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Original Research

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

  1. Ivonne Sluijs, MSC1,
  2. Joline W.J. Beulens, PHD1,2,
  3. Daphne L. van der A, PHD3,
  4. Annemieke M.W. Spijkerman, PHD2,
  5. Diederick E. Grobbee, MD, PHD1 and
  6. Yvonne T. van der Schouw, PHD1
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands;
  2. 2Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands;
  3. 3Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  1. Corresponding author: Ivonne Sluijs, i.sluijs-2{at}umcutrecht.nl.
Diabetes Care 2010 Jan; 33(1): 43-48. https://doi.org/10.2337/dc09-1321
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Article Figures & Tables

Tables

  • Table 1

    Baseline characteristics of the study population, according to quartiles of daily nutritional total protein intake

    Quartile 1 (low)Quartile 2Quartile 3Quartile 4 (high)
    Participants9,5239,5249,5249,523
    Male sex2,643 (27.8)2,685 (28.2)2,450 (25.7)1,962 (20.6)
    Age (years)48 ± 1248 ± 1250 ± 1251 ± 11
    Energy intake (kcal/day)2,036 ± 6452,106 ± 6182,078 ± 6021,998 ± 622
    Animal protein intake (g/day)35.2 ± 7.044.5 ± 5.251.3 ± 5.262.9 ± 8.3
    Vegetable protein intake (g/day)27.0 ± 5.527.6 ± 4.827.6 ± 4.826.9 ± 4.7
    Saturated fat intake (g/day)31.2 ± 6.232.5 ± 5.633.0 ± 5.633.4 ± 5.9
    Polyunsaturated fat intake (g/day)15.3 ± 4.315.3 ± 3.814.9 ± 3.714.2 ± 3.6
    Monounsaturated fat intake (g/day)29.2 ± 5.529.7 ± 5.029.6 ± 5.029.2 ± 5.2
    Cholesterol intake (mg/day)190.0 ± 53.0210.4 ± 51.1223.4 ± 53.5245.3 ± 64.2
    Carbohydrate intake (g/day)231.5 ± 34.3223.7 ± 29.0219.3 ± 28.2213.6 ± 28.8
    Glycemic load intake (g/day)120.8 ± 24.7114.7 ± 20.1110.8 ± 18.9106.0 ± 18.3
    Fiber intake (g/day)22.1 ± 5.223.2 ± 4.623.8 ± 4.624.2 ± 4.7
    Vitamin C intake (mg/day)101.4 ± 49.7106.6 ± 43.1111.6 ± 42.6118.0 ± 44.0
    Vitamin E intake (mg/day)12.9 ± 3.612.5 ± 3.212.1 ± 3.011.5 ± 3.0
    Magnesium intake (mg/day)304.9 ± 46.2327.2 ± 41.7343.9 ± 40.9365.9 ± 43.3
    Iron intake (mg/day)10.8 ± 1.611.3 ± 1.511.7 ± 1.612.1 ± 1.7
    Heme iron intake (mg/day)1.6 ± 0.71.9 ± 0.72.1 ± 0.72.5 ± 0.9
    Alcohol intake (g/day)15.8 ± 24.411.0 ± 15.99.7 ± 13.98.0 ± 12.6
    BMI (kg/m2)24.7 ± 3.725.3 ± 3.725.8 ± 3.926.7 ± 4.3
    Waist circumference (cm)83.1 ± 11.284.6 ± 11.285.5 ± 11.287.1 ± 11.7
    Current smoker3,655 (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 education1,993 (20.9)2,104 (22.1)2,030 (21.3)1,703 (17.9)
    Parental history of diabetes1,559 (16.4)1,615 (17.0)1,767 (18.5)1,922 (20.2)
    Systolic blood pressure (mmHg)124.3 ± 18.6125.3 ± 18.8126.6 ± 18.7127.8 ± 19.0
    Diastolic blood pressure (mmHg)77.2 ± 10.677.5 ± 10.578.0 ± 10.678.4 ± 10.7
    Hypertension3,108 (32.6)3,307 (34.7)3,491 (36.7)3,762 (39.5)
    • Data are n (%) or means ± SD.

    • ↵*Inactive according to Cambridge physical activity index.

  • 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 2Quartile 3Quartile 4 (high)PtrendPer 10 g
    Total protein
        Cases/at risk (n)153/9,523185/9,524249/9,524331/9,523
        Quartile median total protein (g/day)64727988
        Univariable11.20 (0.97–1.49)1.63 (1.33–1.99)*2.15 (1.77–2.60)*<0.0011.36 (1.28–1.44)*
        Model 1†: age and sex11.17 (0.94–1.45)1.50 (1.23–1.84)*1.85 (1.53–1.25)*<0.0011.28 (1.22–1.36)*
        Model 2‡: model 1 + dietary intake11.24 (0.99–1.54)1.65 (1.32–2.07)*2.16 (1.69–2.76)*<0.0011.45 (1.34–1.56)*
        Model 3§: model 2 + diabetes risk factors11.16 (0.92–1.45)1.45 (1.15–1.83)*1.67 (1.29–2.16)*<0.0011.33 (1.22–1.45)*
        Model 4‖: model 3 + waist and BMI11.03 (0.82–1.29)1.20 (0.95–1.51)1.18 (0.91–1.53)0.151.16 (1.06–1.26)¶
    Animal protein
        Cases/at risk (n)155/9,523182/9,524243/9,524338/9,523
        Quartile median animal protein (g/day)35445262
        Univariable11.16 (0.94–1.44)1.56 (1.28–1.91)*2.18 (1.80–2.63)*<0.0011.32 (1.25–1.39)*
        Model 1†: age and sex11.08 (0.87–1.33)1.35 (1.10–1.65)¶1.73 (1.43–2.10)*<0.0011.24 (1.17–1.30)*
        Model 2‡: model 1 + dietary intake11.17 (0.94–1.46)1.54 (1.23–1.92)*2.09 (1.64–2.67)*<0.0011.40 (1.30–1.51)*
        Model 3§: model 2 + diabetes risk factors11.09 (0.87–1.36)1.31 (1.05–1.65)¶1.58 (1.23–2.04)*<0.0011.28 (1.18–1.39)*
        Model 4‖: model 3 + waist and BMI10.99 (0.79–1.23)1.11 (0.89–1.40)1.14 (0.88–1.47)0.221.13 (1.04–1.22)¶
    Vegetable protein
        Cases/at risk (n)245/9,524228/9,524235/9,523210/9,523
        Quartile median vegetable protein (g/day)22262933
        Univariable10.92 (0.76–1.10)0.95 (0.79–1.13)0.84 (0.70–1.01)0.100.87 (0.76–0.99)¶
        Model 1†: age and sex10.94 (0.79–1.13)1.02 (0.85–1.22)1.02 (0.85–1.23)0.641.01 (0.88–1.15)
        Model 2‡: model 1 + dietary intake10.89 (0.73–1.08)0.96 (0.77–1.19)0.91 (0.70–1.19)0.630.85 (0.69–1.06)
        Model 3§: model 2 + diabetes risk factors10.95 (0.78–1.16)1.03 (0.83–1.27)1.05 (0.80–1.37)0.630.97 (0.78–1.20)
        Model 4‖: model 3 + waist and BMI10.99 (0.82–1.21)1.11 (0.89–1.38)1.15 (0.88–1.50)0.231.04 (0.83–1.29)
    • Data are HRs (95% CI).

    • ↵*Significant at P < 0.001 level.

    • ↵†Model 1: Corrected for sex (male or female) and age at recruitment (continuous).

    • ↵‡Model 2: model 1 + energy-adjusted intake of saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, vitamin E, magnesium, fiber, and glycemic load (continuous).

    • ↵§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).

    • ↵‖Model 4: model 3 + BMI (<20, 20–25 [reference group], 25–30, or >30 kg/m2), and waist circumference (continuous).

    • ↵¶Significant at P < 0.05 level.

  • 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 fat1.72 (1.41–2.12)‡1.31 (1.06–1.61)§
        Substitution protein for carbohydrates1.91 (1.52–2.40)‡1.28 (1.01–1.61)§
    Animal protein
        Substitution protein for fat1.51 (1.26–1.82)‡1.19 (0.99–1.44)
        Substitution protein for carbohydrates1.72 (1.39–2.12)‡1.20 (0.97–1.49)
    Vegetable protein
        Substitution protein for fat1.13 (0.67–1.92)1.32 (0.82–2.13)
        Substitution protein for carbohydrates0.97 (0.57–1.65)1.17 (0.73–1.89)
    • Data are HRs (95% CI).

    • ↵*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).

    • ↵†Model 4: model 3 + BMI (<20, 20–25 [reference group], 25–30, or >30 kg/m2) and waist circumference (continuous).

    • ↵‡Significant at P < 0.001 level.

    • ↵§Significant at P < 0.05 level.

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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
Ivonne Sluijs, Joline W.J. Beulens, Daphne L. van der A, Annemieke M.W. Spijkerman, Diederick E. Grobbee, Yvonne T. van der Schouw
Diabetes Care Jan 2010, 33 (1) 43-48; DOI: 10.2337/dc09-1321

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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
Ivonne Sluijs, Joline W.J. Beulens, Daphne L. van der A, Annemieke M.W. Spijkerman, Diederick E. Grobbee, Yvonne T. van der Schouw
Diabetes Care Jan 2010, 33 (1) 43-48; DOI: 10.2337/dc09-1321
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