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Intake of animal and plant proteins and risk of all-cause mortality in patients with type 2 diabetes: results from NHANES

Subjects

Abstract

Background/Objective

There is little and inconsistent data on the relationship between protein intake and mortality in patients with type 2 diabetes. Our goal was to look at the relationship between consuming plant- and animal-based proteins and the risk of all-cause death in patients with type 2 diabetes.

Subjects/Methods

We included 4646 patients with type 2 diabetes aged ≥20 years participating in continuous NHANES from 1999 to 2018. All-cause mortality was ascertained through linkage to National Death Index until December 31, 2019. Cox proportional hazard regression models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95%CIs.

Results

Over an average follow-up of nine years, 969 deaths took place. The multivariable-adjusted HRs of all-cause mortality across quartiles of plant protein intake, were, respectively, 1.00 (reference), 0.77 (95%CI: 0.65, 0.93), 0.79 (95%CI: 0.64, 0.97), and 0.73 (95%CI: 0.58, 0.93) (Ptrend = 0.022). Intake of animal protein was not linked to all-cause mortality. The HR was 0.94 (95%CI: 0.81, 1.08) for replacing 5% of energy from animal protein with plant protein. Intake of protein from individual animal- and plant-based foods was not related to the risk of all-cause mortality, nor was replacing 5% of energy intake from red meat protein with those from other foods.

Conclusions

Among individuals with type 2 diabetes, a higher intake of plant protein is linked to a lower risk of death from all causes. Nevertheless, the results should be interpreted with caution because some subgroups did not show an inverse relationship, and observational studies have limitations.

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Fig. 1: Dose-response association between plant protein intake and risk of all-cause mortality in patients with type 2 diabetes participating in continuous NHANES from 1999 to 2018 (Pnonlinearity = 0.007).

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon reasonable request to the corresponding author.

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Contributions

AJ conceived and designed the study; AJ and MSZ contributed to data verification, AJ and MSZ conducted statistical analyses; AJ, AG, AN, and MSZ wrote the first draft of the manuscript, contributed to the interpretation of the results and critically revised the manuscript for important intellectual content. AJ had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final manuscript. AJ is the guarantor.

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Correspondence to Ahmad Jayedi.

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The authors declare no competing interests.

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NHANES received approval from the National Center for Health Statistics, and all participants gave their written informed consent.

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Jayedi, A., Gohari, A., Najafi, A. et al. Intake of animal and plant proteins and risk of all-cause mortality in patients with type 2 diabetes: results from NHANES. Eur J Clin Nutr 79, 214–223 (2025). https://doi.org/10.1038/s41430-024-01535-4

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