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Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study.
Diabetes Care 2014; 37(7):1854-62DC

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.

Authors+Show Affiliations

Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands monique.vannielen@wur.nl.Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.Andalusian School of Public Health, Granada, Spain.Public Health Division of Gipuzkoa, San Sebastian, SpainCIBER Epidemiología y Salud Pública, Madrid, Spain.CIBER Epidemiología y Salud Pública, Madrid, SpainNavarre Public Health Institute, Pamplona, Spain.Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, France.Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, FranceUniversité Paris-Sud, France.Inserm, Centre for Research in Epidemiology and Population Health, Villejuif, FranceUniversité Paris-Sud, France.Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.Danish Cancer Society Research Center, Copenhagen, Denmark.CIBER Epidemiología y Salud Pública, Madrid, SpainDepartment of Epidemiology, Murcia Regional Health Council, Murcia, Spain.German Cancer Research Center, Heidelberg, Germany.Cancer Epidemiology Unit, University of Oxford, Oxford, U.K.Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.National Cancer Institute, Milan, Italy.German Cancer Research Center, Heidelberg, Germany.Public Health Directorate, Asturias, Spain.Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.School of Public Health, Aarhus University, Denmark.Cancer Research and Prevention Institute, Florence, Italy.Dipartimento di medicina clinica e chirurgia, federico ii University, Naples, Italy.Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.International Agency for Research on Cancer, Lyon, France.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.Andalusian School of Public Health, Granada, SpainCIBER Epidemiología y Salud Pública, Madrid, Spain.German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.National Institute for Public Health and the Environment, Bilthoven, the Netherlands.Danish Cancer Society Research Center, Copenhagen, Denmark.Cancer Registry and Histopathology Unit, Ragusa, Italy.National Institute for Public Health and the Environment, Bilthoven, the Netherlands.School of Public Health, Aarhus University, Denmark.Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, SpainBellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K.Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24722499

Citation

van Nielen, Monique, et al. "Dietary Protein Intake and Incidence of Type 2 Diabetes in Europe: the EPIC-InterAct Case-Cohort Study." Diabetes Care, vol. 37, no. 7, 2014, pp. 1854-62.
van Nielen M, Feskens EJ, Mensink M, et al. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study. Diabetes Care. 2014;37(7):1854-62.
van Nielen, M., Feskens, E. J., Mensink, M., Sluijs, I., Molina, E., Amiano, P., ... 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), pp. 1854-62. doi:10.2337/dc13-2627.
van Nielen M, et al. Dietary Protein Intake and Incidence of Type 2 Diabetes in Europe: the EPIC-InterAct Case-Cohort Study. Diabetes Care. 2014;37(7):1854-62. PubMed PMID: 24722499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary protein intake and incidence of type 2 diabetes in Europe: 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, AU - ,, Y1 - 2014/04/10/ PY - 2014/4/12/entrez PY - 2014/4/12/pubmed PY - 2014/12/15/medline SP - 1854 EP - 62 JF - Diabetes care JO - Diabetes Care VL - 37 IS - 7 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], 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. SN - 1935-5548 UR - http://www.unboundmedicine.com/medline/citation/24722499/full_citation L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=24722499 DB - PRIME DP - Unbound Medicine ER -