German Institute of Human Nutrition Potsdam-Rehbrücke, Clinical Nutrition-DZD, Arthur-Scheunert-Allee 114-116, D-14558 Nuthetal, Germany.
Charité University Medicine, Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Hindenburgdamm 30, D-12203 Berlin, Germany.
Nutrients. 2020 Jan 30;12(2):365. doi: 10.3390/nu12020365.
The recommended amount and quality of protein in diets of diabetic patients are highly controversial. In order to provide evidence-based information, the Diabetes Nutrition Study Group (DNSG) used a grading procedure used for quality of evidence and strength of recommendations (GRADE). A protein intake of 10% to 20% of energy intake (E%) or about 0.8 to 1.3 g/kg body weight in people below 65 years of age, and 15% to 20% of E% in people above 65 years of age appeared safe in weight-stable conditions. There were no intervention studies addressing metabolic effects, mortality, or cardiovascular events over prolonged periods. Body weight is closely linked to metabolic control and high protein diets are often recommended. Weight-loss diets that include 23% to 32% of E% as protein for up to one year reduced blood pressure and body weight slightly but significantly more than lower protein diets, whereas blood lipids, fasting blood glucose, and HbA1c improved similarly with higher or lower protein intakes in participants with a glomerular filtration rate (GFR) >60 mL/min/1.73 m. Patients with a GFR <60 mL/min/1.73 m did not show a faster decline of GFR or kidney function with protein intakes around 0.8 g/kg body weight as compared with lower intakes, thereby arguing against a restriction. The effects of protein intake on diabetic eye or nerve disease have not been reported. There are a number of studies that have compared different types of animal proteins (milk, chicken, beef, pork, and fish) or compared animal with plant protein in diabetic patients and have reported a greater reduction of serum cholesterol with plant protein. In summary, the suggested range of protein intake appears to be safe and can be adapted according to personal dietary preferences.
糖尿病患者饮食中蛋白质的推荐量和质量存在很大争议。为了提供基于证据的信息，糖尿病营养研究组（DNSG）使用了一种用于评估证据质量和推荐强度的分级程序（GRADE）。对于 65 岁以下人群，能量摄入（E%）的 10%至 20%或体重大约 0.8 至 1.3 g/kg ，以及 65 岁以上人群 E%的 15%至 20%，在体重稳定的情况下似乎是安全的。没有研究干预代谢效应、死亡率或心血管事件的长期效果。体重与代谢控制密切相关，因此常推荐高蛋白饮食。在一年的时间内，包含 23%至 32% E%的蛋白质的减肥饮食可使血压和体重略有但显著降低，而对于肾小球滤过率（GFR）>60 mL/min/1.73 m 的参与者，较高或较低的蛋白质摄入量可使血脂、空腹血糖和 HbA1c 同样得到改善。GFR<60 mL/min/1.73 m 的患者，与较低的蛋白质摄入量相比，蛋白质摄入量约为 0.8 g/kg 体重大约不会导致 GFR 或肾功能更快下降，因此不建议限制蛋白质摄入量。蛋白质摄入量对糖尿病眼病或神经病变的影响尚未报道。有许多研究比较了不同类型的动物蛋白（牛奶、鸡肉、牛肉、猪肉和鱼）或糖尿病患者的动物蛋白与植物蛋白，报告称植物蛋白可更大程度地降低血清胆固醇。总之，建议的蛋白质摄入量范围似乎是安全的，并可根据个人饮食偏好进行调整。
