Plasma levels of insulin-like growth factor I (IGF-I) have been associated with risk of several cancers. Although protein-calorie malnutrition is known to decrease IGF-I levels, few published studies have related diet to IGF-I levels in well-nourished humans. We examined the cross-sectional association of plasma IGF-I and IGF-binding protein 3 (IGFBP-3) levels with intakes of alcohol, energy, macronutrients, micronutrients, and specific foods in 1037 healthy women. Adjusted mean hormone levels across categories of dietary variables were calculated by linear regression. Results were adjusted for non-dietary factors found to be associated with IGF levels. Total energy intake was positively associated with IGF-I levels when adjusted for covariates. Adjusted mean levels of IGF-I (ng/ml) across increasing quintiles of energy intake were 181, 185, 191, 199, and 195 (P for the linear trend = 0.006). In other multivariate analyses, energy-adjusted fat and carbohydrate intake had no association with IGF-I levels. The most consistent finding was a positive association between protein intake with circulating IGF-I concentration (174, 188, 201, 192, and 196 ng/ml across quintiles of protein intake; P = 0.002), which was largely attributable to milk intake. Adjusted mean levels of IGF-I (ng/ml) across increasing quartiles of milk intake were 183, 189, 188, and 200 (P = 0.01). Higher fat intake, in particular saturated fat, was associated with lower levels of IGFBP-3. We conclude that higher energy, protein, and milk intakes were associated with higher levels of IGF-I. These associations raise the possibility that diet could affect cancer risk through influencing IGF-I level.

IGFs3 are important in the growth and function of many organs (1). Circulating IGF-I concentration is a complex trait influenced by both genetic and nongenetic factors, but these have not yet been characterized in detail (2). There is considerable interindividual variation in plasma levels of the peptide hormone IGF-I, and differences in circulating IGF-I levels have been associated with risk of diseases. There is some evidence that higher plasma levels of IGF-I are associated with lower risk of osteoporosis (3) and heart disease (4). Several studies provide evidence that higher circulating levels of IGF-I and/or lower levels of the principal IGF binding protein, IGFBP-3, are associated with increased risk of prostate cancer (5, 6, 7), colon cancer (8, 9, 10, 11), lung cancer (12), and premenopausal breast cancer (13, 14, 15). Several of these studies provide prospective evidence for cancer risk (5, 7, 8, 9, 13, 15). The biological plausibility of the IGF-cancer link has been reviewed recently (16).

It is well established that protein-calorie malnutrition lowers IGF levels (17); however, little is known about how diet affects IGF levels in well-nourished humans. One study reported that IGF-I levels were positively associated with intake of red meat and total fat and inversely associated with intake of carbohydrates (18). In other studies, positive associations have been seen between IGF-I levels and alcohol (19) and zinc (20).

Knowledge of dietary factors associated with IGF levels may elucidate disease mechanisms and offer methods of disease prevention. In the present study, we examined the cross-sectional association of IGF-I and IGFBP-3 levels with intakes of various dietary factors in 1037 healthy women enrolled in the NHS. In another report, we address the association of IGFs with age, BMI, smoking, physical activity, and reproductive and menopausal factors (21).

The methods for the collection of blood samples and laboratory assays are described in detail elsewhere (13, 21). Briefly, the study participants were women in the NHS from whom blood samples were collected in 1989 or 1990. Participants were 43–69 years of age at the time. Samples used in this analysis were frozen and stored and later assayed in two batches in 1996 and 1998. This study was approved by the Institutional Review Board of the Brigham and Women’s Hospital. IGF-I and IGFBP-3 were assayed by ELISA with reagents from Diagnostic Systems Laboratory (Webster, TX). Details of the assays for IGF-I and IGFBP-3 levels have been reported previously (13, 21).

Women included in this analysis were controls in a nested case-control study of plasma hormone levels and breast cancer risk (13). In addition, 49 women who had reported very low fat intake (<25 and <19% of energy on the 1986 and 1990 FFQs, respectively) were added to increase the range of fat intake. These cutpoints were chosen to maximize the number of women with low fat intakes on both questionnaires, and all women meeting these criteria were included in this analysis. Because fat intake decreased in the entire cohort over time, we were able to use a more stringent criteria for the later (1990) FFQ. These samples were interspersed with the control and were assayed at the same time. Women defined as postmenopausal had no menses for at least 12 months before blood sampling. To increase the number of premenopausal women, additional women were chosen according to the following criteria: 50 years of age or less at time of phlebotomy, premenopausal at time of phlebotomy (still having cycles and not taking HRT), not previously in any case-control data set, had sufficient plasma available, and had answered the 1990 diet questionnaire. Of women fitting these criteria, 400 were chosen randomly, and 88 additional premenopausal women with specific characteristics were oversampled: 25 women with a family history of breast cancer, 25 women reporting ≥15 g of alcohol daily in 1990, and 38 women with a reported fat intake <25% of calories in 1986 and ≤20% in 1990, and ≤2 drinks of alcohol/day and total daily energy intake between 1000 and 3000 kilocalories and BMI between 18 and 30 in both 1986 and 1990. Samples from these women were analyzed in the second batch. Participants had no previously diagnosed cancer (except nonmelanoma skin cancer) and could not have implausible scores for total energy intake (<500 kcal or >3500 kcal/day).

In each case, the factor that was oversampled is either hypothesized or known to affect cancer risk. If IGF-I or IGFBP-3 levels are correlated with these factors, then IGF-I or IGFBP-3 might be the mechanism by which these factors affect cancer risk. However, the distribution of these factors in the NHS population is such that a random sample would not provide enough women in the extremes of the distribution to test these associations, and thus we oversampled women in these extreme categories.

The FFQ used has been described in detail, and its validity and reproducibility have been documented elsewhere (22). In this analysis, nutrient intakes from the 1986 and the 1990 FFQs were averaged for each woman. In a previous analysis of dietary intake and steroid hormone levels, we found that associations were stronger for the average of the two dietary assessments than with the dietary assessment closest to blood collection (23). This is presumably because averaging two measurements of dietary intake reduces random error. Alcohol intake was categorized as 0, <5, 5–14.9, and at least 15 g/day. Nutrient and food intakes were energy-adjusted using the residual method (24). Nutrient intakes were categorized into quintiles. Some nutrients, particularly vitamins, are frequently found in nutritional supplements. We report results for the total nutrient, which includes supplement intake, and for the nutrient intake from food only.

Because the FFQ allows only nine choices of intake for foods, the distribution of food intakes is more discontinuous than that of nutrients because nutrients can come from many foods. Therefore, foods were divided into approximate quartiles of intake. We calculated a the glycemic load of a food by multiplying its carbohydrate content by its glycemic index value (25, 26, 27); we then multiplied this by the frequency of consumption and summed overall food items to produce the dietary glycemic load. Dietary glycemic load thus represents the quality and quantity of carbohydrates and their interaction, with a higher glycemic index having a greater impact at higher carbohydrate intakes. Each unit of dietary glycemic load represents the equivalent of 1 g of carbohydrate from white bread.

Statistical analyses were done with SAS software (SAS Institute, Cary NC). We excluded 3 women whose hormone values were greater than the absolute value of the 75th percentile plus three times the interquartile range. Adjusted least-square mean hormone levels across categories of factors were calculated by linear regression (28). Ps are reported for the linear trend across categories. Multivariate models were adjusted for laboratory batch and those factors previously found to be associated with IGF levels: age, menopausal status, type and duration of hormone replacement use, smoking status, physical activity, BMI, parity, and history of ever having breastfed (21).

There were 1037 women included in the study. In 1990, participants in the study had a median (10th–90th percentile) age of 50.5 (45–66) years and a median BMI of 24.1 (21–34) kg/m2. Median energy intake was 1745 (1205–2398) kcal/day. The distributions of hormone levels and other covariates are described elsewhere (21).

We calculated the age- and energy-adjusted associations of IGF-I and IGFBP-3 with intake of alcohol, energy, macronutrients, vitamins A, C, D, and E, calcium, zinc, caffeine, and seven food groups. The results of multivariate analyses were similar, and only the multivariate results are shown here.

Table 1 shows the multivariate association of alcohol, energy, and nutrients with IGF-I and IGFBP-3. The highest category of alcohol intake was associated with a statistically significant higher IGFBP-3 level compared with no alcohol intake (4042 ng/ml versus 3910 ng/ml; P = 0.02 for comparison between extreme categories). Higher total energy intake (as measured in kilocalories/day) was associated with higher IGF-I (quintile 5 = 195 ng/ml versus 181 ng/ml for quintile 1; P for the linear trend = 0.006) and higher IGFBP-3 (quintile 5 = 4092 ng/ml versus quintile 1 = 3935 ng/ml; P = 0.02).

Higher fat intake was associated with lower IGFBP-3; this association appeared to be primarily attributable to saturated fat. There was little other relation between specific types of fat (animal, vegetable, polyunsaturated, monounsaturated, saturated, trans-unsaturated and ω-3 fats from marine sources) and IGF levels. Dietary carbohydrate, glycemic load, and fiber intake were also not associated with IGF-I or IGFBP-3 levels. Higher intake of protein was associated with higher levels of IGF-I. This association was limited to animal protein and did not apply to vegetable protein, possibly because the amount and range of vegetable protein intake was much lower.

We also examined the association of vitamins and other micronutrients with IGF-I and IGFBP-3. Several of these nutrients (vitamin D, calcium, and vitamin A) had a positive association with IGF-I levels only when examining the nutrient intake that came from food sources and not when considering total nutrient intake, which included intake from supplements. For vitamin A, the strongest association was with retinol (preformed vitamin A) from food sources only. Lycopene intake was positively associated with IGFBP-3.

Vitamin E, whether from food sources only or including supplements, had no association with either IGF-I or IGFBP-3. Although total vitamin C had little association with either IGF-I or IGFBP-3, vitamin C from food sources had a modest positive association with IGFBP-3. Zinc intake, whether from food sources only or including supplements, had a modest positive association with IGF-I. Caffeine intake was not associated with IGF-I or IGFBP-3.

Table 2 shows the multivariate associations of food groups and foods with IGF-I and IGFBP-3. Fruit, vegetable, and poultry intake had little association with either IGF-I or IGFBP-3 levels. Red meat intake had a borderline inverse association with IGFBP-3.

IGF-I levels were higher with greater intake of whole or skim milk, even after adjustment for multiple factors, but not with other dairy foods. In addition, higher intakes of cooked or cold breakfast cereal and pasta were associated with higher levels of IGF-I. Other grain-containing foods such as bread and rice did not have this association.

The positive association between energy intake and IGFs was confined to the leaner women. For the 611 women with a BMI <25, the multivariate adjusted mean levels of IGF-I (ng/ml) across increasing quintiles of energy intake were 178, 189, 193, 205, and 202 (P for the linear trend = 0.0007). The corresponding values for the 426 women with BMI ≥25 were 187, 179, 188, 188, and 184 (P = 0.75). However, the P for the interaction term (energy intake × overweight) was not statistically significant (P = 0.11).

Among dietary factors, the association of higher dairy intake with higher IGF-I levels was particularly consistent. This association was similar among women with and without obesity, a history of benign breast disease, or a family history of breast cancer or colon cancer. The positive association between dairy intake and IGF-I was seen in the 526 premenopausal women (lowest versus highest quartile of intake; P for the linear trend, 199 versus 226 ng/ml; P = 0.001), with little relationship in the 456 postmenopausal women (174 versus 174 ng/ml; P = 0.46). However, again, the P for the interaction term (dairy intake × menopausal status) was not statistically significant (P = 0.54). Results were similar for the comparison between premenopausal women and the 306 postmenopausal women not currently using HRT.

The inverse association between IGFBP-3 and saturated fat appeared to be confined to postmenopausal women only. The mean IGFBP-3 levels (ng/ml) across increasing quintiles of saturated fat intake among premenopausal women were 3844, 3855, 3823, 3952, 3872 (P for linear trend = 0.55). The corresponding IGFBP-3 levels for postmenopausal women, not using HRT, were 4493, 4255, 3970, 4115, and 4024 (P for linear trend = 0.02). The P for the interaction term (menopausal status × saturated fat intake) was 0.06. There was no significant interaction between menopausal status and other foods or nutrients.

Methods proposed to estimate the biologically active fraction of IGF-I did not substantially change the results. The molar ratio of IGF-I:IGFBP-3 has been proposed to reflect tissue bioactivity (29). We calculated it as (0.130 × IGF-I concentration in ng/ml) / (0.036 × IGFBP-3 concentration in ng/ml) for each of the factors in Tables 1 and 2. The positive association of total energy intake with IGF-I was attenuated with the molar ratio (1st versus 5th quintile, 0.167 versus 0.173; P = 0.09).

We also calculated mean levels of IGF-I across categories of predictors, controlling for levels of IGFBP-3 (and other covariates) and likewise, levels of IGFBP-3 controlling for levels of IGF-I. The positive association of total energy with IGF-I was also attenuated when controlled for levels of IGFBP-3 (1st versus 5th quintile, 184 versus 192 ng/ml; P = 0.07). Other findings were essentially unchanged.

In this cross-sectional analysis among >1000 women, we found associations between IGF-I and IGFBP-3 and several foods and nutrients. In particular, we found that total energy and protein intake were positively associated with plasma IGF-I levels. The association with protein intake was largely attributable to higher IGF-I levels among women who consumed higher amounts of milk. We had the ability to average two dietary assessments collected 3–4 years prior and near the time of blood collection, which should reduce random error in dietary measurement. However, we examined many foods and nutrients; associations could occur by chance and should be replicated in other studies.

Plasma IGF-I levels are decreased by malnutrition, in both animals and humans, and protein is particularly important for increasing IGF-I levels during refeeding (17, 30). However, few studies have been examined linking dietary components in relation to IGF levels in well-nourished humans. Kaklamani et al. (18) examined the associations of dietary data collected by a FFQ with plasma IGF-I and IGFBP-3 levels in 130 healthy Greek subjects between 30 and 84 years of age. They found that IGF-I levels were positively associated with intake of red meat and total fat and inversely associated with intake of carbohydrates. In addition, they found that levels of IGFBP-3 were inversely associated with intake of saturated fat (18).

Goodman-Gruen and Barrett-Connor (19) reported a positive association between alcohol use and IGF-I levels among men and women in Rancho Bernardo, and the linear relationship was statistically significant among men. We found a nonlinear association between alcohol intake and IGF-I that was somewhat positive for low intakes but inverse for the highest category of intake. However, the distribution of alcohol intake in the Rancho Bernardo study, which was conducted in an older population (mean age of the women, 77 years), overlapped only the low end of the intake distribution in our study. Therefore, the results of the two studies were compatible. We also found a positive association between alcohol intake and IGFBP-3 levels. The significance of this finding is not clear, but it would tend to make bioavailable levels of IGF-I even lower in the highest category of alcohol intake.

We found a positive association between IGF-I levels and intake of total energy, after controlling for BMI and physical activity, with an 8% increase between the lowest and highest intake. We also found a positive association between protein intake and IGF-I levels (13% increase between extremes of intake). Turnover of epithelial cells requires substantial energy and protein and is increased by IGF-I (31). It is possible that at times of protein-calorie malnutrition, down-regulation of cell turnover may be advantageous to conserve protein and energy. Thus, the decline of IGF-I levels in the setting of malnourishment could serve a physiological purpose. On the other hand, we speculate that there may be a tendency in some individuals for excess nutrition to be associated with elevation of IGF-I levels and increased cellular turnover rate that over prolonged periods of time could lead to increased cancer risk. In an animal carcinogenesis model, supplementation of IGF-I attenuated the protective effect that dietary restriction had on tumor incidence (32). However, in this cross-sectional study, we cannot distinguish which comes first: whether high intake of energy leads to higher IGF-I levels or whether having high IGF-I levels causes an individual to consume more energy.

Total energy intake has been consistently associated with cancer development in animals (33, 34, 35, 36), although less consistently in humans (37, 38, 39). The positive association of IGF-I levels with intake of total energy in our study was somewhat stronger among the leanest women. This association could also be a reflection of residual confounding with physical activity (21). It may be important in the future to assess the association between energy intake and human cancer risk stratified by obesity.

The association between protein and IGF-I appeared to be limited to animal and not vegetable protein intake. Among animal protein-containing food groups, we found no association with red meat or poultry intake and a moderate positive association with fish intake. The relationship between protein or animal protein intake and IGF-I was not completely attenuated when controlled for dairy intake. However, the lack of association between IGF-I and other sources of animal protein makes dairy food the most likely cause of the relationship between IGF-I and protein.

Devine et al. (20) reported that zinc intake, as measured by weighed diet records, was positively associated with IGF-I levels in >100 postmenopausal women enrolled in a study of calcium supplementation for bone density. Although the major source of zinc in the diet is animal products, in their study this association persisted after control for protein intake. The authors postulated that zinc is necessary for hepatic IGF-I gene synthesis (20). We also found that intake of zinc, whether from food sources only or including supplements, was associated with higher levels of IGF-I.

Among other micronutrients, we found a positive association with calcium from foods but not from total calcium including supplements. Likewise, we found a stronger association with vitamin A from foods, retinol from foods, and vitamin D from foods than from total vitamin A, retinol, and vitamin D including supplements. These findings cast doubt on calcium, vitamin A, retinol, and vitamin D being a cause of higher IGF-I levels. In fact, in models containing both dairy intake and calcium, vitamin A, retinol, or vitamin D from foods, the association with IGF-I is attenuated, except for vitamin A from foods, where the association is approximately the same. In 1990, the largest (nonsupplement) dietary source of calcium and vitamin D was dairy food, and dairy foods were among the highest contributors to the intake of vitamin A and retinol from foods as well. The positive association we observed between lycopene intake and IGFBP-3 is consistent with the inverse association of lycopene with prostate cancer risk (40).

Our most consistent dietary finding was the positive association of IGF-I levels with total dairy and milk intake. This association is the most logical explanation for our finding a stronger association with calcium from foods but not total calcium including supplements, and the similar results with vitamin A and retinol. Supporting this finding was a positive association with grain-containing foods, most strongly with breakfast cereal. We also found no association with dietary fiber. In our data, the correlation between milk intake and cereal intake was 0.29. It is possible that these findings are attributable to the joint consumption of cereal and milk.

Dairy foods other than milk (ice cream, yogurt, and cheese) did not have an association with IGF-I. It is possible that either IGF-I in cows’ milk or a substance in milk that stimulates endogenous production of IGF-I is inactivated during the processing of milk to ice cream, yogurt, or cheese. There was an inverse association between ice cream intake and levels of IGFBP-3. This may have to do with the saturated fat content of ice cream. However, cheese also has a high saturated fat content, and no such association was seen with cheese.

Two other studies have supported an effect of milk intake on IGF-I levels. A randomized trial of 204 men and women where the intervention was to encourage consumption of three servings/day of nonfat milk to affect bone remodeling found that the 101 subjects in the intervention group had a statistically significant 10% average increase in serum IGF-I levels, whereas the control group had no change in levels (41). In addition, Ma et al. (42) observed a positive association between intake of dairy food and IGF-I levels among 318 men enrolled in the Physicians’ Health Study.

IGF-I occurs naturally in cows’ milk, but orally ingested IGF-I has been thought not to be absorbed. Supporting this conclusion is an unpublished study done by the Monsanto Agricultural Co. and communicated to the Food and Drug Administration in 1989 (43). Because IGF-I mediates the actions of GH, this study was conducted in anticipation of the Food and Drug Administration’s approval of the use of rBGH in dairy cows to improve milk production. In this study, rats were orally administered high doses of recombinant IGF-I. No changes were seen in the serum IGF-I levels, blood and urine chemistries, and organ weights of the treated rats, as were seen in rats administered IGF-I or GH parenterally. Thus, it was considered unlikely to have any effect when ingested orally by humans. However, a recent study has reported that radioactively labeled IGF-I in milk fed to neonatal rats could be detected in low levels in their systemic circulation (44). In addition, neonatal rats fed excess amounts of IGF-I had increased growth of specific organs (45).

It is uncertain whether results of absorption studies in neonatal rats are relevant to the adult humans in the present study. In any case, the Food and Drug Administration’s approval of the use of rBGH for dairy cows did not occur until 1994, and thus, the blood samples in the present study, collected in 1989 and 1990, were not affected by rBGH. However, bovine IGF-I (which is identical to human IGF-I), normally occurs in the milk of untreated cows, which is identical to human IGF-I and is increased in rBGH-treated cows (43). The possibilities that IGF-I in milk could be absorbed by the human gut, or that a component of milk, a food ideally suited for the growth of the infant mammal, may stimulate endogenous production of IGF-I, deserve investigation.

The primary limitation of this study is its cross-sectional nature; there is no way to know whether factors associated with IGF levels determine those levels or are in fact determined by them. Because subjects were sampled to increase the range of fat and alcohol intake, the distribution of dietary factors in the study population does not necessarily reflect the distribution of these factors in the underlying population. The strengths of this study include its large size and the extensive information on diet and lifestyle factors collected over 25 years.

We examined many dietary factors and found associations with several. However, the clearest findings in this study of healthy women were a positive association between intake of total energy and milk and circulating IGF-I levels. The milk association is supported by several pieces of evidence. This includes positive associations between IGF-I and nutrients from food sources but not supplements where the most frequent food source of those nutrients is milk. The milk association is consistent with similar findings in a cross-sectional study of men (42) and a randomized trial of increasing milk intake (41). These results raise the possibility that milk consumption could influence cancer risk by a mechanism involving IGF-I. In fact, positive associations between milk intake and risk of prostate cancer have been reported (46, 47, 48, 49, 50, 51). In the NHS, one or more servings of milk/day was associated with a higher risk of serous ovarian cancer (relative risk, 1.66; 95% confidence interval, 1.10–2.51) compared with three or fewer servings/month (52).

In conclusion, we found that women consuming higher levels of alcohol and lower levels of saturated fat had higher levels of IGFBP-3. In addition, those consuming higher levels of protein, energy, and milk had higher circulating IGF-I levels. These results raise the possibility that cancer risk could be reduced by dietary manipulation of IGF levels.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

1

Supported by NIH Grants CA87969 and CA49449. S. E. H. was partially supported by Career Development Award DAMD17-96-1-6021 from the United States Army Medical Research and Materiel Command. M. N. P. was supported by the National Cancer Institute of Canada and the Canadian Breast Cancer Research Initiative and by a grant from the Streams of Excellence program of the Canadian Breast Cancer Research Initiative. M. D. H. was partially funded by the National Cancer Institute Specialized Program of Research Excellence in Breast Cancer at Brigham and Women’s Hospital.

3

The abbreviations used are: IGF, insulin-like growth factor; IGFBP-3, IGF binding protein 3; NHS, Nurses’ Health Study; BMI, body mass index; FFQ, food frequency questionnaire; HRT, hormone replacement therapy; GH, growth hormone; rBGH, recombinant bovine GH.

Table 1

Multivariate adjusted mean levels of IGF-I, and IGFBP-3, by category of alcohol, energy, and nutrients, and the P for the linear trend across categories

All dietary factors were adjusted for: energy intake (quintiles), age in years (<45, 45–49, 50–54, 55–59, 60–64, ≥65), laboratory batch, menopausal status, type, and duration of hormone replacement (premenopausal, uncertain menopausal status, postmenopausal non-hormone user, postmenopausal and oral estrogen user, postmenopausal and oral estrogen plus progesterone use for <5 years, postmenopausal and oral estrogen plus progesterone use for ≥5 years, postmenopausal and other hormone user, missing menopausal status and/or hormone use), smoking status (never, past, current), physical activity in MET-hours/week (<4, 4–11.9, 12–24.9, 25+), parity and history of ever lactating (nulliparous, 1 birth and no lactation, 1 birth and lactation, 2 births and no lactation, 2 births and lactation, 3 births and no lactation, 3 births and lactation, 4+ births and no lactation, 4+ births and lactation, missing parity and/or lactation), and BMI in kg/m2 (<21, 21–22.9, 23–24.9, 25–28.9, ≥29). Total Vitamin A, total retinol, total vitamin E, total vitamins, and total zinc refer to intake from both supplements and food.

Dietary variableCategorya and range of intakeIGF-I (ng/ml)IGFBP-3 (ng/ml)
Energy (kilocalories/day)    
 Q1 <1383 181 3935 
 Q2 1383–1624 185 3944 
 Q3 1625–1871 191 3992 
 Q4 1872–2154 199 4078 
 Q5 ≥2155 195 4092 
  P = 0.006 P = 0.02 
Alcohol (g/day)  None 186 3910 
  <5 192 4004 
  5–14.9 204 4127 
  ≥15 171 4042 
  P = 0.65 P = 0.02 
Total fat (g/day) Q1 ≤47.8 200 4191 
 Q2 47.9–54.3 188 4000 
 Q3 54.4–58.8 193 3995 
 Q4 58.9–63.6 182 3923 
 Q5 >63.6 187 3932 
  P = 0.08 P = 0.006 
Animal fat (g/day) Q1 ≤23.9 187 4080 
 Q2 24–28.4 192 4112 
 Q3 28.5–32.3 187 3941 
 Q4 32.4–36.7 194 3987 
 Q5 >36.7 191 3920 
  P = 0.52 P = 0.02 
Vegetable fat (g/day) Q1 ≤19.1 197 3968 
 Q2 19.2–23.1 192 4082 
 Q3 23.2–26.4 194 4027 
 Q4 26.5–30.8 185 3989 
 Q5 ≥30.9 184 3977 
  P = 0.04 P = 0.63 
Saturated fat (g/day) Q1 <16.0 198 4158 
 Q2 16.0–18.5 187 4057 
 Q3 18.6–20.5 189 3951 
 Q4 20.6–22.6 194 3982 
 Q5 >22.6 184 3892 
  P = 0.28 P = 0.005 
Monounsaturated fat (g/day) Q1 <17.4 198 4127 
 Q2 17.4–20.1 194 4045 
 Q3 20.2–22.1 181 3941 
 Q4 22.2–24.1 188 3996 
 Q5 ≥24.2 190 3936 
  P = 0.21 P = 0.04 
Polyunsaturated fat (g/day) Q1 <8.5 198 4001 
 Q2 8.5–9.9 190 3982 
 Q3 10.0–11.0 184 4032 
 Q4 11.1–12.5 193 4044 
 Q5 >12.5 186 3982 
  P = 0.22 P = 0.92 
trans-Unsaturated fat (g/day) Q1 <1.8 195 4065 
 Q2 1.8–2.2 185 4013 
 Q3 2.3–2.6 195 4026 
 Q4 2.7–3.2 189 3949 
 Q5 >3.2 188 3989 
  P = 0.58 P = 0.31 
ω-3 fats from fish (g/day) Q1 <0.11 178 3922 
 Q2 0.11–0.17 197 4011 
 Q3 0.18–0.23 190 3955 
 Q4 0.24–0.33 190 4040 
 Q5 ≥0.34 195 4116 
  P = 0.07 P = 0.03 
Total protein (g/day) Q1 <70 174 3913 
 Q2 70–72.2 188 4061 
 Q3 72.3–77.2 201 4096 
 Q4 77.3–83 192 4072 
 Q5 >83 196 3900 
  P = 0.002 P = 0.93 
Animal protein (g/day) Q1 <45 173 3895 
 Q2 45–51 188 4101 
 Q3 52–56 200 4075 
 Q4 56–63 198 4097 
 Q5 >63 192 3874 
  P = 0.002 P = 0.82 
Vegetable protein (g/day) Q1 ≤17.5 189 3990 
 Q2 17.6–19.5 186 3950 
 Q3 19.6–21.2 194 3982 
 Q4 21.3–23.6 190 4044 
 Q5 >23.6 193 4077 
  P = 0.49 P = 0.17 
Carbohydrate (g/day) Q1 ≤176 181 3933 
 Q2 177–190 195 3996 
 Q3 191–203 192 4056 
 Q4 204–221 193 3997 
 Q5 >221 190 4059 
  P = 0.29 P = 0.21 
Fiber (g/day) Q1 ≤13.8 183 3997 
 Q2 13.9–16.0 185 3969 
 Q3 16.1–18.4 195 3988 
 Q4 18.5–21.5 196 4053 
 Q5 >21.5 192 4034 
  P = 0.08 P = 0.43 
Glycemic load (units/day) Q1 <128 178 3914 
 Q2 128–141 197 4018 
 Q3 142–153 191 4069 
 Q4 154–168 194 4008 
 Q5 >168 191 4033 
  P = 0.10 P = 0.24 
Vitamin D (IU/day) Q1 <156 189 3969 
 Q2 156–240 182 3996 
 Q3 241–345 193 3969 
 Q4 346–494 193 3927 
 Q5 >494 195 4180 
  P = 0.12 P = 0.07 
Vitamin D, food sources only (IU/day) Q1 ≤116 185 3952 
 Q2 117–157 184 3972 
 Q3 158–202 184 4007 
 Q4 203–266 200 4070 
 Q5 >266 198 4040 
  P = 0.006 P = 0.15 
Calcium (mg/day) Q1 <672 190 4006 
 Q2 672–873 187 4029 
 Q3 874–1072 190 4014 
 Q4 1073–1358 191 3130 
 Q5 ≥1359 193 4062 
  P = 0.49 P = 0.95 
Calcium, food sources only (mg/day) Q1 ≤537 182 3959 
 Q2 538–640 187 4006 
 Q3 641–751 190 4032 
 Q4 752–911 191 4041 
 Q5 ≥912 201 4003 
  P = 0.009 P = 0.51 
Total vitamin A (IU/day) Q1 <8136 183 3905 
 Q2 8136–10704 186 3972 
 Q3 10705–13636 194 4062 
 Q4 13637–17895 200 4141 
 Q5 >17895 190 3962 
  P = 0.08 P = 0.15 
Vitamin A, food sources only (IU/day) Q1 <6998 178 3946 
 Q2 6998–8821 187 3941 
 Q3 8822–10909 199 4108 
 Q4 10910–13963 195 4051 
 Q5 >13963 192 3994 
  P = 0.02 P = 0.28 
α-Carotene (μg/day) Q1 <381 185 3983 
 Q2 381–549 191 3988 
 Q3 550–738 198 4130 
 Q4 739–1096 189 3956 
 Q5 >1096 188 3983 
  P = 0.85 P = 0.87 
β-Carotene (μg/day) Q1 <2592 180 3937 
 Q2 2593–3530 192 3991 
 Q3 3531–4476 198 4079 
 Q4 4477–5907 187 4020 
 Q5 >5907 194 4014 
  P = 0.15 P = 0.34 
β-Cryptoxanthin (μg/day) Q1 <1261 180 3964 
 Q2 1261–1760 186 3977 
 Q3 1761–2298 197 4064 
 Q4 2299–3170 197 4050 
 Q5 >3170 192 3987 
  P = 0.03 P = 0.52 
Carotene (IU/day) Q1 ≤5407 180 3918 
 Q2 5408–7308 192 4041 
 Q3 7309–9229 194 3973 
 Q4 9230–12493 191 4119 
 Q5 ≥12494 194 3990 
  P = 0.08 P = 0.27 
Lutein/Zeaxanthin (μg/day) Q1 ≤1867 191 4018 
 Q2 1868–2586 184 3969 
 Q3 2587–3413 188 3950 
 Q4 3414–4683 198 4118 
 Q5 >4683 191 3986 
  P = 0.34 P = 0.66 
Lycopene (μg/day) Q1 <5708 194 3973 
 Q2 5709–7350 181 3831 
 Q3 7351–9361 193 4051 
 Q4 9362–11879 188 4036 
 Q5 ≥11880 195 4149 
  P = 0.50 P = 0.003 
Total retinol (IU/day) Q1 ≤1487 183 3991 
 Q2 1488–2272 187 3975 
 Q3 2273–3750 200 4033 
 Q4 3751–6125 186 3969 
 Q5 >6125 195 4073 
  P = 0.14 P = 0.40 
Retinol, food sources only (IU/day) Q1 ≥1029 184 4025 
 Q2 1030–1439 183 4008 
 Q3 1440–1793 191 3949 
 Q4 1794–2383 198 4096 
 Q5 ≤2384 195 3963 
  P = 0.02 P = 0.84 
Total Vitamin E (mg/day) Q1 ≤6.0 192 4045 
 Q2 6.1–8.2 185 3878 
 Q3 8.3–19.6 189 3983 
 Q4 19.7–177.2 188 3988 
 Q5 ≤177.3 197 4143 
  P = 0.36 P = 0.11 
Vitamin E, food sources only (mg/day) Q1 ≤5.0 189 4044 
 Q2 5.1–5.7 190 3996 
 Q3 5.8–6.5 191 4016 
 Q4 6.6–7.4 190 3974 
 Q5 ≥7.5 191 4014 
  P = 0.83 P = 0.67 
Total Vitamin C (mg/day) Q1 <126 187 3910 
 Q2 127–177 196 4008 
 Q3 178–250 186 4028 
 Q4 251–484 196 4068 
 Q5 ≥485 186 4027 
  P = 0.97 P = 0.13 
Vitamin C, food sources only Q1 <97 180 3919 
 Q2 97–126 197 4042 
 Q3 127–153 188 3923 
 Q4 154–189 193 4006 
 Q5 >189 192 4151 
  P = 0.20 P = 0.03 
Total zinc (mg/day) Q1 ≤9.6 180 4045 
 Q2 9.7–10.9 190 3967 
 Q3 11.0–12.6 194 3977 
 Q4 12.7–18.1 188 3971 
 Q5 ≥18.2 198 4081 
  P = 0.02 P = 0.68 
Zinc, food sources only (mg/day) Q1 ≤9.2 178 3974 
 Q2 9.3–10.1 190 4067 
 Q3 10.2–11.0 195 4107 
 Q4 11.1–12.1 197 3984 
 Q5 ≥12.2 192 3905 
  P = 0.02 P = 0.24 
Caffeine (mg/day) Q1 ≤70 197 4016 
 Q2 71–156 183 3957 
 Q3 157–261 190 4075 
 Q4 262–385 195 4076 
 Q5 ≥386 187 3916 
  P = 0.66 P = 0.70 
Dietary variableCategorya and range of intakeIGF-I (ng/ml)IGFBP-3 (ng/ml)
Energy (kilocalories/day)    
 Q1 <1383 181 3935 
 Q2 1383–1624 185 3944 
 Q3 1625–1871 191 3992 
 Q4 1872–2154 199 4078 
 Q5 ≥2155 195 4092 
  P = 0.006 P = 0.02 
Alcohol (g/day)  None 186 3910 
  <5 192 4004 
  5–14.9 204 4127 
  ≥15 171 4042 
  P = 0.65 P = 0.02 
Total fat (g/day) Q1 ≤47.8 200 4191 
 Q2 47.9–54.3 188 4000 
 Q3 54.4–58.8 193 3995 
 Q4 58.9–63.6 182 3923 
 Q5 >63.6 187 3932 
  P = 0.08 P = 0.006 
Animal fat (g/day) Q1 ≤23.9 187 4080 
 Q2 24–28.4 192 4112 
 Q3 28.5–32.3 187 3941 
 Q4 32.4–36.7 194 3987 
 Q5 >36.7 191 3920 
  P = 0.52 P = 0.02 
Vegetable fat (g/day) Q1 ≤19.1 197 3968 
 Q2 19.2–23.1 192 4082 
 Q3 23.2–26.4 194 4027 
 Q4 26.5–30.8 185 3989 
 Q5 ≥30.9 184 3977 
  P = 0.04 P = 0.63 
Saturated fat (g/day) Q1 <16.0 198 4158 
 Q2 16.0–18.5 187 4057 
 Q3 18.6–20.5 189 3951 
 Q4 20.6–22.6 194 3982 
 Q5 >22.6 184 3892 
  P = 0.28 P = 0.005 
Monounsaturated fat (g/day) Q1 <17.4 198 4127 
 Q2 17.4–20.1 194 4045 
 Q3 20.2–22.1 181 3941 
 Q4 22.2–24.1 188 3996 
 Q5 ≥24.2 190 3936 
  P = 0.21 P = 0.04 
Polyunsaturated fat (g/day) Q1 <8.5 198 4001 
 Q2 8.5–9.9 190 3982 
 Q3 10.0–11.0 184 4032 
 Q4 11.1–12.5 193 4044 
 Q5 >12.5 186 3982 
  P = 0.22 P = 0.92 
trans-Unsaturated fat (g/day) Q1 <1.8 195 4065 
 Q2 1.8–2.2 185 4013 
 Q3 2.3–2.6 195 4026 
 Q4 2.7–3.2 189 3949 
 Q5 >3.2 188 3989 
  P = 0.58 P = 0.31 
ω-3 fats from fish (g/day) Q1 <0.11 178 3922 
 Q2 0.11–0.17 197 4011 
 Q3 0.18–0.23 190 3955 
 Q4 0.24–0.33 190 4040 
 Q5 ≥0.34 195 4116 
  P = 0.07 P = 0.03 
Total protein (g/day) Q1 <70 174 3913 
 Q2 70–72.2 188 4061 
 Q3 72.3–77.2 201 4096 
 Q4 77.3–83 192 4072 
 Q5 >83 196 3900 
  P = 0.002 P = 0.93 
Animal protein (g/day) Q1 <45 173 3895 
 Q2 45–51 188 4101 
 Q3 52–56 200 4075 
 Q4 56–63 198 4097 
 Q5 >63 192 3874 
  P = 0.002 P = 0.82 
Vegetable protein (g/day) Q1 ≤17.5 189 3990 
 Q2 17.6–19.5 186 3950 
 Q3 19.6–21.2 194 3982 
 Q4 21.3–23.6 190 4044 
 Q5 >23.6 193 4077 
  P = 0.49 P = 0.17 
Carbohydrate (g/day) Q1 ≤176 181 3933 
 Q2 177–190 195 3996 
 Q3 191–203 192 4056 
 Q4 204–221 193 3997 
 Q5 >221 190 4059 
  P = 0.29 P = 0.21 
Fiber (g/day) Q1 ≤13.8 183 3997 
 Q2 13.9–16.0 185 3969 
 Q3 16.1–18.4 195 3988 
 Q4 18.5–21.5 196 4053 
 Q5 >21.5 192 4034 
  P = 0.08 P = 0.43 
Glycemic load (units/day) Q1 <128 178 3914 
 Q2 128–141 197 4018 
 Q3 142–153 191 4069 
 Q4 154–168 194 4008 
 Q5 >168 191 4033 
  P = 0.10 P = 0.24 
Vitamin D (IU/day) Q1 <156 189 3969 
 Q2 156–240 182 3996 
 Q3 241–345 193 3969 
 Q4 346–494 193 3927 
 Q5 >494 195 4180 
  P = 0.12 P = 0.07 
Vitamin D, food sources only (IU/day) Q1 ≤116 185 3952 
 Q2 117–157 184 3972 
 Q3 158–202 184 4007 
 Q4 203–266 200 4070 
 Q5 >266 198 4040 
  P = 0.006 P = 0.15 
Calcium (mg/day) Q1 <672 190 4006 
 Q2 672–873 187 4029 
 Q3 874–1072 190 4014 
 Q4 1073–1358 191 3130 
 Q5 ≥1359 193 4062 
  P = 0.49 P = 0.95 
Calcium, food sources only (mg/day) Q1 ≤537 182 3959 
 Q2 538–640 187 4006 
 Q3 641–751 190 4032 
 Q4 752–911 191 4041 
 Q5 ≥912 201 4003 
  P = 0.009 P = 0.51 
Total vitamin A (IU/day) Q1 <8136 183 3905 
 Q2 8136–10704 186 3972 
 Q3 10705–13636 194 4062 
 Q4 13637–17895 200 4141 
 Q5 >17895 190 3962 
  P = 0.08 P = 0.15 
Vitamin A, food sources only (IU/day) Q1 <6998 178 3946 
 Q2 6998–8821 187 3941 
 Q3 8822–10909 199 4108 
 Q4 10910–13963 195 4051 
 Q5 >13963 192 3994 
  P = 0.02 P = 0.28 
α-Carotene (μg/day) Q1 <381 185 3983 
 Q2 381–549 191 3988 
 Q3 550–738 198 4130 
 Q4 739–1096 189 3956 
 Q5 >1096 188 3983 
  P = 0.85 P = 0.87 
β-Carotene (μg/day) Q1 <2592 180 3937 
 Q2 2593–3530 192 3991 
 Q3 3531–4476 198 4079 
 Q4 4477–5907 187 4020 
 Q5 >5907 194 4014 
  P = 0.15 P = 0.34 
β-Cryptoxanthin (μg/day) Q1 <1261 180 3964 
 Q2 1261–1760 186 3977 
 Q3 1761–2298 197 4064 
 Q4 2299–3170 197 4050 
 Q5 >3170 192 3987 
  P = 0.03 P = 0.52 
Carotene (IU/day) Q1 ≤5407 180 3918 
 Q2 5408–7308 192 4041 
 Q3 7309–9229 194 3973 
 Q4 9230–12493 191 4119 
 Q5 ≥12494 194 3990 
  P = 0.08 P = 0.27 
Lutein/Zeaxanthin (μg/day) Q1 ≤1867 191 4018 
 Q2 1868–2586 184 3969 
 Q3 2587–3413 188 3950 
 Q4 3414–4683 198 4118 
 Q5 >4683 191 3986 
  P = 0.34 P = 0.66 
Lycopene (μg/day) Q1 <5708 194 3973 
 Q2 5709–7350 181 3831 
 Q3 7351–9361 193 4051 
 Q4 9362–11879 188 4036 
 Q5 ≥11880 195 4149 
  P = 0.50 P = 0.003 
Total retinol (IU/day) Q1 ≤1487 183 3991 
 Q2 1488–2272 187 3975 
 Q3 2273–3750 200 4033 
 Q4 3751–6125 186 3969 
 Q5 >6125 195 4073 
  P = 0.14 P = 0.40 
Retinol, food sources only (IU/day) Q1 ≥1029 184 4025 
 Q2 1030–1439 183 4008 
 Q3 1440–1793 191 3949 
 Q4 1794–2383 198 4096 
 Q5 ≤2384 195 3963 
  P = 0.02 P = 0.84 
Total Vitamin E (mg/day) Q1 ≤6.0 192 4045 
 Q2 6.1–8.2 185 3878 
 Q3 8.3–19.6 189 3983 
 Q4 19.7–177.2 188 3988 
 Q5 ≤177.3 197 4143 
  P = 0.36 P = 0.11 
Vitamin E, food sources only (mg/day) Q1 ≤5.0 189 4044 
 Q2 5.1–5.7 190 3996 
 Q3 5.8–6.5 191 4016 
 Q4 6.6–7.4 190 3974 
 Q5 ≥7.5 191 4014 
  P = 0.83 P = 0.67 
Total Vitamin C (mg/day) Q1 <126 187 3910 
 Q2 127–177 196 4008 
 Q3 178–250 186 4028 
 Q4 251–484 196 4068 
 Q5 ≥485 186 4027 
  P = 0.97 P = 0.13 
Vitamin C, food sources only Q1 <97 180 3919 
 Q2 97–126 197 4042 
 Q3 127–153 188 3923 
 Q4 154–189 193 4006 
 Q5 >189 192 4151 
  P = 0.20 P = 0.03 
Total zinc (mg/day) Q1 ≤9.6 180 4045 
 Q2 9.7–10.9 190 3967 
 Q3 11.0–12.6 194 3977 
 Q4 12.7–18.1 188 3971 
 Q5 ≥18.2 198 4081 
  P = 0.02 P = 0.68 
Zinc, food sources only (mg/day) Q1 ≤9.2 178 3974 
 Q2 9.3–10.1 190 4067 
 Q3 10.2–11.0 195 4107 
 Q4 11.1–12.1 197 3984 
 Q5 ≥12.2 192 3905 
  P = 0.02 P = 0.24 
Caffeine (mg/day) Q1 ≤70 197 4016 
 Q2 71–156 183 3957 
 Q3 157–261 190 4075 
 Q4 262–385 195 4076 
 Q5 ≥386 187 3916 
  P = 0.66 P = 0.70 
a

Quintile unless otherwise noted.

Table 2

Multivariate adjusted mean levels of IGF-I, IGFBP-3, and the molar ratio by quartile of food intake, and the P for the linear trend across categories

All dietary factors were adjusted for: energy intake, age, laboratory batch, menopausal status; use, type, and duration of hormone replacement; smoking, physical activity, parity, history of lactation and BMI. Categories the same as in the footnote to Table 1.

Dietary variableQuartile and range of intake (servings/day)IGF-I (ng/ml)IGFBP-3 (ng/ml)
Fruit Q1 <1.5 185 3987 
 Q2 1.5–2.2 193 3981 
 Q3 2.2–3.2 194 4035 
 Q4 ≥3.2 188 4031 
  P = 0.58 P = 0.49 
Vegetables Q1 ≤2.37 187 4051 
 Q2 2.38–3.40 192 3972 
 Q3 3.41–4.56 198 4028 
 Q4 ≥4.57 184 3981 
  P = 0.90 P = 0.55 
Red meat Q1 ≤0.6 195 4110 
 Q2 0.6–0.9 189 4026 
 Q3 0.9–1.2 186 3948 
 Q4 >1.2 191 3949 
  P = 0.57 P = 0.04 
Poultry Q1 <0.18 189 4017 
 Q2 0.21–0.29 185 3933 
 Q3 0.32–0.42 192 4024 
 Q4 ≥0.43 194 4057 
  P = 0.25 P = 0.38 
Fish Q1 <0.18 179 3917 
 Q2 0.21–0.28 193 3970 
 Q3 0.29–0.46 197 4016 
 Q4 ≥0.46 193 4137 
  P = 0.008 P = 0.004 
Dairy Q1 ≤1.1 188 4002 
 Q2 1.2–1.7 182 3993 
 Q3 1.7–2.5 190 4055 
 Q4 ≥2.6 201 3983 
  P = 0.02 P = 0.96 
Milk Q1 <0.3 183 3921 
 Q2 0.3–0.7 189 4080 
 Q3 0.7–1.6 188 3978 
 Q4 ≥1.6 200 4035 
  P = 0.01 P = 0.37 
Ice cream Q1 ≤0.03 190 4076 
 Q2 0.07 191 4057 
 Q3 0.10–0.14 190 3952 
 Q4 >0.21 190 3917 
  P = 1.00 P = 0.02 
Yogurt Q1 None 188 3970 
 Q2 ≤0.03 187 4019 
 Q3 0.07–0.14 192 4058 
 Q4 >0.21 194 4009 
  P = 0.28 P = 0.43 
Cheese Q1 <0.3 193 4041 
 Q2 0.3–0.5 191 3957 
 Q3 0.5–0.8 187 4092 
 Q4 ≥0.8 190 3945 
  P = 0.53 P = 0.53 
Grains Q1 ≤1.6 181 3915 
 Q2 1.6–2.2 192 4088 
 Q3 2.2–3.1 187 3998 
 Q4 >3.1 201 4032 
  P = 0.02 P = 0.40 
Cereal Q1 ≤0.1 171 3816 
 Q2 0.2–0.4 196 4153 
 Q3 0.5–0.7 199 4063 
 Q4 ≥0.8 195 4008 
  P = 0.0002 P = 0.04 
Bread Q1 ≤0.5 184 3960 
 Q2 0.6–0.9 188 3989 
 Q3 0.9–1.7 194 4050 
 Q4 >1.7 195 4033 
  P = 0.08 P = 0.27 
Rice Q1 ≤0.07 187 3966 
 Q2 0.11 188 4022 
 Q3 0.14–0.21 191 3997 
 Q4 >0.21 195 4062 
  P = 0.18 P = 0.26 
Pasta Q1 <0.07 179 3906 
 Q2 0.10–0.14 190 3967 
 Q3 0.21–0.25 194 3901 
 Q4 ≥0.28 196 4144 
  P = 0.02 P = 0.002 
Dietary variableQuartile and range of intake (servings/day)IGF-I (ng/ml)IGFBP-3 (ng/ml)
Fruit Q1 <1.5 185 3987 
 Q2 1.5–2.2 193 3981 
 Q3 2.2–3.2 194 4035 
 Q4 ≥3.2 188 4031 
  P = 0.58 P = 0.49 
Vegetables Q1 ≤2.37 187 4051 
 Q2 2.38–3.40 192 3972 
 Q3 3.41–4.56 198 4028 
 Q4 ≥4.57 184 3981 
  P = 0.90 P = 0.55 
Red meat Q1 ≤0.6 195 4110 
 Q2 0.6–0.9 189 4026 
 Q3 0.9–1.2 186 3948 
 Q4 >1.2 191 3949 
  P = 0.57 P = 0.04 
Poultry Q1 <0.18 189 4017 
 Q2 0.21–0.29 185 3933 
 Q3 0.32–0.42 192 4024 
 Q4 ≥0.43 194 4057 
  P = 0.25 P = 0.38 
Fish Q1 <0.18 179 3917 
 Q2 0.21–0.28 193 3970 
 Q3 0.29–0.46 197 4016 
 Q4 ≥0.46 193 4137 
  P = 0.008 P = 0.004 
Dairy Q1 ≤1.1 188 4002 
 Q2 1.2–1.7 182 3993 
 Q3 1.7–2.5 190 4055 
 Q4 ≥2.6 201 3983 
  P = 0.02 P = 0.96 
Milk Q1 <0.3 183 3921 
 Q2 0.3–0.7 189 4080 
 Q3 0.7–1.6 188 3978 
 Q4 ≥1.6 200 4035 
  P = 0.01 P = 0.37 
Ice cream Q1 ≤0.03 190 4076 
 Q2 0.07 191 4057 
 Q3 0.10–0.14 190 3952 
 Q4 >0.21 190 3917 
  P = 1.00 P = 0.02 
Yogurt Q1 None 188 3970 
 Q2 ≤0.03 187 4019 
 Q3 0.07–0.14 192 4058 
 Q4 >0.21 194 4009 
  P = 0.28 P = 0.43 
Cheese Q1 <0.3 193 4041 
 Q2 0.3–0.5 191 3957 
 Q3 0.5–0.8 187 4092 
 Q4 ≥0.8 190 3945 
  P = 0.53 P = 0.53 
Grains Q1 ≤1.6 181 3915 
 Q2 1.6–2.2 192 4088 
 Q3 2.2–3.1 187 3998 
 Q4 >3.1 201 4032 
  P = 0.02 P = 0.40 
Cereal Q1 ≤0.1 171 3816 
 Q2 0.2–0.4 196 4153 
 Q3 0.5–0.7 199 4063 
 Q4 ≥0.8 195 4008 
  P = 0.0002 P = 0.04 
Bread Q1 ≤0.5 184 3960 
 Q2 0.6–0.9 188 3989 
 Q3 0.9–1.7 194 4050 
 Q4 >1.7 195 4033 
  P = 0.08 P = 0.27 
Rice Q1 ≤0.07 187 3966 
 Q2 0.11 188 4022 
 Q3 0.14–0.21 191 3997 
 Q4 >0.21 195 4062 
  P = 0.18 P = 0.26 
Pasta Q1 <0.07 179 3906 
 Q2 0.10–0.14 190 3967 
 Q3 0.21–0.25 194 3901 
 Q4 ≥0.28 196 4144 
  P = 0.02 P = 0.002 
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