Background and Significance: The incidence of type 2 diabetes mellitus (T2DM) and pre-diabetes continues to increase. Many individuals
are not aware of having the disease or early stages of the disease, pre-diabetes, until symptoms develop and it is of particular importance to
try to prevent the development of T2DM during the pre-diabetic stage. T2DM is a major contributor to morbidity and mortality due to its
increased risk of cardiovascular disease (CVD), where more than half of individuals with T2DM will die from complications due to CVD. Diet and
lifestyle modifications play a critical role in the development and prevention of pre-diabetes and T2DM. Much focus has been given to limiting
carbohydrate consumption within this population, yet there are no established recommended dietary allowance (RDA) for pre-diabetes and T2DM for
protein consumption. The intake of protein above the RDA may play a role in prevention or progression of T2DM and risk factors associated with
CVD. There is a sparsity of studies examining the role of protein on glycemic control as well as CVD in people with pre-diabetes and T2DM.
Therefore, the purpose of this cross-sectional study was to examine the relationship between protein consumption as well as animal versus plant
protein on glycemic control and indices of cardiovascular health in individuals with pre-diabetes and T2DM. Methods: A total of 62 men and women
with pre-diabetes or T2DM that were overweight or obese between the ages of 45-75 years old were in included in this study. Participants were
stratified based on their intake from a three-day food record into the following three groups based on their protein intake: protein levels of
less than 0.8 grams per kilogram body weight (g/kg/bw), between 0.8 to 1.0 g/kg/bw and greater than or equal to 1.0 g/kg/bw as below-, meeting-,
and above recommended-levels, respectively. During the study visit, after an overnight fast, participant's blood was drawn, anthropometric
parameters were assessed, resting brachial blood pressure was taken, duel-energy x-ray absorptiometry (DXA) scans were completed, and three-day
food records were assessed. Results: Weight, body mass index (BMI), and hip circumference (HC), were higher in participants who consumed below
and meeting the recommended levels of protein (P≤0.01 for all values and P<0.05 for all values, respectively) than those in the above
recommended protein group. Waist circumference (WC) was greater (P≤0.01) for participants who consumed below recommended protein levels versus
those who consumed above the recommended level. There were differences (P<0.05) in total energy, monounsaturated fat, polyunsaturated fat,
cholesterol, carbohydrate, and fiber intake, as well as animal and plant protein consumption amongst groups. When groups were compared, intake
of animal protein, similar to total protein was different amongst groups (P≤0.01). Whereas plant protein intake was only greater in participants
consuming above the recommended protein level (P≤0.01, P=0.02, below and recommended protein levels, respectively). The results of this study
suggest that the higher the animal-to-plant protein ratio the higher the insulin secretion as indicated by the HOMA- β equation. Our findings
also demonstrated that the higher the plant protein intake the lower the high density lipoprotein (HDL)-cholesterol concentration. Furthermore,
a higher animal protein intake was associated with lower triglyceride (TG) concentrations. Participants who consumed above recommended protein
had lower (P≤0.01) fat mass (FM) and higher lean mass (LM) (P<0.05) in all sites assessed when compared to participants who consumed below or
recommended protein levels. Fat-to-lean mass ratio (FM/LM) ratio was lower in participants who consumed above the recommended protein level when
compared to participants who consumed below (P=0.03) and recommended protein (P≤0.01) levels. Total-, low density lipoprotein (LDL)-, and
HDL-cholesterol were significantly higher in participants who met the recommended protein intake (P=0.01, P≤0.01, P=0.04, respectively) versus
participants who consumed below the recommended protein. Conclusion: Findings of this study suggest that consumption of greater than or equal to
1.0 g/kg/bw protein is associated with lowered insulin resistance in addition to BMI, HC, WC, and FM without having adverse effects on lipid
profiles in overweight and obese individuals with pre-diabetes or T2DM. Additionally, increased animal protein was associated with better β-cell
function and lower TG levels. / A Dissertation submitted to the Department of Nutrition, Food and Exercise Sciences in partial fulfillment of
the requirements for the degree of Doctor of Philosophy. / Fall Semester 2018. / November 2, 2018. / Cardiovascular Risk, Dietary Protein, Glycemic Control, Pre-diabetes, Type 2 Diabetes Mellitus / Includes bibliographical references. / Bahram H. Arjmandi, Professor Directing Dissertation; Cathy W. Levenson, University Representative; Robert
C. Hickner, Committee Member; Lynn B. Panton, Committee Member.
| Identifer | oai:union.ndltd.org:fsu.edu/oai:fsu.digital.flvc.org:fsu_661118 |
| Contributors | Akhavan, Neda S. (Neda Sara) (author), Arjmandi, Bahram H. (professor directing dissertation), Levenson, Cathy W. (university representative), Hickner, Robert C., 1962- (committee member), Panton, Lynn B. (committee member), Florida State University (degree granting institution), College of Human Sciences (degree granting college), Department of Nutrition, Food, and Exercise Science (degree granting departmentdgg) |
| Publisher | Florida State University |
| Source Sets | Florida State University |
| Language | English, English |
| Detected Language | English |
| Type | Text, text, doctoral thesis |
| Format | 1 online resource (144 pages), computer, application/pdf |
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