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@ARTICLE{Sobiecki:275648,
      author       = {J. G. Sobiecki and F. Imamura and C. R. Davis and S. J.
                      Sharp and A. Koulman and J. M. Hodgson and M. Guevara and M.
                      B. Schulze and J.-S. Zheng and C. Agnoli and C. Bonet and S.
                      M. Colorado-Yohar and G. Fagherazzi and P. W. Franks and T.
                      E. Gundersen and F. Jannasch and R. Kaaks$^*$ and V.
                      Katzke$^*$ and E. Molina-Montes and P. M. Nilsson and D.
                      Palli and S. Panico and K. Papier and O. Rolandsson and C.
                      Sacerdote and A. Tjønneland and T. Y. N. Tong and Y. T. van
                      der Schouw and J. Danesh and A. S. Butterworth and E. Riboli
                      and K. J. Murphy and N. J. Wareham and N. G. Forouhi},
      title        = {{A} nutritional biomarker score of the {M}editerranean diet
                      and incident type 2 diabetes: {I}ntegrated analysis of data
                      from the {M}ed{L}ey randomised controlled trial and the
                      {EPIC}-{I}nter{A}ct case-cohort study.},
      journal      = {PLoS medicine},
      volume       = {20},
      number       = {4},
      issn         = {1549-1277},
      address      = {Lawrence, Kan.},
      publisher    = {PLoS},
      reportid     = {DKFZ-2023-00836},
      pages        = {e1004221 -},
      year         = {2023},
      abstract     = {Self-reported adherence to the Mediterranean diet has been
                      modestly inversely associated with incidence of type 2
                      diabetes (T2D) in cohort studies. There is uncertainty about
                      the validity and magnitude of this association due to
                      subjective reporting of diet. The association has not been
                      evaluated using an objectively measured biomarker of the
                      Mediterranean diet.We derived a biomarker score based on 5
                      circulating carotenoids and 24 fatty acids that
                      discriminated between the Mediterranean or habitual diet
                      arms of a parallel design, 6-month partial-feeding
                      randomised controlled trial (RCT) conducted between 2013 and
                      2014, the MedLey trial (128 participants out of 166
                      randomised). We applied this biomarker score in an
                      observational study, the European Prospective Investigation
                      into Cancer and Nutrition (EPIC)-InterAct case-cohort study,
                      to assess the association of the score with T2D incidence
                      over an average of 9.7 years of follow-up since the baseline
                      (1991 to 1998). We included 22,202 participants, of whom
                      9,453 were T2D cases, with relevant biomarkers from an
                      original case-cohort of 27,779 participants sampled from a
                      cohort of 340,234 people. As a secondary measure of the
                      Mediterranean diet, we used a score estimated from
                      dietary-self report. Within the trial, the biomarker score
                      discriminated well between the 2 arms; the cross-validated
                      C-statistic was 0.88 $(95\%$ confidence interval (CI) 0.82
                      to 0.94). The score was inversely associated with incident
                      T2D in EPIC-InterAct: the hazard ratio (HR) per standard
                      deviation of the score was 0.71 $(95\%$ CI: 0.65 to 0.77)
                      following adjustment for sociodemographic, lifestyle and
                      medical factors, and adiposity. In comparison, the HR per
                      standard deviation of the self-reported Mediterranean diet
                      was 0.90 $(95\%$ CI: 0.86 to 0.95). Assuming the score was
                      causally associated with T2D, higher adherence to the
                      Mediterranean diet in Western European adults by 10
                      percentiles of the score was estimated to reduce the
                      incidence of T2D by $11\%$ $(95\%$ CI: $7\%$ to $14\%).$ The
                      study limitations included potential measurement error in
                      nutritional biomarkers, unclear specificity of the biomarker
                      score to the Mediterranean diet, and possible residual
                      confounding.These findings suggest that objectively assessed
                      adherence to the Mediterranean diet is associated with lower
                      risk of T2D and that even modestly higher adherence may have
                      the potential to reduce the population burden of T2D
                      meaningfully.Australian New Zealand Clinical Trials Registry
                      (ANZCTR) ACTRN12613000602729
                      https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363860.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37104291},
      doi          = {10.1371/journal.pmed.1004221},
      url          = {https://inrepo02.dkfz.de/record/275648},
}