1.00–1.47) 1.15 (0.95–1.40) 1.35 (1.11–1.64) 0.003 
Animal fat       
    Median intake (g/day) 19.7 26.0 30.4 35.2 43.1  
    Cases/person-years 238/65,645 237/65,740 304/65,547 346/65,228 433/64,715  
    Age, energy adjusted 1.00 1.00 (0.84–1.20) 1.30 (1.10–1.54) 1.49 (1.27–1.76) 1.90 (1.62–2.23) <0.0001 
    Multivariate model 1* 1.00 0.93 (0.77–1.11) 1.03 (0.87–1.23) 1.08 (0.91–1.28) 1.17 (0.99–1.38) 0.01 
    Multivariate model 2 1.00 0.94 (0.78–1.15) 1.05 (0.86–1.29) 1.08 (0.87–1.34) 1.13 (0.90–1.43) 0.16 
Vegetable fat       
    Median intake (g/day) 16.9 22.0 25.9 30.2 37.3  
    Cases/person-years 286/64,927 294/65,311 326/65,460 317/65,535 335/65,644  
    Age, energy adjusted 1.00 1.01 (0.86–1.19) 1.12 (0.95–1.31) 1.08 (0.92–1.27) 1.14 (0.98–1.34) 0.07 
    Multivariate model 1* 1.00 0.97 (0.83–1.15) 1.10 (0.94–1.30) 1.04 (0.89–1.23) 0.94 (0.80–1.11) 0.59 
    Multivariate model 2 1.00 0.98 (0.82–1.16) 1.08 (0.90–1.28) 0.98 (0.81–1.18) 0.85 (0.70–1.03) 0.08 
Animal protein       
    Median intake (g/day) 39.8 50.5 57.8 65.3 77.3  
    Cases/person-years 233/65,541 290/65,512 306/65,415 352/65,274 377/65,133  
    Age, energy adjusted 1.00 1.25 (1.05–1.48) 1.33 (1.12–1.58) 1.55 (1.31–1.83) 1.70 (1.44–2.00) <0.0001 
    Multivariate model 1* 1.00 1.19 (1.00–1.42) 1.24 (1.04–1.48) 1.34 (1.13–1.59) 1.27 (1.08–1.51) 0.004 
    Multivariate model 2 1.00 1.24 (1.03–1.48) 1.33 (1.10–1.60) 1.48 (1.21–1.79) 1.44 (1.16–1.78) 0.001 
Vegetable protein       
    Median intake (g/day) 17.1 20.2 22.5 24.9 29.2  
    Cases/person-years 393/64,754 284/65,550 320/65,746 314/65,403 247/65,423  
    Age, energy adjusted 1.00 0.70 (0.60–0.82) 0.79 (0.68–0.92) 0.77 (0.66–0.89) 0.61 (0.52–0.71) <0.0001 
    Multivariate model 1* 1.00 0.80 (0.68–0.93) 0.95 (0.82–1.11) 0.92 (0.79–1.07) 0.82 (0.69–0.97) 0.10 
    Multivariate model 2 1.00 0.84 (0.71–0.99) 1.03 (0.86–1.23) 1.01 (0.83–1.23) 0.91 (0.73–1.14) 0.83 
Heme iron       
    Median intake (mg/day) 0.59 0.84 1.02 1.22 1.55  
    Cases/person-years 216/65,859 265/63,533 290/67,652 349/65,284 438/64,548  
    Age, energy adjusted 1.00 1.29 (1.07–1.54) 1.33 (1.12–1.59) 1.67 (1.41–1.98) 2.17 (1.84–2.55) <0.0001 
    Multivariate model 1* 1.00 1.18 (0.98–1.42) 1.13 (0.95–1.36) 1.30 (1.09–1.55) 1.41 (1.19–1.67) <0.0001 
    Multivariate model 2 1.00 1.20 (1.00–1.45) 1.17 (0.97–1.41) 1.35 (1.12–1.63) 1.46 (1.20–1.78) <0.0001 
Total iron       
    Median intake (mg/day) 10.0 11.8 13.7 18.0 33.8  
    Cases/person-years 304/65,405 365/65,431 353/65,076 267/65,450 269/65,514  
    Age, energy adjusted 1.00 1.17 (1.00–1.36) 1.11 (0.95–1.30) 0.83 (0.70–0.98) 0.86 (0.73–1.02) 0.001 
    Multivariate model 1* 1.00 1.18 (1.01–1.38) 1.14 (0.97–1.34) 0.99 (0.83–1.17) 1.03 (0.87–1.22) 0.37 
    Multivariate model 2 1.00 1.24 (1.05–1.45) 1.23 (1.04–1.46) 1.09 (0.90–1.31) 1.13 (0.93–1.37) 0.94 

Data are RR (95% CI).

*

Multivariate model 1: adjusted for age (continuous), BMI (continuous), total energy intake (quintiles), smoking (current, past, and never), exercise (rarely/never, <1 time/week, 1–3 times/week, and ≥4 times/week), alcohol use (rarely/never, 1–3 drinks/month, 1–6 drinks/week, and ≥1 drink/day), and family history of diabetes (yes/no).

Multivariate model 2: model 1 with additional adjustment for dietary intakes of fiber intake (quintiles), glycemic load (quintiles), magnesium (quintiles), and total fat (quintiles).

n-3 polyunsaturated fat included 18:3, 20:5, 22:5, and 22:6 while n-6 fat included 18:2 and 20:4 fatty acids.

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