Isocaloric substitution of carbohydrates with protein: the association with weight change and mortality among patients with type 2 diabetes

Abstract

BackgroundThe health impact of dietary replacement of carbohydrates with protein for patients with type 2 diabetes is still debated. This study aimed to investigate the association between dietary substitution of carbohydrates with (animal and plant) protein and 5-year weight change, and all-cause and cardiovascular (CVD) mortality risk in patients with type 2 diabetes.MethodsThe study included 6,107 diabetes patients from 15 European cohorts. Patients with type 1 diabetes were excluded. At recruitment, validated country-specific food-frequency questionnaires were used to estimate dietary intake. Multivariable adjusted linear regression was used to examine the associations between dietary carbohydrate substitution with protein and 5-year weight change, and Cox regression to estimate hazard ratios (HRs) for (CVD) mortality.ResultsAnnual weight loss of patients with type 2 diabetes was 0.17 (SD 1.24) kg. After a mean follow-up of 9.2 (SD 2.3)y, 787 (13%) participants had died, of which 266 (4%) deaths were due to CVD. Substitution of 10 gram dietary carbohydrate with total (ß = 187 [75;299]g) and animal (ß = 196 [137;254]g) protein was associated with mean 5-year weight gain. Substitution for plant protein was not significantly associated with weight change (β = 82 [−421;584]g). Substitution with plant protein was associated with lower all-cause mortality risk (HR = 0.79 [0.64;0.97]), whereas substitution with total or animal protein was not associated with (CVD) mortality risk.ConclusionsIn diabetes patients, substitution with plant protein was beneficial with respect to weight change and all-cause mortality as opposed to substitution with animal protein. Therefore, future research is needed whether dietary guidelines should not actively promote substitution of carbohydrates by total protein, but rather focus on substitution of carbohydrates with plant protein.

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

“…Finally, 32 papers of cohort studies were included in the systematic review,79101112131415161718454647484950515253545556575859606162636465 and 31 papers were included in this meta-analysis 791011121314151617184546474849505152535455565758596061636465. Twenty two papers reported effect sizes for all cause mortality,791011121314151617184647495051525455596365 17 for cardiovascular disease mortality,91011131415161718…”

“…Twenty two papers reported effect sizes for all cause mortality,791011121314151617184647495051525455596365 17 for cardiovascular disease mortality,910111314151617184749505153575864 and 14 for cancer mortality 79131415161718454648566061. Of these publications, 26 had reported effect sizes for intake of total protein,79101214161718454647484950515253545556596061636465 16 for intake of animal protein,7910121314151618454956586162…”

Dietary protein insufficiency: an important consideration in fatty liver disease?

“…Such studies would also need to address the type, source and quality of amino acid/protein used. For example, plant protein but not animal protein has been reported to reduce mortality risk in people with diabetes (81) . The feasibility of improving dietary protein as an approach to NAFLD is further supported by the recent report that an increase in daily protein intake to 25 % by weight was sufficient to reduce intrahepatic lipid accumulation in people with diabetes following a weight-reduction diet (80) .…”

“…In a secondary analysis of data from the randomised controlled DIOGenes trial, which investigated dietary protein composition and glycaemic index on weight loss maintenance and cardiometabolic risk factors in obesity, plant protein offered the greatest health benefits, while a higher plant protein intake from non-cereal products instead of cereal products (matched by a decrease in other sources of protein intake) benefited by body weight maintenance and blood pressure (79) . In a 5-year follow-up study, it was reported that substitution with 10 g carbohydrate with plant (but not animal) protein did not lead to any weight change and all-cause mortality was reduced (81) .…”

An Overview of Dietary Interventions and Strategies to Optimize the Management of Non-Alcoholic Fatty Liver Disease

“…Increased protein diets can support weight loss by increasing satiety, improving glucose homeostasis, increased meal-induced thermogenesis, protecting lean body mass, and increasing energy expenditure [ 23 , 24 ]. The substitution of carbohydrates with protein in studies indicated improved satiety and lower cholesterol and triglycerides levels with a decreased risk of cardiovascular disease in patients [ 25 , 26 ]. The recommendation for protein for patients with cirrhosis is up to 1.5 g/kg/day [ 4 ].…”