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
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Tables
- Table 1
Baseline characteristics of the study population, according to quartiles of daily nutritional total protein intake
Quartile 1 (low) Quartile 2 Quartile 3 Quartile 4 (high) Participants 9,523 9,524 9,524 9,523 Male sex 2,643 (27.8) 2,685 (28.2) 2,450 (25.7) 1,962 (20.6) Age (years) 48 ± 12 48 ± 12 50 ± 12 51 ± 11 Energy intake (kcal/day) 2,036 ± 645 2,106 ± 618 2,078 ± 602 1,998 ± 622 Animal protein intake (g/day) 35.2 ± 7.0 44.5 ± 5.2 51.3 ± 5.2 62.9 ± 8.3 Vegetable protein intake (g/day) 27.0 ± 5.5 27.6 ± 4.8 27.6 ± 4.8 26.9 ± 4.7 Saturated fat intake (g/day) 31.2 ± 6.2 32.5 ± 5.6 33.0 ± 5.6 33.4 ± 5.9 Polyunsaturated fat intake (g/day) 15.3 ± 4.3 15.3 ± 3.8 14.9 ± 3.7 14.2 ± 3.6 Monounsaturated fat intake (g/day) 29.2 ± 5.5 29.7 ± 5.0 29.6 ± 5.0 29.2 ± 5.2 Cholesterol intake (mg/day) 190.0 ± 53.0 210.4 ± 51.1 223.4 ± 53.5 245.3 ± 64.2 Carbohydrate intake (g/day) 231.5 ± 34.3 223.7 ± 29.0 219.3 ± 28.2 213.6 ± 28.8 Glycemic load intake (g/day) 120.8 ± 24.7 114.7 ± 20.1 110.8 ± 18.9 106.0 ± 18.3 Fiber intake (g/day) 22.1 ± 5.2 23.2 ± 4.6 23.8 ± 4.6 24.2 ± 4.7 Vitamin C intake (mg/day) 101.4 ± 49.7 106.6 ± 43.1 111.6 ± 42.6 118.0 ± 44.0 Vitamin E intake (mg/day) 12.9 ± 3.6 12.5 ± 3.2 12.1 ± 3.0 11.5 ± 3.0 Magnesium intake (mg/day) 304.9 ± 46.2 327.2 ± 41.7 343.9 ± 40.9 365.9 ± 43.3 Iron intake (mg/day) 10.8 ± 1.6 11.3 ± 1.5 11.7 ± 1.6 12.1 ± 1.7 Heme iron intake (mg/day) 1.6 ± 0.7 1.9 ± 0.7 2.1 ± 0.7 2.5 ± 0.9 Alcohol intake (g/day) 15.8 ± 24.4 11.0 ± 15.9 9.7 ± 13.9 8.0 ± 12.6 BMI (kg/m2) 24.7 ± 3.7 25.3 ± 3.7 25.8 ± 3.9 26.7 ± 4.3 Waist circumference (cm) 83.1 ± 11.2 84.6 ± 11.2 85.5 ± 11.2 87.1 ± 11.7 Current smoker 3,655 (38.4) 3,014 (31.7) 2,541 (26.8) 2,420 (25.5) Physically inactive* 3,983 (41.8) 3,609 (37.9) 3,482 (36.6) 3,413 (35.9) Higher education 1,993 (20.9) 2,104 (22.1) 2,030 (21.3) 1,703 (17.9) Parental history of diabetes 1,559 (16.4) 1,615 (17.0) 1,767 (18.5) 1,922 (20.2) Systolic blood pressure (mmHg) 124.3 ± 18.6 125.3 ± 18.8 126.6 ± 18.7 127.8 ± 19.0 Diastolic blood pressure (mmHg) 77.2 ± 10.6 77.5 ± 10.5 78.0 ± 10.6 78.4 ± 10.7 Hypertension 3,108 (32.6) 3,307 (34.7) 3,491 (36.7) 3,762 (39.5) -
Data are n (%) or means ± SD.
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↵*Inactive according to Cambridge physical activity index.
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- Table 2
Univariable and adjusted HRs (95% CI) for the association between intake of protein, in quartiles and per 10 g, and incident type 2 diabetes
Quartile 1 (low) Quartile 2 Quartile 3 Quartile 4 (high) Ptrend Per 10 g Total protein Cases/at risk (n) 153/9,523 185/9,524 249/9,524 331/9,523 Quartile median total protein (g/day) 64 72 79 88 Univariable 1 1.20 (0.97–1.49) 1.63 (1.33–1.99)* 2.15 (1.77–2.60)* <0.001 1.36 (1.28–1.44)* Model 1†: age and sex 1 1.17 (0.94–1.45) 1.50 (1.23–1.84)* 1.85 (1.53–1.25)* <0.001 1.28 (1.22–1.36)* Model 2‡: model 1 + dietary intake 1 1.24 (0.99–1.54) 1.65 (1.32–2.07)* 2.16 (1.69–2.76)* <0.001 1.45 (1.34–1.56)* Model 3§: model 2 + diabetes risk factors 1 1.16 (0.92–1.45) 1.45 (1.15–1.83)* 1.67 (1.29–2.16)* <0.001 1.33 (1.22–1.45)* Model 4‖: model 3 + waist and BMI 1 1.03 (0.82–1.29) 1.20 (0.95–1.51) 1.18 (0.91–1.53) 0.15 1.16 (1.06–1.26)¶ Animal protein Cases/at risk (n) 155/9,523 182/9,524 243/9,524 338/9,523 Quartile median animal protein (g/day) 35 44 52 62 Univariable 1 1.16 (0.94–1.44) 1.56 (1.28–1.91)* 2.18 (1.80–2.63)* <0.001 1.32 (1.25–1.39)* Model 1†: age and sex 1 1.08 (0.87–1.33) 1.35 (1.10–1.65)¶ 1.73 (1.43–2.10)* <0.001 1.24 (1.17–1.30)* Model 2‡: model 1 + dietary intake 1 1.17 (0.94–1.46) 1.54 (1.23–1.92)* 2.09 (1.64–2.67)* <0.001 1.40 (1.30–1.51)* Model 3§: model 2 + diabetes risk factors 1 1.09 (0.87–1.36) 1.31 (1.05–1.65)¶ 1.58 (1.23–2.04)* <0.001 1.28 (1.18–1.39)* Model 4‖: model 3 + waist and BMI 1 0.99 (0.79–1.23) 1.11 (0.89–1.40) 1.14 (0.88–1.47) 0.22 1.13 (1.04–1.22)¶ Vegetable protein Cases/at risk (n) 245/9,524 228/9,524 235/9,523 210/9,523 Quartile median vegetable protein (g/day) 22 26 29 33 Univariable 1 0.92 (0.76–1.10) 0.95 (0.79–1.13) 0.84 (0.70–1.01) 0.10 0.87 (0.76–0.99)¶ Model 1†: age and sex 1 0.94 (0.79–1.13) 1.02 (0.85–1.22) 1.02 (0.85–1.23) 0.64 1.01 (0.88–1.15) Model 2‡: model 1 + dietary intake 1 0.89 (0.73–1.08) 0.96 (0.77–1.19) 0.91 (0.70–1.19) 0.63 0.85 (0.69–1.06) Model 3§: model 2 + diabetes risk factors 1 0.95 (0.78–1.16) 1.03 (0.83–1.27) 1.05 (0.80–1.37) 0.63 0.97 (0.78–1.20) Model 4‖: model 3 + waist and BMI 1 0.99 (0.82–1.21) 1.11 (0.89–1.38) 1.15 (0.88–1.50) 0.23 1.04 (0.83–1.29) -
Data are HRs (95% CI).
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↵*Significant at P < 0.001 level.
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↵†Model 1: Corrected for sex (male or female) and age at recruitment (continuous).
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↵‡Model 2: model 1 + energy-adjusted intake of saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, vitamin E, magnesium, fiber, and glycemic load (continuous).
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↵§Model 3: model 2 + energy-adjusted alcohol consumption (<11, 11–25, 26–50, or >50 g/day), physical activity (not active, moderately inactive, moderately active, or active), mean systolic and diastolic blood pressure (continuous), education level (high, middle, or low), and parental history of diabetes (no, one parent, or both parents).
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↵‖Model 4: model 3 + BMI (<20, 20–25 [reference group], 25–30, or >30 kg/m2), and waist circumference (continuous).
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↵¶Significant at P < 0.05 level.
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- Table 3
Multivariable HRs (95% CI) for the association between the consumption of 5% energy from protein at the expense of 5% energy from fat or carbohydrates while keeping total energy intake constant and incident type 2 diabetes
Model 3* Model 4† Total protein Substitution protein for fat 1.72 (1.41–2.12)‡ 1.31 (1.06–1.61)§ Substitution protein for carbohydrates 1.91 (1.52–2.40)‡ 1.28 (1.01–1.61)§ Animal protein Substitution protein for fat 1.51 (1.26–1.82)‡ 1.19 (0.99–1.44) Substitution protein for carbohydrates 1.72 (1.39–2.12)‡ 1.20 (0.97–1.49) Vegetable protein Substitution protein for fat 1.13 (0.67–1.92) 1.32 (0.82–2.13) Substitution protein for carbohydrates 0.97 (0.57–1.65) 1.17 (0.73–1.89) -
Data are HRs (95% CI).
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↵*Model 3: corrected for sex (male or female), age at recruitment (continuous), energy-adjusted intake of cholesterol, vitamin E, magnesium, fiber, and glycemic load (continuous), total energy intake (continuous), energy densities of fat, carbohydrates, and alcohol (per 5 energy %), physical activity (not active, moderately inactive, moderately active, or active), mean systolic and diastolic blood pressure (continuous), education level (high, middle, or low), and parental history of diabetes (no, one parent, or both parents).
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↵†Model 4: model 3 + BMI (<20, 20–25 [reference group], 25–30, or >30 kg/m2) and waist circumference (continuous).
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↵‡Significant at P < 0.001 level.
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↵§Significant at P < 0.05 level.
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