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Educational disparities in the association of protein diversity and type 2 diabetes: a multi-country population-based prospective case-cohort study
Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada; IMS Epidemiology (formerly MRC Epidemiology Unit), University of Cambridge, Cambridge, United Kingdom.
IMS Epidemiology (formerly MRC Epidemiology Unit), University of Cambridge, Cambridge, United Kingdom.
School of Population and Public Health, University of British Columbia, BC, Vancouver, Canada; Cancer Control Research, BC Cancer Research, BC, Vancouver, Canada.
IMS Epidemiology (formerly MRC Epidemiology Unit), University of Cambridge, Cambridge, United Kingdom.
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2026 (English)In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 65, no 4, article id 152Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate socio-economic disparities in the association between dietary diversity and type 2 diabetes (T2D).

Methods: Prospective secondary analysis study of 10,363 incident cases of T2D over 12 years and a random sub-cohort of 13,937 individuals in the EPIC-InterAct case-cohort study. We used baseline self-reported diet data (1991–1998) to construct scores for diversity between food groups (range: 0–5) and diversity within subtypes of vegetables (0–4), and plant protein sources (0–5). Prentice-weighted Cox regressions estimated multivariable-adjusted hazard ratios (HR) and 95% confidence intervals of incident T2D for each diversity score stratified by education, employment, and marital status.

Results: Overall group differences were evident for education in the association between plant-protein diversity and incident T2D (p for group effect = 0.04). University-educated participants consuming three plant-protein subtypes had 35% lower T2D incidence (HR 0.65 [95% CI: 0.45, 0.95]). Greater vegetable diversity (3–4 subtypes vs 0–1) was associated with 61%, 22% and 18% lower T2D incidence for, respectively, those who were single, had primary education or were employed. Total diet diversity (5 food groups versus ≤ 3) was associated with 43%, 30%, 20% and 15% lower T2D incidence for, respectively, those who were single, employed, had primary education or were married.

Conclusion: Education modified the association between plant-protein diversity and T2D onset in European adults, and certain socioeconomic groups specifically benefited from higher diversity reducing T2D risk. Promoting diet diversity overall may support T2D prevention across populations, while tailored messages of plant-protein diversity may improve relevance and equity in nutrition and diabetes.

Place, publisher, year, edition, pages
Springer Nature, 2026. Vol. 65, no 4, article id 152
Keywords [en]
Educational disparities, Protein diversity, Socioeconomic status, Type 2 diabetes
National Category
Public Health, Global Health and Social Medicine Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:umu:diva-256536DOI: 10.1007/s00394-026-03980-2ISI: 001786705800001PubMedID: 42249949Scopus ID: 2-s2.0-105040998164OAI: oai:DiVA.org:umu-256536DiVA, id: diva2:2086068
Funder
European CommissionWorld Cancer Research Fund InternationalSwedish Research CouncilNovo Nordisk FoundationSwedish Heart Lung FoundationSwedish Diabetes AssociationAvailable from: 2026-07-13 Created: 2026-07-13 Last updated: 2026-07-13Bibliographically approved

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