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Diabetes Care. 2014 Jul;37(7):1854-62. doi: 10.2337/dc13-2627. Epub 2014 Apr 10.

Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study.

Author information

  • 1Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
  • 2Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
  • 3Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
  • 4Andalusian School of Public Health, Granada, Spain.
  • 5Public Health Division of Gipuzkoa, San Sebastian, SpainCIBER Epidemiología y Salud Pública, Madrid, Spain.
  • 6CIBER Epidemiología y Salud Pública, Madrid, SpainNavarre Public Health Institute, Pamplona, Spain.
  • 7Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, France.
  • 8German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
  • 9Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, FranceUniversité Paris-Sud, France.
  • 10Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
  • 11Danish Cancer Society Research Center, Copenhagen, Denmark.
  • 12CIBER Epidemiología y Salud Pública, Madrid, SpainDepartment of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
  • 13German Cancer Research Center, Heidelberg, Germany.
  • 14Cancer Epidemiology Unit, University of Oxford, Oxford, U.K.
  • 15Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.
  • 16National Cancer Institute, Milan, Italy.
  • 17Public Health Directorate, Asturias, Spain.
  • 18School of Public Health, Aarhus University, Denmark.
  • 19Cancer Research and Prevention Institute, Florence, Italy.
  • 20Dipartimento di medicina clinica e chirurgia, federico ii University, Naples, Italy.
  • 21Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
  • 22International Agency for Research on Cancer, Lyon, France.
  • 23Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention, Turin, ItalyHuman Genetics Foundation, Turin, Italy.
  • 24Andalusian School of Public Health, Granada, SpainCIBER Epidemiología y Salud Pública, Madrid, Spain.
  • 25National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • 26Cancer Registry and Histopathology Unit, Ragusa, Italy.
  • 27Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, SpainBellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.
  • 28Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K.



The long-term association between dietary protein and type 2 diabetes incidence is uncertain. We aimed to investigate the association between total, animal, and plant protein intake and the incidence of type 2 diabetes.


The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from eight European countries, with an average follow-up time of 12.0 years. Pooled country-specific hazard ratios (HRs) and 95% CI of prentice-weighted Cox regression analyses were used to estimate type 2 diabetes incidence according to protein intake.


After adjustment for important diabetes risk factors and dietary factors, the incidence of type 2 diabetes was higher in those with high intake of total protein (per 10 g: HR 1.06 [95% CI 1.02-1.09], P(trend) < 0.001) and animal protein (per 10 g: 1.05 [1.02-1.08], P(trend) = 0.001). Effect modification by sex (P < 0.001) and BMI among women (P < 0.001) was observed. Compared with the overall analyses, associations were stronger in women, more specifically obese women with a BMI >30 kg/m(2) (per 10 g animal protein: 1.19 [1.09-1.32]), and nonsignificant in men. Plant protein intake was not associated with type 2 diabetes (per 10 g: 1.04 [0.93-1.16], P(trend) = 0.098).


High total and animal protein intake was associated with a modest elevated risk of type 2 diabetes in a large cohort of European adults. In view of the rapidly increasing prevalence of type 2 diabetes, limiting iso-energetic diets high in dietary proteins, particularly from animal sources, should be considered.

© 2014 by the American Diabetes Association.

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