Dietary protein and multiple health outcomes: An umbrella review of systematic reviews and meta-analyses of observational studies

Lv, Jia-Le; Wu, Qi‐Jun; Li, Xinyu; Gao, Chang; Xu, Mengque; Yang, Juan; Zang, Si-Tian; Luan, Jie; Cai, Dong-Zhen; Chang, Qing; Zhao, Yuhong

doi:10.1016/j.clnu.2022.06.005

Cited by 13 publications

(11 citation statements)

References 63 publications

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“…More recent SRs by Ye et al [ 25 ] and Fan et al [ 23 ] were not included in the umbrella review by Neuschwander et al [ 6 ], likely because of the later time of publication. Lv et al have reviewed SRs on protein intake and multiple health outcomes, including T2D [ 50 ]. The authors included 2 SRs (Zhao et al [ 22 ], Ye et al [ 25 ]).…”

Section: Discussionmentioning

confidence: 99%

Protein intake and type 2 diabetes mellitus: an umbrella review of systematic reviews for the evidence-based guideline for protein intake of the German Nutrition Society

Schulze,

Haardt,

Amini

et al. 2023

Eur J Nutr

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Purpose Protein-rich foods show heterogeneous associations with the risk of type 2 diabetes (T2D) and it remains unclear whether habitual protein intake is related to T2D risk. We carried out an umbrella review of systematic reviews (SR) of randomised trials and/or cohort studies on protein intake in relation to risks of T2D. Methods Following a pre-specified protocol (PROSPERO: CRD42018082395), we retrieved SRs on protein intake and T2D risk published between July 1st 2009 and May 22nd 2022, and assessed the methodological quality and outcome-specific certainty of the evidence using a modified version of AMSTAR 2 and NutriGrade, respectively. The overall certainty of evidence was rated according to predefined criteria. Results Eight SRs were identified of which six contained meta-analyses. The majority of SRs on total protein intake had moderate or high methodological quality and moderate outcome-specific certainty of evidence according to NutriGrade, however, the latter was low for the majority of SRs on animal and plant protein. Six of the eight SRs reported risk increases with both total and animal protein. According to one SR, total protein intake in studies was ~ 21 energy percentage (%E) in the highest intake category and 15%E in the lowest intake category. Relative Risks comparing high versus low intake in most recent SRs ranged from 1.09 (two SRs, 95% CIs 1.02–1.15 and 1.06–1.13) to 1.11 (1.05–1.16) for total protein (between 8 and 12 cohort studies included) and from 1.13 (1.08–1.19) to 1.19 (two SRs, 1.11–1.28 and 1.11–1.28) (8–9 cohort studies) for animal protein. However, SRs on RCTs examining major glycaemic traits (HbA1c, fasting glucose, fasting insulin) do not support a clear biological link with T2D risk. For plant protein, some recent SRs pointed towards risk decreases and non-linear associations, however, the majority did not support an association with T2D risk. Conclusion Higher total protein intake was possibly associated with higher T2D risk, while there is insufficient evidence for a risk increase with higher intakes of animal protein and a risk decrease with plant protein intake. Given that most SRs on plant protein did not indicate an association, there is possibly a lack of an effect.

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Section: Discussionmentioning

confidence: 99%

Protein intake and type 2 diabetes mellitus: an umbrella review of systematic reviews for the evidence-based guideline for protein intake of the German Nutrition Society

Schulze,

Haardt,

Amini

et al. 2023

Eur J Nutr

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“…We applied quantitative criteria to categorize the credibility of each association into convincing, highly suggestive, suggestive, or weak according to previously published UR ( Table 1 ) ( 23 , 41 , 42 ).…”

Section: Methodsmentioning

confidence: 99%

“…The UR is an approach used to provide an overview of published systematic reviews with meta-analyses on the same topic and evaluate the credibility of associations (22)(23)(24). In this UR, we strictly followed the Preferred Reporting Items for Systematic Reviews and Metaanalyses reporting guideline (Supplementary Table S1) and metaanalysis of Observational Studies in Epidemiology guidelines (Supplementary Table S2) (25,26), and the protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023427297).…”

Section: Methodsmentioning

confidence: 99%

Ultra-processed food consumption and metabolic disease risk: an umbrella review of systematic reviews with meta-analyses of observational studies

Lv,

Wei,

Sun

et al. 2024

Front. Nutr.

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Background and aimsThere is an ongoing debate on whether to advocate reducing ultra-processed food (UPF) in dietary guidelines to control metabolic disease (such as obesity and type 2 diabetes mellitus [T2DM]). We aimed to summarize the evidence from systematic reviews with meta-analyses between UPF consumption and metabolic diseases risk, assess the credibility, and verify the robustness of these associations.MethodsWe systematically searched PubMed, Web of Science, Embase, and Cochrane Library databases from their inception to July 15, 2023, to identify relevant systematic reviews with meta-analyses. We used the random-effects model to evaluate the summary effect size, along with 95% confidence interval and prediction interval. We also assessed heterogeneity, evidence of small-study effects and excess significance bias, and categorized the credibility of each association based on quantitative umbrella review criteria. Additionally, we conducted subgroup and sensitivity analyses to assess the robustness of associations based on continents, study design, dietary assessment methods, definition methods of UPF, population, and units of UPF consumption.ResultsOverall, 6 systematic reviews with 13 meta-analyses were included. Three (23.08%) meta-analyses were classified as highly suggestive evidence for meeting the criteria that associations were significant at p < 10−6, had more than 1,000 cases, and presented the largest study with significance at p < 0.05. Among them, the highest UPF consumption quantile was associated with an increased risk of obesity (OR = 1.55, 95% CI: 1.36–1.77) when compared with the lowest UPF consumption quantile. The highest UPF consumption quantile was associated with an increased risk of T2DM (RR = 1.40, 95% CI: 1.23–1.59) when compared with the lowest UPF consumption quantile, and a 10% increase in UPF consumption (% g/d) was associated with an increased risk of T2DM (RR = 1.12, 95% CI: 1.10–1.13). Meanwhile, the robustness of these associations was verified by a series of subgroup and sensitivity analyses.ConclusionUPF consumption may be a risk factor for several metabolic diseases. However, well-designed studies are still needed to verify our findings in the future.

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“…For example, there are phytochemicals such as isoflavones and glucosinolates, which theoretically could exert both favorable and unfavorable effects, and phytate, which inhibits mineral absorption but is also an antioxidant [ 102 , 103 ]. In general, over the past several years, systematic reviews and meta-analyses of observational data have found that animal protein is associated with increased risks of type 2 diabetes, cardiovascular mortality, and all-cause mortality, whereas plant protein is associated with decreases risks of these outcomes [ 12 , 104 , 105 ].…”

Section: Differences Between Animal and Plant Proteinmentioning

confidence: 99%

Perspective: Plant-Based Meat Alternatives Can Help Facilitate and Maintain a Lower Animal to Plant Protein Intake Ratio

Messina¹,

Duncan²,

Glenn³

et al. 2023

Advances in Nutrition

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Dietary protein and multiple health outcomes: An umbrella review of systematic reviews and meta-analyses of observational studies

Cited by 13 publications

References 63 publications

Protein intake and type 2 diabetes mellitus: an umbrella review of systematic reviews for the evidence-based guideline for protein intake of the German Nutrition Society

Protein intake and type 2 diabetes mellitus: an umbrella review of systematic reviews for the evidence-based guideline for protein intake of the German Nutrition Society

Ultra-processed food consumption and metabolic disease risk: an umbrella review of systematic reviews with meta-analyses of observational studies

Perspective: Plant-Based Meat Alternatives Can Help Facilitate and Maintain a Lower Animal to Plant Protein Intake Ratio

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