Major Dietary Protein Sources and Risk of Coronary Heart Disease in Women

Abstract

Background-With the exception of fish, few major dietary protein sources have been studied in relation to the development of coronary heart disease (CHD). Our objective was to examine the relation between foods that are major dietary protein sources and incident CHD. Methods and Results-We prospectively followed 84 136 women aged 30 to 55 years in the Nurses' Health Study with no known cancer, diabetes mellitus, angina, myocardial infarction, stroke, or other cardiovascular disease. Diet was assessed by a standardized and validated questionnaire and updated every 4 years. During 26 years of follow-up, we documented 2210 incident nonfatal infarctions and 952 deaths from CHD. In multivariable analyses including age, smoking, and other risk factors, higher intakes of red meat, red meat excluding processed meat, and high-fat dairy were significantly associated with elevated risk of CHD. Higher intakes of poultry, fish, and nuts were significantly associated with lower risk. In a model controlling statistically for energy intake, 1 serving per day of nuts was associated with a 30% (95% confidence interval, 17% to 42%) lower risk of CHD compared with 1 serving per day of red meat. Similarly, compared with 1 serving per day of red meat, a lower risk was associated with 1 serving per day of low-fat dairy (13%; 95% confidence interval, 6% to 19%), poultry (19%; 95% confidence interval, 3% to 33%), and fish (24%; 95% confidence interval, 6% to 39%). Conclusions-These data suggest that high red meat intake increases risk of CHD and that CHD risk may be reduced importantly by shifting sources of protein in the US diet. (Circulation. 2010;122:876-883.)Key Words: coronary disease Ⅲ diet Ⅲ epidemiology Ⅲ risk factors Ⅲ women W ith the exception of fish, relatively few foods that are major sources of dietary protein have been examined in relation to incident coronary heart disease (CHD). The relation of these foods to CHD may not be predicted by the composition of their individual nutrients because of either synergy or antagonism among the nutrients or because of the presence of other constituents in the foods. Although neither animal protein nor vegetable protein has been associated with CHD risk, 1 other nutrients in protein-rich foods, such as saturated fat, 2,3 polyunsaturated fat, 3,4 and vitamins E, B 6 , and folate, 5 have been associated with risk. Editorial see p 859 Clinical Perspective on p 883We have reported previously on the relation between red meat, poultry, fish, and dairy products in relation to CHD risk over 14 years. 2 We observed that red meat was not significantly associated with CHD, but increasing poultry and fish intake was associated with a decreased risk. A clear understanding of the relation between these food groups and CHD risk over a longer period of time, as well as an examination of the individual foods that contribute to each food group and the relation of other major dietary protein sources and CHD risk, would allow individuals to reduce their risk by substituting one protein source for anothe...

Legume consumption and CVD risk: a systematic review and meta-analysis

“…One possible explanation for the lack of significant results in meta-analyses of studies conducted in Mediterranean countries could be the impact on cardiovascular health of all components of the diet typically consumed in these countries, or at least those included in the individual analyses. (17) Bernstein et al (2010) (23) , F Buckland et al (2009) (20) , M Kelemen et al (2005) (18) , F Kokubo et al (2007) (19) , M Buckland et al (2009) (20) , F Kokubo et al (2007) (19) , F Martinez-Gonzalez et al (2011) (24) Nagura et al (2009) (22) Dilis et al (2012) (25) , F Dilis et al (2012) (25) , M Haring et al (2014) (23) Total ( (19) , M Mizrahi et al (2009) (21) Misirili et al (2012) (27) Haring et al (2015) (29) Total ( (24) Bazzano et al (2001) (17) Kokubo et al (2007) (19) , F Kokubo et al (2007) (19) , M Nouri et al (2016) (30) Nagura et al (2009) (22) Total ( The study-specific RR and 95 % CI are represented by the black square and horizontal line, respectively; the area of the black square is proportional ...…”

“…Among the thirty-four articles obtained after screening on the basis of title and abstract, twenty studies were excluded after a full-text examination because they were not relevant for the research (n 11), did not study CVD as outcome (n 3), had a study design other than prospective (n 2), reported insufficient statistics (n 2), were conducted on the same cohort of another study but had shorter follow-up (n 1) or considered composite legume and other foods consumption (n 1). This inclusion strategy resulted in the final inclusion of fourteen studies (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and thirty-two data sets eligible to be considered for the quantitative analysis. Studies included were conducted on eleven cohorts and accounted for a total of 367 000 individuals and 18 475 cases of CVD, including 7451 CHD and 6336 stroke cases.…”

“…Legume consumption and CHD risk The analysis relative to CHD risk related to consumption of legumes comprised twelve data sets derived from eight studies (17)(18)(19)(20)23,24,25,28) . Comparison of the highest v. the lowest legume consumption category showed a similar risk estimate to the previous analysis considering CVD as outcome (RR = 0·90; 95 % CI 0·84, 0·97; Fig.…”

‘The way to a man's heart is through his gut microbiota’ – dietary pro- and prebiotics for the management of cardiovascular risk

“…Moreover, the authors confirmed the essential role of the gut microbiota in TMAO production from dietary choline in germ-free animals, while broad spectrum antibiotics lowered macrophage cholesterol accumulation, foam cell formation and aortic lesions in high-fat-fed conventional animals. Koeth et al (14) more recently showed that another compound, L-carnitine with a TMA structure similar to that of choline and commonly found in meat, may also be converted to TMA by the gut microbiota and contribute to the increased CVD risk associated with high red meat consumption (110,111) . They confirmed microbial involvement in TMA(O) formation from dietary L-carnitine using a stable isotope dilution method and broad spectrum antibiotic microbiota suppression in five healthy omnivorous subjects and in germ-free and antibiotic-treated animals.…”

Dietary fats and coronary heart disease

“…In this comparison, consumption of soybean oil was associated with the lowest risk, consistent with its fatty acid composition that includes both N-6 and N-3 polyunsaturated fatty acids. In an example explicitly comparing food sources, red meat, a major source of saturated fat, was associated with higher risk of CHD when compared with other major protein sources [89]. Whether the substantial differences were due only to the differences in fatty acid composition is not clear, but components of these foods may contribute.…”