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dc.contributor.authorPatel, Pinal Sen
dc.contributor.authorCooper, Andrewen
dc.contributor.authorO’Connell, Tamsin Cen
dc.contributor.authorKuhnle, Gunter GCen
dc.contributor.authorKneale, Catherine Ken
dc.contributor.authorMulligan, Angelaen
dc.contributor.authorLuben, Roberten
dc.contributor.authorBrage, Sorenen
dc.contributor.authorKhaw, Kay-Teeen
dc.contributor.authorWareham, Nicholasen
dc.contributor.authorForouhi, Nitaen
dc.identifier.citationPinal S Patel, Andrew JM Cooper, Tamsin C O'Connell, Gunter GC Kuhnle, Catherine K Kneale, Angela M Mulligan, Robert N Luben, Soren Brage, Kay-Tee Khaw, Nicholas J Wareham, and Nita G Forouhi "Serum carbon and nitrogen stable isotopes as potential biomarkers of dietary intake and their relation with incident type 2 diabetes: the EPIC-Norfolk study" Am J Clin Nutr 2014 ajcn.068577; First published online July 2, 2014. doi:10.3945/ajcn.113.068577en
dc.description.abstractBackground - Stable-isotope ratios of carbon (13C/12C, expressed as δ13C) and nitrogen (15N/14N, or δ15N) have been proposed as potential nutritional biomarkers to distinguish between meat, fish, and plant-based foods. Objective - The objective was to investigate dietary correlates of δ13C and δ15N and examine the association of these biomarkers with incident type 2 diabetes in a prospective study. Design - Serum δ13C and δ15N (‰) were measured by using isotope ratio mass spectrometry in a case-cohort study (n = 476 diabetes cases; n = 718 subcohort) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)–Norfolk population-based cohort. We examined dietary (food-frequency questionnaire) correlates of δ13C and δ15N in the subcohort. HRs and 95% CIs were estimated by using Prentice-weighted Cox regression. Results - Mean (±SD) δ13C and δ15N were −22.8 ± 0.4‰ and 10.2 ± 0.4‰, respectively, and δ13C (r = 0.22) and δ15N (r = 0.20) were positively correlated (P < 0.001) with fish protein intake. Animal protein was not correlated with δ13C but was significantly correlated with δ15N (dairy protein: r = 0.11; meat protein: r = 0.09; terrestrial animal protein: r = 0.12, P ≤ 0.013). δ13C was inversely associated with diabetes in adjusted analyses (HR per tertile: 0.74; 95% CI: 0.65, 0.83; P-trend < 0.001], whereas δ15N was positively associated (HR: 1.23; 95% CI: 1.09, 1.38; P-trend = 0.001). Conclusions - The isotope ratios δ13C and δ15N may both serve as potential biomarkers of fish protein intake, whereas only δ15N may reflect broader animal-source protein intake in a European population. The inverse association of δ13C but a positive association of δ15N with incident diabetes should be interpreted in the light of knowledge of dietary intake and may assist in identifying dietary components that are associated with health risks and benefits.
dc.description.sponsorshipThe EPIC-Norfolk study is supported by program grants from the Medical Research Council UK and Cancer Research UK. MRC Epidemiology Unit core support is acknowledged (MC_UU_12015/1 and MC_UU_12015/5). TCO and CKK were supported by the Wellcome Trust (grant no. 074229/Z/04/Z).
dc.publisherAmerican Society for Nutrition
dc.rightsAttribution 2.0 UK: England & Wales*
dc.rightsCreative Commons Attribution License 2.0 UK
dc.titleSerum carbon and nitrogen stable isotopes as potential biomarkers of dietary intake and their relation with incident type 2 diabetes: the EPIC-Norfolk studyen
dc.description.versionThis version is the published accepted manuscript, distributed under a Creative Commons Attribution License 2.0. It can also be found on the publisher's website at:
prism.publicationNameThe American Journal of Clinical Nutritionen
dc.contributor.orcidMulligan, Angela [0000-0001-5546-971X]
dc.contributor.orcidLuben, Robert [0000-0002-5088-6343]
dc.contributor.orcidBrage, Soren [0000-0002-1265-7355]
dc.contributor.orcidKhaw, Kay-Tee [0000-0002-8802-2903]
dc.contributor.orcidWareham, Nicholas [0000-0003-1422-2993]
dc.contributor.orcidForouhi, Nita [0000-0002-5041-248X]
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMRC (G1000143)
pubs.funder-project-idMRC (MC_UU_12015/1)
pubs.funder-project-idMRC (MC_UU_12015/3)
pubs.funder-project-idMRC (MC_UU_12015/5)
pubs.funder-project-idWellcome Trust (074229/Z/04/Z)
pubs.funder-project-idMRC (G0801534)
pubs.funder-project-idMRC (G0401527)
pubs.funder-project-idMedical Research Council (MC_U106179471)

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Attribution 2.0 UK: England & Wales
Except where otherwise noted, this item's licence is described as Attribution 2.0 UK: England & Wales