Abstract
We conducted a comprehensive and in-depth assessment of different dietary protein sources related to type 2 diabetes (T2D) and determined whether the association is mediated by insulin resistance (IR) and β-cell dysfunction in a population-based cross sectional study of 4,427 women and 2,394 men aged 20–74 years in northeast China. We observed that the intake of total protein, animal protein, and red meat protein was positively associated with T2D prevalence in women. Comparing the women in the highest quintile of protein intake with those in the lowest quintile, the multivariable-adjusted odds ratios of T2D were 2.13 [95% confidence interval (CI): 1.18–3.81] for total protein, 2.27 (95% CI: 1.18–4.35) for animal protein, and 1.75 (95% CI: 1.14–2.68) for red meat protein. Mediation analyses indicated that these associations were mediated mainly by the IR as measured by the homeostasis model (HOMA-IR). The proportions via the mediation of HOMA-IR were 29.0% (95% CI: 10.3%–55.5%), 35.0% (95% CI: 12.9%–83.3%), and 17.2% (95% CI: 5.2%–44.8%) for total protein-, animal protein-, and red meat protein–T2D associations, respectively. These findings support the notion that modifying the sources of dietary protein may be potentially applied to prevent T2D.
Highlights
Type 2 diabetes (T2D) is the consequence of a complex interplay of genetic and environmental factors[1]
We confirmed that higher intakes of total protein and animal protein, especially red meat protein, were associated with higher prevalence of type 2 diabetes (T2D) in Chinese women, but not in men
Substitutions of total protein for total carbohydrate, animal protein for plant protein, and protein from red meat for protein from egg, seafood, and poultry were associated with the increased prevalence of T2D. These findings demonstrated that the association between dietary protein intake and prevalence of T2D depended on the food sources of protein and sex difference
Summary
Type 2 diabetes (T2D) is the consequence of a complex interplay of genetic and environmental factors[1]. A large body of observational studies have examined dietary fat and carbohydrate affecting T2D risk[4], relatively few studies have directly investigated the role of dietary protein in relation to T2D risk. Large and long-term observational studies generally pointed in the opposite direction relating the effect of protein intake to insulin sensitivity and T2D risk[9,10,11,12]. In one short-term intervention study involving 15 men, dietary protein intake elicits an insulinotropic effect promoting insulin secretion[6]. No studies have yet directly and comprehensively investigated the amount of specific sources of dietary protein in relation to T2D risk in Chinese population. We conducted a population-based study in Northeast China to examine the association of total and specific dietary protein intake with T2D prevalence directly. We adopted the strategy of mediation analysis to quantify the extent to which either IR or β-cell dysfunction may contribute to the protein–T2D relation
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