American Diabetes Association
ESM-IA-replace_redmeat_alternatives_DC_R1.pdf (1.12 MB)

Replacement of red and processed meat with other food sources of protein and the risk of type 2 diabetes in European populations; the EPIC-InterAct study

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posted on 2020-08-31, 22:34 authored by Daniel B. Ibsen, Marinka Steur, Fumiaki Imamura, Kim Overvad, Matthias B. Schulze, Benedetta Bendinelli, Marcela Guevara, Antonio Agudo, Pilar Amiano, Dagfinn Aune, Aurelio Barricarte, Ulrika Ericson, Guy Fagherazzi, Paul W. Franks, Heinz Freisling, Jose R. Quiros, Sara Grioni, Alicia K. Heath, Inge Huybrechts, Verena Katze, Nasser Laouali, Francesca Mancini, Giovanna Masala, Anja Olsen, Keren Papier, Stina Ramne, Olov Rolandsson, Carlotta Sacerdote, Maria-José Sánchez, Carmen Santiuste, Vittorio Simeon, Annemieke M.W. Spijkerman, Bernard Srour, Anne Tjønneland, Tammy Y.N. Tong, Rosario Tumino, Yvonne T. van der Schouw, Elisabete Weiderpass, Clemens Wittenbecher, Stephen J. Sharp, Elio Riboli, Nita G. Forouhi, Nick J. Wareham

There is sparse evidence for suitable food substitutions for red and processed meat on risk of type 2 diabetes. We modelled the association between replacing red and processed meat with other protein sources and the risk of type 2 diabetes and estimated its population impact.


The European Prospective Investigation into Cancer (EPIC)-InterAct case-cohort included 11,741 type 2 diabetes cases and a subcohort of 15,450 participants in eight countries. We modelled the replacement of self-reported red and processed meat with poultry, fish, eggs, legumes, cheese, cereals, yogurt, milk and nuts. Country-specific hazard ratios (HR) for incident type 2 diabetes were estimated by Prentice-weighted Cox regression and pooled using random-effects meta-analysis.


There was a lower hazard for type 2 diabetes for the modelled replacement of red and processed meat (50 g/day) with cheese (HR 0.90, 95% confidence interval 0.83–0.97; 30 g/day), yogurt (0.90, 0.86–0.95; 70 g/day), nuts (0.90, 0.84–0.96; 10 g/day) or cereals (0.92, 0.88–0.96; 30 g/day) but null for replacements with poultry, fish, eggs, legumes or milk. Assuming a causal association, replacing red and processed meat with cheese, yogurt or nuts could prevent 8.8%, 8.3% or 7.5%, respectively, of new cases of type 2 diabetes.


Replacement of red and processed meat with cheese, yogurt, nuts or cereals was associated with a lower rate of type 2 diabetes. Substituting red and processed meat by other protein sources may contribute to the prevention of incident type 2 diabetes in European populations.


Funding for the InterAct project was provided by the European Union Sixth Framework Programme (grant no. LSHM_CT_2006_037197). Additionally, InterAct investigators acknowledge funding from the following agencies: NJW and NGF acknowledge funding from the Medical Research Council Epidemiology Unit MC_UU_12015/1 and MC_UU_12015/5, and NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215-20014). MS reports Core MRC Unit support through the Nutritional Epidemiology Programme (MC_UU_12015/5). MBS acknowledges funding by the German Ministry of Education and Research (BMBF) and the State of Brandenburg (DZD grant 82DZD00302). MG acknowledges funding by the Regional Government of Navarre. VS was supported by the Programma VALERE, University of Campania “Luigi Vanvitelli.” The funding sources did not participate in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript.


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