Association between Low Protein Intake and Mortality in Patients with Type 2 Diabetes

Abstract

The aim of this study was to investigate the association between protein intake and mortality risk in patients with type 2 diabetes. We analyzed a pooled data of 2494 diabetic patients from two prospective longitudinal studies. Nutritional intake was assessed using a Food Frequency Questionnaire at baseline. Protein intake per body weight (kg) per day was categorized into quartile groups. Adjusted hazard ratios (HRs) and 95% confidence interval (CI) were calculated using Cox regression analysis. During the six-year follow-up, there were 152 incidents of all-cause mortality. The HR for mortality in the lowest quartile of protein intake per body weight compared with the highest quartile was 2.26 (95% CI: 1.34–3.82, p = 0.002) after adjustment for covariates. Subgroup analyses revealed significant associations between low protein intake and mortality in patients aged over 75 years or under 65 years. After further adjustment of the total energy intake, a significant association between protein intake and mortality remained in patients aged ≥ 75 years, whereas the association was attenuated in those aged < 65 years. Our results suggest that adequate protein intake is necessary in older diabetic patients over 75 years, whereas with diabetes, whereas whole optimal total energy intake is required in younger patients with type 2 diabetes.

Functional categories based on cognition and activities of daily living predict all‐cause mortality in older adults with diabetes mellitus: The Japanese Elderly Diabetes Intervention Trial

“…We slightly modified the previous variables 20 in accordance with the previous study. 28 Analyses were carried out using the two models (crude model, not adjusted; adjusted model, adjusted for age, sex, body mass index, HbA1c level, systolic blood pressure, total cholesterol level, estimated glomerular filtration rate and frequency of hypoglycemic event). Patients with missing data in the analyses were excluded (complete case analysis).…”

Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty

“…In contrast, in very old mice, high protein diet reduced mortality whereas low protein diet remarkably reduced body weight and increased mortality [179]. The pooled analysis of the J-EDIT and the JDCS also demonstrated that the lowest quartile of protein intake was associated with highest mortality after adjustment for covariates in patients with diabetes aged 75 years or older but not in those aged younger than 65 years [131].…”

“…We analyzed the data pooled from the J-EDIT and the Japan Diabetes Complications Study (JDCS), which originally intended to validate the effect of lifestyle intervention on prevention of diabetic complications [130]. We found that those with low protein intake (<0.92 g/kg/body weight) showed significantly higher mortality, especially in those aged 75 years or older [131]. Since diabetes is a well-known risk factor for sarcopenia, sufficient protein intake should be recommended in older patients with diabetes except for those with end-stage renal failure.…”

Sodium Intake and Incidence of Diabetes Complications in Elderly Patients with Type 2 Diabetes—Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT)

“…Therefore, the impact of nutrients on health outcomes may vary with age [ 31 ]. It has been reported that the risk of death is increased in those with type 2 diabetes older than 75 years who have low protein, vegetable, and fish intakes [ 32 , 33 ]. Elderly patients with type 2 diabetes should have their dietary intake monitored not only for excessive sodium intake, but also for intakes other food groups and nutrition intakes that occur with low sodium intake to avoid dietary habits that would lead to malnutrition, sarcopenia, frailty development of diabetic complications and death.…”