Protein intake and the incidence of pre-diabetes and diabetes in 4 population-based studies: the PREVIEW project

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Diewertje Sluik, Elske M Brouwer-Brolsma, Agnes A M Berendsen, Vera Mikkilä, Sally D Poppitt, Marta P Silvestre, Angelo Tremblay, Louis Pérusse, Claude Bouchard, Anne Raben, Edith J M Feskens

Background: Data on the relationship between protein intake and the risk of type 2 diabetes are conflicting.

Objective: We studied prospective associations between the intake of total, plant-based, and animal protein and the risk of pre-diabetes and diabetes in 4 population-based studies included in the PREVIEW project.

Methods: Analyses were conducted with the use of data from 3 European cohorts and 1 Canadian cohort, including 78,851 participants. Protein intake was assessed through the use of harmonized data from food-frequency questionnaires or 3-d dietary records. Cohort-specific incidence ratios (IRs) were estimated for pre-diabetes and diabetes, adjusting for general characteristics, lifestyle and dietary factors, disease history, and body mass index (BMI) and waist circumference; results were pooled based on a random-effects meta-analysis.

Results: Higher total protein intake (g · kg-1 · d-1) was associated with lower incidences of pre-diabetes and diabetes (pooled IRs: 0.84; 95% CI: 0.82, 0.87 and 0.49; 95% CI: 0.28, 0.83, respectively); plant-based protein intake was the main determinant (pooled IRs: 0.83; 95% CI: 0.81, 0.86 and 0.53; 95% CI: 0.36, 0.76, respectively). Substituting 2 energy percentage (E%) protein at the expense of carbohydrates revealed increased risks of pre-diabetes and diabetes (pooled IRs: 1.04; 95% CI: 1.01, 1.07 and 1.09; 95% CI: 1.01, 1.18, respectively). Except for the associations between intakes of total protein and plant-based protein (g · kg-1 · d-1) and diabetes, all other associations became nonsignificant after adjustment for BMI and waist circumference.

Conclusions: Higher protein intake (g · kg-1 · d-1) was associated with a lower risk of pre-diabetes and diabetes. Associations were substantially attenuated after adjustments for BMI and waist circumference, which demonstrates a crucial role for adiposity and may account for previous conflicting findings. This study was registered at ISRCTN as ISRCTN31174892.

Original languageEnglish
JournalAmerican Journal of Clinical Nutrition
Volume109
Issue number5
Pages (from-to)1310-1318
Number of pages9
ISSN0002-9165
DOIs
Publication statusPublished - 2019

    Research areas

  • The Faculty of Science - Diabetes, Impaired glucose metabolism, Protein intake, Observational studies, Epidemiology

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