Dietary protein intake and incidence of type 2 diabetes in Europe: The EPIC-InterAct case-cohort study

Monique Van Nielen, Edith J M Feskens, Marco Mensink, Ivonne Sluijs, Esther Molina, Pilar Amiano, Eva Ardanaz, Beverly Balkau, Joline W J Beulens, Heiner Boeing, Françoise Clavel-Chapelon, Guy Fagherazzi, Paul W. Franks, Jytte Halkjaer, José Maria Huerta, Verena Katzke, Timothy J. Key, Kay Tee Khaw, Vittorio Krogh, Tilman KühnVirginia V M Menéndez, Peter Nilsson, Kim Overvad, Domenico Palli, Salvatore Panico, Olov Rolandsson, Isabelle Romieu, Carlotta Sacerdote, Maria José Sánchez, Matthias B. Schulze, Annemieke M W Spijkerman, Anne Tjonneland, Rosario Tumino, Daphne L. Van Der A, Anne M L Würtz, Raul Zamora-Ros, Claudia Langenberg, Stephen J. Sharp, Nita G. Forouhi, Elio Riboli, Nicholas J. Wareham

Research output: Contribution to journalArticlepeer-review


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], Ptrend = 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/m2 (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], Ptrend = 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.

Original languageEnglish
Pages (from-to)1854-1862
Number of pages9
JournalDiabetes Care
Issue number7
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing
  • Medicine(all)


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