Protein diversity, type 2 diabetes, and effect modifiers: a multi-country prospective study

Area of Science:

• Nutritional Epidemiology
• Chronic Disease Prevention
• Dietary Pattern Analysis

Background:

• Dietary diversity is linked to health outcomes, but its specific impact on type 2 diabetes (T2D) risk, particularly protein source diversity, remains understudied.
• Previous research has not comprehensively evaluated the association between various dietary diversity scores and the incidence of T2D.

Purpose of the Study:

• To investigate the association between five dietary diversity scores and the 10-year risk of developing type 2 diabetes (T2D) in a large European cohort.
• To examine potential effect modification by sex and obesity status on the relationship between dietary diversity and T2D risk.

Main Methods:

• Prospective cohort study involving 340,234 participants across eight European countries (1993-2007), with 10,363 incident T2D cases.
• Dietary diversity was assessed using five scores derived from self-reported intake, including food groups, and subtypes of vegetables, meat/alternatives, animal-protein, and plant-protein sources.
• Prentice-weighted Cox regression and mixed-effects models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), stratified by sex and obesity status.

Main Results:

• Higher dietary diversity (five food groups vs. three) was associated with a reduced risk of T2D overall (HR 0.86), in females (HR 0.86), and in individuals without central obesity (HR 0.79).
• Consuming three or more plant-protein subtypes was inversely associated with T2D risk overall (HR 0.78), in females (HR 0.75), and in those without central obesity (HR 0.82).
• Inclusion of three vegetable subtypes showed an inverse association with T2D risk overall (HR 0.90) and in males (HR 0.85).

Conclusions:

• Dietary patterns rich in diverse food groups and plant-protein sources are associated with a lower incidence of type 2 diabetes.
• These benefits appear particularly pronounced for European females and individuals without central obesity.
• Promoting dietary diversity, especially in plant-protein sources, may be a valuable strategy for type 2 diabetes prevention.