Dietary protein intake and risk of type 2 diabetes in US men and women
Open accessAbstract
Dietary proteins are important modulators of glucose metabolism. However, few longitudinal studies have evaluated the associations between intake of protein and protein type and risk of type 2 diabetes (T2D). We investigated the associations between total, animal, and vegetable protein and incident T2D in 72,992 women from the Nurses' Health Study (1984-2008), 92,088 women from Nurses' Health Study II (1991-2009) and 40,722 men from the Health Professionals Follow-up Study (1986-2008). During 4,146,216 person-years of follow-up, we documented 15,580 cases of T2D. In pooled multivariate models including body mass index, participants in the highest quintiles of percentage of energy derived from total protein and animal protein had 7% (95% confidence interval (CI): 1, 17) and 13% (95% CI: 6, 21) increased risks of T2D compared with those in the lowest quintiles, respectively. Percentage of energy intake from vegetable protein was associated with a moderately decreased risk of T2D (comparing extreme quintiles, hazard ratio =0.91, 95% CI: 0.84, 0.98). Substituting 5% of energy intake from vegetable protein for animal protein was associated with a 23% (95% CI: 16, 30) reduced risk of T2D. In conclusion, higher intake of animal protein was associated with an increased risk of T2D, while higher intake of vegetable protein was associated with a modestly reduced risk.
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The strongest evidence on eating patterns for preventing type 2 diabetes in prediabetes concerns Mediterranean-style diets.
“The most robust research available regarding eating/meal patterns for T2D prevention in prediabetes pertains to Mediterranean-style diets.698,724–726,814–816”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [815]
The paper’s Discussion (p. 12) concerns animal and vegetable protein intake and type 2 diabetes risk. Searches for Mediterranean-style diets, prediabetes, and comparative strength of evidence found no passage addressing the claim; the reference to a Mediterranean Islands study (p. 13) is not evidence about a Mediterranean-style diet. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn a PREDIMED subgroup of nondiabetic people with metabolic syndrome traits, Mediterranean diets enriched with olive oil and without energy restriction significantly reduced progression to diabetes compared with standard advice to avoid fats (HR 0.60; 95% CI 0.43-0.85).
“In a subgroup analysis of the PREDIMED trial, nondiabetic persons with metabolic syndrome traits who were randomized to Mediterranean diets enriched with olive oil without restrictions on energy intake experienced a significant reduction in the progression to DM compared with standard dietary advice to avoid fats (HR [0.60; 95% CI, 0.43–0.85]).814,815”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [815]
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Experimental — accuracy not yet measuredEpidemiologic studies correlate DASH eating pattern with a lower risk of developing type 2 diabetes.
“Epidemiologic studies correlate Mediterranean-style (76), vegetarian (77 -80), and Dietary Approaches to Stop Hypertension (DASH) (76,81) eating patterns with a lower risk of developing type 2 diabetes, with no effect for lowcarbohydrate eating patterns (82).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [81]
The paper discusses protein sources and type 2 diabetes risk (Introduction, p. 1; Discussion, p. 12), but those passages do not address the DASH eating pattern. Searches for “DASH,” “Dietary Approaches to Stop Hypertension,” and dietary patterns did not find a passage linking DASH adherence to lower diabetes risk. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAnother study found that replacing meat protein with nonmeat protein was favorably linked to fasting insulin levels and insulin resistance.
“A recent systematic review 27 found that consumption of plant protein (soy protein with isoflavones) was more strongly linked to lower levels of total and low-density lipoprotein cholesterol than the consumption of animal protein, whereas another study 31 found that substitution of nonmeat protein for meat protein was favorably associated with fasting insulin levels and insulin resistance.”
From Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort (2019) · cites this paper as [31]
All rigorously investigated healthy dietary patterns (Mediterranean-style, vegetarian, Nordic, DASH) have been associated with a lower risk of developing T2DM.
“All rigorously investigated healthy dietary patterns, i.e., Mediterranean-style diet [94,95,96], vegetarian diets [97,98,99,100], Nordic diet [101], and the Dietary Approaches to Stop Hypertension (DASH) [94,102] have been associated with a lower risk of developing T2DM.”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [100]
Substituting 5% of energy intake from vegetable protein for animal protein was associated with a 23% reduced risk of type 2 diabetes in the Nurses' Health Study II.
“Malik et al. [79], analyzing data from the Nurses’ Health Study II, found that substituting 5% of energy intake from vegetable protein for animal protein was associated with a 23% reduced risk of type 2 diabetes.”
From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [79]
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References 42 · Cited by 251
Research works printed but not linked: 2
- [14]14. semiquantitative food frequency questionnaire among male health professionals. AmJEpidemiol . 1992;135(10):1114 -1126.
- [7]7. systematic review and meta-analysis of prospective studies. Diabetes Care . 2012;35(4):918 -929.
- Authors
- Malik, V. S., Li, Y., Tobias, D. K., Pan, A., & Hu, F. B.
- Affiliations
- Harvard University (US)
- Corresponding author
- Malik, Vasanti S.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-03-28
- Volume
- 183
- Issue
- 8
- Pages
- 715-728
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- PMC
- PMC4832052
- OpenAlex
- W2335020211
- Cited by
- 251
- References
- 42
- Citations by year
- 2026: 17 · 2025: 20 · 2024: 30 · 2023: 28 · 2022: 33 · 2021: 27 · 2020: 21 · 2019: 26 · 2018: 17 · 2017: 20 · 2016: 11 · 2015: 1
- FWCI
- 24.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (U54CA155626, P30DK46200, DK58845, UM1CA186107, UM1CA176726, UM1CA167552)
- Peanut Institute
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- type 2 diabetes, dietary protein, animal protein, plant proteins, protein substitution, energy intake, Nurses' Health Study, Health Professionals Follow-up Study, diabetes risk
- MeSH terms
- Glycemic Load, Adult, Aged, Energy Intake, Diabetes Mellitus, Type 2, Dietary Proteins, Female, Humans, Longitudinal Studies, Male, Meat, Middle Aged, Regression Analysis, Risk Factors, United States, Plant Proteins, Dietary, Body Mass Index, Proportional Hazards Models, Protective Factors
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