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


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.
Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands monique.vannielen@wur.nl.
Monique
M
van Nielen
Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
Edith J M
EJ
Feskens
Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
Marco
M
Mensink
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
Ivonne
I
Sluijs
Andalusian School of Public Health, Granada, Spain.
Esther
E
Molina
Public Health Division of Gipuzkoa, San Sebastian, SpainCIBER Epidemiología y Salud Pública, Madrid, Spain.
Pilar
P
Amiano
CIBER Epidemiología y Salud Pública, Madrid, SpainNavarre Public Health Institute, Pamplona, Spain.
Eva
E
Ardanaz
Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, France.
Beverly
B
Balkau
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
Joline W J
JW
Beulens
German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
Heiner
H
Boeing
Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, FranceUniversité Paris-Sud, France.
Françoise
F
Clavel-Chapelon
Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, FranceUniversité Paris-Sud, France.
Guy
G
Fagherazzi
Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Paul W
PW
Franks
Danish Cancer Society Research Center, Copenhagen, Denmark.
Jytte
J
Halkjaer
CIBER Epidemiología y Salud Pública, Madrid, SpainDepartment of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
José Maria
JM
Huerta
German Cancer Research Center, Heidelberg, Germany.
Verena
V
Katzke
Cancer Epidemiology Unit, University of Oxford, Oxford, U.K.
Timothy J
TJ
Key
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.
Kay Tee
KT
Khaw
National Cancer Institute, Milan, Italy.
Vittorio
V
Krogh
German Cancer Research Center, Heidelberg, Germany.
Tilman
T
Kühn
Public Health Directorate, Asturias, Spain.
Virginia V M
VV
Menéndez
Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Peter
P
Nilsson
School of Public Health, Aarhus University, Denmark.
Kim
K
Overvad
Cancer Research and Prevention Institute, Florence, Italy.
Domenico
D
Palli
Dipartimento di medicina clinica e chirurgia, federico ii University, Naples, Italy.
Salvatore
S
Panico
Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Olov
O
Rolandsson
International Agency for Research on Cancer, Lyon, France.
Isabelle
I
Romieu
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.
Carlotta
C
Sacerdote
Andalusian School of Public Health, Granada, SpainCIBER Epidemiología y Salud Pública, Madrid, Spain.
Maria-José
MJ
Sánchez
German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
Matthias B
MB
Schulze
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Annemieke M W
AM
Spijkerman
Danish Cancer Society Research Center, Copenhagen, Denmark.
Anne
A
Tjonneland
Cancer Registry and Histopathology Unit, Ragusa, Italy.
Rosario
R
Tumino
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Daphne L
DL
van der A
School of Public Health, Aarhus University, Denmark.
Anne M L
AM
Würtz
Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, SpainBellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.
Raul
R
Zamora-Ros
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.
Claudia
C
Langenberg
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.
Stephen J
SJ
Sharp
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.
Nita G
NG
Forouhi
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K.
Elio
E
Riboli
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.
Nicholas J
NJ
Wareham
D000328:Adult; D000818:Animals; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008460:Meat; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors
D004044:Dietary Proteins