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 Kühn; Virginia 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

doi:10.2337/dc13-2627

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

Fondazione IRCCS Istituto Nazionale dei Tumori

Research output: Contribution to journal › Article › peer-review

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/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], 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.

Original language	English
Pages (from-to)	1854-1862
Number of pages	9
Journal	Diabetes Care
Volume	37
Issue number	7
DOIs	https://doi.org/10.2337/dc13-2627
Publication status	Published - 2014

ASJC Scopus subject areas

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

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10.2337/dc13-2627

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Van Nielen, M., Feskens, E. J. M., Mensink, M., Sluijs, I., Molina, E., Amiano, P., Ardanaz, E., Balkau, B., Beulens, J. W. J., Boeing, H., Clavel-Chapelon, F., Fagherazzi, G., Franks, P. W., Halkjaer, J., Huerta, J. M., Katzke, V., Key, T. J., Khaw, K. T., Krogh, V., ... Wareham, N. J. (2014). Dietary protein intake and incidence of type 2 diabetes in Europe: The EPIC-InterAct case-cohort study. Diabetes Care, 37(7), 1854-1862. https://doi.org/10.2337/dc13-2627

Van Nielen, M, Feskens, EJM, Mensink, M, Sluijs, I, Molina, E, Amiano, P, Ardanaz, E, Balkau, B, Beulens, JWJ, Boeing, H, Clavel-Chapelon, F, Fagherazzi, G, Franks, PW, Halkjaer, J, Huerta, JM, Katzke, V, Key, TJ, Khaw, KT, Krogh, V, Kühn, T, Menéndez, VVM, Nilsson, P, Overvad, K, Palli, D, Panico, S, Rolandsson, O, Romieu, I, Sacerdote, C, Sánchez, MJ, Schulze, MB, Spijkerman, AMW, Tjonneland, A, Tumino, R, Van Der A, DL, Würtz, AML, Zamora-Ros, R, Langenberg, C, Sharp, SJ, Forouhi, NG, Riboli, E & Wareham, NJ 2014, 'Dietary protein intake and incidence of type 2 diabetes in Europe: The EPIC-InterAct case-cohort study', Diabetes Care, vol. 37, no. 7, pp. 1854-1862. https://doi.org/10.2337/dc13-2627

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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], 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.",

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 Fran{\c c}oise Clavel-Chapelon and Guy Fagherazzi and Franks, {Paul W.} and Jytte Halkjaer and Huerta, {Jos{\'e} Maria} and Verena Katzke and Key, {Timothy J.} and Khaw, {Kay Tee} and Vittorio Krogh and Tilman K{\"u}hn and Men{\'e}ndez, {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 S{\'a}nchez, {Maria Jos{\'e}} and Schulze, {Matthias B.} and Spijkerman, {Annemieke M W} and Anne Tjonneland and Rosario Tumino and {Van Der A}, {Daphne L.} and W{\"u}rtz, {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 Care",

issn = "1935-5548",

publisher = "American Diabetes Association Inc.",

number = "7",

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TY - JOUR

T1 - Dietary protein intake and incidence of type 2 diabetes in Europe

T2 - The EPIC-InterAct case-cohort study

AU - Van Nielen, Monique

AU - Feskens, Edith J M

AU - Mensink, Marco

AU - Sluijs, Ivonne

AU - Molina, Esther

AU - Amiano, Pilar

AU - Ardanaz, Eva

AU - Balkau, Beverly

AU - Beulens, Joline W J

AU - Boeing, Heiner

AU - Clavel-Chapelon, Françoise

AU - Fagherazzi, Guy

AU - Franks, Paul W.

AU - Halkjaer, Jytte

AU - Huerta, José Maria

AU - Katzke, Verena

AU - Key, Timothy J.

AU - Khaw, Kay Tee

AU - Krogh, Vittorio

AU - Kühn, Tilman

AU - Menéndez, Virginia V M

AU - Nilsson, Peter

AU - Overvad, Kim

AU - Palli, Domenico

AU - Panico, Salvatore

AU - Rolandsson, Olov

AU - Romieu, Isabelle

AU - Sacerdote, Carlotta

AU - Sánchez, Maria José

AU - Schulze, Matthias B.

AU - Spijkerman, Annemieke M W

AU - Tjonneland, Anne

AU - Tumino, Rosario

AU - Van Der A, Daphne L.

AU - Würtz, Anne M L

AU - Zamora-Ros, Raul

AU - Langenberg, Claudia

AU - Sharp, Stephen J.

AU - Forouhi, Nita G.

AU - Riboli, Elio

AU - Wareham, Nicholas J.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

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JO - Diabetes Care

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

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