title: Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries.
abstract: OBJECTIVE
  Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes (T2D) risk, but studies on foods high in fat per unit weight are sparse. We assessed whether the intake of vegetable oil, butter, margarine, nuts and seeds and cakes and cookies is related to incident T2D.
  
  
  METHODS
  A case-cohort study was conducted, nested within eight countries of the European Prospective Investigation into Cancer (EPIC), with 12,403 incident T2D cases and a subcohort of 16,835 people, identified from a cohort of 340,234 people. Diet was assessed at baseline (1991-1999) by country-specific questionnaires. Country-specific hazard ratios (HRs) across four categories of fatty foods (nonconsumers and tertiles among consumers) were combined with random-effects meta-analysis.
  
  
  RESULTS
  After adjustment not including body mass index (BMI), nonconsumers of butter, nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption. Among consumers, cakes and cookies were inversely related to T2D (HRs across increasing tertiles 1.14, 1.00 and 0.92, respectively; P-trend <0.0001). All these associations attenuated upon adjustment for BMI, except the higher risk of nonconsumers of cakes and cookies (HR 1.57). Higher consumption of margarine became positively associated after BMI adjustment (HRs across increasing consumption tertiles: 0.93, 1.00 and 1.12; P-trend 0.03). Within consumers, vegetable oil, butter and nuts and seeds were unrelated to T2D.
  
  
  CONCLUSIONS
  Fatty foods were generally not associated with T2D, apart from weak positive association for margarine. The higher risk among nonconsumers of cakes and cookies needs further explanation.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Buijsse
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Drogan
authors.affiliation: Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: M B
authors.initials: MB
authors.lastname: Schulze
authors.affiliation: Division of Human Nutrition-Section Nutrition and Epidemiology, University of Wageningen, Wageningen, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Feskens
authors.affiliation: 1] Public Health Division of Gipuzkoa, San Sebastian, Spain [2] Instituto BIO-Donostia, San Sebastian, Spain [3] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.
authors.forename: P
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authors.lastname: Amiano
authors.affiliation: 1] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain [2] Navarre Public Health Institute, Pamplona, Spain.
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authors.initials: A
authors.lastname: Barricarte
authors.affiliation: 1] INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France [2] Paris South University, Villejuif, France.
authors.forename: F
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: 1] INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France [2] Paris South University, Villejuif, France.
authors.forename: B
authors.initials: B
authors.lastname: de Lauzon-Guillain
authors.affiliation: 1] INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France [2] Paris South University, Villejuif, France.
authors.forename: G
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: Unit Nutrition, Environment and Cancer, Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Fonseca-Nunes
authors.affiliation: 1] Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Lund University, Malmö, Sweden [2] Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: P W
authors.initials: PW
authors.lastname: Franks
authors.affiliation: 1] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain [2] Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: M U
authors.initials: MU
authors.lastname: Jakobsen
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: K T
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Cancer Research and Prevention Institute, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Masala
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Moskal
authors.affiliation: Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: P M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: 1] Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark [2] Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Pala
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Panico
authors.affiliation: Consejería de Sanidad, Public Health Directorate, Oviedo-Asturias, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Redondo
authors.affiliation: Human Genetics Foundation, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ricceri
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Rolandsson
authors.affiliation: 1] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain [2] Andalusian School of Public Health, Instituto de Investigación Biosanitaria (IBS GRANADA) and Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Sluijs
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Spijkerman
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Tjonneland
authors.affiliation: 1] Histopathology Unit, 'Civic MP Arezzo' Hospital, ASP Ragusa, Italy [2] Associazone Iblea per la Ricerca Epidemiologica-Onlus, Ragusa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tumino
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: D L
authors.initials: DL
authors.lastname: van der A
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Y T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: C
authors.initials: C
authors.lastname: Langenberg
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Sharp
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: N G
authors.initials: NG
authors.lastname: Forouhi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Riboli
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: N J
authors.initials: NJ
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mesh_terms: D000328:Adult; D015992:Body Mass Index; D002079:Butter; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004032:Diet; D004041:Dietary Fats / Q000008:administration & dosage*; D002149:Energy Intake; D004734:Energy Metabolism; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008383:Margarine; D011939:Mental Recall; D015596:Nutrition Assessment; D009754:Nuts; D010938:Plant Oils; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D004041:Dietary Fats; D010938:Plant Oils; D002079:Butter; D008383:Margarine