Protein diversity, type 2 diabetes, and effect modifiers : A multi-country prospective study
(2025) In International Journal of Epidemiology 54(3).- Abstract
Background Dietary diversity may affect type 2 diabetes (T2D) but no studies have examined protein diversity by source. We examined five diversity scores and the 10-year risk of T2D and effect modification. Methods A prospective study of 10 363 incident T2D cases and a representative sub-cohort of 13 937 individuals sampled from a cohort of 340 234 participants in eight European countries (1993-2007). Five diversity scores were derived from self-reported diet data (gr/day): diversity of food groups (range: 0-5); and diversity within subtype of vegetables (0-4); meat/alternatives (0-6); animal-protein (0-8); and plant-protein sources (0-5). Country-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained by using... (More)
Background Dietary diversity may affect type 2 diabetes (T2D) but no studies have examined protein diversity by source. We examined five diversity scores and the 10-year risk of T2D and effect modification. Methods A prospective study of 10 363 incident T2D cases and a representative sub-cohort of 13 937 individuals sampled from a cohort of 340 234 participants in eight European countries (1993-2007). Five diversity scores were derived from self-reported diet data (gr/day): diversity of food groups (range: 0-5); and diversity within subtype of vegetables (0-4); meat/alternatives (0-6); animal-protein (0-8); and plant-protein sources (0-5). Country-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained by using Prentice-weighted Cox regression and combined by using mixed-effects models. Models were stratified by sex (male/female) and obesity status (body mass index ≥ 30 kg/m2; waist circumference ≥ 88 cm for females and ≥102 cm for males). Results Daily intake of five food groups (versus up to three) was linked to lower T2D incidence overall [HR 0.86 (95% CI 0.75, 0.98)], in females [0.86 (0.77, 0.96)], and in people without central obesity [0.79 (0.70, 0.89)]. Three or more subtypes of plant protein were inversely associated with T2D overall [0.78 (0.65, 0.98)], in females [0.75 (0.62, 0.90)] and people without central obesity [0.82 (0.68, 1.00)]. Additionally, consuming three subtypes of vegetables was inversely associated with T2D overall [0.90 (0.83, 0.98)] and in males [0.85 (0.73, 0.99)]. Conclusion Diabetes prevention may benefit not only from a diet consisting of five different food groups, but also from a diet that is diverse in plant-protein sources, with specific benefits for female Europeans and those without central obesity.
(Less)
- author
- organization
- publishing date
- 2025-06-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- case-cohort study, dietary diversity, protein diversity, type 2 diabetes
- in
- International Journal of Epidemiology
- volume
- 54
- issue
- 3
- article number
- dyaf057
- publisher
- Oxford University Press
- external identifiers
-
- scopus:105008090537
- pmid:40492563
- ISSN
- 0300-5771
- DOI
- 10.1093/ije/dyaf057
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025 The Author(s).
- id
- 624b8c19-0004-4dcb-85d2-1c9f2b45f635
- date added to LUP
- 2025-12-19 14:30:52
- date last changed
- 2025-12-20 03:00:08
@article{624b8c19-0004-4dcb-85d2-1c9f2b45f635,
abstract = {{<p>Background Dietary diversity may affect type 2 diabetes (T2D) but no studies have examined protein diversity by source. We examined five diversity scores and the 10-year risk of T2D and effect modification. Methods A prospective study of 10 363 incident T2D cases and a representative sub-cohort of 13 937 individuals sampled from a cohort of 340 234 participants in eight European countries (1993-2007). Five diversity scores were derived from self-reported diet data (gr/day): diversity of food groups (range: 0-5); and diversity within subtype of vegetables (0-4); meat/alternatives (0-6); animal-protein (0-8); and plant-protein sources (0-5). Country-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained by using Prentice-weighted Cox regression and combined by using mixed-effects models. Models were stratified by sex (male/female) and obesity status (body mass index ≥ 30 kg/m<sup>2</sup>; waist circumference ≥ 88 cm for females and ≥102 cm for males). Results Daily intake of five food groups (versus up to three) was linked to lower T2D incidence overall [HR 0.86 (95% CI 0.75, 0.98)], in females [0.86 (0.77, 0.96)], and in people without central obesity [0.79 (0.70, 0.89)]. Three or more subtypes of plant protein were inversely associated with T2D overall [0.78 (0.65, 0.98)], in females [0.75 (0.62, 0.90)] and people without central obesity [0.82 (0.68, 1.00)]. Additionally, consuming three subtypes of vegetables was inversely associated with T2D overall [0.90 (0.83, 0.98)] and in males [0.85 (0.73, 0.99)]. Conclusion Diabetes prevention may benefit not only from a diet consisting of five different food groups, but also from a diet that is diverse in plant-protein sources, with specific benefits for female Europeans and those without central obesity.</p>}},
author = {{Mozaffari, Hadis and Imamura, Fumiaki and Murphy, Rachel A. and Jessri, Mahsa and Sharp, Stephen J. and Forouhi, Nita G. and Wareham, Nicholas J. and Ibsen, Daniel B. and Dahm, Christina C. and Huerta, José María and Molina-Montes, Esther and Nickel, Daniela V. and Rolandsson, Olov and Sacerdote, Carlotta and Schulze, Matthias B. and Gonzalez-Martin, Jon Ander and Guevara, Marcela and Nilsson, Peter M. and Panico, Salvatore and Winkvist, Anna and Conklin, Annalijn I.}},
issn = {{0300-5771}},
keywords = {{case-cohort study; dietary diversity; protein diversity; type 2 diabetes}},
language = {{eng}},
month = {{06}},
number = {{3}},
publisher = {{Oxford University Press}},
series = {{International Journal of Epidemiology}},
title = {{Protein diversity, type 2 diabetes, and effect modifiers : A multi-country prospective study}},
url = {{http://dx.doi.org/10.1093/ije/dyaf057}},
doi = {{10.1093/ije/dyaf057}},
volume = {{54}},
year = {{2025}},
}