Switching Carbohydrate to Protein: Weight & Mortality in T2D
Switching Carbohydrate to Protein: Weight & Mortality in T2D
Overweight is very common among patients with type 2 diabetes, and weight loss may reduce mortality by 25% in these patients. A low-fat (and thus relatively high carbohydrate) diet has been recommended to patients with type 2 diabetes to prevent cardiovascular diseases and as a means to lose weight, although initially, carbohydrates were avoided due to their postprandial glucose and insulin raising effects. However, there is still debate on the optimal percentage of carbohydrates and its substitutions in the calorie reduced diet for patients with type 2 diabetes.
Recent studies suggested that high dietary protein intake contributes to weight loss due to higher satiety with a high-protein diet. Recently, an ad-libitum intervention study in healthy obese participants showed a modest increase in dietary protein to be beneficial for the maintenance of weight loss after 26 weeks, whereas an observational study in healthy people showed that a higher protein intake was associated with weight gain, mostly as fat mass after 6 years. Iso-energetic studies found no significant difference on weight change between high-protein or high-carbohydrate diets in the short term and inconclusive evidence in the long term. Moreover, one study suggested differences in effects of animal and plant protein, with a direct association of animal protein and risk of overweight and obesity, and an inverse association for plant protein.
Despite these potential effects on body weight, the evidence for a relationship between total protein intake and all-cause mortality risk or cardiovascular diseases is inconclusive in the general population. There is suggestive evidence for an association between long-term low-carbohydrate–high-protein diets and a higher all-cause mortality risk and for an inverse association between plant protein and cardiovascular (CVD) mortality.
We are aware of only three studies in patients with type 2 diabetes. Two short term randomized trials found no significant difference in weight change after one year of a high protein diet compared to a regular diet. After twelve weeks, women with type 2 diabetes on a high-protein diet achieved significantly higher total and abdominal fat loss compared with women on a low-protein diet, whereas no differences were found in men. We are not aware of any long term studies in patients with type 2 diabetes on the relationship between protein intake and either weight change or (CVD) mortality.
The aim of this study was to investigate the association between dietary carbohydrate intake and substitution with (animal and plant) protein and subsequent weight (and waist) change in patients with type 2 diabetes. Second, we aimed to investigate prospectively the associations with risk of CVD and all-cause mortality.
Background
Overweight is very common among patients with type 2 diabetes, and weight loss may reduce mortality by 25% in these patients. A low-fat (and thus relatively high carbohydrate) diet has been recommended to patients with type 2 diabetes to prevent cardiovascular diseases and as a means to lose weight, although initially, carbohydrates were avoided due to their postprandial glucose and insulin raising effects. However, there is still debate on the optimal percentage of carbohydrates and its substitutions in the calorie reduced diet for patients with type 2 diabetes.
Recent studies suggested that high dietary protein intake contributes to weight loss due to higher satiety with a high-protein diet. Recently, an ad-libitum intervention study in healthy obese participants showed a modest increase in dietary protein to be beneficial for the maintenance of weight loss after 26 weeks, whereas an observational study in healthy people showed that a higher protein intake was associated with weight gain, mostly as fat mass after 6 years. Iso-energetic studies found no significant difference on weight change between high-protein or high-carbohydrate diets in the short term and inconclusive evidence in the long term. Moreover, one study suggested differences in effects of animal and plant protein, with a direct association of animal protein and risk of overweight and obesity, and an inverse association for plant protein.
Despite these potential effects on body weight, the evidence for a relationship between total protein intake and all-cause mortality risk or cardiovascular diseases is inconclusive in the general population. There is suggestive evidence for an association between long-term low-carbohydrate–high-protein diets and a higher all-cause mortality risk and for an inverse association between plant protein and cardiovascular (CVD) mortality.
We are aware of only three studies in patients with type 2 diabetes. Two short term randomized trials found no significant difference in weight change after one year of a high protein diet compared to a regular diet. After twelve weeks, women with type 2 diabetes on a high-protein diet achieved significantly higher total and abdominal fat loss compared with women on a low-protein diet, whereas no differences were found in men. We are not aware of any long term studies in patients with type 2 diabetes on the relationship between protein intake and either weight change or (CVD) mortality.
The aim of this study was to investigate the association between dietary carbohydrate intake and substitution with (animal and plant) protein and subsequent weight (and waist) change in patients with type 2 diabetes. Second, we aimed to investigate prospectively the associations with risk of CVD and all-cause mortality.
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