Patterns of protein intake and mortality in patients with type 2 diabetes: results from NHANES

We aimed to look at the potential relationship between patterns of protein intake and risk of death in adults with type 2 diabetes. We included 4646 adults with type 2 diabetes participating in NHANES (1999-2018). We estimated intake of proteins from 11 animal- and plant-based food groups and then, used principal component analysis to explore data-driven patterns of protein intake. All-cause mortality was ascertained through linkage to National Death Index until December 31, 2019 (n = 969 deaths). Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Four dietary protein patterns were identified: "healthy" (high in proteins from legumes, fruits, nuts, seeds, and fish and low in red meat protein), "red meat and egg" (high in red meat and egg proteins and low in fish and poultry proteins), "vegetables/fish" and "dairy/nuts" patterns. The HRs of all-cause mortality for the highest compared to the lowest quartile of "healthy" and "red meat and egg" protein patterns were, respectively, 0.77 (95%CI: 0.62, 0.97; Ptrend = 0.014) and 1.28 (95%CI: 1.06, 1.54; Ptrend = 0.033). Greater adherence to a healthy protein pattern may be associated with a reduced risk of death in patients with type 2 diabetes, while greater adherence to a dietary pattern rich in red meat and egg proteins and low in fish and poultry proteins may be associated with a higher risk.