Replacing Red Meat with Alternative Food Sources of Protein on Risk of Type 2 Diabetes - Modeling Dietary Changes in a Causal Framework

Abstract

Abstract Objectives We investigated whether decreasing the intake of red meat and simultaneously increasing the intake of alternative food sources of protein affects the risk of type 2 diabetes compared with no changes in the substituted foods. We also examined interaction with the age at which participants changed their diet. Methods We used the Danish Diet, Cancer and Health cohort including men and women, two measures of diet taken roughly 5 years apart using food frequency questionnaires and information on incident type 2 diabetes derived from the Danish National Diabetes Register (n = 39,349; aged 55 to 72 years at the second diet measure; n cases = 3759). The pseudo-observation method was used to estimate the average exposure effect of decreasing the intake of red meat (processed and unprocessed) while increasing the intake of either poultry, fish, cheese, eggs or whole grains compared with no changes in the substituted foods on the subsequent 10-year risk of development type 2 diabetes. Results In multivariable adjusted models, we found that replacing 1 serving/day (100 g) of red meat with 1 serving/day of eggs (50 g) (risk difference −2.4%, 95% confidence interval −3.7 to −1.1%) or whole grains (30 g) (−1.4%, −2.2 to −0.6%) was associated with a reduced risk of type 2 diabetes. No effects were observed for other replacements. In general, the lowest risk was observed for replacements at age 55 years compared with older ages (up to 70 years) for all replacements. Conclusions Replacing red meat with eggs or whole grains may reduce the risk of type 2 diabetes compared with no changes in the substituted foods. Changing red meat intake in midlife may be more beneficial than at older ages. Funding Sources Aarhus University.