Abstract
The aim of this study was to investigate the association between protein intake and mortality risk in patients with type 2 diabetes. We analyzed a pooled data of 2494 diabetic patients from two prospective longitudinal studies. Nutritional intake was assessed using a Food Frequency Questionnaire at baseline. Protein intake per body weight (kg) per day was categorized into quartile groups. Adjusted hazard ratios (HRs) and 95% confidence interval (CI) were calculated using Cox regression analysis. During the six-year follow-up, there were 152 incidents of all-cause mortality. The HR for mortality in the lowest quartile of protein intake per body weight compared with the highest quartile was 2.26 (95% CI: 1.34–3.82, p = 0.002) after adjustment for covariates. Subgroup analyses revealed significant associations between low protein intake and mortality in patients aged over 75 years or under 65 years. After further adjustment of the total energy intake, a significant association between protein intake and mortality remained in patients aged ≥ 75 years, whereas the association was attenuated in those aged < 65 years. Our results suggest that adequate protein intake is necessary in older diabetic patients over 75 years, whereas with diabetes, whereas whole optimal total energy intake is required in younger patients with type 2 diabetes.
Highlights
IntroductionNutrients 2020, 12, 1629 of cardiovascular complications, may explain the increased risk of death in diabetes, but the exact cause is unknown
Diabetes is associated with a high risk of mortality despite recent advances in treatment [1].Hyperglycemia, hypoglycemia, hypertension, dyslipidemia, and obesity, all of which could be causesNutrients 2020, 12, 1629; doi:10.3390/nu12061629 www.mdpi.com/journal/nutrientsNutrients 2020, 12, 1629 of cardiovascular complications, may explain the increased risk of death in diabetes, but the exact cause is unknown
hemoglobin A1c (HbA1c), exercise, urine albumin-to-creatinine ratio, and estimated glomerular filtration rate (eGFR) did not differ significantly according to quartiles of protein intake
Summary
Nutrients 2020, 12, 1629 of cardiovascular complications, may explain the increased risk of death in diabetes, but the exact cause is unknown. In older adults with diabetes, malnutrition (low body mass index (BMI)), sarcopenia, and frailty have been reported to be risk factors for mortality [2,3,4]. Increased protein intake in individuals with diabetes can exacerbate nephropathy, which could lead to death. Reduced protein intake in patients with diabetes, especially in older people, might increase the risk of death by causing sarcopenia and frailty. Studies on the effects of protein restriction on renal function in patients with diabetes showed conflicting results on changes in estimated glomerular filtration rate (eGFR) or incident end-stage renal disease [5,6,7] and increased mortality [8]
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