Association of Major Dietary Protein Sources With All‐Cause and Cause‐Specific Mortality: Prospective Cohort Study

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.

The Isocaloric Substitution of Plant-Based and Animal-Based Protein in Relation to Aging-Related Health Outcomes: A Systematic Review

“…A total of 1822 records were identified from PubMed and Embase after removing duplicates, among which full-text review was conducted for 103 articles. After excluding studies not meeting the inclusion criteria with reasons listed in Figure 1, 12 articles published between 2005 and 2021 were included for final analyses [7,10,[29][30][31][32][33][34][35][36][37][38]. Among these, 1 article described substitution results only based on the combined dataset of 2 prospective cohorts [10] and another reported substitutional effects based on fixed-effects meta-analysis of 3 prospective cohorts without individual study results [33], while all the others described only 1 population in the study; therefore, we reported associations from a total of 12 studies in the present review.…”

“…We included 9 prospective cohort studies [7,10,[29][30][31][32][33]35,37] and 3 cross-sectional studies [34,36,38] with a total of 1,450,178 participants aged from 15 to 79 years, in the review (Table 2). Two cross-sectional studies were conducted at baseline within respective European cohort studies [34,38], and another cross-sectional analysis was conducted within a clinical trial, i.e., European Diet, Obesity and Genes Trial (DIOGenes) [36].…”

“…Two cross-sectional studies were conducted at baseline within respective European cohort studies [34,38], and another cross-sectional analysis was conducted within a clinical trial, i.e., European Diet, Obesity and Genes Trial (DIOGenes) [36]. Of the 9 cohort studies, 6 were conducted in the United States [10,[30][31][32][33]35], 2 in Europe [7,37] and 1 in Japan [29], with mean or median follow-up time ranging from 7 years [37] to the longest 27 years [10]. A total of 156,064 overall deaths including 55,505 deaths from cancer and 41,836 deaths from CVD were identified from 5 cohort studies [10,[29][30][31]35] while a total of 29,851 incident cases of various aging-related diseases were identified from the other 4 cohort studies [31][32][33]37], which consisted of 13,838 cancer cases, 15,580 T2D cases, 298 hypertension cases, and 135 microalbuminuria cases.…”

“…Recently, several studies were published on the topic of isocaloric substitution of animaland plant-based protein on a wide array of aging-related health outcomes [7,10,[29][30][31][32][33][34][35][36][37][38]. However, summary evidence on this topic is lacking.…”

Dietary Regulation of Gut-Brain Axis in Alzheimer’s Disease: Importance of Microbiota Metabolites

“…Moreover, the type of protein consumed may also be critical. Generally, consumption of high amounts of animalderived protein have detrimental effects on cognitive function, while plant-based protein has protective effects on brain health (Albanese et al, 2009;Grant, 2014;Sun et al, 2021;Zhang et al, 2021). Indeed, a recent cohort study identified highmeat consumption as a potential risk factor for incidence of dementia (Zhang et al, 2021).…”