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Considering the limited knowledge on the effects of dietary amino acid intake on dysglycemia, we assessed the possible association of dietary protein and amino acid patterns with the risk of pre-diabetes in a prospective population-based study. Participants without diabetes and pre-diabetes ( n = 1878) were recruited from the Tehran Lipid and Glucose Study and were followed for a mean of 5.8 years. Their dietary protein and amino acid intakes were assessed at baseline (2006-2008); demographic, lifestyle, and biochemical variables were evaluated at baseline and in follow-up examinations. Pre-diabetes was defined according to the American Diabetes Association criteria. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the risk of pre-diabetes across tertiles of dietary protein and amino acid pattern scores. The mean age of the participants (44.9% men) was 38.3 ± 12.7 years at baseline. Three major amino acid patterns were characterized: (1) higher loads of lysine, methionine, valine, aspartic acids, tyrosine, threonine, isoleucine, leucine, alanine, histidine, and serine; (2) higher loads of glycine, cysteine, arginine, and tryptophan; and (3) higher loads of proline and glutamic acid. Dietary total protein intake Hazard Ratio (HR) = 1.13, 95% Confidence Interval (CI) = 0.92-1.38 and HR = 1.00, 95% CI = 0.81-1.23, in the second and third tertile, respectively) was not related to the development of pre-diabetes. The highest score of second dietary amino acid pattern tended to be associated with a decreased risk of pre-diabetes (HR = 0.81, 95% CI = 0.65-1.01), whereas the third pattern was related to an increased risk in the fully adjusted model (HR = 1.24, 95% CI = 1.02-1.52; p for trend = 0.05). These novel data suggest that the amino acid composition of an individual's diet may modify their risk of pre-diabetes.

Dietary Protein and Amino Acid Profiles in Relation to Risk of Dysglycemia: Findings from a Prospective Population-Based Study