Affiliation:
1. Department of Epidemiology College of Public Health University of Iowa Iowa City IA
2. Department of Family Medicine and Public Health School of Medicine University of California, San Diego La Jolla CA
3. Division of Research Kaiser Permanente Northern California Oakland CA
4. Department of Medicine I/Cardiology University of Würzburg Germany
5. MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Science Washington DC
6. Division of Preventive Medicine School of Medicine University of Alabama at Birmingham Birmingham AL
7. Medstar Washington Hospital Center and Georgetown University School of Medicine Washington DC
8. Obesity Research and Education Initiative University of Iowa Iowa City IA
9. Fraternal Order of Eagles Diabetes Research Center University of Iowa Iowa City IA
Abstract
Background
Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient.
Methods and Results
We included 102 521 postmenopausal women enrolled in the Women’s Health Initiative between 1993 and 1998, and followed them through February 2017. During 1 876 205 person‐years of follow‐up, 25 976 deaths occurred. Comparing the highest with the lowest quintile, plant protein intake was inversely associated with all‐cause mortality (hazard ratio [HR], 0.91 [0.86, 0.96]), cardiovascular disease mortality (HR, 0.88 [0.79, 0.97]), and dementia mortality (HR, 0.79 [0.67, 0.94]). Among major protein sources, comparing the highest with the lowest quintile of consumption, processed red meat (HR, 1.06 [1.01, 1.10]) or eggs (HR, 1.14 [1.10, 1.19]) was associated with higher risk of all‐cause mortality. Unprocessed red meat (HR, 1.12 [1.02, 1.23]), eggs (HR, 1.24 [1.14, 1.34]), or dairy products (HR, 1.11 [1.02, 1.22]) was associated with higher risk of cardiovascular disease mortality. Egg consumption was associated with higher risk of cancer mortality (HR, 1.10 [1.02, 1.19]). Processed red meat consumption was associated with higher risk of dementia mortality (HR, 1.20 [1.05, 1.32]), while consumption of poultry (HR, 0.85 [0.75, 0.97]) or eggs (HR, 0.86 [0.75, 0.98]) was associated with lower risk of dementia mortality. In substitution analysis, substituting of animal protein with plant protein was associated with a lower risk of all‐cause mortality, cardiovascular disease mortality, and dementia mortality, and substitution of total red meat, eggs, or dairy products with nuts was associated with a lower risk of all‐cause mortality.
Conclusions
Different dietary protein sources have varying associations with all‐cause mortality, cardiovascular disease mortality, and dementia mortality. Our findings support the need for consideration of protein sources in future dietary guidelines.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Reference43 articles.
1. US Department of Health and Human Services and US Department of Agriculture
. 2015–2020 Dietary Guidelines for Americans. 2016.
2. Public Health England
. Eatwell Guide. 2016.
3. The Chinese Nutrition Society 2016
. The Food Guide Pagoda for Chinese Residents. 2016.
4. Low-Carbohydrate-Diet Score and the Risk of Coronary Heart Disease in Women
5. Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality