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

Background Dietary diversity may affect type 2 diabetes (T2D) but no studies have examined protein diversity by source. We examined five diversity scores and the 10-year risk of T2D and effect modification. Methods A prospective study of 10 363 incident T2D cases and a representative sub-cohort of 13 937 individuals sampled from a cohort of 340 234 participants in eight European countries (1993-2007). Five diversity scores were derived from self-reported diet data (gr/day): diversity of food groups (range: 0-5); and diversity within subtype of vegetables (0-4); meat/alternatives (0-6); animal-protein (0-8); and plant-protein sources (0-5). Country-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained by using Prentice-weighted Cox regression and combined by using mixed-effects models. Models were stratified by sex (male/female) and obesity status (body mass index ≥ 30 kg/m2; waist circumference ≥ 88 cm for females and ≥102 cm for males). Results Daily intake of five food groups (versus up to three) was linked to lower T2D incidence overall [HR 0.86 (95% CI 0.75, 0.98)], in females [0.86 (0.77, 0.96)], and in people without central obesity [0.79 (0.70, 0.89)]. Three or more subtypes of plant protein were inversely associated with T2D overall [0.78 (0.65, 0.98)], in females [0.75 (0.62, 0.90)] and people without central obesity [0.82 (0.68, 1.00)]. Additionally, consuming three subtypes of vegetables was inversely associated with T2D overall [0.90 (0.83, 0.98)] and in males [0.85 (0.73, 0.99)]. Conclusion Diabetes prevention may benefit not only from a diet consisting of five different food groups, but also from a diet that is diverse in plant-protein sources, with specific benefits for female Europeans and those without central obesity.