Top

Published in:

Open Access 01-12-2022 | Research article

Variety and quantity of dietary protein intake from different sources and risk of new-onset diabetes: a Nationwide Cohort Study in China

Authors: Chun Zhou, Chengzhang Liu, Zhuxian Zhang, Mengyi Liu, Yuanyuan Zhang, Huan Li, Panpan He, Qinqin Li, Xianhui Qin

Published in: BMC Medicine | Issue 1/2022

Abstract

Background

The relation of the variety and quantity of different sources of dietary proteins intake and diabetes remains uncertain. We aimed to investigate the associations between the variety and quantity of proteins intake from eight major food sources and new-onset diabetes, using data from the China Health and Nutrition Survey (CHNS).

Methods

16,260 participants without diabetes at baseline from CHNS were included. Dietary intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of protein sources was defined as the number of protein sources consumed at the appropriate level, accounting for both types and quantity of proteins. New-onset diabetes was defined as self-reported physician-diagnosed diabetes or fasting glucose ≥7.0mmol/L or glycated hemoglobin ≥6.5% during the follow-up.

Results

During a median follow-up of 9.0 years, 1100 (6.8%) subjects developed diabetes. Overall, there were U-shaped associations of percentages energy from total protein, whole grain-derived and poultry-derived proteins with new-onset diabetes; J-shaped associations of unprocessed or processed red meat-derived proteins with new-onset diabetes; a reverse J-shaped association of the fish-derived protein with new-onset diabetes; L-shaped associations of egg-derived and legume-derived proteins with new-onset diabetes; and a reverse L-shaped association of the refined grain-derived protein with new-onset diabetes (all P values for nonlinearity<0.001). Moreover, a significantly lower risk of new-onset diabetes was found in those with a higher variety score of protein sources (per score increment; HR, 0.69; 95%CI, 0.65–0.72).

Conclusions

There was an inverse association between the variety of proteins with appropriate quantity from different food sources and new-onset diabetes.

Available only for authorised users

Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383(9933):1999–2007. https://doi.org/10.1016/S0140-6736(14)60613-9.CrossRefPubMedPubMedCentral

Gadgil MD, Appel LJ, Yeung E, Anderson CA, Sacks FM, Miller ER. The effects of carbohydrate, unsaturated fat, and protein intake on measures of insulin sensitivity: results from the OmniHeart trial. Diabetes Care. 2013;36(5):1132–7. https://doi.org/10.2337/dc12-0869.CrossRefPubMedPubMedCentral

Imamura F, Micha R, Wu JH, de Oliveira Otto MC, Otite FO, Abioye AI, et al. Effects of saturated fat, polyunsaturated fat, monounsaturated fat, and carbohydrate on glucose-insulin homeostasis: a systematic review and meta-analysis of randomised controlled feeding trials. PLoS Med. 2016;13(7):e1002087. https://doi.org/10.1371/journal.pmed.1002087.CrossRefPubMedPubMedCentral

Nuttall FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P. Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care. 1984;7(5):465–70. https://doi.org/10.2337/diacare.7.5.465.CrossRefPubMed

van den Brandt PA. Red meat, processed meat, and other dietary protein sources and risk of overall and cause-specific mortality in The Netherlands Cohort Study. Eur J Epidemiol. 2019;34(4):351–69. https://doi.org/10.1007/s10654-019-00483-9.CrossRefPubMedPubMedCentral

Zhao LG, Zhang QL, Liu XL, Wu H, Zheng JL, Xiang YB. Dietary protein intake and risk of type 2 diabetes: a dose-response meta-analysis of prospective studies. Eur J Nutr. 2019;58(4):1351–67. https://doi.org/10.1007/s00394-018-1737-7.CrossRefPubMed

Ye J, Yu Q, Mai W, Liang P, Liu X, Wang Y. Dietary protein intake and subsequent risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies. Acta Diabetol. 2019;56(8):851–70. https://doi.org/10.1007/s00592-019-01320-x.CrossRefPubMed

Fan M, Li Y, Wang C, Mao Z, Zhou W, Zhang L, et al. Dietary protein consumption and the risk of type 2 diabetes: a dose-response meta-analysis of prospective studies. Nutrients. 2019;11(11):2783. https://doi.org/10.3390/nu11112783.CrossRefPubMedCentral

Tian S, Xu Q, Jiang R, Han T, Sun C, Na L. Dietary protein consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Nutrients. 2017;9(9):982. https://doi.org/10.3390/nu9090982.CrossRefPubMedCentral

10.

Virtanen HEK, Koskinen TT, Voutilainen S, Mursu J, Tuomainen TP, Kokko P, et al. Intake of different dietary proteins and risk of type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr. 2017;117(6):882–93. https://doi.org/10.1017/S0007114517000745.CrossRefPubMed

11.

Chen Z, Franco OH, Lamballais S, Ikram MA, Schoufour JD, Muka T, et al. Associations of specific dietary protein with longitudinal insulin resistance, prediabetes, and type 2 diabetes: The Rotterdam Study. Clin Nutr. 2020;39(1):242–9. https://doi.org/10.1016/j.clnu.2019.01.021.CrossRefPubMed

12.

Cooper AJ, Sharp SJ, Lentjes MA, Luben RN, Khaw KT, Wareham NJ, et al. A prospective study of the association between quantity and variety of fruit and vegetable intake and incident type 2 diabetes. Diabetes Care. 2012;35(6):1293–300. https://doi.org/10.2337/dc11-2388.CrossRefPubMedPubMedCentral

13.

Conklin AI, Monsivais P, Khaw KT, Wareham NJ, Forouhi NG. Dietary diversity, diet cost, and incidence of type 2 diabetes in the united kingdom: a prospective cohort study. PLoS Med. 2016;13(7):e1002085. https://doi.org/10.1371/journal.pmed.1002085.CrossRefPubMedPubMedCentral

14.

Popkin BM, Du S, Zhai F, Zhang B. Cohort profile: the China Health and Nutrition Survey--monitoring and understanding socio-economic and health change in China, 1989-2011. Int J Epidemiol. 2010;39(6):1435–40. http://www.cpc.unc.edu/projects/china. https://doi.org/10.1093/ije/dyp322.CrossRefPubMed

15.

Zhang B, Zhai FY, Du SF, Popkin BM. The China Health and Nutrition Survey, 1989-2011. Obes Rev. 2014;15(Suppl 1):2–7. http://www.cpc.unc.edu/projects/china. https://doi.org/10.1111/obr.12119.CrossRefPubMed

16.

Liu M, Zhou C, Zhang Z, Li Q, He P, Zhang Y, et al. Inverse association between riboflavin intake and new-onset hypertension: a nationwide cohort study in China. Hypertension. 2020;76(6):1709–16. https://doi.org/10.1161/HYPERTENSIONAHA.120.16211.CrossRefPubMed

17.

Zhang Z, Liu M, Zhou C, He P, Zhang Y, Li H, et al. Evaluation of dietary niacin and new-onset hypertension among chinese adults. JAMA Netw Open. 2021;4(1):e2031669. https://doi.org/10.1001/jamanetworkopen.2020.31669.CrossRefPubMedPubMedCentral

18.

Yuan S, Ming-Wei L, Qi-Qiang H, Larsson SC. Egg, cholesterol and protein intake and incident type 2 diabetes mellitus: results of repeated measurements from a prospective cohort study. Clin Nutr. 2021;S0261-5614(21)00068-6. doi: 10.1016/j.clnu.2021.01.041 [Online ahead of print]

19.

Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. The Lancet Public Health. 2018;3(9):e419–28. https://doi.org/10.1016/S2468-2667(18)30135-X.CrossRefPubMedPubMedCentral

20.

Zhai F, Guo X, Popkin B, Ma L, Wang Q, Yu W, et al. Evaluation of the 24-hour individual recall method in China. Food Nutr Bull. 1996;17(2):1–5. https://doi.org/10.1177/156482659601700209.CrossRef

21.

Wang G, et al. China Food Composition Table 1991. People's Medical Press; Beijing, China: 1991. pp. 1–194.

22.

Yang Y, et al. China food composition table 2002. Peking University Medical Press; Beijing, China: 2002. pp. 1–377.

23.

Yang Y, et al. China food composition table 2004. Peking University Medical Press; Beijing, China: 2004. pp. 1–404.

24.

Shan Z, Rehm CD, Rogers G, Ruan M, Wang DD, Hu FB, et al. Trends in dietary carbohydrate, protein, and fat intake and diet quality among US Adults, 1999-2016. JAMA. 2019;322(12):1178–87. https://doi.org/10.1001/jama.2019.13771.CrossRefPubMedPubMedCentral

25.

U.S. Department of Agriculture (USDA). USDA Choose MyPlate.gov Vegetable Group Food Gallery. Accessed June 8, 2021. https://www.choosemyplate.gov/ vegetable-group-food-gallery (8 June 2021).

26.

Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498–504. https://doi.org/10.1097/00005768-200009001-00009.CrossRefPubMed

27.

Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, et al. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. 1999;149(6):531–40. https://doi.org/10.1093/oxfordjournals.aje.a009849.CrossRefPubMed

28.

Yuan X, Liu T, Wu L, Zou ZY, Li C. Validity of self-reported diabetes among middle-aged and older Chinese adults: the China Health and Retirement Longitudinal Study. BMJ Open. 2015;5(4):e6633. https://doi.org/10.1136/bmjopen-2014-006633.CrossRef

29.

Jia W, Weng J, Zhu D, Ji L, Lu J, Zhou Z, et al. Standards of medical care for type 2 diabetes in China 2019. Diabetes Metab Res Rev. 2019;35(6):e3158. https://doi.org/10.1002/dmrr.3158.CrossRefPubMed

30.

World Health Organization. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. Geneva: World Health Organization; 2011. http://www.who.int/iris/handle/10665/70523

31.

van Nielen M, Feskens EJ, Mensink M, Sluijs I, Molina E, Amiano P, et al. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct case-cohort study. Diabetes Care. 2014;37(7):1854–62. https://doi.org/10.2337/dc13-2627.CrossRefPubMed

32.

Ericson U, Sonestedt E, Gullberg B, Hellstrand S, Hindy G, Wirfält E, et al. High intakes of protein and processed meat associate with increased incidence of type 2 diabetes. Br J Nutr. 2013;109(6):1143–53. https://doi.org/10.1017/S0007114512003017.CrossRefPubMed

33.

Tinker LF, Sarto GE, Howard BV, Huang Y, Neuhouser ML, Mossavar-Rahmani Y, et al. Biomarker-calibrated dietary energy and protein intake associations with diabetes risk among postmenopausal women from the Women’s Health Initiative. Am J Clin Nutr. 2011;94(6):1600–6. https://doi.org/10.3945/ajcn.111.018648.CrossRefPubMedPubMedCentral

34.

Sluijs I, Beulens JW. van der A DL, Spijkerman AM, Grobbee DE, van der Schouw YT. 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. 2010;33(1):43–8. https://doi.org/10.2337/dc09-1321.CrossRefPubMed

35.

Malik VS, Li Y, Tobias DK, Pan A, Hu FB. Dietary protein intake and risk of type 2 diabetes in US men and women. Am J Epidemiol. 2016;183(8):715–28. https://doi.org/10.1093/aje/kwv268.CrossRefPubMedPubMedCentral

36.

Shang X, Scott D, Hodge AM, English DR, Giles GG, Ebeling PR, et al. 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. 2016;104(5):1352–65. https://doi.org/10.3945/ajcn.116.140954.CrossRefPubMed

37.

Alhazmi A, Stojanovski E, McEvoy M, Garg ML. Macronutrient intake and type 2 diabetes risk in middle-aged Australian women. Results from the Australian Longitudinal Study on Women’s Health. Public Health Nutr. 2014;17(7):1587–94. https://doi.org/10.1017/S1368980013001870.CrossRefPubMed

38.

Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.

39.

Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011;141(6):1140–5. https://doi.org/10.3945/jn.110.135566.CrossRefPubMed

40.

Rietman A, Schwarz J, Tome D, Kok FJ, Mensink M. High dietary protein intake, reducing or eliciting insulin resistance? Eur J Clin Nutr. 2014;68(9):973–9. https://doi.org/10.1038/ejcn.2014.123.CrossRefPubMed

41.

Laplante M, Sabatini DM. mTOR signaling in growth control and disease. Cell. 2012;149(2):274e93–293. https://doi.org/10.1016/j.cell.2012.03.017.CrossRef

42.

Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Willett WC, et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011;94(4):1088e96–1096. https://doi.org/10.3945/ajcn.111.018978.CrossRef

43.

Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003;78(4):734–41. https://doi.org/10.1093/ajcn/78.4.734.CrossRefPubMed

44.

Mozaffarian D, Lemaitre RN, Kuller LH, Burke GL, Tracy RP, Siscovick DS. Cardiovascular Health Study. Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation. 2003;107(10):1372–7. https://doi.org/10.1161/01.CIR.0000055315.79177.16.CrossRefPubMed

45.

Uhe AM, Collier GR, O’Dea K. A comparison of the effects of beef, chicken and fish protein on satiety and amino acid profiles in lean male subjects. J Nutr. 1992;122(3):467–72. https://doi.org/10.1093/jn/122.3.467.CrossRefPubMed

46.

Ouellet V, Marois J, Weisnagel SJ, Jacques H. Dietary cod protein improves insulin sensitivity in insulin-resistant men and women: a randomized controlled trial. Diabetes Care. 2007;30(11):2816–21. https://doi.org/10.2337/dc07-0273.CrossRefPubMed

47.

Ibsen DB, Steur M, Imamura F, Overvad K, Schulze MB, Bendinelli B, et al. Replacement of red and processed meat with other food sources of protein and the risk of type 2 diabetes in European populations: the EPIC-InterAct Study. Diabetes Care. 2020;43(11):2660–7. https://doi.org/10.2337/dc20-1038.CrossRefPubMedPubMedCentral

48.

Ibsen DB, Jakobsen MU, Halkjær J. Replacing red meat with other nonmeat food sources of protein is associated with a reduced risk of type 2 diabetes in a danish cohort of middle-aged adults. J Nutr. 2021; nxaa448. doi: 10.1093/jn/nxaa448. [Online ahead of print]

49.

Fujisawa T, Ikegami H, Inoue K, Kawabata Y, Ogihara T. Effect of two alpha-glucosidase inhibitors, voglibose and acarbose, on postprandial hyperglycemia correlates with subjective abdominal symptoms. Metabolism. 2005;54(3):387–90. https://doi.org/10.1016/j.metabol.2004.10.004.CrossRefPubMed

50.

Son M, Wu J. Egg white hydrolysate and peptide reverse insulin resistance associated with tumor necrosis factor-alpha (TNF-alpha) stimulated mitogen-activated protein kinase (MAPK) pathway in skeletal muscle cells. Eur J Nutr. 2019;58(5):1961–9. https://doi.org/10.1007/s00394-018-1753-7.CrossRefPubMed

51.

Uenishi H, Kabuki T, Seto Y, Serizawa A, Nakajima H. Isolation and identification of casein-derived dipeptidyl-peptidase 4 (DPP-4)-inhibitory peptide LPQNIPPL from gouda-type cheese and its effect on plasma glucose in rats. Int Dairy J. 2012;22(1):24–30. https://doi.org/10.1016/j.idairyj.2011.08.002.CrossRef

52.

Zhou Y, Qiu L, Xiao Q, Wang Y, Meng X, Xu R, et al. Obesity and diabetes related plasma amino acid alterations. Clin Biochem. 2013;46(15):1447–52. https://doi.org/10.1016/j.clinbiochem.2013.05.045.CrossRefPubMed

53.

Thompson SV, Hannon BA, An R, Holscher HD. Effects of isolated soluble fiber supplementation on body weight, glycemia, and insulinemia in adults with overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2017;106(6):1514–28. https://doi.org/10.3945/ajcn.117.163246.CrossRefPubMed

54.

Yao B, Fang H, Xu W, Yan Y, Xu H, Liu Y, et al. Dietary fiber intake and risk of type 2 diabetes: a dose-response analysis of prospective studies. Eur J Epidemiol. 2014;29(2):79–88. https://doi.org/10.1007/s10654-013-9876-x.CrossRefPubMed

55.

de la Cruz-Ares S, Gutiérrez-Mariscal FM, Alcalá-Díaz JF, Quintana-Navarro GM, Podadera-Herreros A, Cardelo MP, et al. Quality and quantity of protein intake influence incidence of type 2 diabetes mellitus in coronary heart disease patients: from the CORDIOPREV study. Nutrients. 2021;13(4):1217. https://doi.org/10.3390/nu13041217.CrossRefPubMedPubMedCentral

56.

Bhathena SJ, Velasquez MT. Beneficial role of dietary phytoestrogens in obesity and diabetes. Am J Clin Nutr. 2002;76(6):1191–201. https://doi.org/10.1093/ajcn/76.6.1191.CrossRefPubMed

57.

Vahouny GV, Adamson I, Chalcarz W, Satchithanandam S, Muesing R, Klurfeld DM, et al. Effects of casein and soy protein on hepatic and serum lipids and lipoprotein lipid distributions in the rat. Atherosclerosis. 1985;56(2):127–37. https://doi.org/10.1016/0021-9150(85)90013-9.CrossRefPubMed

58.

Lavigne C, Marette A, Jacques H. Cod and soy proteins compared with casein improve glucose tolerance and insulin sensitivity in rats. Am J Physiol Endocrinol Metab. 2000;278(3):E491–500. https://doi.org/10.1152/ajpendo.2000.278.3.E491.CrossRefPubMed

59.

Bernstein MA, Tucker KL, Ryan ND, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc. 2002;102(8):1096–104. https://doi.org/10.1016/S0002-8223(02)90246-4.CrossRefPubMed

60.

Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet .2017; 390:2050-2062.

61.

Hu FB, Stampfer MJ, Rimm E, et al. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol .1999; 149:531-540.

62.

Xue H, Yang M, Liu Y, Duan R, Cheng G, Zhang X. Relative validity of a 2-day 24-hour dietary recall compared with a 2-day weighed dietary record among adults in South China. Nutr Diet. 2017;74(3):298–307. https://doi.org/10.1111/1747-0080.12315.CrossRefPubMed

63.

Yao M, McCrory MA, Ma G, et al. Relative influence of diet and physical activity on body composition in urban Chinese adults. Am J Clin Nutr. 2003;77(6):1409–16. https://doi.org/10.1093/ajcn/77.6.1409.CrossRefPubMed

Title: Variety and quantity of dietary protein intake from different sources and risk of new-onset diabetes: a Nationwide Cohort Study in China
Authors: Chun Zhou
Chengzhang Liu
Zhuxian Zhang
Mengyi Liu
Yuanyuan Zhang
Huan Li
Panpan He
Qinqin Li
Xianhui Qin
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2022
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02199-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Variety and quantity of dietary protein intake from different sources and risk of new-onset diabetes: a Nationwide Cohort Study in China

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Assessing the feasibility of sustaining SARS-CoV-2 local containment in China in the era of highly transmissible variants

Longitudinal evolution of motor and non-motor symptoms in early-stage multiple system atrophy: a 2-year prospective cohort study

Childhood diabetes mellitus and early-onset kidney diseases later in life: a nationwide population-based matched cohort study

How often do cancer researchers make their data and code available and what factors are associated with sharing?

International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials

Barriers to management of opioid withdrawal in hospitals in England: a document analysis of hospital policies on the management of substance dependence