In a paper published in Diabetes Care, a research team led by scientists at the MRC Epidemiology Unit and the Department of Public Health at Aarhus University in Denmark found that replacing red and processed meat with cheese, yogurt, nuts or cereals was associated with a lower risk of type 2 diabetes.

Many dietary guidelines across the world recommend lowering consumption of red and processed meat, but if people are to eat less red and processed meat they will likely eat more of other foods. A relevant replacement could be other protein rich foods.

Daniel Ibsen, a PhD student at the Research Unit for Epidemiology in the Department of Public Health at Aarhus University and first author on the Diabetes Care paper explained:

It is important to understand that the health effect of any given food is not only determined by the food itself, but also what replaces it or what it replaces in the diet.  However, surprisingly little research evidence has been published on the link between replacing meat consumption with other specific foods and health outcomes.

This is relevant because this type of information is often neglected when having conversations about diet and health, which usually focus on eating either less or more of some foods.”

To investigate this the researchers undertook analysis of data from the EPIC-InterAct study, comparing data on 11,741 new cases of type 2 diabetes with 14,719 people who remained free of diabetes over time. The EPIC-InterAct study, led by Professor Nick Wareham of the MRC Epidemiology Unit, is the world’s largest prospective case-cohort study of incident type 2 diabetes, established across 8 European countries and nested within the pan-European EPIC study. Volunteers provided extensive demographic, socio-economic and lifestyle information, as well as blood samples for genotyping and metabolic profiling.

The researchers statistically modelled the association between consuming a 1 serving (50 grams) per day lower intake of red and processed meat while consuming a 1 serving per day higher intake of other protein sources on the risk of developing type 2 diabetes. The other protein sources in the study were poultry, fish, eggs, legumes (e.g. beans, peas and lentils) (all 50 grams), cheese (30 grams), yoghurt (70 grams), milk (200 grams), cereals (mainly bread, rice and pasta) (30 grams) and nuts (10 grams).

The analysis found that replacing red and processed meat with cheese, yoghurt, nuts or cereals was associated with a lower future risk of type 2 diabetes. Although replacement with poultry, fish, eggs or milk suggested a lower risk of type 2 diabetes, there was too much uncertainty when a wide range of social factors and lifestyle behaviours of the participants were accounted for. They found no association between replacement of red and processed meat with legumes and type 2 diabetes risk.

The researchers estimated that if all participants had replaced their intake of 1 serving per day of red and processed meat with 1 serving per day of cheese, yoghurt or nuts, 8-9% of the observed new diabetes cases could have been prevented. Their estimates for cereals were suggestive of a similar impact but with greater uncertainty.

Professor Nita Forouhi, Programme leader for Nutritional Epidemiology at the MRC Epidemiology Unit and a senior author on the paper, said:

There may be a potential public health benefit for the prevention of type 2 diabetes if the dietary habits of meat-consuming European populations were shifted away from consuming red and processed meat and instead towards consuming cheese, yoghurt, nuts and, possibly, cereals.”

Aarhus University has produced a short video outlining the researcher’s findings and the public health benefits of shifting dietary habits away from consuming read meats and towards other non-meat foods.

The researchers note limitations of their research, which was based on recall of dietary habits and used data modelling techniques to study food replacement effects. However, it would be unrealistic to conduct large randomised clinical trials asking people to change and adhere to particular diets for long durations, and the study is well placed to stimulate research in other study populations to confirm the current findings and also to inform public health guidelines.

• Daniel B. Ibsen et al. 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. Diabetes Care (2020) 43(11):2660-2667. DOI:10.2337/dc20-1038
• Watch the Aarhus University video “Food Substitution”.

Image credit: Health-Aarhus University.