Introduction
T2D, Cancer
TYPE 2 DIABETES, DISEASES, CANCER
The Mediterranean diet is a dietary pattern typically characterised by high consumption of vegetables, legumes, fruit, nuts, grains, fish and seafood, virgin olive oil, and moderate intake of meat, dairy, and wine. It has been reported to be associated with decreased incidence of multiple noncommunicable diseases including type 2 diabetes (T2D) [Nutritional biomarkers can complement the self-reported assessment of habitual dietary exposure. Dietary patterns, however, lack biologically plausible single biomarkers and, therefore, necessitate combining multiple analytes into composite biomarker scores [Our objectives were to derive a nutritional biomarker score that could discriminate between the Mediterranean diet intervention and the habitual diet arms of a randomised controlled trial (RCT), the MedLey trial, and to test the association of the biomarker score with incident T2D in a population-based observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study. Additionally, we aimed to estimate the potential population impact of greater adherence to the Mediterranean diet, as assessed by the biomarker score, and future risk of T2D. We undertook a comparison between the biomarker score and a score based on self-report as previously reported in the EPIC-InterAct [