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

OBJECTIVE <p>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.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>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. </p> <p>RESULTS</p> <p>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.</p> <p>CONCLUSIONS</p> <p>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.</p>