title: Biomarker-calibrated dietary energy and protein intake associations with diabetes risk among postmenopausal women from the Women's Health Initiative.
abstract: BACKGROUND
  Self-report of dietary energy and protein intakes has been shown to be systematically and differentially underreported.
  
  
  OBJECTIVE
  We assessed and compared the association of diabetes among postmenopausal women with biomarker-calibrated and uncalibrated dietary energy and protein intakes from food-frequency questionnaires (FFQs).
  
  
  METHODS
  The analyses were performed for 74,155 participants of various race-ethnicities from the Women's Health Initiative. Uncalibrated and calibrated energy and protein intakes from FFQs were assessed for associations with incident diabetes by using HR estimates based on Cox regression.
  
  
  RESULTS
  A 20% increment in uncalibrated energy consumption was associated with increased diabetes risk (HR) of 1.03 (95% CI: 1.01, 1.05), 2.41 (95% CI: 2.06, 2.82) with biomarker calibration, and 1.30 (95% CI: 0.96, 1.76) after adjustment for BMI. A 20% increment in uncalibrated protein (g/d) resulted in an HR of 1.05 (95% CI: 1.03, 1.07), 1.82 (95% CI: 1.56, 2.12) with calibration, and 1.16 (95% CI: 1.05, 1.28) with adjustment for BMI. A 20% increment in uncalibrated protein density (% of energy from protein) resulted in an HR of 1.13 (95% CI: 1.09, 1.17), 1.01 (95% CI: 0.75, 1.37) with calibration, and 1.19 (95% CI: 1.07, 1.32) with adjustment for BMI.
  
  
  CONCLUSIONS
  Higher protein and total energy intakes (calibrated) appear to be associated with a substantially increased diabetes risk that may be mediated by an increase in body mass over time. Diet-disease associations without correction of self-reported measurement error should be viewed with caution. This trial is registered at clinicaltrials.gov as NCT00000611.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. ltinker@whi.org
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Tinker
authors.forename: Gloria E
authors.initials: GE
authors.lastname: Sarto
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Mossavar-Rahmani
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Beasley
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.forename: Ross L
authors.initials: RL
authors.lastname: Prentice
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015992:Body Mass Index; D002138:Calibration; D003920:Diabetes Mellitus / Q000209:etiology*; D004034:Diet Surveys; D004044:Dietary Proteins / Q000009:adverse effects*; D002149:Energy Intake; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D004044:Dietary Proteins
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