The recommended amount and quality of protein in diets of diabetic patients are highly controversial. In order to provide evidence-based information, the Diabetes Nutrition Study Group (DNSG) used a grading procedure used for quality of evidence and strength of recommendations (GRADE). A protein intake of 10% to 20% of energy intake (E%) or about 0.8 to 1.3 g/kg body weight in people below 65 years of age, and 15% to 20% of E% in people above 65 years of age appeared safe in weight-stable conditions. There were no intervention studies addressing metabolic effects, mortality, or cardiovascular events over prolonged periods. Body weight is closely linked to metabolic control and high protein diets are often recommended. Weight-loss diets that include 23% to 32% of E% as protein for up to one year reduced blood pressure and body weight slightly but significantly more than lower protein diets, whereas blood lipids, fasting blood glucose, and HbA1c improved similarly with higher or lower protein intakes in participants with a glomerular filtration rate (GFR) >60 mL/min/1.73 m2. Patients with a GFR <60 mL/min/1.73 m2 did not show a faster decline of GFR or kidney function with protein intakes around 0.8 g/kg body weight as compared with lower intakes, thereby arguing against a restriction. The effects of protein intake on diabetic eye or nerve disease have not been reported. There are a number of studies that have compared different types of animal proteins (milk, chicken, beef, pork, and fish) or compared animal with plant protein in diabetic patients and have reported a greater reduction of serum cholesterol with plant protein. In summary, the suggested range of protein intake appears to be safe and can be adapted according to personal dietary preferences.

Department of Endocrinology and Metabolism Aarhus University Hospital 8200 AarhusAarhus Denmark

Department of Nutritional Sciences Faculty of Medicine University of Toronto University of Toronto Toronto ON M5S 1A8 Canada Toronto 3D Knowledge Synthesis and Clinical trials Unit Clinical Nutrition and Risk Factor Modification Centre St Michael's Hospital Toronto ON M5C 2T2 Canada

Department of Nutritional Sciences Faculty of Medicine University of Toronto University of Toronto Toronto ON M5S 1A8 Canada Toronto 3D Knowledge Synthesis and Clinical trials Unit Clinical Nutrition and Risk Factor Modification Centre St Michael's Hospital Toronto ON M5C 2T2 Canada Division of Endocrinology and Metabolism Department of Medicine St Michael's Hospital Toronto ON M5C 2T2 Canada Li Ka Shing Knowledge Institute St Michael's Hospital Toronto ON M5C 2T2 Canada

Department of Public Health and Caring Sciences Clinical Nutrition and Metabolism Uppsala University Box 564 75122 Uppsala Sweden

Diabetes Center 2nd Department of Internal Medicine Medical School National and Kapodistian University of Athens 11527 Greece

Endocrinology and Metabolic Diseases Vuk Vrhovac University Clinic for Diabetes Merkur University Hospital 10000 Zagreb Croatia University of Zagreb School of Medicine 10000 Zagreb Croatia

German Institute of Human Nutrition Potsdam Rehbrücke Clinical Nutrition DZD Arthur Scheunert Allee 114 116 D 14558 Nuthetal Germany Charité University Medicine Department of Endocrinology Diabetes and Nutrition Campus Benjamin Franklin Hindenburgdamm 30 D 12203 Berlin Germany German Center for Diabetes Research 85764 München Neuherberg Germany

German Institute of Human Nutrition Potsdam Rehbrücke Clinical Nutrition DZD Arthur Scheunert Allee 114 116 D 14558 Nuthetal Germany German Center for Diabetes Research 85764 München Neuherberg Germany

Human Nutrition Unit Faculty of Medicine and Health Sciences Institute of Health Pere Virgili Universitat Rovira i Virgili 43201 Reus Spain CIBER Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos 3 28029 Madrid Spain

Institute for Clinical and Experimental Medicine 14021 Prague Czech Republic Physicians Committee for Responsible Medicine Washington DC 20016 USA

Institute of Public Health and Clinical Nutrition School of Medicine University of Eastern Finland Kuopio Campus 70211 Kuopio Finland

Institute of Public Health and Clinical Nutrition School of Medicine University of Eastern Finland Kuopio Campus 70211 Kuopio Finland Department of Medicine Endocrinology and Clinical Nutrition Kuopio University Hospital 70029 KYS Kuopio Finland

Oslo University Hospital Division of Medicine Department of Clinical Service Section of Nutrition and Dietetics 0424 Oslo Norway

School of Pharmacy and Medical sciences University of South Australia Adelaide SA 5000 Australia

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$a The Effects of Different Quantities and Qualities of Protein Intake in People with Diabetes Mellitus / $c AFH. Pfeiffer, E. Pedersen, U. Schwab, U. Risérus, AM. Aas, M. Uusitupa, A. Thanopoulou, C. Kendall, JL. Sievenpiper, H. Kahleová, D. Rahélic, J. Salas-Salvadó, S. Gebauer, K. Hermansen,

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$a The recommended amount and quality of protein in diets of diabetic patients are highly controversial. In order to provide evidence-based information, the Diabetes Nutrition Study Group (DNSG) used a grading procedure used for quality of evidence and strength of recommendations (GRADE). A protein intake of 10% to 20% of energy intake (E%) or about 0.8 to 1.3 g/kg body weight in people below 65 years of age, and 15% to 20% of E% in people above 65 years of age appeared safe in weight-stable conditions. There were no intervention studies addressing metabolic effects, mortality, or cardiovascular events over prolonged periods. Body weight is closely linked to metabolic control and high protein diets are often recommended. Weight-loss diets that include 23% to 32% of E% as protein for up to one year reduced blood pressure and body weight slightly but significantly more than lower protein diets, whereas blood lipids, fasting blood glucose, and HbA1c improved similarly with higher or lower protein intakes in participants with a glomerular filtration rate (GFR) >60 mL/min/1.73 m2. Patients with a GFR <60 mL/min/1.73 m2 did not show a faster decline of GFR or kidney function with protein intakes around 0.8 g/kg body weight as compared with lower intakes, thereby arguing against a restriction. The effects of protein intake on diabetic eye or nerve disease have not been reported. There are a number of studies that have compared different types of animal proteins (milk, chicken, beef, pork, and fish) or compared animal with plant protein in diabetic patients and have reported a greater reduction of serum cholesterol with plant protein. In summary, the suggested range of protein intake appears to be safe and can be adapted according to personal dietary preferences.

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