Changes in quantity plant based protein intake on type 2 diabetes remission in coronary heart disease patients: from the CORDIOPREV study

Authors: GUITIERREZ MARISCAL, FRANCISCO - University Of Cordoba; ALCALA DIAZ, JUAN - University Of Cordoba; QUINTANA NAVARRO, GRACIA - University Of Cordoba; DE LA CRUZ, ARES - University Of Cordoba; TORRES PENA, JOSE - University Of Cordoba; CARDELO, MAGDALENA - University Of Cordoba; ARENAS LARRIVA, ANTONIO - University Of Cordoba; MALAGON, MARIA - University Of Cordoba; ROMERO CABRERA, JUAN - University Of Cordoba; ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; PEREZ MARTINEZ, PABLO - University Of Cordoba; DELGADO LISTA, JAVIER - University Of Cordoba; YUBERO SERRANO, ELENA - University Of Cordoba; LOPEZ MIRANDA, JOSE - University Of Cordoba

Submitted to: European Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/21/2022
Publication Date: 3/4/2023
Citation: Guitierrez Mariscal, F., Alcala Diaz, J., Quintana Navarro, G., de la Cruz, A.S., Torres Pena, J.D., Cardelo, M.P., Arenas Larriva, A.P., Malagon, M.M., Romero Cabrera, J.L., Ordovas, J.M., Perez Martinez, P., Delgado Lista, J., Yubero Serrano, E., Lopez Miranda, J. 2023. Changes in quantity plant based protein intake on type 2 diabetes remission in coronary heart disease patients: from the CORDIOPREV study. European Journal of Nutrition. https://doi.org/10.1007/s00394-022-03080-x.
DOI: https://doi.org/10.1007/s00394-022-03080-x

Interpretive Summary: Our study investigated whether increasing plant protein consumption in one's diet could be an effective method for managing type 2 diabetes. Individuals with recently diagnosed type 2 diabetes who were not on glucose-lowering treatment were divided into two groups and were instructed to follow either a Mediterranean diet or a low-fat diet. Over five years, researchers tracked changes in the individuals' dietary intake, with particular focus on plant protein consumption. The results suggested that an increase in plant protein intake could indeed lead to diabetes remission. Additionally, a higher plant protein intake was associated with healthier eating habits overall, including a lower intake of animal protein, cholesterol, saturated fatty acids, and fat, and a higher intake of whole grains, fiber, carbohydrates, legumes, and tree nuts. The study's findings emphasize the potential of dietary adjustments for managing type 2 diabetes. By increasing the intake of plant proteins, individuals with type 2 diabetes may significantly improve their health outcomes.

Technical Abstract: Purpose: Diabetes remission is a phenomenon described in the context of drastic weight loss due to bariatric surgery or low-calorie diets. Evidence suggests that increasing the intake of plant protein could reduce the risk of type 2 diabetes. We sought for association between changes in plant protein intake in the context of 2 healthy diets without weight loss nor glucose-lowering medication, and diabetes remission in coronary heart disease patients from the CORDIOPREV study. Methods: Newly diagnosed type 2 diabetes participants without glucose-lowering treatment were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was assessed with a median follow-up of 60 months according to the ADA recommendation. Information on patient's dietary intake was collected using food-frequency questionnaires. At first year of intervention, 177 patients were classified according to changes in plant protein consumption into those who increased or decreased its intake, in order to perform an observational analysis on the association between protein intake and diabetes remission. Results: Cox regression showed that patients increasing plant protein intake were more likely to remit from diabetes than those who decreased its intake (HR?=?1.71(1.05-2.77)). The remission occurred mainly at first and second year of follow-up with diminished number of patients achieving remission in the third year onwards. The increase in plant protein was associated with lower intake of animal protein, cholesterol, saturated fatty acids, and fat, and with higher intake of whole grains, fibre, carbohydrates, legumes, and tree nuts. Conclusion: These results support the need to increase protein intake of vegetal origin as dietary therapy to reverse type 2 diabetes in the context of healthy diets without weight loss.