Pre-diagnostic plasma enterolactone concentrations are associated with lower mortality among individuals with type 2 diabetes: a case-cohort study in the Danish Diet, Cancer and Health cohort

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  • Anne K Eriksen, Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark., Danmark
  • Cecilie Kyrø, Danish Cancer Society Research Center, Unit of Diet, Genes and Environment, Strandboulevarden 49, Copenhagen DK-2100, Denmark., Danmark
  • Natalja P Nørskov
  • Kirsten Frederiksen, Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark., Danmark
  • Knud-Erik Bach Knudsen
  • Kim Overvad
  • Rikard Landberg, Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden., Sverige
  • Anne Tjønneland, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Danmark
  • Anja Olsen

AIMS/HYPOTHESIS: The phytoestrogen enterolactone is a gut microbiota-derived metabolite of plant lignans with suggested beneficial properties for health. In the current study, we investigated the association between pre-diagnostic plasma enterolactone concentrations and mortality among individuals diagnosed with type 2 diabetes.

METHODS: In a population of people diagnosed with diabetes, nested within the Danish Diet, Cancer and Health cohort, we conducted a case-cohort study including a random sample of n = 450 cases (deceased) and a randomly selected subcohort of n = 850 (in total n = 617 deaths). Information on diagnosis, vital status and cause of death was obtained from Danish registers. Cox proportional hazard models with special weighting were applied to assess all-cause and cause-specific mortality.

RESULTS: The median enterolactone concentration of the current population was low, 10.9 nmol/l (5th percentile to 95th percentile: 1.3-59.6), compared with previously reported concentrations from the Diet, Cancer and Health cohort. Pre-diagnostic enterolactone concentrations were associated with lower all-cause mortality when assessed linearly per doubling in concentration (log2) (HR 0.91 [95% CI 0.85, 0.96]) and according to quartiles (HR 0.63 [95% CI 0.48, 0.84]) for the highest quartile of enterolactone compared with the lowest quartile. For cause-specific mortality, only death from diabetes (registered as underlying cause of death) reached statistical significance.

CONCLUSIONS/INTERPRETATION: Based on this large cohort of people with diabetes with detailed and complete baseline and follow-up information, pre-diagnostic enterolactone concentrations were inversely associated with mortality. To our knowledge, this is the first study on enterolactone and type 2 diabetes mortality. Our findings call for further exploration of enterolactone in type 2 diabetes management.

Sider (fra-til)959-969
Antal sider11
StatusUdgivet - jun. 2019

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