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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

OBJECTIVE

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.

RESEARCH DESIGN AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.