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van Nielen, Monique; Feskens, Edith J M; Mensink, Marco; Sluijs, Ivonne; Molina, Esther; Amiano, Pilar; Ardanaz, Eva; Balkau, Beverly; Beulens, Joline W J; Boeing, Heiner; Clavel-Chapelon, Françoise; Fagherazzi, Guy; Franks, Paul W; Halkjaer, Jytte; Huerta, José Maria; Katzke, Verena; Key, Timothy J; Khaw, Kay Tee; Krogh, Vittorio; Kühn, Tilman; Menéndez, Virginia V M; Nilsson, Peter; Overvad, Kim; Palli, Domenico; Panico, Salvatore; Rolandsson, Olov; Romieu, Isabelle; Sacerdote, Carlotta; Sánchez, Maria-José; Schulze, Matthias B; Spijkerman, Annemieke M W; Tjonneland, Anne; Tumino, Rosario; van der A, Daphne L; Würtz, Anne M L; Zamora-Ros, Raul; Langenberg, Claudia; Sharp, Stephen J; Forouhi, Nita G; Riboli, Elio; Wareham, Nicholas J
Diabetes care 37, Issue: 7Journal Article
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. 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. 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). 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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