In US adults with type 2 diabetes, an optimal range of dietary protein density is associated with lower CVD mortality risk, while dietary cholesterol and egg consumption are not significantly associated with long-term survival.
Higher dietary protein density was significantly associated with reduced CVD mortality risk in adults with type 2 diabetes.
Restricted cubic spline analyses revealed a U-shaped association between dietary protein density and all-cause mortality, and an L-shaped association with CVD mortality.
Dietary cholesterol and egg consumption were not significantly associated with all-cause, CVD, or diabetes-specific mortality in fully adjusted models.
Significant racial disparities were found in the association between dietary protein density and all-cause mortality.
The study analyzed a large, nationally representative US sample of adults with type 2 diabetes using prospective cohort methodology.
This research suggests that for people with type 2 diabetes in the United States, the proportion of calories coming from protein in the diet is linked to heart disease death risk. Specifically, people who got a higher share of their calories from protein had about half the risk of dying from cardiovascular disease compared to those with the lowest protein density in their diet. However, the relationship was not simply 'more is better' — statistical analyses showed a U-shaped curve for overall death risk, meaning that both very low and very high protein intake were associated with higher mortality, pointing to a 'sweet spot' of moderate protein consumption. Importantly, this study found no significant link between dietary cholesterol or egg consumption and death from any cause, cardiovascular disease, or diabetes specifically. This challenges older nutritional guidance that emphasized strict limits on eggs and cholesterol for people with diabetes. The findings also revealed that the benefit of higher protein density was particularly strong among Mexican Americans, who showed a 64% lower risk of all-cause mortality in the highest protein group, highlighting that dietary recommendations may not affect all racial and ethnic groups equally. This research suggests that nutritional strategies for managing type 2 diabetes should focus on optimizing the balance of macronutrients — particularly ensuring adequate but not excessive protein intake — rather than concentrating primarily on limiting cholesterol-containing foods like eggs. The study's large, nationally representative sample and nearly two-decade follow-up period lend strength to these findings, though as an observational study it cannot prove causation.
Wang W, Li J, Zhang Z, Hu Y, Kong D. (2026). Dietary protein density, cholesterol, egg consumption and mortality in US adults with type 2 diabetes: A prospective cohort study.. Medicine. https://doi.org/10.1097/MD.0000000000050479