Dietary protein intake and risk of type 2 diabetes: a dose–response meta-analysis of prospective studies

Zhao, Longgang; Zhang, Qingli; Liu, Xiaoli; Wu, Hua; Zheng, Jiali; Xiang, Yong‐Bing

doi:10.1007/s00394-018-1737-7

Cited by 51 publications

(69 citation statements)

References 39 publications

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“…We found meta-analyses on the following exposures: healthy dietary pattern,23 unhealthy dietary pattern,24 HEI,25 alternative HEI (AHEI),25 DASH,25 Mediterranean diet,26 vegetarian diet,27 low carbohydrate diet,28 breakfast skipping,29 high glycaemic index,30 high glycaemic load,30 dietary acid load,31 dairy11 and dairy products,32 33 34 chocolate,35 eggs,11 meat36 and specific types of meat,36 37 38 39 total fish or seafood11 40 and types of fish,40 butter,41 olive oil,42 potatoes and types of potatoes,43 whole grain11 and whole grain products,44 refined grain,11 rice,45 white rice,44 brown rice,44 soy products,46 legumes,11 nuts,11 fruit and vegetables,47 total fruit11 and specific types of fruit,48 49 50 total vegetables11 and specific types of vegetables,51 52 tea,53 coffee,54 55 sugar sweetened beverages,56 artificially sweetened beverages,56 total fruit juice56 and types of fruit juice,57 total protein and types of protein,58 animal protein-to-potassium ratio,31 total fat,59 types of fat59 and fatty acids,59 60 61 62 dietary cholesterol,63 carbohydrates59 and types of carbohydrates,59 64 total fibre65 and types of fibre,65 vitamin D,66 niacin,67 iron,68 magnesium,69 calcium,70 selenium,71 polyphenols and subgroups of po...…”

Section: Resultsmentioning

confidence: 99%

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

Neuenschwander

Ballon

Weber

et al. 2019

BMJ

341

309

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Objective To summarise the evidence of associations between dietary factors and incidence of type 2 diabetes and to evaluate the strength and validity of these associations. Design Umbrella review of systematic reviews with meta-analyses of prospective observational studies. Data sources PubMed, Web of Science, and Embase, searched up to August 2018. Eligibility criteria Systematic reviews with meta-analyses reporting summary risk estimates for the associations between incidence of type 2 diabetes and dietary behaviours or diet quality indices, food groups, foods, beverages, alcoholic beverages, macronutrients, and micronutrients. Results 53 publications were included, with 153 adjusted summary hazard ratios on dietary behaviours or diet quality indices (n=12), food groups and foods (n=56), beverages (n=10), alcoholic beverages (n=12), macronutrients (n=32), and micronutrients (n=31), regarding incidence of type 2 diabetes. Methodological quality was high for 75% (n=115) of meta-analyses, moderate for 23% (n=35), and low for 2% (n=3). Quality of evidence was rated high for an inverse association for type 2 diabetes incidence with increased intake of whole grains (for an increment of 30 g/day, adjusted summary hazard ratio 0.87 (95% confidence interval 0.82 to 0.93)) and cereal fibre (for an increment of 10 g/day, 0.75 (0.65 to 0.86)), as well as for moderate intake of total alcohol (for an intake of 12-24 g/day v no consumption, 0.75 (0.67 to 0.83)). Quality of evidence was also high for the association for increased incidence of type 2 diabetes with higher intake of red meat (for an increment of 100 g/day, 1.17 (1.08 to 1.26)), processed meat (for an increment of 50 g/day, 1.37 (1.22 to 1.54)), bacon (per two slices/day, 2.07 (1.40 to 3.05)), and sugar sweetened beverages (for an increase of one serving/day, 1.26 (1.11 to 1.43)). Conclusions Overall, the association between dietary factors and type 2 diabetes has been extensively studied, but few of the associations were graded as high quality of evidence. Further factors are likely to be important in type 2 diabetes prevention; thus, more well conducted research, with more detailed assessment of diet, is needed. Systematic review registration PROSPERO CRD42018088106.

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Section: Resultsmentioning

confidence: 99%

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

Neuenschwander

Ballon

Weber

et al. 2019

BMJ

341

309

View full text Add to dashboard Cite

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“…Higher plant protein intake was associated with lower all-cause and CVD-related mortality, and replacement of red and processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality [8,9]. Two recent meta-analyses found an association between total and animal protein intake and higher risk of T2D, while the association between plant protein intake was less clear or U-shaped [10,11]. In a large US cohort study, modelling the substitution of plant protein for animal protein was associated with reduced risk of CRC, and in more detail, the reduction in risk was limited to the substitution of protein from cereals for protein from red meat [12].…”

Section: Introductionmentioning

confidence: 99%

Replacing Animal-Based Proteins with Plant-Based Proteins Changes the Composition of a Whole Nordic Diet—A Randomised Clinical Trial in Healthy Finnish Adults

et al. 2020

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Increased consumption of plant-based foods and decreased consumption of animal-based foods is recommended for healthy diets and sustainable food production. We investigated the effects of partial replacement of dietary animal proteins with plant-based ones on intake of energy-yielding nutrients, fibre, and plasma lipoproteins. This 12-week randomised clinical intervention comprised 107 women and 29 men (20–69 years) in three diet groups with different dietary protein compositions (“ANIMAL”: Animal 70%/plant 30%; “50/50”: Animal 50%/plant 50%; “PLANT”: Animal 30%/plant 70%; all: Protein intake 17 E%). Nutrient intakes were assessed by 4-day food records. Saturated fat intake (E%) was lower and polyunsaturated fatty acid intake (E%) higher in the PLANT and 50/50 groups compared to the ANIMAL group (p < 0.001 for all). Fibre intake was higher in the PLANT (p ˂ 0.001) and 50/50 (p = 0.012) groups. Total and LDL cholesterol were lower in the PLANT than in the ANIMAL group (p = 0.003 for both) but no differences in HDL cholesterol or triglycerides were observed (p > 0.05). Replacing animal protein with plant protein sources in the diet led to an increased fibre intake and improved dietary fat quality as well as blood lipoprotein profile. Flexitarian diets could provide healthy and more sustainable alternatives for the current, predominantly animal-based diets.

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“…results, i.e., showing a higher risk of T2D with higher total protein intakes (RR: 1.27; 95% CI: 1.23, 1.31), largely due to the intake of protein of animal origin (RR: 1.32; 95% CI: 1.27, 1.36). Plant protein showed a borderline inverse association with T2D risk (RR: 0.89; 95% CI: 0.71, 1.11) (30). In most studies, additional adjustment for BMI attenuated, e.g., weakened, the association between protein intake (g/d) and diabetes risk.…”

Section: Discussionmentioning

confidence: 95%

Protein intake and the incidence of pre-diabetes and diabetes in 4 population-based studies: the PREVIEW project

Sluik

Brouwer‐Brolsma

Berendsen

et al. 2019

The American Journal of Clinical Nutrition

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Background Data on the relationship between protein intake and the risk of type 2 diabetes are conflicting. Objective We studied prospective associations between the intake of total, plant-based, and animal protein and the risk of pre-diabetes and diabetes in 4 population-based studies included in the PREVIEW project. Methods Analyses were conducted with the use of data from 3 European cohorts and 1 Canadian cohort, including 78,851 participants. Protein intake was assessed through the use of harmonized data from food-frequency questionnaires or 3-d dietary records. Cohort-specific incidence ratios (IRs) were estimated for pre-diabetes and diabetes, adjusting for general characteristics, lifestyle and dietary factors, disease history, and body mass index (BMI) and waist circumference; results were pooled based on a random-effects meta-analysis. Results Higher total protein intake (g · kg–1 · d–1) was associated with lower incidences of pre-diabetes and diabetes (pooled IRs: 0.84; 95% CI: 0.82, 0.87 and 0.49; 95% CI: 0.28, 0.83, respectively); plant-based protein intake was the main determinant (pooled IRs: 0.83; 95% CI: 0.81, 0.86 and 0.53; 95% CI: 0.36, 0.76, respectively). Substituting 2 energy percentage (E%) protein at the expense of carbohydrates revealed increased risks of pre-diabetes and diabetes (pooled IRs: 1.04; 95% CI: 1.01, 1.07 and 1.09; 95% CI: 1.01, 1.18, respectively). Except for the associations between intakes of total protein and plant-based protein (g · kg–1 · d–1) and diabetes, all other associations became nonsignificant after adjustment for BMI and waist circumference. Conclusions Higher protein intake (g · kg–1 · d–1) was associated with a lower risk of pre-diabetes and diabetes. Associations were substantially attenuated after adjustments for BMI and waist circumference, which demonstrates a crucial role for adiposity and may account for previous conflicting findings. This study was registered at ISRCTN as ISRCTN31174892.

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Dietary protein intake and risk of type 2 diabetes: a dose–response meta-analysis of prospective studies

Abstract: These findings indicate that the consumption of protein particularly animal protein may be associated with an increased risk of type 2 diabetes.

Cited by 51 publications

References 39 publications

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

Replacing Animal-Based Proteins with Plant-Based Proteins Changes the Composition of a Whole Nordic Diet—A Randomised Clinical Trial in Healthy Finnish Adults

Protein intake and the incidence of pre-diabetes and diabetes in 4 population-based studies: the PREVIEW project

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