Dietary Intake of Total, Animal, and Vegetable Protein and Risk of Type 2 Diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL Study

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherland.
Diabetes care (Impact Factor: 8.42). 10/2009; 33(1):43-8. DOI: 10.2337/dc09-1321
Source: PubMed


Dietary recommendations are focused mainly on relative dietary fat and carbohydrate content in relation to diabetes risk. Meanwhile, high-protein diets may contribute to disturbance of glucose metabolism, but evidence from prospective studies is scarce. We examined the association among dietary total, vegetable, and animal protein intake and diabetes incidence and whether consuming 5 energy % from protein at the expense of 5 energy % from either carbohydrates or fat was associated with diabetes risk.
A prospective cohort study was conducted among 38,094 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL study. Dietary protein intake was measured with a validated food frequency questionnaire. Incident diabetes was verified against medical records.
During 10 years of follow-up, 918 incident cases of diabetes were documented. Diabetes risk increased with higher total protein (hazard ratio 2.15 [95% CI 1.77-2.60] highest vs. lowest quartile) and animal protein (2.18 [1.80-2.63]) intake. Adjustment for confounders did not materially change these results. Further adjustment for adiposity measures attenuated the associations. Vegetable protein was not related to diabetes. Consuming 5 energy % from total or animal protein at the expense of 5 energy % from carbohydrates or fat increased diabetes risk.
Diets high in animal protein are associated with an increased diabetes risk. Our findings also suggest a similar association for total protein itself instead of only animal sources. Consumption of energy from protein at the expense of energy from either carbohydrates or fat may similarly increase diabetes risk. This finding indicates that accounting for protein content in dietary recommendations for diabetes prevention may be useful.

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    • "Please cite this article in press as: Djouss e L, et al., Egg consumption and risk of type 2 diabetes among African Americans: The Jackson Heart Study, Clinical Nutrition (2015), were associated with a higher risk of DM [9] whereas a metaanalysis of three studies showed no association of animal proteins with DM [10]. Among individual foods, eggs could play a unique role among dietary factors affecting the risk of DM, partly because they are rich in proteins, cholesterol, and other nutrients. "
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    ABSTRACT: Type 2 diabetes (DM) disproportionally affects African Americans. Data on the association between egg consumption and risk of DM are sparse. We sought to examine whether egg consumption is associated with the prevalence and incidence of DM among African Americans. We analyzed baseline data from 4568 participants of the Jackson Heart Study. Egg consumption was obtained using a food frequency questionnaire designed for this population. We used generalized estimating equations to calculate adjusted prevalence ratios of DM and Cox regression to estimate hazard ratios of DM with corresponding 95% confidence intervals (CI). The average age was 55 ± 13 years and 64% of subjects were women. The median frequency of egg consumption was 2/week for men and 1/week for women. The prevalence of DM was 22% overall (21% of men and 23% of women). Multivariable adjusted prevalence ratio [PR (95% CI)] for DM were: 1.00 (ref), 1.14 (0.90-1.44), 1.33 (1.04-1.70), 1.33 (1.06-1.68), 1.26 (0.99-1.61), and 1.52 (1.17-1.97) for egg consumption of <1/month, 1-3/month, 1/week, 2/week, 3-4/week, and 5+/week, respectively, p for linear trend 0.0024. Corresponding multivariable adjusted hazard ratios were 1.00 (ref), 0.88 (0.65-1.19), 0.94 (0.68-1.30), 0.91 (0.66-1.25), 1.11 (0.81-1.52), and 1.17 (0.81-1.70), respectively, during a mean follow up of 7.3 years (p for linear trend 0.22). While egg consumption was positively associated with prevalent DM, prospective analysis did not show an association of egg intake with incidence of DM among African Americans. Published by Elsevier Ltd.
    No preview · Article · Apr 2015 · Clinical nutrition (Edinburgh, Scotland)
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    • "Intake of animal protein (% of total protein) in the studied 6-year-olds was similar to that observed in the previously studied Polish 4-6-year-olds [6], Belgian 4–6.5-year-olds [10] and Vietnamese 4-5-year-olds [41]. It is recommended to reduce the intake of animal protein since its high intake is related to an increased diabetes risk [42], as well as to earlier pubertal onset which may contribute to a higher risk of breast cancer [43]. Moreover, it causes reduced intake of plant protein which is inversely related to the risk of ischaemic heart disease [44]. "
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    ABSTRACT: Background The studies on dietary intake in Polish children are sparse and the information about dietary intake in 6-year-olds in Europe is limited. The published studies on dietary intake in children rarely provide information on the intake of animal protein, plant protein and water. The purpose of the study was to analyse energy and macronutrient intakes in 6-year-old children from southern Poland. Methods The studied population comprised 120 children, 64 girls and 56 boys. Energy and macronutrient intakes were estimated from a three-day food record. Weight and height were measured, and body mass index was calculated. Results Intakes of energy (kJ, kcal), plant protein (g), total fat (g), saturated fatty acids (g, % of energy, g/1000 kcal), monounsaturated fatty acids (g) and starch (g, % of energy, g/1000 kcal) were significantly higher in boys, while intakes of sucrose (% of energy, g/1000 kcal) and total water (g/1000 kcal) were significantly higher in girls. The children’s diets were characterised by excessive intake of total fat, saturated fatty acids, sucrose, and by inadequate intake of polyunsaturated fatty acids, available carbohydrates and starch. Conclusions The observed adverse characteristics of the children’s diets are similar to those observed in the diets of children in other European countries and show the need to work out a common educational programme to improve nutrition in young European children. It is also important to provide the lacking information about the intake of animal protein, plant protein and water in young children.
    Full-text · Article · Aug 2014 · BMC Pediatrics
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    • "Fish is an assumed source of beneficial dietary protein, and recent studies showed that dietary protein intake, despite its known beneficial effects on weight loss, may in fact increase insulin resistance and the risk of developing type 2 diabetes [53], which might be true for the positive association found in our study. Many people, and particularly patients with diabetes, will not sustain initially achieved weight loss, regardless ofthe chosen dietary strategy [54,55]. "
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    ABSTRACT: Objectives: Recent studies have shown that the choice of foods plays a role in diabetes prevention. However, little empirical evidence on this association exists in developing countries. We aimed to examine the association between frequency of fish intake and self-reported diabetes status among adult men and women in India. Methods: Analysis of cross-sectional data from participants in India's third National Family Health Survey conducted during 2005–2006 was performed. Associations between fish intake, determined by frequency of consumption (daily, weekly, occasionally, and never), and self-reported diabetes were estimated using multivariable-adjusted models in 99,574 women, 56,742 men, and 39,257 couples aged 20–49 years after adjusting for frequency of consumption of other food items, body mass index (BMI) status, tobacco smoking, alcohol drinking, watching television, age, education, living standard of the household, and place of residence. Results: After adjustment for other dietary, lifestyle, and socioeconomic and demographic characteristics, odds of diabetes were 2 times higher (odds ratio [OR]: 2.02; 95% confidence interval [CI], 1.59–2.57; p < 0.0001) among those who reported consuming fish daily compared to those who never consumed fish. Weekly fish intake was also associated with a higher odds of having diabetes (OR: 1.55; 95% CI, 1.25–1.93; p < 0.0001). The adjusted effect of daily fish intake on diabetes was greater among men (OR: 2.46; 95% CI, 1.66–3.65) than among women (OR: 1.72; 95% CI, 1.26–2.33). In cross-spousal sensitivity analysis, the odds of a husband having diabetes was also associated with wife's daily/weekly consumption of fish (OR: 1.36; 95% CI, 0.92–2.01) and the odds of a wife having diabetes was also associated with husband's daily/weekly consumption of fish (OR: 1.21; 95% CI, 0.87–1.68). Conclusions: In a large nationally representative sample of adult men and women in India, daily or weekly fish intake was positively associated with the presence of diabetes. However, this is an observational finding and uncontrolled confounding cannot be excluded as an explanation for the association. More epidemiological research with better measures of food intake and clinical measures of diabetes is needed in a developing country setting to validate the findings.
    Full-text · Article · May 2014 · Journal of the American College of Nutrition
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