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

Campmans-Kuijpers, M. J., Sluijs, I., Nöthlings, U., Freisling, H., Overvad, K., Weiderpass, E., Fagherazzi, G., Kühn, T., Katzke, V. A., Mattiello, A., Sonestedt, E., Masala, G., Agnoli, C., Tumino, R., Spijkerman, A. M. W., Barricarte, A., Ricceri, F., Chamosa, S., Johansson, I., Winkvist, A., Tjønneland, A., Sluik, D., Boeing, H. & Beulens, J. W. J., 18-Apr-2015, In : Cardiovascular Diabetology. 14, 10 p., 39.

Research output: Contribution to journalArticleAcademicpeer-review

  • Marjo Je Campmans-Kuijpers
  • Ivonne Sluijs
  • Ute Nöthlings
  • Heinz Freisling
  • Kim Overvad
  • Elisabete Weiderpass
  • Guy Fagherazzi
  • Tilman Kühn
  • Verena A Katzke
  • Amalia Mattiello
  • Emily Sonestedt
  • Giovanna Masala
  • Claudia Agnoli
  • Rosario Tumino
  • Annemieke M W Spijkerman
  • Aurelio Barricarte
  • Fulvio Ricceri
  • Saioa Chamosa
  • Ingegerd Johansson
  • Anna Winkvist
  • Anne Tjønneland
  • Diewertje Sluik
  • Heiner Boeing
  • Joline W J Beulens

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.

Original languageEnglish
Article number39
Number of pages10
JournalCardiovascular Diabetology
Volume14
Publication statusPublished - 18-Apr-2015
Externally publishedYes

    Keywords

  • Cohort Studies, Diabetes Mellitus, Type 2/diet therapy, Diet, Reducing/methods, Dietary Carbohydrates/administration & dosage, Dietary Proteins/administration & dosage, Energy Intake/physiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality/trends, Plant Proteins, Dietary/administration & dosage, Prospective Studies, Risk Factors, Weight Gain/physiology, Weight Loss/physiology

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