Mozaffari Hadis, Imamura Fumiaki, Murphy Rachel A, Jessri Mahsa, Sharp Stephen J, Forouhi Nita G, Wareham Nicholas J, Ibsen Daniel B, Dahm Christina C, Huerta José María, Molina-Montes Esther, Nickel Daniela V, Rolandsson Olov, Sacerdote Carlotta, Schulze Matthias B, Gonzalez-Martin Jon Ander, Guevara Marcela, Nilsson Peter M, Panico Salvatore, Winkvist Anna, Conklin Annalijn I
Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada.
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Int J Epidemiol. 2025 Apr 12;54(3). doi: 10.1093/ije/dyaf057.
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.
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).
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)].
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.
饮食多样性可能会影响2型糖尿病（T2D），但尚无研究按来源考察蛋白质多样性。我们研究了五种多样性评分与T2D的10年发病风险及效应修正情况。
对10363例新发T2D病例进行前瞻性研究，并从8个欧洲国家的340234名参与者队列中抽取13937名个体作为代表性亚队列（1993 - 2007年）。五种多样性评分源自自我报告的饮食数据（克/天）：食物组多样性（范围：0 - 5）；蔬菜亚型内多样性（0 - 4）；肉类/替代物（0 - 6）；动物蛋白（0 - 8）；以及植物蛋白来源（0 - 5）。通过使用普伦蒂斯加权Cox回归获得特定国家的风险比（HRs）和95%置信区间（CIs），并使用混合效应模型进行合并。模型按性别（男性/女性）和肥胖状态（体重指数≥30 kg/m²；女性腰围≥88 cm，男性腰围≥102 cm）分层。
总体而言，每日摄入五种食物组（相对于最多三种）与较低的T2D发病率相关[HR 0.86（95%CI 0.75, 0.98）]，在女性中[0.86（0.77, 0.96）]以及在无中心性肥胖的人群中[0.79（0.70, 0.89）]。三种或更多亚型的植物蛋白与总体T2D呈负相关[0.78（0.65, 0.98）]，在女性中[0.75（0.62, 0.90）]以及无中心性肥胖的人群中[0.82（0.68, 1.00）]。此外，食用三种蔬菜亚型与总体T2D呈负相关[0.90（0.83, 0.98）]，在男性中[0.85（0.73, 0.99）]。
糖尿病预防不仅可能受益于包含五种不同食物组的饮食，还可能受益于植物蛋白来源多样的饮食，对欧洲女性和无中心性肥胖者有特定益处。
