Macronutrient Intakes and Development of Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies
Abstract
OBJECTIVE: To synthesize the best available evidence on the association between macronutrient intake and type 2 diabetes risk. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Cochrane Library, ProQuest, Mednar, and the JBI Library of Systematic Reviews were searched up to July 2012 to identify published and unpublished studies. The review was restricted to human participants only but was not restricted by date or by language. STUDY ELIGIBILITY: Studies were included in the review if they were a cohort study examining the relationship between dietary macronutrient intake and type 2 diabetes risk, included healthy participants with no history of type 2 diabetes at the baseline assessment, and reported risk estimates (odds ratios, hazards ratios, or relative risks [RRs]) and corresponding 95% confidence intervals for type 2 diabetes risk by comparison of the highest with the lowest level of macronutrient consumption. METHODS: Data extraction and risk of bias assessments were performed in duplicate by 2 reviewers. Random-effects meta-analyses were performed to pool RR estimates from individual studies to assess the relationship between dietary macronutrient (carbohydrate, fat, protein, and macronutrient subtypes) intake and type 2 diabetes risk. Statistical heterogeneity was assessed using the I(2) statistic. Sensitivity analyses were performed to assess robustness of results, and publication bias was evaluated by the visual inspection of funnel plots and was formally assessed using Egger's test. RESULTS: Twenty-two relevant cohort studies were eligible for inclusion in this review. High intake of total dietary carbohydrate was associated with an increased type 2 diabetes risk (relative risk [RR] = 1.11, 95% confidence interval [CI]: 1.01 to 1.22, p = 0.035); however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake was associated with a reduced type 2 diabetes risk in females (RR = 0.76, 95% CI: 0.68 to 0.85, p < 0.001). Other macronutrients were not significantly associated with type 2 diabetes risk. CONCLUSIONS AND IMPLICATIONS: The results of this systematic review and meta-analysis indicate that total carbohydrate is associated with an increased risk of type 2 diabetes; however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake may decrease type 2 diabetes risk in females. There is a need for further well-designed prospective cohort studies to examine the potential association between macronutrient intake and type 2 diabetes risk.
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Total carbohydrate consumption has little relation to cardiometabolic health.
“While total carbohydrate consumption has little relation to cardiometabolic health, the quality of carbohydrate-rich foods is linked to risk (Figure 6, Figure 7).152-160”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [157]
The quality of carbohydrate-rich foods is linked to cardiometabolic risk.
“the quality of carbohydrate-rich foods is linked to risk (Figure 6, Figure 7).152-160”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [157]
Both prospective cohorts and large randomized trials confirm that low-fat diets have no benefits for major chronic diseases.
“Both prospective cohorts and large randomized trials confirm that low-fat diets have no benefits for major chronic diseases (Figure 7).157, 331”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [157]
Many longitudinal cohort studies demonstrate largely neutral effects of overall saturated fat intake.
“This is consistent with the many longitudinal cohort studies demonstrating largely neutral effects of overall saturated fat intake (Figure 7).39, 157, 344”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [157]
While monounsaturated fat has conventionally been considered a cardioprotective fat, the evidence supporting this notion is mixed.
“While monounsaturated fat (predominantly oleic acid, 18:1) has conventionally been considered a cardioprotective fat, the evidence supporting this notion is mixed (Figure 7).21, 39, 157, 352”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [157]
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- Authors
- Alhazmi, A., Stojanovski, E., McEvoy, M., & Garg, M. L.
- Affiliations
- University of Newcastle Australia (AU)
- Corresponding author
- Garg, Manohar L.
- Venue
- Journal of the American College of Nutrition
- Publisher
- Informa UK Limited
- Published
- 2012-08
- Volume
- 31
- Issue
- 4
- Pages
- 243-258
- ISSN
- 0731-5724 (ISSN-L)
- 1541-1087
- OpenAlex
- W2060564918
- Cited by
- 81
- References
- 39
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 3 · 2019: 8 · 2018: 8 · 2017: 4 · 2016: 8 · 2015: 10 · 2014: 5 · 2013: 5
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- type 2 diabetes, macronutrient intake, dietary carbohydrates, vegetable fats, dietary fat, dietary protein, sex differences, diabetes risk factors, dietary habits, healthy eating guidelines, Mediterranean diet, low-carbohydrate diet, low-fat diet, low-protein diet, dietary cholesterol, dietary sodium, dietary fiber intake, dietary fat intake, protein intake, carbohydrate intake
- MeSH terms
- Diabetes Mellitus, Type 2, Diet, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Female, Humans, Male, Risk Factors, Databases, Factual
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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