Dietary Protein Intake and Incidence of Type 2 Diabetes in Europe: The EPIC-InterAct Case-Cohort Study

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title = "Dietary Protein Intake and Incidence of Type 2 Diabetes in Europe: The EPIC-InterAct Case-Cohort Study",
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.",
author = "{van Nielen}, Monique and Feskens, {Edith J. M.} and Marco Mensink and Ivonne Sluijs and Esther Molina and Pilar Amiano and Eva Ardanaz and Beverly Balkau and Beulens, {Joline W. J.} and Heiner Boeing and Francoise Clavel-Chapelon and Guy Fagherazzi and Paul Franks and Jytte Halkjaer and {Maria Huerta}, Jose and Verena Katzke and Key, {Timothy J.} and Khaw, {Kay Tee} and Vittorio Krogh and Tilman Kuhn and Menendez, {Virginia V. M.} and Peter Nilsson and Kim Overvad and Domenico Palli and Salvatore Panico and Olov Rolandsson and Isabelle Romieu and Carlotta Sacerdote and Maria-Jose Sanchez and Schulze, {Matthias B.} and Spijkerman, {Annemieke M. W.} and Anne Tjonneland and Rosario Tumino and Daphne, {L. van der A.} and Wurtz, {Anne M. L.} and Raul Zamora-Ros and Claudia Langenberg and Sharp, {Stephen J.} and Forouhi, {Nita G.} and Elio Riboli and Wareham, {Nicholas J.}",
year = "2014",
doi = "10.2337/dc13-2627",
language = "English",
volume = "37",
pages = "1854--1862",
journal = "Diabetes Reviews",
issn = "1935-5548",
publisher = "American Diabetes Association",
number = "7",