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Is protein the forgotten ingredient: Effects of higher compared to lower protein diets on cardiometabolic risk factors. A systematic review and meta-analysis of randomised controlled trials

  • Yakima D. Vogtschmidt
    Correspondence
    Corresponding author. Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Harry Nursten Building, Reading RG6 6DZ, United Kingdom.
    Affiliations
    KingdomHugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Harry Nursten Building, Reading RG6 6DZ, United Kingdom

    Institute for Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6DZ, United Kingdom

    Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom
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  • Anne Raben
    Affiliations
    Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark

    Steno Diabetes Center Copenhagen (SDCC), Niels Steensens Vej 2, 2820, Gentofte, Denmark
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  • Ilona Faber
    Affiliations
    Department of Food Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
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  • Claudia de Wilde
    Affiliations
    Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5000, LE Tilburg, the Netherlands
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  • Julie A. Lovegrove
    Affiliations
    KingdomHugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Harry Nursten Building, Reading RG6 6DZ, United Kingdom

    Institute for Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6DZ, United Kingdom

    Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom
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  • D. Ian Givens
    Affiliations
    Institute for Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6DZ, United Kingdom

    Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom
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  • Andreas F.H. Pfeiffer
    Affiliations
    German Center for Diabetes Research, Partner Potsdam, Berlin, Germany

    Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12200, Berlin, Germany
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  • Sabita S. Soedamah-Muthu
    Affiliations
    Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom

    Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5000, LE Tilburg, the Netherlands
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      Highlights

      • Dietary proteins are an important part of a healthy diet.
      • Higher protein diets showed favourable effects on cardiometabolic risk factors.
      • The effects were small and more research on the long-term impacts is needed.

      Abstract

      Background and aims

      Higher protein (HP) diets may lead to lower cardiometabolic risk, compared to lower protein (LP) diets. This systematic review and meta-analysis aims to investigate the effects of HP versus LP diets on cardiometabolic risk factors in adults, using the totality of the current evidence from randomised controlled trials (RCTs).

      Methods

      Systematic searches were conducted in electronic databases, up to November 2020. Random effects meta-analyses were conducted to pool the standardised mean differences (SMD) and 95% confidence intervals (CI). The main outcomes were weight loss, body mass index (BMI), waist circumference, fat mass, systolic and diastolic BP, total cholesterol, HDL-and LDL-cholesterol, triacylglycerol, fasting glucose and insulin, and glycated haemoglobin.

      Results

      Fifty-seven articles reporting on 54 RCTs were included, involving 4344 participants (65% female, mean age: 46 (SD 10) years, mean BMI: 33 (SD 3) kg/m2), with a mean study duration of 18 weeks (range: 4 to 156 weeks). Compared to LP diets (range protein (E%):10–23%), HP diets (range protein (E%): 20–45%) led to more weight loss (SMD -0.13, 95% CI: -0.23, −0.03), greater reductions in fat mass (SMD -0.14, 95% CI: -0.24, −0.04), systolic BP (SMD -0.12, 95% CI: -0.21, −0.02), total cholesterol (SMD -0.11, 95% CI: -0.19, −0.02), triacylglycerol (SMD -0.22, 95% CI: -0.30, −0.14) and insulin (SMD -0.12, 95% CI: -0.22, −0.03). No significant differences were observed for the other outcomes.

      Conclusions

      Higher protein diets showed small, but favourable effects on weight loss, fat mass loss, systolic blood pressure, some lipid outcomes and insulin, compared to lower protein diets.

      Graphical abstract

      Keywords

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