Abstract
OBJECTIVE: To analyze possible associations of dietary components, especially protein intake, with blood pressure (BP) during ambulatory BP monitoring (ABPM) in patients with type 2 diabetes. METHODS: In this cross-sectional study, BP of outpatients with type 2 diabetes was evaluated by 24-hour ABPM (Spacelabs 90207) and usual diet by 3-day weighed diet records. Patients were divided into 2 groups according to their daytime ABPM: uncontrolled BP (systolic BP ≥ 135 mmHg or diastolic BP ≥ 85 mmHg) and controlled BP (systolic BP < 135 mmHg and diastolic BP < 85 mmHg). Logistic regression models unadjusted and adjusted for possible confounders (covariates) were used to analyze the association of protein and uncontrolled BP. RESULTS: A total of 121 patients with type 2 diabetes aged 62.3 years, 54.5% of whom were women, were studied. The uncontrolled BP group had higher glycated hemoglobin (HbA1C) values (8.4 ± 2.0 vs 7.6 ± 1.3%; p = 0.04) and consumed more protein (20.0 ± 3.8 vs 18.2 ± 3.6% of energy; p = 0.01) and meat, (2.6 [1.45, 2.95] vs 2.0 [1.49, 2.90] g/kg weight; p = 0.04) than the controlled BP group. In a multivariate analysis, protein intake (% of energy) increased the chance for uncontrolled BP (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02, 1.30; p = 0.02), adjusted for body mass index (BMI), HbA1C, low-density lipoprotein (LDL) cholesterol, number of antihypertensive medications, and ethnicity. Meat consumption higher than 3.08 g/kg weight/day more than doubled the chance for uncontrolled BP (OR = 2.53; 95% CI, 1.01, 7.60; p = 0.03). CONCLUSION: High protein intake and meat consumption were associated with high daytime ABPM values in patients with type 2 diabetes. Reducing meat intake might represent an additional dietary intervention in hypertensive patients with type 2 diabetes.
Generated Summary
This cross-sectional study investigated the relationship between dietary components, particularly protein intake, and blood pressure (BP) in patients with type 2 diabetes. The study involved outpatients with type 2 diabetes who underwent 24-hour ambulatory BP monitoring (ABPM) and had their usual diet assessed using 3-day weighed diet records. Patients were categorized into two groups based on their daytime ABPM readings: those with uncontrolled BP (systolic BP ≥ 135 mmHg or diastolic BP ≥ 85 mmHg) and those with controlled BP. Logistic regression models were used to analyze the association of protein intake and uncontrolled BP, adjusting for potential confounders. The study aimed to analyze potential dietary components and associations, focusing on protein intake in patients with type 2 diabetes by using ABPM. The study design included 121 patients with type 2 diabetes. The approach involved a cross-sectional study where ABPM was used to monitor BP over 24 hours and diet was assessed using weighed diet records. The participants were divided into two groups based on their BP control: uncontrolled and controlled. Statistical analysis was performed to identify any correlations between protein intake and uncontrolled BP, considering other potential factors.
Key Findings & Statistics
- Sample Size: A total of 121 patients with type 2 diabetes were studied.
- Age: The average age of the patients was 62.3 years.
- Gender: 54.5% of the participants were women.
- Glycated Hemoglobin (HbA1C): The uncontrolled BP group had higher HbA1C values (8.4 ± 2.0%) compared to the controlled BP group (7.6 ± 1.3%; p = 0.04).
- Protein Intake: The uncontrolled BP group consumed more protein (20.0 ± 3.8% of energy) compared to the controlled BP group (18.2 ± 3.6% of energy; p = 0.01).
- Meat Consumption: The uncontrolled BP group consumed more meat (2.6 [1.45, 2.95] g/kg weight) compared to the controlled BP group (2.0 [1.49, 2.90] g/kg weight; p = 0.04).
- Multivariate Analysis – Protein Intake: In a multivariate analysis, increased protein intake (% of energy) was associated with an increased chance of uncontrolled BP (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02, 1.30; p = 0.02), adjusted for body mass index (BMI), HbA1C, low-density lipoprotein (LDL) cholesterol, number of antihypertensive medications, and ethnicity.
- Multivariate Analysis – Meat Consumption: Meat consumption higher than 3.08 g/kg weight/day more than doubled the chance for uncontrolled BP (OR = 2.53; 95% CI, 1.01, 7.60; p = 0.03).
Other Important Findings
- The study found a significant association between higher protein intake and increased likelihood of uncontrolled BP in patients with type 2 diabetes.
- Increased meat consumption was also linked to higher daytime ABPM values in the same patient population.
- The findings suggest that reducing meat intake could be a valuable dietary intervention for hypertensive patients with type 2 diabetes.
Limitations Noted in the Document
- The study’s cross-sectional design limits the ability to establish causality between protein intake, meat consumption, and uncontrolled BP.
- The reliance on weighed diet records for assessing dietary intake may be subject to recall bias and inaccuracies in self-reported data.
- The study’s findings may not be generalizable to all populations with type 2 diabetes due to the specific characteristics of the study participants.
- The study did not account for all potential confounding factors that could influence the relationship between protein intake and BP.
Conclusion
The study’s findings highlight the association between high protein intake, specifically through increased meat consumption, and elevated daytime ABPM values in individuals with type 2 diabetes. This suggests that dietary modifications, particularly reducing meat intake, could be an effective intervention to manage BP in these patients. The multivariate analysis results indicate that the relationship between protein intake and uncontrolled BP remains significant even after adjusting for various confounders, reinforcing the importance of this dietary factor. The study underscores the potential of nutritional strategies in the management of hypertension among individuals with diabetes. Further research, including longitudinal studies and controlled dietary interventions, is needed to confirm these findings and explore the long-term effects of dietary changes on BP control in this population. The study’s conclusion emphasizes the potential of dietary interventions, especially reducing meat intake, in managing hypertension among individuals with type 2 diabetes. This points to a shift towards a more holistic approach to treating hypertension, suggesting that lifestyle and dietary changes are significant additions to other forms of treatment.