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Cardiovasc Diabetol. 2015 Apr 18;14:39. doi: 10.1186/s12933-015-0202-7.

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

Author information

1
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. M.J.E.Campmans-Kuijpers@umcutrecht.nl.
2
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. I.Sluijs-2@umcutrecht.nl.
3
Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany. noethlings@uni-bonn.de.
4
International Agency for Research on Cancer (IARC-WHO), Lyon, France. FreislingH@iarc.fr.
5
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark. ko@soci.au.dk.
6
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. Elisabete.Weiderpass.Vainio@ki.se.
7
Institut Gustave-Roussy, Villejuif, France. guy.fagherazzi@gustaveroussy.fr.
8
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. t.kuehn@dkfz.de.
9
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. v.katzke@dkfz.de.
10
Dipartimento Di Medicina Clinica E Chirurgia Federico II University, Naples, Italy. amattiel@unina.it.
11
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. emily.sonestedt@med.lu.se.
12
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy. g.masala@ispo.toscana.it.
13
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy. claudia.agnoli@istitutotumori.mi.it.
14
Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP, Ragusa, Italy. rosario.tumino@asp.rg.it.
15
National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, PO Box 1, 3720, BA, Bilthoven, The Netherlands. Annemieke.Spijkerman@rivm.nl.
16
Jefe Del Servicio De Epidemiologia, Prevencion Y Promocion De La Salud, Instituto de Salud Pública, Leyre 15, 31003, Pamplona, Spain. abarricg@cfnavarra.es.
17
Unit of Cancer Epidemiology - CERMS, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy. fulvio.ricceri@gmail.com.
18
Public Health Division of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastian, Spain. s-chamosa@ej-gv.es.
19
Institutionen för odontologi, Umeå university, Umeå, Sweden. ingegerd.johansson@odont.umu.se.
20
Institutionen för medicin, Göteborgs universitet, Göteborg, Sweden. anna.winkvist@nutrition.gu.se.
21
Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark. annet@cancer.dk.
22
Division of human nutrition, WU Agrotechnology & Food Sciences, P.O. Box 8129, 6700, EV, Wageningen, The Netherlands. Diewertje.sluik@wur.nl.
23
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany. boeing@dife.de.
24
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. J.Beulens@umcutrecht.nl.

Abstract

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.

PMID:
25896172
PMCID:
PMC4403776
DOI:
10.1186/s12933-015-0202-7
[Indexed for MEDLINE]
Free PMC Article

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