Biomarker-Calibrated Total Sugars Intake and Risk of Type 2 Diabetes and Cardiovascular Disease in the Women's Health Initiative Observational Study

Abstract

The inconsistent findings from epidemiologic studies relating total sugars (TS) consumption to cardiovascular disease (CVD) or type 2 diabetes (T2D) risk may be partly due to measurement error (ME) in self-reported intake. Using regression calibration equations developed based on the predictive biomarker for TS and recovery biomarker for energy, we examined the association of TS with T2D and CVD risk, before and after dietary calibration, in 82,254 postmenopausal women of the Women's Health Initiative-Observational Study. After up to 16 years of follow-up (1993–2010), 6,621 T2D and 5,802 CVD incident cases were identified. The hazard ratio (HR) for T2D per 20% increase in calibrated TS was 0.94 (95% CI: 0.77, 1.15) in multivariable energy substitution (ES), and 1.00 (0.85, 1.18) in energy partition (EP) models. Multivariable HRs for total CVD were 0.97 (0.87, 1.09) from ES, and 0.91 (0.80, 1.04) from EP models. Uncalibrated TS generated a statistically significant inverse association with T2D and total CVD risk in both multivariable ES and EP models. The lack of conclusive findings from our calibrated analyses may be due to the low explanatory power of the calibration equations for TS, which could have led to incomplete deattenuation of the risk estimates.