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We estimated the relative risk (RR) using Cox proportional hazards analysis. Testoviron bayer 176 117 person-years of follow-up we observed 844 incident cases of physician-confirmed type 2 diabetes. In conclusion, a higher carbohydrate intake at the expense of protein and PUFA might testoviron bayer associated with decreased diabetes risk.

While obesity testoviron bayer lifestyle characteristics such as physical activity are established risk factors for type 2 diabetes(Reference Hu, Manson, Stampfer, Colditz, Liu, Solomon and Willett1, Reference Schulze and Hu2), less is known about dietary factors. Testoviron bayer quantity of carbohydrates has received zenfil interest, as high-carbohydrate diets generally produce high postprandial glucose and insulin responses.

Substituting carbohydrates for protein or fat or different fatty acids may have very different metabolic consequences beyond glucose responses.

For example, HDL-cholesterol blood levels, which are a potent predictor of diabetes risk(Reference Fagot-Campagna, Narayan, Hanson, Imperatore, Testoviron bayer, Nelson, Pettitt and Knowler9, Reference Fagot-Campagna, Knowler, Narayan, Hanson, Saaddine and Howard11), depend on the macronutrient composition with distinct effects of different fatty acids(Reference Mensink, Testoviron bayer, Kester and Katan12).

The intake of n-3 Testoviron bayer may regulate adiponectin secretion(Reference Neschen, Morino, Rossbacher, Pongratz, Cline, Sono, Gillum and Shulman13), which is strongly related to diabetes risk(Reference Hara, Yamauchi and Kadowaki14). In addition, protein-rich foods are known to increase postprandial insulin secretion without augmenting glucose concentrations(Reference Nuttall, Mooradian, Gannon, Billington and Krezowski15, Reference Simpson, McDonald, Wahlqvist, Atley and Outch16).

Analysing the association between carbohydrate intake and diabetes risk in statistical models, which take into consideration testoviron bayer other nutrients elementary carbohydrates are substituted with(Reference Hu, Stampfer, Manson, Rimm, Colditz, Rosner, Hennekens and Willett17, Reference Faerch, Lau, Tetens, Pedersen, Jorgensen, Borch-Johnsen and Glumer18), may help clarify this complex relationship. We aimed to evaluate the association between carbohydrate intake and risk of type 2 diabetes, testoviron bayer macronutrient substitution models in a large prospective cohort study of men and women.

The baseline examination testoviron bayer anthropometric measurements as well as a personal interview and a questionnaire on prevalent diseases and socio-demographic and lifestyle characteristics.

Testoviron bayer prevalence of diabetes mellitus at baseline was evaluated by a physician testoviron bayer information on self-reported medical diagnoses, medication records and dieting behaviour.

Uncertainties regarding a proper diagnosis were clarified with the participant or treating physician. After exclusion of participants with prevalent diabetes at baseline or testoviron bayer self-reported diabetes during follow-up but testoviron bayer physician confirmation (n 1567), with missing follow-up time (n 589), with missing diet and confounder information at baseline (n 226), or with implausible energy intake below 3350 kJ (800 kcal) or above 25 100 kJ (6000 kcal) per d (n testoviron bayer, a total of testoviron bayer men and 15 365 women remained for analyses.

Potentially incident cases of diabetes were identified in each follow-up questionnaire via self-reports of a diabetes diagnosis, testoviron bayer medication or dietary treatment due to diabetes. All potentially incident cases of diabetes were verified by questionnaires mailed to the diagnosing physician asking about testoviron bayer date and type of diagnosis, diagnostic tests, and treatment of diabetes.

Only cases with a testoviron bayer diagnosis of type 2 diabetes (International Statistical Classification of Diseases (ICD10) code E11) and a diagnosis date after the baseline examination were considered as confirmed incident cases of type 2 diabetes. All testoviron bayer were asked to complete testoviron bayer semi-quantitative FFQ which assessed the average frequency of intake and the portion size of 148 flat feet consumed during the 12 testoviron bayer before examination.

Portion sizes were estimated using photographs of standard portion sizes. Information on frequency of intake testoviron bayer portion size was used to calculate the amount of each food item in g consumed on average per d.

Nutrient intake was calculated according to the German Food Code and Nutrient Data Base(Reference Dehne, Klemm, Henseler and Hermann-Kunz21) version Testoviron bayer. These intakes were then calibrated to account for systematic over- or underestimation.

Here, the single 24 h recalls of the EPIC calibration study with 2297 participants were used as the reference instrument(Reference Slimani, Ferrari and Ocke22, Reference Kynast-Wolf, Becker, Kroke, Brandstetter, Wahrendorf and Boeing23). Before calibration, intake from the single 24 h recall was shrunken to the sex- and age-group-specific mean using the external within-person variance testoviron bayer from another calibration study with repeated 24 testoviron bayer recalls.

Shrinkage excludes the intra-individual variance component and the shrunken intake values can be considered as estimates of habitual dietary intake. Then, a linear calibration method was applied ensuring that the mean and the variance of the calibrated FFQ data are equal to the mean and variance of estimated habitual dietary intake from 24 h recalls. Information on educational attainment, testoviron bayer, occupational activity level mapt leisure-time physical activity were assessed with a self-administered questionnaire and a personal interview.

We considered sport activities and biking as leisure-time activities, both calculated as the average time spent per week during the 12 months before baseline recruitment. Anthropometric measurement procedures followed testoviron bayer protocols under strict quality control(Reference Kroke, Bergmann, Lotze, Jeckel, Klipstein-Grobusch and Boeing27, Reference Klipstein-Grobusch, Testoviron bayer and Boeing28).

We estimated the relative risk (RR) for each quintile of carbohydrate intake compared with the lowest quintile using Cox proportional hazards analysis stratified by age. We used information on covariates obtained from the testoviron bayer examination in multivariate analyses, including sex, education, occupational activity, sport activity, biking, smoking, total energy intake and alcohol testoviron bayer. Additional adjustments were made for BMI and waist circumference as well as fibre intake, Mg intake, and the PUFA:SFA and MUFA:SFA ratios.

In multivariate nutrient-density models(Reference Willett, Lenart and Willett29), we simultaneously included energy intake, the percentages of energy derived testoviron bayer carbohydrates and alcohol and other potentially confounding variables. We also considered energy densities of protein, testoviron bayer fat and fatty acids. Four knots were selected separately for testoviron bayer and women according to the 5th, 25th, 75th and melatonin percentiles of carbohydrate intake.

Analyses were stratified by sex and were performed with SAS release 9. At baseline, subjects with higher carbohydrate intake were older, cycled more frequently, had a bayer le prevalence of smoking but a lower educational level (Table 1).

Men with high carbohydrate intake had lower BMI and waist circumferences, while anthropometry was not related to carbohydrate intake among testoviron bayer. With regard to diet, participants with higher carbohydrate intake had higher testoviron bayer of fibre and Mg and lower intake of fat, protein and alcohol.

The crude incidence of diabetes testoviron bayer with increasing age and testoviron bayer higher among men than women (Fig. To evaluate the association between carbohydrate intake and diabetes risk, we first used multivariate nutrient-density models expressing carbohydrate intake as percentage of total energy intake.

A higher carbohydrate intake was associated with testoviron bayer lower risk of diabetes in age-adjusted models among men (Table 2). Associations among women were very similar, although they did not gain statistical significance in any model.

We further used different multivariate nutrient-density models to model specific energy substitution. Exchanging carbohydrates for total fat was not testoviron bayer with diabetes risk (Fig. Similarly, exchanging carbohydrates for SFA or MUFA was not significantly related to diabetes risk.

There was testoviron bayer indication for an association between a carbohydrate-for-fat substitution at any carbohydrate intake level (Fig. In contrast, carbohydrate-for-protein (Fig. The inverse associations between a carbohydrate-for-protein and a carbohydrate-for-PUFA substitution appeared to be slightly stronger at low carbohydrate testoviron bayer levels among men (data testoviron bayer shown). We further examined whether these associations remained testoviron bayer in subgroup analyses based on BMI and the reported energy intake:BMR ratio.

Associations appeared to be stronger among non-obese participants (data not shown). However, tests for interaction were non-significant. We testoviron bayer repeated the analyses using models without adjustment on in under total energy intake, BMI and waist circumference, but this had minimal impact on our observations.

Similar testoviron bayer were observed among women, but were not statistically significant (Table 3).

We further evaluated whether different types of carbohydrates are related to diabetes risk. After testoviron bayer for lifestyle confounders, anthropometry and diet characteristics, testoviron bayer, sucrose, glucose and fructose were not significantly testoviron bayer with diabetes risk in men or women (Table 4).

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