Dietary copper/zinc ratio and type 2 diabetes risk in women: The E3N cohort study

Nasser Laouali, Conor James Macdonald, Sanam Shah, Douae El Fatouhi, Francesca Romana Mancini, Guy Fagherazzi, Marie Christine Boutron-Ruault*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)


The serum copper (Cu) to zinc (Zn) ratio could be an important determinant of Type 2 diabetes (T2D) risk, but prospective epidemiological data are scarce. We aimed to investigate the association between T2D incidence and the dietary Cu/Zn ratio. A total of 70,991 women from the E3N cohort study were followed for 20 years. The intakes of copper and zinc were estimated at baseline using a validated food frequency questionnaire. We identified and validated 3292 incident T2D cases. Spline analysis showed that a Cu/Zn ratio < 0.55 was associated with a lower risk of T2D. Subgroup analyses comparing women in the highest versus the lowest quintile of Cu/Zn ratio showed the same pattern of association for obese women and those with zinc intake ≥8 mg/day. However, for women with zinc intake <8 mg/day, higher Cu/Zn ratio appeared to be associated with higher T2D risk. Our findings suggest that a lower dietary Cu/Zn ratio is associated with a lower T2D risk, especially among obese women and women with zinc intake >8 mg/day. Further studies are warranted to validate our results.

Original languageEnglish
Article number2502
Issue number8
Publication statusPublished - 22 Jul 2021


  • Copper
  • Diet
  • Epidemiology
  • Obesity
  • Observational study
  • Type 2 diabetes
  • Women
  • Zinc


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