TY - JOUR
T1 - Isocaloric substitution of carbohydrates with protein
T2 - the association with weight change and mortality among patients with type 2 diabetes
AU - Campmans-Kuijpers, Marjo Je
AU - Sluijs, Ivonne
AU - Nöthlings, Ute
AU - Freisling, Heinz
AU - Overvad, Kim
AU - Weiderpass, Elisabete
AU - Fagherazzi, Guy
AU - Kühn, Tilman
AU - Katzke, Verena A
AU - Mattiello, Amalia
AU - Sonestedt, Emily
AU - Masala, Giovanna
AU - Agnoli, Claudia
AU - Tumino, Rosario
AU - Spijkerman, Annemieke M W
AU - Barricarte, Aurelio
AU - Ricceri, Fulvio
AU - Chamosa, Saioa
AU - Johansson, Ingegerd
AU - Winkvist, Anna
AU - Tjønneland, Anne
AU - Sluik, Diewertje
AU - Boeing, Heiner
AU - Beulens, Joline W J
PY - 2015/4/18
Y1 - 2015/4/18
N2 - BACKGROUND: The 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.METHODS: The 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.RESULTS: Annual 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.CONCLUSIONS: In 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.
AB - BACKGROUND: The 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.METHODS: The 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.RESULTS: Annual 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.CONCLUSIONS: In 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.
KW - Cohort Studies
KW - Diabetes Mellitus, Type 2/diet therapy
KW - Diet, Reducing/methods
KW - Dietary Carbohydrates/administration & dosage
KW - Dietary Proteins/administration & dosage
KW - Energy Intake/physiology
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Mortality/trends
KW - Plant Proteins, Dietary/administration & dosage
KW - Prospective Studies
KW - Risk Factors
KW - Weight Gain/physiology
KW - Weight Loss/physiology
U2 - 10.1186/s12933-015-0202-7
DO - 10.1186/s12933-015-0202-7
M3 - Article
C2 - 25896172
SN - 1475-2840
VL - 14
SP - 39
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
ER -
