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Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = -0.15%; 95%-CI: -0.26, -0.05%), FG (MD = -0.53 mmol/L; 95%-CI: -0.92, -0.13 mmol/L) and FI (MD = -10.09 pmol/L; 95%-CI: -17.31, -2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials.

TRIAL REGISTRATION

ClinicalTrials.gov registration number: NCT02037321.

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  • Authors+Show Affiliations

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. effie.viguiliouk@mail.utoronto.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. effie.viguiliouk@mail.utoronto.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. sarahe.stewart@mail.utoronto.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. sarahe.stewart@mail.utoronto.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. viranda.jayalath@mail.utoronto.ca. Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2C4, Canada. viranda.jayalath@mail.utoronto.ca. Undergraduate Medical Education, University of Toronto, Toronto, ON M5S 2E8, Canada. viranda.jayalath@mail.utoronto.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. alena.ng@mail.utoronto.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. smirrahimi@qmed.ca. School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada. smirrahimi@qmed.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. rdesouz@mcmaster.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. rdesouz@mcmaster.ca. Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada. rdesouz@mcmaster.ca.

    ,

    Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. anthony.hanley@utoronto.ca. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada. anthony.hanley@utoronto.ca. Department of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. anthony.hanley@utoronto.ca. Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 2E8, Canada. anthony.hanley@utoronto.ca.

    ,

    Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. richard.bazinet@utoronto.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. BlancoMejiaS@smh.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. BlancoMejiaS@smh.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. LeiterL@smh.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. LeiterL@smh.ca. Department of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. LeiterL@smh.ca. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. LeiterL@smh.ca. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. LeiterL@smh.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. JosseRG@smh.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. JosseRG@smh.ca. Department of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. JosseRG@smh.ca. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. JosseRG@smh.ca. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. JosseRG@smh.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. cyril.kendall@utoronto.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. cyril.kendall@utoronto.ca. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada. cyril.kendall@utoronto.ca.

    ,

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. NutritionProject@smh.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. NutritionProject@smh.ca. Department of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. NutritionProject@smh.ca. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. NutritionProject@smh.ca. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. NutritionProject@smh.ca.

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. john.sievenpiper@utoronto.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada. john.sievenpiper@utoronto.ca. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. john.sievenpiper@utoronto.ca. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada. john.sievenpiper@utoronto.ca.

    Source

    Nutrients 7:12 2015 Dec 01 pg 9804-24

    MeSH

    Animals
    Blood Glucose
    Diabetes Mellitus
    Dietary Proteins
    Humans
    Meat
    Plant Proteins
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    26633472

    Citation

    Viguiliouk, Effie, et al. "Effect of Replacing Animal Protein With Plant Protein On Glycemic Control in Diabetes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials." Nutrients, vol. 7, no. 12, 2015, pp. 9804-24.
    Viguiliouk E, Stewart SE, Jayalath VH, et al. Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2015;7(12):9804-24.
    Viguiliouk, E., Stewart, S. E., Jayalath, V. H., Ng, A. P., Mirrahimi, A., de Souza, R. J., ... Sievenpiper, J. L. (2015). Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 7(12), pp. 9804-24. doi:10.3390/nu7125509.
    Viguiliouk E, et al. Effect of Replacing Animal Protein With Plant Protein On Glycemic Control in Diabetes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2015 Dec 1;7(12):9804-24. PubMed PMID: 26633472.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. AU - Viguiliouk,Effie, AU - Stewart,Sarah E, AU - Jayalath,Viranda H, AU - Ng,Alena Praneet, AU - Mirrahimi,Arash, AU - de Souza,Russell J, AU - Hanley,Anthony J, AU - Bazinet,Richard P, AU - Blanco Mejia,Sonia, AU - Leiter,Lawrence A, AU - Josse,Robert G, AU - Kendall,Cyril W C, AU - Jenkins,David J A, AU - Sievenpiper,John L, Y1 - 2015/12/01/ PY - 2015/08/29/received PY - 2015/10/29/revised PY - 2015/11/17/accepted PY - 2015/12/4/entrez PY - 2015/12/4/pubmed PY - 2016/9/16/medline KW - animal protein KW - diabetes KW - glycemic control KW - plant protein SP - 9804 EP - 24 JF - Nutrients JO - Nutrients VL - 7 IS - 12 N2 - UNLABELLED: Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = -0.15%; 95%-CI: -0.26, -0.05%), FG (MD = -0.53 mmol/L; 95%-CI: -0.92, -0.13 mmol/L) and FI (MD = -10.09 pmol/L; 95%-CI: -17.31, -2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT02037321. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/26633472/full_citation L2 - http://www.mdpi.com/resolver?pii=nu7125509 DB - PRIME DP - Unbound Medicine ER -