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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

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

Abstract

OBJECTIVE:

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.

RESEARCH DESIGN AND METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

PMID:
24722499
DOI:
10.2337/dc13-2627
[Indexed for MEDLINE]

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