Associations of serum calcium levels and dietary calcium intake with incident type 2 diabetes over 10 years: the Korean Genome and Epidemiology Study (KoGES)

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Abstract

Background

Previous evidence regarding the associations between serum calcium concentrations, dietary calcium intake, and type 2 diabetes (T2D) is limited. We investigated the longitudinal associations of serum calcium levels and dietary calcium intake with T2D development.

Methods

This study used data from the Ansung–Ansan cohort, a community-based, prospective cohort that was followed up for 10 years. Cox regression models adjusted for potential confounders were used to evaluate the associations of serum calcium levels (mean, 9.41 mg/dL) and dietary calcium intake (median, 389.59 mg/day) with T2D incidence. Association between dietary calcium intake and serum calcium levels was assessed using linear regression models.

Results

Albumin-adjusted serum calcium levels were not associated with T2D risk (hazard ratio [HR] = 1.07, 95% confidence interval [CI] 0.96, 1.19, p-value = 0.2333). A one-unit increase in log-transformed, energy-adjusted dietary calcium intake was associated with a decreased risk of T2D (HR = 0.88, 95% CI 0.77, 1.00, p-value = 0.0460) and lower albumin-adjusted serum calcium levels ( β = − 0.04, 95% CI − 0.07, − 0.02, p-value = 0.0014). The associations did not differ according to sex (all p-values for interaction > 0.10).

Conclusions

Serum calcium levels were not associated with T2D risk, while higher dietary calcium intake was associated with a decreased risk of T2D development. These results have public health implications for predicting and preventing T2D development, as well as providing guidelines for diet and calcium supplementation.

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Most cited references 26

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Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements.

F Hu, M Stampfer, E Rimm … (1999)

Previous cohort studies of fat intake and risk of coronary heart disease (CHD) have been inconsistent, probably due in part to methodological differences and various limitations, including inadequate dietary assessment and incomplete adjustment for total energy intake. The authors analyzed repeated assessment of diet from the Nurses' Health Study to examine the associations between intakes of four major types of fat (saturated, monounsaturated, polyunsaturated, and trans fats) and risk of CHD during 14 years of follow-up (1980-1994) by using alternative methods for energy adjustment. In particular, the authors compared four risk models for energy adjustment: the standard multivariate model, the energy-partition model, the nutrient residual model, and the multivariate nutrient density model. Within each model, the authors compared four different approaches for analyzing repeated dietary measurements: baseline diet only, the most recent diet, and two different algorithms for calculating cumulative average diets. The substantive results were consistent across all models; that is, higher intakes of saturated and trans fats were associated with increased risk of CHD, while higher intakes of monounsaturated and polyunsaturated fats were associated with reduced risk. When nutrients were considered as continuous variables, the four energy-adjustment methods yielded similar associationS. However, the interpretation of the relative risks differed across models. In addition, within each model, the methods using the cumulative averages in general yielded stronger associations than did those using either only baseline diet or the most recent diet. When the nutrients were categorized according to quintiles, the residual and the nutrient density models, which gave similar results, yielded statistically more significant tests for linear trend than did the standard and the partition models.

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National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants.

Goodarz Danaei, Mariel Finucane, Yuan Yuan Lu … (2011)

Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories. We obtained data from health examination surveys and epidemiological studies (370 country-years and 2·7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative. In 2008, global age-standardised mean FPG was 5·50 mmol/L (95% uncertainty interval 5·37-5·63) for men and 5·42 mmol/L (5·29-5·54) for women, having risen by 0·07 mmol/L and 0·09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9·8% (8·6-11·2) in men and 9·2% (8·0-10·5) in women in 2008, up from 8·3% (6·5-10·4) and 7·5% (5·8-9·6) in 1980. The number of people with diabetes increased from 153 (127-182) million in 1980, to 347 (314-382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6·09 mmol/L, 5·73-6·49 for men; 6·08 mmol/L, 5·72-6·46 for women) and diabetes prevalence (15·5%, 11·6-20·1 for men; and 15·9%, 12·1-20·5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0·07 mmol/L per decade for men and 0·03 mmol/L per decade for women; North America had the largest rise, 0·18 mmol/L per decade for men and 0·14 mmol/L per decade for women. Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae. Bill & Melinda Gates Foundation and WHO. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study.

K L Kimm-Brinson, Y G Joo, Han Park … (2007)

To evaluate validity and reliability of the food-frequency questionnaire (FFQ) developed for the Korean Genome Epidemiologic Study (KoGES). FFQ was administered twice at 1-year interval (first FFQ (FFQ1) at the beginning and second FFQ (FFQ2) at the end of the study) and diet records (DRs) were collected for 3 days during each of the four seasons from December 2002 to May 2004 for those who attended the health examination center. At the end of the study period, we collected the 12-day DRs of 124 participants. The nutrient intakes from the DRs were compared with both FFQ1 and FFQ2. The intakes of energy and some nutrients estimated from FFQ1 and FFQ2 were different from those assessed by the DRs. Especially, the consumption of carbohydrates was higher in FFQ1 and FFQ2 than in the DRs. The de-attenuated, age, sex and energy intake adjusted correlation coefficients between the FFQ2 and the 12-day DRs in Korean population ranged between 0.23 (Vitamin A) and 0.64 (carbohydrate). The median for all nutrients was 0.39. The correlations were similar when we compared nutrient densities of both methods. Joint classification of calorie-adjusted nutrient intakes assessed by FFQ2 and 12-day DRs by quartile ranged from 25.8% (vitamin A) to 39.5% (carbohydrate, iron) for exact concordance. Except vitamin A, the proportion of subjects classified into distant quartile was less than 7% in all nutrients. The median of correlations between the two FFQs 1 year apart were 0.45 for all nutrient intakes and 0.39 for nutrient densities. We conclude that the FFQ we have developed appears to be an acceptable tool for assessing the nutrient intakes in this population. Further studies for calibration of the FFQ collected from multicenters participating in the KoGES are needed. This study was supported by the budget of the National Genome Research Institute, Korea National Institute of Health (2002-347-6111-221).

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Author and article information

Contributors

Kyoung-Nam Kim: kkn002@snu.ac.kr

Se-Young Oh: seyoung@khu.ac.kr

Yun-Chul Hong: +82-2-740-8394 , ychong1@snu.ac.kr

Journal

Journal ID (nlm-ta): Diabetol Metab Syndr

Journal ID (iso-abbrev): Diabetol Metab Syndr

Title: Diabetology & Metabolic Syndrome

Publisher: BioMed Central (London )

ISSN (Electronic): 1758-5996

Publication date (Electronic): 19 June 2018

Publication date PMC-release: 19 June 2018

Publication date Collection: 2018

Volume: 10

Electronic Location Identifier: 50

Affiliations

[1 ]ISNI 0000 0001 0302 820X, GRID grid.412484.f, Division of Public Health and Preventive Medicine, , Seoul National University Hospital, ; 101 Daehak-Ro Jongno-Gu, Seoul, Republic of Korea

[2 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Department of Preventive Medicine, , Seoul National University College of Medicine, ; 28 Yongon-Dong, Chongno-Gu, Seoul, 110-799 Republic of Korea

[3 ]ISNI 0000 0001 2171 7818, GRID grid.289247.2, Department of Food and Nutrition, Research Center for Human Ecology, College of Human Ecology, , Kyung Hee University, ; 26 Kyungheedae-Ro Dongdaemun-Gu, Seoul, Republic of Korea

[4 ]ISNI 0000 0001 0302 820X, GRID grid.412484.f, Institute of Environmental Medicine, , Seoul National University Medical Research Center, ; 103 Daehak-Ro Jongno-Gu, Seoul, Republic of Korea

[5 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Environmental Health Center, , Seoul National University College of Medicine, ; 103 Daehak-Ro Jongno-Gu, Seoul, Republic of Korea

Article

Publisher ID: 349

DOI: 10.1186/s13098-018-0349-y

PMC ID: 6006916

PubMed ID: 29946367

SO-VID: f47ad90b-ecb0-4a1b-96c6-ec51eb911e4d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 April 2018

Date accepted : 2 June 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003725, National Research Foundation of Korea;

Award ID: 2014M3C8A5030619

Award Recipient : Yun-Chul Hong

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: cohort study,dietary calcium,serum calcium,type 2 diabetes mellitus

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: cohort study, dietary calcium, serum calcium, type 2 diabetes mellitus

Associations of serum calcium levels and dietary calcium intake with incident type 2 diabetes over 10 years: the Korean Genome and Epidemiology Study (KoGES)

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Abstract

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Conclusions

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Karger: Nutrition and Dietetics

Most cited references 26

Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements.

National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants.

Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study.

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