Dietary protein intake and risk of type 2 diabetes: a dose–response meta-analysis of prospective studies
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The association between dietary protein intake and type 2 diabetes risk has been inconsistent in the previous epidemiological studies. We aimed to quantitatively assess whether dietary total, animal, and plant protein would be associated with type 2 diabetes risk.
A comprehensive literature review was conducted to identify related articles by searching PubMed, Embase, Web of Science, and Wiley Online Library through 20th March 2018. Generalized least squares for trend estimation and restricted cubic spline regression model were applied in the dose–response analysis.
Eight publications with ten prospective cohorts of 34,221 type 2 diabetes cases were included. After adjustment of potential confounders, a 5% of energy increment from dietary total and animal protein intake was related to a 9% (1.04, 1.13; I2 = 42.0%) and 12% (95% CI 1.08, 1.17; I2 = 14.0%) higher risk of type 2 diabetes respectively. However, for plant protein, a significant U-shaped curve was observed with the most risk reduction at intake of about 6% of energy intake from plant protein intake (Pnonlinearity = 0.001). The results were robust in sensitivity analysis and no publication bias was detected.
These findings indicate that the consumption of protein particularly animal protein may be associated with an increased risk of type 2 diabetes.
KeywordsDietary protein intake Dose–response analysis Type 2 diabetes Meta-analysis Prospective study
Type 2 diabetes
Body mass index
We would like to thank the original studies for the contribution to conduct our meta-analysis.
Y-BX obtained the funding, conducted the research design, interpreted the results, and also had primary responsibility for the final content. L-GZ and Q-LZ analyzed the data and interpreted the results. L-GZ and Q-LZ drafted first manuscript. All authors critically reviewed and approved the manuscript. No authors have any conflicts of interest to declare.
This work was supported by funds from the State Key Laboratory of Oncogenes and Related Genes (#91-15-10).
Compliance with ethical standards
Conflict of interest
The authors declare no competing financial interests.
- 1.World Health Organization (2016) Global report on diabetes. World Health Organization, GenevaGoogle Scholar
- 3.Promintzer M, Krebs M (2006) Effects of dietary protein on glucose homeostasis. Curr Opin Clin Nutr Metab Care 9:463–468. https://doi.org/10.1097/01.mco.0000232909.84483.a9 CrossRefGoogle Scholar
- 5.Westerterp-Plantenga MS, Nieuwenhuizen A, Tome D, Soenen S, Westerterp KR (2009) Dietary protein, weight loss, and weight maintenance. Annu Rev Nutr 29:21–41. https://doi.org/10.1146/annurev-nutr-080508-141056 CrossRefGoogle Scholar
- 7.Bendinelli B, Palli D, Masala G, Sharp SJ, Schulze MB, Guevara M, van der AD, Sera F, Amiano P, Balkau B, Barricarte A, Boeing H, Crowe FL, Dahm CC, Dalmeijer G, de Lauzon-Guillain B, Egeberg R, Fagherazzi G, Franks PW, Krogh V, Huerta JM, Jakszyn P, Khaw KT, Li K, Mattiello A, Nilsson PM, Overvad K, Ricceri F, Rolandsson O, Sanchez MJ, Slimani N, Sluijs I, Spijkerman AM, Teucher B, Tjonneland A, Tumino R, van den Berg SW, Forouhi NG, Langeberg C, Feskens EJ, Riboli E, Wareham NJ (2013) Association between dietary meat consumption and incident type 2 diabetes: the EPIC-InterAct study. Diabetologia 56:47–59. https://doi.org/10.1007/s00125-012-2718-7 CrossRefGoogle Scholar
- 10.Sluijs I, Beulens JW, van der AD, Spijkerman AM, Grobbee DE, van der Schouw YT (2010) Dietary intake of total, animal, and vegetable protein and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL study. Diabetes Care 33:43–48. https://doi.org/10.2337/dc09-1321 CrossRefGoogle Scholar
- 13.Nielen M, Feskens EJM, Mensink M, Sluijs I, Molina E, Amiano P, Ardanaz E, Balkau B, Beulens JWJ, Boeing H, Clavel-Chapelon F, Fagherazzi G, Franks PW, Halkjaer J, Huerta JM, Katzke V, Key TJ, Khaw KT, Krogh V, Kuhn T, Menendez VVM, Nilsson P, Overvad K, Palli D, Panico S, Rolandsson O, Romieu I, Sacerdote C, Sanchez MJ, Schulze MB, Spijkerman AMW, Tjonneland A, Tumino R, A DL, Wurtz AML, Zamora-Ros R, Langenberg C, Sharp SJ, Forouhi NG, Riboli E, Wareham NJ (2014) Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct case-cohort study. Diabetes Care 37:1854–1862. https://doi.org/10.2337/dc13-2627 CrossRefGoogle Scholar
- 15.Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, Group P-P (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 349:g7647. https://doi.org/10.1136/bmj.g7647 (Clinical research ed.) CrossRefGoogle Scholar
- 16.Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 11 Nov 2017
- 26.Tinker LF, Sarto GE, Howard BV, Huang Y, Neuhouser ML, Mossavar-Rahmani Y, Beasley JM, Margolis KL, Eaton CB, Phillips LS, Prentice RL (2011) Biomarker-calibrated dietary energy and protein intake associations with diabetes risk among postmenopausal women from the Women’s Health Initiative. Am J Clin Nutr 94:1600–1606. https://doi.org/10.3945/ajcn.111.018648 CrossRefGoogle Scholar
- 28.Shang X, Scott D, Hodge AM, English DR, Giles GG, Ebeling PR, Sanders KM (2016) Dietary protein intake and risk of type 2 diabetes: results from the Melbourne Collaborative Cohort Study and a meta-analysis of prospective studies. Am J Clin Nutr 104:1352–1365. https://doi.org/10.3945/ajcn.116.140954 CrossRefGoogle Scholar
- 29.Virtanen HEK, Koskinen TT, Voutilainen S, Mursu J, Tuomainen TP, Kokko P, Virtanen JK (2017) Intake of different dietary proteins and risk of type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr 117:882–893. https://doi.org/10.1017/S0007114517000745 CrossRefGoogle Scholar
- 30.Nanri A, Mizoue T, Kurotani K, Goto A, Oba S, Noda M, Sawada N, Tsugane S (2015) Low-carbohydrate diet and type 2 diabetes risk in Japanese men and women: the Japan Public Health Center-Based Prospective Study. PLoS One 10:e0118377. https://doi.org/10.1371/journal.pone.0118377 CrossRefGoogle Scholar
- 31.Van Nielen M, Feskens E, Mensink M, Forouhi N, Wareham N (2013) Dietary protein intake and the incidence of type 2 diabetes in Europe: the epic-interact case-cohort study. Ann Nutr Metab 63:201Google Scholar
- 33.Koloverou E, Esposito K, Giugliano D, Panagiotakos D (2014) The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants. Metab Clin Exp 63:903–911. https://doi.org/10.1016/j.metabol.2014.04.010 CrossRefGoogle Scholar
- 34.McEvoy CT, Cardwell CR, Woodside JV, Young IS, Hunter SJ, McKinley MC (2014) A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and meta-analysis. J Acad Nutr Diet 114:1759–1775 e1754. https://doi.org/10.1016/j.jand.2014.05.001 CrossRefGoogle Scholar
- 35.Neu A, Behret F, Braun R, Herrlich S, Liebrich F, Loesch-Binder M, Schneider A, Schweizer R (2015) Higher glucose concentrations following protein- and fat-rich meals—the Tuebingen Grill Study: a pilot study in adolescents with type 1 diabetes. Pediatr Diabetes 16:587–591. https://doi.org/10.1111/pedi.12224 CrossRefGoogle Scholar
- 36.Tremblay F, Lavigne C, Jacques H, Marette A (2007) Role of dietary proteins and amino acids in the pathogenesis of insulin resistance. Annu Rev Nutr 27:293–310. https://doi.org/10.1146/annurev.nutr.25.050304.092545 CrossRefGoogle Scholar
- 37.Wang TJ, Larson MG, Vasan RS, Cheng S, Rhee EP, McCabe E, Lewis GD, Fox CS, Jacques PF, Fernandez C, O’Donnell CJ, Carr SA, Mootha VK, Florez JC, Souza A, Melander O, Clish CB, Gerszten RE (2011) Metabolite profiles and the risk of developing diabetes. Nat Med 17:448–453. https://doi.org/10.1038/nm.2307 CrossRefGoogle Scholar
- 38.Floegel A, Stefan N, Yu Z, Muhlenbruch K, Drogan D, Joost HG, Fritsche A, Haring HU, Hrabe de Angelis M, Peters A, Roden M, Prehn C, Wang-Sattler R, Illig T, Schulze MB, Adamski J, Boeing H, Pischon T (2013) Identification of serum metabolites associated with risk of type 2 diabetes using a targeted metabolomic approach. Diabetes 62:639–648. https://doi.org/10.2337/db12-0495 CrossRefGoogle Scholar
- 40.Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML (2008) Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31(Suppl 1):S61–78. https://doi.org/10.2337/dc08-S061 Google Scholar