Associations of dietary macronutrients and energy intake with diabetic kidney disease and all-cause mortality in diabetes: evidence from NHANES
Authors' conclusion
In this observational analysis, higher protein (>74 g/day) and fiber intake (>14 g/day) were associated with lower DKD prevalence in diabetes, while maintaining daily energy within 1750-1810 kcal is associated with the lowest all-cause mortality risk.
Study context
- Population
- Diabetic adults, NHANES 2011–2018 (representing 30.3 million individuals in the USA)
- Participants
- 3,066 adults
- Exposure
- Highest vs lowest quartile of macronutrient and energy intake
- Outcome
- Prevalence of DKD and all-cause mortality
Methodological detailsNHANES 2011-2018, weighted logistic regression, Cox regression, dose-response analyses, mediation testing, multivariable adjustment
- NHANES 2011-2018
- Weighted logistic regression
- Cox regression
- Dose-response analyses
- Mediation testing
- Multivariable adjustment
Main finding
As reported in the abstract
DKD odds, Q4 vs Q1
Q4 vs Q1Odds ratio (95% CI)
Protein
0.41(0.21–0.79)
Fiber
0.50(0.31–0.82)
- Higher protein and dietary fiber intake showed significant inverse linear associations with diabetic kidney disease (DKD)
- P for trend < 0.05
- Inflection point for lower DKD odds, protein
- >74 g/day
- Inflection point for lower DKD odds, fiber
- >14 g/day
Observational data: associations, not effects.
Further findings
All-cause mortality · 48 months median follow-up
- Deaths
- 366
- Only energy intake exhibited a significant U-shaped association with mortality risk
- non-linear p<0.05
- Mortality lowest with daily energy intake
- 1750 kcal to 1810 kcal
Exploratory mediation analysis
- BMI and hemoglobin partially explained the associations of proteins and fibers with DKD, respectively
- Exploratory
Original publication
Associations of dietary macronutrients and energy intake with diabetic kidney disease and all-cause mortality in diabetes: evidence from NHANES. BMJ Open Diabetes Res Care. Published 30 September 2026. doi:10.
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