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Zheng JS, Steur M, Imamura F, Freisling H, Johnson L, van der Schouw YT, Tong TY, Weiderpass E, Bajracharya R, Crous-Bou M, Dahm CC, Heath AK, Ibsen DB, Jannasch F, Katzke V, Masala G, Moreno-Iribas C, Sacerdote C, Schulze MB, Sieri S, Wareham NJ, Danesh J, Butterworth AS, Forouhi NG. Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study. Am J Clin Nutr 2024; 119:1164-1174. [PMID: 38479550 PMCID: PMC11130694 DOI: 10.1016/j.ajcnut.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Epidemiological evidence suggests that a potential association between dietary protein intake and cardiovascular disease (CVD) may depend on the protein source, that is, plant- or animal-derived, but past research was limited and inconclusive. OBJECTIVES To evaluate the association of dietary plant- or animal-derived protein consumption with risk of CVD, and its components ischemic heart disease (IHD) and stroke. METHODS This analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD case-cohort study included 16,244 incident CVD cases (10,784 IHD and 6423 stroke cases) and 15,141 subcohort members from 7 European countries. We investigated the association of estimated dietary protein intake with CVD, IHD, and stroke (total, fatal, and nonfatal) using multivariable-adjusted Prentice-weighted Cox regression. We estimated isocaloric substitutions of replacing fats and carbohydrates with plant- or animal-derived protein and replacing food-specific animal protein with plant protein. Multiplicative interactions between dietary protein and prespecified variables were tested. RESULTS Neither plant- nor animal-derived protein intake was associated with incident CVD, IHD, or stroke in adjusted analyses without or with macronutrient-specified substitution analyses. Higher plant-derived protein intake was associated with 22% lower total stroke incidence among never smokers [HR 0.78, 95% confidence intervals (CI): 0.62, 0.99], but not among current smokers (HR 1.08, 95% CI: 0.83, 1.40, P-interaction = 0.004). Moreover, higher plant-derived protein (per 3% total energy) when replacing red meat protein (HR 0.52, 95% CI: 0.31, 0.88), processed meat protein (HR 0.39, 95% CI: 0.17, 0.90), and dairy protein (HR 0.54, 95% CI: 0.30, 0.98) was associated with lower incidence of fatal stroke. CONCLUSION Plant- or animal-derived protein intake was not associated with overall CVD. However, the association of plant-derived protein consumption with lower total stroke incidence among nonsmokers, and with lower incidence of fatal stroke highlights the importance of investigating CVD subtypes and potential interactions. These observations warrant further investigation in diverse populations with varying macronutrient intakes and dietary patterns.
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Affiliation(s)
- Ju-Sheng Zheng
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; School of Life Sciences, Westlake University, Hangzhou, China.
| | - Marinka Steur
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Laura Johnson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tammy Yn Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Rashmita Bajracharya
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marta Crous-Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, Barcelona, Spain; Department of Epidemiology, Harvard T.H. Chan School of Public Health. Boston, MA, United States
| | | | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Daniel B Ibsen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Public Health, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus, Denmark; Department of Nutrition, Sports and Exercise, University of Copenhagen, Copenhagen, Denmark
| | - Franziska Jannasch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Via Venezian, Milan, Italy
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom; National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom; Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom; National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
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Mirón-Mérida VA, Soria-Hernández C, Richards-Chávez A, Ochoa-García JC, Rodríguez-López JL, Chuck-Hernández C. The Effect of Ultrasound on the Extraction and Functionality of Proteins from Duckweed ( Lemna minor). Molecules 2024; 29:1122. [PMID: 38474634 DOI: 10.3390/molecules29051122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The inclusion of protein in the regular human diet is important for the prevention of several chronic diseases. In the search for novel alternative protein sources, plant-based proteins are widely explored from a sustainable and ecological point of view. Duckweed (Lemna minor), also known as water lentil, is an aquatic plant with potential applications for human consumption due to its protein content and carbohydrate contents. Among all the conventional and novel protein extraction methods, the utilization of ultrasound has attracted the attention of scientists because of its effects on improving protein extraction and its functionalities. In this work, a Box-Behnken experimental design was proposed to optimize the alkaline extraction of protein from duckweed. In addition, an exploration of the effects of ultrasound on the morphological, structural, and functional properties of the extracted protein was also addressed. The optimal extraction parameters were a pH of 11.5 and an ultrasound amplitude and processing time of 60% and 20 min, respectively. These process conditions doubled the protein content extracted in comparison to the value from the initial duckweed sample. Furthermore, the application of ultrasound during the extraction of protein generated changes in the FTIR spectra, color, and structure of the duckweed protein, which resulted in improvements in its solubility, emulsifying properties, and foaming capacity.
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Affiliation(s)
- Vicente Antonio Mirón-Mérida
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Colonia Tecnológico, Monterrey 64700, Mexico
| | - Cintya Soria-Hernández
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Colonia Tecnológico, Monterrey 64700, Mexico
| | - Alejandro Richards-Chávez
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Colonia Tecnológico, Monterrey 64700, Mexico
| | - Juan Carlos Ochoa-García
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Colonia Tecnológico, Monterrey 64700, Mexico
| | - Jorge Luis Rodríguez-López
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Colonia Tecnológico, Monterrey 64700, Mexico
| | - Cristina Chuck-Hernández
- Instituto para la Investigación en Obesidad, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Sur Tecnológico, Monterrey 64849, Mexico
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3
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Ma Y, Zheng Z, Zhuang L, Wang H, Li A, Chen L, Liu L. Dietary Macronutrient Intake and Cardiovascular Disease Risk and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrients 2024; 16:152. [PMID: 38201983 PMCID: PMC10780780 DOI: 10.3390/nu16010152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Many epidemiological studies have evaluated the intake of macronutrients and the risk of mortality and cardiovascular disease (CVD). However, current evidence is conflicting and warrants further investigation. Therefore, we carried out an umbrella review to examine and quantify the potential dose-response association of dietary macronutrient intake with CVD morbidity and mortality. Prospective cohort studies from PubMed, Embase, and CENTRAL were reviewed, which reported associations of macronutrients (protein, fat, and carbohydrate) with all-cause, CVD, cancer mortality, or CVD events. Multivariable relative risks (RR) were pooled, and heterogeneity was assessed. The results of 124 prospective cohort studies were included in the systematic review and 101 in the meta-analysis. During the follow-up period from 2.2 to 30 years, 506,086 deaths and 79,585 CVD events occurred among 5,107,821 participants. High total protein intake was associated with low CVD morbidity (RR 0.88, 95% confidence interval 0.82-0.94), while high total carbohydrate intake was associated with high CVD morbidity (1.08, 1.02-1.13). For fats, a high intake of total fat was associated with a decreased all-cause mortality risk (0.92, 0.85-0.99). Saturated fatty acid intake was only associated with cancer mortality (1.10, 1.06-1.14); Both monounsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake was associated with all-cause mortality (MUFA: 0.92, 0.86-0.98; PUFA: 0.91, 0.86-0.96). This meta-analysis supports that protein intake is associated with a decreased risk of CVD morbidity, while carbohydrate intake is associated with an increased risk of CVD morbidity. High total fat intake is associated with a low risk of all-cause mortality, and this effect was different in an analysis stratified by the type of fat.
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Affiliation(s)
- Yibin Ma
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Zekun Zheng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Litao Zhuang
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Huiting Wang
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Anni Li
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
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The Impact of High Protein Diets on Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Nutrients 2023; 15:nu15061372. [PMID: 36986102 PMCID: PMC10058321 DOI: 10.3390/nu15061372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
High protein diets have gained increased popularity as a means of losing weight, increasing muscle mass and strength, and improving cardiometabolic parameters. Only a few meta-analyses have addressed their impact on cardiovascular morbidity and mortality and failed to show any significant associations without applying strict values to define high protein intake. Due to the conflicting research background, we conducted a meta-analysis to assess the impact of high protein diets compared to normal protein consumption on cardiovascular outcomes in adults without established cardiovascular disease. Fourteen prospective cohort studies were included. A total of 6 studies, including 221,583 participants, reported data about cardiovascular death, without showing a statistically significant difference in the random effect model (odds ratio: 0.94; confidence interval: 0.60–1.46; I2 = 98%; p = 0.77). Analysis of three studies, which included 90,231 participants showed that a high protein diet was not associated with a lower risk of stroke (odds ratio: 1.02; confidence interval: 0.94–1.10; I2 = 0%; p = 0.66). Regarding the secondary outcome of non-fatal myocardial infarction, stroke, or cardiovascular death, 13 studies that included 521,155 participants showed no statistically significant difference (odds ratio; 0.87; confidence interval: 0.70–1.07; I2 = 97%; p = 0.19). In conclusion, according to our study results, high protein consumption does not affect cardiovascular prognosis.
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Kondo K, Miura K, Okamura T, Okayama A, Ueshima H. Dietary Factors, Dietary Patterns, and Cardiovascular Disease Risk in Representative Japanese Cohorts: NIPPON DATA80/90. J Atheroscler Thromb 2023; 30:207-219. [PMID: 36436878 PMCID: PMC9981349 DOI: 10.5551/jat.rv22001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diet is one of the most important factors affecting healthy life expectancy through the onset of cardiovascular disease (CVD) risk as well as various chronic diseases. Because dietary habits and disease structure differ depending on the country, region, and/or race, evidence from each population is required. NIPPON DATA80/90 is a long-term cohort study of a representative Japanese population that participated in national nutrition surveys. Among the many findings of this cohort study, a dietary pattern with higher intake of fruits, vegetables, fish (n-3 polyunsaturated fatty acids), and dietary fiber and lower intake of salt as well as sodium-to-potassium ratio was found to be associated with a lower risk of CVD mortality. The results from our cohort study would be useful for effectively preventing CVD. This article reviews the published studies from the NIPPON DATA80/90 to highlight the significant findings that may be used to develop risk prevention strategies for CVD.
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Affiliation(s)
- Keiko Kondo
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
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Shirota M, Watanabe N, Suzuki M, Kobori M. Japanese-Style Diet and Cardiovascular Disease Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Nutrients 2022; 14:nu14102008. [PMID: 35631146 PMCID: PMC9147868 DOI: 10.3390/nu14102008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/27/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
This systematic review and meta-analysis elucidate the effects of the Japanese-style diet and characteristic Japanese foods on the mortality risk of cardiovascular disease (CVD), cerebrovascular disease (stroke), and heart disease (HD). This review article followed the PRISMA guidelines. A systematic search in PubMed, The Cochrane Library, JDreamIII, and ICHUSHI Web identified prospective cohort studies on Japanese people published till July 2020. The meta-analysis used a random-effects model, and heterogeneity and publication bias were evaluated with I2 statistic and Egger’s test, respectively. Based on inclusion criteria, we extracted 58 articles, including 9 on the Japanese-style diet (n = 469,190) and 49 (n = 2,668,238) on characteristic Japanese foods. With higher adherence to the Japanese-style diet, the pooled risk ratios (RRs) for CVD, stroke, heart disease/ischemic heart disease combined (HD/IHD) mortality were 0.83 (95% CI, 0.77–0.89, I2 = 58%, Egger’s test: p = 0.625, n = 9 studies), 0.80 (95% CI, 0.69–0.93, I2 = 66%, Egger’s test: p = 0.602, n = 6 studies), and 0.81 (95% CI, 0.75–0.88, I2 = 0%, Egger’s test: p = 0.544, n = 6 studies), respectively. Increased consumption of vegetables, fruits, fish, green tea, and milk and dairy products decreased the RR for CVD, stroke, or HD mortality. Increased salt consumption elevated the RR for CVD and stroke mortality. Increased consumption of dietary fiber and plant-derived protein decreased the RR for CVD, stroke, and HD/IHD mortality. The Japanese-style diet and characteristic Japanese foods may reduce CVD mortality. Most studies conducted diet surveys between 1980 and the 1990s. This meta-analysis used articles that evaluated the same cohort study by a different method. A new large-scale cohort study matching the current Japanese dietary habits is needed to confirm these findings.
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Affiliation(s)
- Masayuki Shirota
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-2 Kannondai, Tsukuba-shi 305-8642, Ibaraki, Japan;
| | - Norikazu Watanabe
- Yakujihou Marketing Jimusho Inc., Level 3, Sanno Park Tower, 2-11-1 Nagata-cho, Chiyoda-ku, Tokyo 100-6162, Japan; (N.W.); (M.S.)
| | - Masataka Suzuki
- Yakujihou Marketing Jimusho Inc., Level 3, Sanno Park Tower, 2-11-1 Nagata-cho, Chiyoda-ku, Tokyo 100-6162, Japan; (N.W.); (M.S.)
| | - Masuko Kobori
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-2 Kannondai, Tsukuba-shi 305-8642, Ibaraki, Japan;
- Correspondence: ; Tel.: +81-29-838-8011
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Zhou C, Yang S, Zhang Y, Wu Q, Ye Z, Liu M, He P, Zhang Y, Li R, Liu C, Nie J, Qin X. Relations of Variety and Quantity of Dietary Proteins Intake from Different Sources with Mortality Risk: A Nationwide Population-Based Cohort. J Nutr Health Aging 2022; 26:1078-1086. [PMID: 36519771 DOI: 10.1007/s12603-022-1870-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The relations of variety and quantity of dietary proteins intake from different sources with mortality risk were still controversial. We aimed to examine the associations of variety and quantity of different sourced proteins with all-cause mortality risk in adults and older adults. MATERIALS AND METHODS 17,310 participants (mean age was 44.0 [SD: 15.9] years and 51.0% were females) with utilizable data from the China Health and Nutrition Survey were included. Dietary intake was collected using three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of protein sources was defined as the number of proteins consumed at the appropriate level, accounting for both types and quantity of proteins. The primary outcome was all-cause mortality. RESULTS Over a median follow-up of 9.0 years, 1324 (7.6%) death cases were reported. There were reversed J-shaped relationships of percentages energy from total protein, and protein from legume with all-cause mortality; U-shaped relationships of proteins from unprocessed red meat, processed red meat, poultry and whole grain with all-cause mortality; L-shaped relationships of proteins from egg and fish with all-cause mortality; and a reversed L-shaped relationship of protein from refined grain with all-cause mortality (all P values for nonlinearity < 0.001). Moreover, there was a significant inverse association between the variety score of protein sources with overall mortality risk (per score increment, HR, 0.69; 95%CI, 0.66-0.72). CONCLUSIONS Greater variety of proteins with appropriate quantity from different food sources was associated with significantly lower risk of mortality in Chinese adults and older adults.
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Affiliation(s)
- C Zhou
- Jing Nie, M.D or Xianhui Qin, M.D, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China, Emails: or
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Pletsch-Borba L, Wernicke C, Apostolopoulou K, Spira D, Pohrt A, Hornemann S, Gerbracht C, Pfeiffer AFH, Spranger J, Mai K. Nutritional counseling frequency and baseline food pattern predict implementation of a high-protein and high-polyunsaturated fatty acid dietary pattern: 1-year results of the randomized NutriAct trial. Clin Nutr 2021; 40:5457-5466. [PMID: 34656026 DOI: 10.1016/j.clnu.2021.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/26/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS NutriAct is a 36-month randomized controlled multi-center trial designed to analyze the effects of a food pattern focusing on a high-protein and high-unsaturated fatty acids (UFA) intake on healthy aging. We aimed to determine factors associated with a successful modulation of dietary pattern after 12 months in elderly participants. METHODS 502 participants were randomized into either usual care control group including dietary recommendations of the German Nutrition Society (DGE) or an intervention group, which used supplementation of rapeseed oil and specifically designed foods as well as repetitive advices to implement a food pattern based on high intake of predominantly plant proteins, UFA and fiber (NutriAct pattern). Food intake was repeatedly assessed by 3-day food records at months 0, 3, 6 and 12. Linear regression models were used to investigate determinants of basal food intake and modulation of dietary pattern during the intervention. RESULTS Food records of 242 intervention and 246 control participants (median age 66 y, 37% males) were available at baseline and were included. At baseline, high BMI was related to higher protein and saturated fatty acids and lower fiber intake. The intervention resulted in higher intake of protein, mono- and polyunsaturated fatty acids (MUFA and PUFA) and fiber, and lower carbohydrate and saturated fatty acid consumption (all p < 0.001). While individuals who were already at baseline closer to the NutriAct pattern also achieved a diet closer to the proposed pattern at month 12, the strongest absolute changes (%E) of dietary behavior were seen in those with dietary patterns further away from the proposed pattern at baseline. Attendance to nutritional sessions was crucial to change MUFA, PUFA, fiber and carbohydrate intake. CONCLUSIONS A successful modification of dietary pattern was achieved by the performed intervention within 12 months. Baseline dietary habits and attendance to nutritional sessions were substantial determinants predicting changes in dietary pattern. CLINICAL TRIAL REGISTRATION The trial was registered at German Clinical Trials Register (drks.de) as DRKS00010049.
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Affiliation(s)
- Laura Pletsch-Borba
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; NutriAct-Competence Cluster Nutrition Research Berlin, Potsdam, Germany
| | - Charlotte Wernicke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; NutriAct-Competence Cluster Nutrition Research Berlin, Potsdam, Germany
| | - Konstantina Apostolopoulou
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; NutriAct-Competence Cluster Nutrition Research Berlin, Potsdam, Germany
| | - Dominik Spira
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; NutriAct-Competence Cluster Nutrition Research Berlin, Potsdam, Germany
| | - Anne Pohrt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Germany
| | - Silke Hornemann
- Human Study Center, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Charité Center for Cardiovascular Research, 10117, Berlin, Germany
| | - Christiana Gerbracht
- Human Study Center, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Andreas F H Pfeiffer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; Human Study Center, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Charité Center for Cardiovascular Research, 10117, Berlin, Germany
| | - Joachim Spranger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Charité Center for Cardiovascular Research, 10117, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.
| | - Knut Mai
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117, Berlin, Germany; NutriAct-Competence Cluster Nutrition Research Berlin, Potsdam, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Charité Center for Cardiovascular Research, 10117, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
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9
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Inverse Association of Poultry, Fish, and Plant Protein Consumption with the Incidence of Cardiovascular Disease. Cardiol Rev 2021; 30:247-252. [PMID: 33883452 DOI: 10.1097/crd.0000000000000392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease (CVD) remains a major cause of death and disability worldwide and food intake plays an important role in its onset or prevention. It is also well known that consumption of red meat (processed and unprocessed) is associated with an increased incidence of CVD, coronary heart disease (CHD), and premature death. However, little is known about the association of consumption of poultry, fish, and plant protein with the incidence of CVD, CHD, and mortality. Several recent studies, reviews and meta-analyses have shown an inverse association of consumption of these foods with the incidence of CVD, CHD, and death. In order to get a better perspective about the current consumption of these foods, a focused Medline search of the English language literature was conducted between 2010 and 2020 using the terms poultry, fish, plant protein consumption, cardiovascular disease, coronary heart disease, mortality; 28 papers with pertinent information were retrieved. The analysis of data from these papers suggest an inverse relationship between the consumption of these foods and the incidence of de novo CVD or worsening of preexisting CVD. They also demonstrate that the consumption of these foods is still low and that great effort should be made to inform the public about the benefits of switching from red meat to an increased consumption of poultry, fish, and plant protein. All the data from the retrieved papers regarding the consumption of these foods, together with collateral literature, will be discussed in this review.
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10
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Koh AS, Kovalik JP. Metabolomics and cardiovascular imaging: a combined approach for cardiovascular ageing. ESC Heart Fail 2021; 8:1738-1750. [PMID: 33783981 PMCID: PMC8120371 DOI: 10.1002/ehf2.13274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this review is to explore how metabolomics can help uncover new biomarkers and mechanisms for cardiovascular ageing. Cardiovascular ageing refers to cardiovascular structural and functional alterations that occur with chronological ageing and that can lead to the development of cardiovascular disease. These alterations, which were previously only detectable on tissue histology or corroborated on blood samples, are now detectable with modern imaging techniques. Despite the emergence of powerful new imaging tools, clinical investigation into cardiovascular ageing is challenging because ageing is a life course phenomenon involving known and unknown risk factors that play out in a dynamic fashion. Metabolomic profiling measures large numbers of metabolites with diverse chemical properties. Metabolomics has the potential to capture changes in biochemistry brought about by pathophysiologic processes as well as by normal ageing. When combined with non-invasive cardiovascular imaging tools, metabolomics can be used to understand pathological consequences of cardiovascular ageing. This review will summarize previous metabolomics and imaging studies in cardiovascular ageing. These methods may be a clinically relevant and novel approach to identify mechanisms of cardiovascular ageing and formulate or personalize treatment strategies.
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Affiliation(s)
- Angela S Koh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jean-Paul Kovalik
- Duke-NUS Medical School, Singapore, Singapore.,Singapore General Hospital, Singapore, Singapore
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11
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Sugano M, Matsuoka R. Nutritional Viewpoints on Eggs and Cholesterol. Foods 2021; 10:494. [PMID: 33669005 PMCID: PMC7996514 DOI: 10.3390/foods10030494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Although most current epidemiologic studies indicate no significant association between consuming one egg daily and blood cholesterol levels and cardiovascular risk, arguments still persist with a positive association. Since the diet is one of the most influential factors for this association, we illustrate characteristic features in Japanese people whose dietary pattern is distinct from that, for example, the US (United States) population. Available epidemiologic studies in healthy Japanese people show no association between consumption of one egg daily and blood cholesterol level, consistent with those observed in the US population. However, when consumption of major nutrients and food sources of cholesterol are compared to the US population, Japanese people may have an extra-reserve against the influence of eggs on cardiovascular risk markers, despite consuming relatively more eggs. Further discussion on the influence of nutrients contained in the egg and dietary pattern, including interaction with gut microbes, is necessary. In addition, special consideration at the personalized level is needed for judgment regarding dietary cholesterol not only for hypercholesterolemic patients but for hyper-responsive healthy persons. Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.
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Affiliation(s)
- Michihiro Sugano
- Kyushu University, Fukuoka 819-0395, Japan;
- Prefectural University of Kumamoto, Kumamoto 862-8502, Japan
- Japan Egg Science Society, Tokyo 182-0002, Japan
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12
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Ni ZJ, Zhang YG, Chen SX, Thakur K, Wang S, Zhang JG, Shang YF, Wei ZJ. Exploration of walnut components and their association with health effects. Crit Rev Food Sci Nutr 2021; 62:5113-5129. [PMID: 33567903 DOI: 10.1080/10408398.2021.1881439] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Traditionally, walnuts have occupied an imperative position in the functional food market with consistently recognized nutritious and functional properties. In the past years, the lipid profile of walnuts has brought much scientific attention via linking a cascade of biological attributes and health-promoting effects. Over time, researchers have focused on diversified composition (polyphenols and vitamins) of different parts of walnut (flower, pellicle, and kernel) and emphasized their physiological significance. Consequently, a plethora of reports has emerged on the potential role of walnut consumption against a series of diseases including cancer, gut dysbiosis, cardiovascular, and neurodegenerative diseases. Therefore, we accumulated the updated data on composition and classification, extraction methods, and utilization of different parts of walnuts as well as associated beneficial effects under in vivo and clinical studies. Altogether, this review summarized the ameliorative effects of a walnut-enriched diet in chronic diseases which can be designated to the synergistic or individual effects of walnut components mainly through anti-oxidative and anti-inflammatory role.
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Affiliation(s)
- Zhi-Jing Ni
- Collaborative Innovation Center for Food Production and Safety, School of Biological Science and Engineering, North Minzu University, Yinchuan, People's Republic of China.,School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
| | - Yi-Ge Zhang
- Collaborative Innovation Center for Food Production and Safety, School of Biological Science and Engineering, North Minzu University, Yinchuan, People's Republic of China.,School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
| | - Sheng-Xiong Chen
- School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
| | - Kiran Thakur
- Collaborative Innovation Center for Food Production and Safety, School of Biological Science and Engineering, North Minzu University, Yinchuan, People's Republic of China.,School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
| | - Shaoyun Wang
- College of Biological Science and Technology, Fuzhou University, Fuzhou, People's Republic of China
| | - Jian-Guo Zhang
- Collaborative Innovation Center for Food Production and Safety, School of Biological Science and Engineering, North Minzu University, Yinchuan, People's Republic of China.,School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
| | - Ya-Fang Shang
- School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
| | - Zhao-Jun Wei
- Collaborative Innovation Center for Food Production and Safety, School of Biological Science and Engineering, North Minzu University, Yinchuan, People's Republic of China.,School of Food Science and Biological Engineering, Hefei University of Technology, Hefei, People's Republic of China
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13
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Dietary sodium:potassium ratio and CVD risk factors among Japanese adults: a retrospective cross-sectional study of pooled data from the National Health and Nutrition Survey, 2003-2017. Br J Nutr 2021; 125:79-91. [PMID: 32674745 DOI: 10.1017/s000711452000269x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few studies have reported associations between the Na:K ratio and risk factors related to CVD among the general population in Asian countries. This study aimed to investigate the dietary Na:K ratio association with CVD risk factors among Japanese adults. This retrospective cross-sectional study included 48 800 Japanese participants (19 386 men and 29 414 women) aged ≥20 years, registered in the 2003-2017 National Health and Nutrition Survey. Multivariate OR and 95 % CI for risk of hypertension, high glycated HbA1c levels, hypercholesterolaemia, low serum levels of HDL-cholesterol and high non-HDL-cholesterol levels according to the Na:K ratio were estimated using logistic regression models. Dietary Na:K ratio decreased for both men and women from 2003 to 2017. Higher Na:K ratio and higher hypertension prevalence were observed (multivariate OR (fifth v. first quintiles) 1·27, 95 % CI 1·15, 1·40; Pfor trend < 0·001 for men and 1·12, 95 % CI 1·01, 1·23; Pfor trend = 0·007 for women). Higher Na:K ratio was associated with higher prevalence of high HbA1c levels in men (multivariate OR 1·56, 95 % CI 1·24, 1·96). Prevalence of low HDL-cholesterol levels was increased with higher Na:K ratio (Pfor trend =0·002 for men and <0·001 for women). No significant associations were found between Na:K ratio and hypercholesterolaemia in men or high non-HDL-cholesterol levels in both men and women. Our findings suggest that dietary Na:K ratio is associated with several CVD risk factors among Japanese adults.
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14
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Mousavi SM, Jayedi A, Jalilpiran Y, Hajishafiee M, Aminianfar A, Esmaillzadeh A. Dietary intake of total, animal and plant proteins and the risk of coronary heart disease and hypertension: a systematic review and dose-response meta-analysis of prospective cohort studies. Crit Rev Food Sci Nutr 2020; 62:1336-1349. [DOI: 10.1080/10408398.2020.1841730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Yahya Jalilpiran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Hajishafiee
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Azadeh Aminianfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Naghshi S, Sadeghi O, Willett WC, Esmaillzadeh A. Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2020; 370:m2412. [PMID: 32699048 PMCID: PMC7374797 DOI: 10.1136/bmj.m2412] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer. DESIGN Systematic review and meta-analysis of prospective cohort studies. DATA SOURCES PubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles. STUDY SELECTION Prospective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older. DATA SYNTHESIS Random effects models were used to calculate pooled effect sizes and 95% confidence intervals for the highest versus lowest categories of protein intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between protein intake and mortality. RESULTS 32 prospective cohort studies were included in the systematic review and 31 in the meta-analysis. During the follow-up period of 3.5 to 32 years, 113 039 deaths (16 429 from cardiovascular disease and 22 303 from cancer) occurred among 715 128 participants. Intake of total protein was associated with a lower risk of all cause mortality (pooled effect size 0.94, 95% confidence interval 0.89 to 0.99, I2=58.4%, P<0.001). Intake of plant protein was significantly associated with a lower risk of all cause mortality (pooled effect size 0.92, 95% confidence interval 0.87 to 0.97, I2=57.5%, P=0.003) and cardiovascular disease mortality (pooled hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, I2=63.7%, P=0.001), but not with cancer mortality. Intake of total and animal protein was not significantly associated with risk of cardiovascular disease and cancer mortality. A dose-response analysis showed a significant inverse dose-response association between intake of plant protein and all cause mortality (P=0.05 for non-linearity). An additional 3% energy from plant proteins a day was associated with a 5% lower risk of death from all causes. CONCLUSIONS Higher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality. Replacement of foods high in animal protein with plant protein sources could be associated with longevity.
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Affiliation(s)
- Sina Naghshi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Sadeghi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box 14155-6117, Tehran, Iran
- Obesity and Eating Habits Research Centre, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Qi XX, Shen P. Associations of dietary protein intake with all-cause, cardiovascular disease, and cancer mortality: A systematic review and meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis 2020; 30:1094-1105. [PMID: 32451273 DOI: 10.1016/j.numecd.2020.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS The relationships between dietary protein intake and risk of all-cause, cardiovascular disease (CVD), and cancer mortality are still unclear. We conducted a systematic review with meta-analysis of cohort studies to summarize the evidence. METHODS AND RESULTS We searched PubMed and Web of Science for relevant studies through February 2020. The associations of total, animal, and plant proteins with all-cause, CVD, and cancer mortality were evaluated. Study-specific relative risks (RR) were pooled using the fixed effect model when no significant heterogeneity was detected; otherwise the random effect model was employed. Twelve cohort studies were eligible for the study. Increased total protein showed no clear association with risk of all-cause, CVD, and cancer mortality. In the stratified analysis by protein sources, higher plant protein intake was associated with a reduced risk of all-cause mortality (highest vs lowest intake: RR = 0.92; 95% CI: 0.88, 0.96; each 3% increment of intake: RR = 0.97; 95% CI: 0.94, 0.99), and may be associated with a reduced risk of CVD mortality (highest vs lowest intake: RR = 0.90; 95% CI: 0.80, 1.01; each 3% increment of intake: RR = 0.95; 95% CI: 0.91, 0.99). Moreover, higher intake of animal protein may be associated with an increased risk of CVD mortality (highest vs lowest intake: RR = 1.11; 95% CI: 1.01, 1.22; each 3% increment of intake: RR = 1.02; 95% CI: 0.98, 1.06). CONCLUSION This study demonstrates that higher plant protein intake is associated with a reduced risk of all-cause and CVD-related mortality. Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.
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Affiliation(s)
- Xiang-Xiu Qi
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Shen
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
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17
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Chen Z, Glisic M, Song M, Aliahmad HA, Zhang X, Moumdjian AC, Gonzalez-Jaramillo V, van der Schaft N, Bramer WM, Ikram MA, Voortman T. Dietary protein intake and all-cause and cause-specific mortality: results from the Rotterdam Study and a meta-analysis of prospective cohort studies. Eur J Epidemiol 2020; 35:411-429. [PMID: 32076944 PMCID: PMC7250948 DOI: 10.1007/s10654-020-00607-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/18/2020] [Indexed: 12/11/2022]
Abstract
Evidence for associations between long-term protein intake with mortality is not consistent. We aimed to examine associations of dietary protein from different sources with all-cause and cause-specific mortality. We followed 7786 participants from three sub-cohorts of the Rotterdam Study, a population-based cohort in the Netherlands. Dietary data were collected using food-frequency questionnaires at baseline (1989-1993, 2000-2001, 2006-2008). Deaths were followed until 2018. Associations were examined using Cox regression. Additionally, we performed a highest versus lowest meta-analysis and a dose-response meta-analysis to summarize results from the Rotterdam Study and previous prospective cohorts. During a median follow-up of 13.0 years, 3589 deaths were documented in the Rotterdam Study. In this cohort, after multivariable adjustment, higher total protein intake was associated with higher all-cause mortality [e.g. highest versus lowest quartile of total protein intake as percentage of energy (Q4 versus Q1), HR = 1.12 (1.01, 1.25)]; mainly explained by higher animal protein intake and CVD mortality [Q4 versus Q1, CVD mortality: 1.28 (1.03, 1.60)]. The association of animal protein intake and CVD was mainly contributed to by protein from meat and dairy. Total plant protein intake was not associated with all-cause or cause-specific mortality, mainly explained by null associations for protein from grains and potatoes; but higher intake of protein from legumes, nuts, vegetables, and fruits was associated with lower risk of all-cause and cause-specific mortality. Findings for total and animal protein intake were corroborated in a meta-analysis of eleven prospective cohort studies including the Rotterdam Study (total 64,306 deaths among 350,452 participants): higher total protein intake was associated with higher all-cause mortality [pooled RR for highest versus lowest quantile 1.05 (1.01, 1.10)]; and for dose-response per 5 energy percent (E%) increment, 1.02 (1.004, 1.04); again mainly driven by an association between animal protein and CVD mortality [highest versus lowest, 1.09 (1.01, 1.18); per 5 E% increment, 1.05 (1.02, 1.09)]. Furthermore, in the meta-analysis a higher plant protein intake was associated with lower all-cause and CVD mortality [e.g. for all-cause mortality, highest versus lowest, 0.93 (0.87, 0.99); per 5 E% increment, 0.87 (0.78, 0.98), for CVD mortality, highest versus lowest 0.86 (0.73, 1.00)]. Evidence from prospective cohort studies to date suggests that total protein intake is positively associated with all-cause mortality, mainly driven by a harmful association of animal protein with CVD mortality. Plant protein intake is inversely associated with all-cause and CVD mortality. Our findings support current dietary recommendations to increase intake of plant protein in place of animal protein.Clinical trial registry number and website NTR6831, https://www.trialregister.nl/trial/6645.
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Affiliation(s)
- Zhangling Chen
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. .,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA. .,Department of Epidemiology, Erasmus MC, Office Na-2718, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Marija Glisic
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Mingyang Song
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hamid A Aliahmad
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xiaofang Zhang
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alice C Moumdjian
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Niels van der Schaft
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC, Office Na-2716, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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18
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Iida M, Harada S, Takebayashi T. Application of Metabolomics to Epidemiological Studies of Atherosclerosis and Cardiovascular Disease. J Atheroscler Thromb 2019; 26:747-757. [PMID: 31378756 PMCID: PMC6753246 DOI: 10.5551/jat.rv17036] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Metabolomics has developed as a powerful tool for investigating the complex pathophysiology underlying atherosclerosis and cardiovascular disease. Many epidemiological studies have applied this technique to accurately and comprehensively assess the effects of environmental factors on health outcomes, which used to be a perpetual challenge. Metabolites are defined as small molecules which are intermediate products of metabolic reactions catalyzed by numerous enzymes occurring within cells. Consequent to both genetic variation and environment, they allow us to explore the gene–environment interactions and to gain a better understanding of multifactorial diseases like cardiovascular disease. This review article highlights the findings of well-known prospective cohort studies around the world that have utilized metabolomics for a wide range of purposes, including biomarker discovery, improving cardiovascular risk prediction and early disease diagnosis, and exploring detailed mechanisms of disease onset and progression. However, technical challenges still exist in applying them clinically. One limitation is due to various analytical platforms that are used based on the judgment of each study; comparative assessments among different platforms need to be conducted in order to correctly interpret and validate each data externally. Secondly, metabolite levels obtained in most high-throughput metabolomics profiling studies are often semiquantitative rather than fully quantitative concentrations, which makes it difficult to compare and combine results among different studies and to determine the levels for practical use. In 2014, the Consortium of Metabolomics Studies was developed, which is expected to take the lead in overcoming these issues.
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Affiliation(s)
- Miho Iida
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
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