Center for Nutrition, Healthy Lifestyle and Disease Prevention, Loma Linda University, School of Public Health, Loma Linda, CA, USA.
UMR PNCA, AgroParisTech, INRA, Université Paris-Saclay, Paris, France.
Int J Epidemiol. 2018 Oct 1;47(5):1603-1612. doi: 10.1093/ije/dyy030.
Current evidence suggests that plant and animal proteins are intimately associated with specific large nutrient clusters that may explain part of their complex relation with cardiovascular health. We aimed at evaluating the association between specific patterns of protein intake with cardiovascular mortality.
We selected 81 337 men and women from the Adventist Health Study-2. Diet was assessed between 2002 and 2007, by using a validated food frequency questionnaire. Dietary patterns based on the participants' protein consumption were derived by factor analysis. Cox regression analysis was used to estimate multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and dietary components.
There were 2276 cardiovascular deaths during a mean follow-up time of 9.4 years. The HRs for cardiovascular mortality were 1.61 [98.75% confidence interval (CI), 1.12 2.32; P-trend < 0.001] for the 'Meat' protein factor and 0.60 (98.75% CI, 0.42 0.86; P-trend < 0.001) for the 'Nuts & Seeds' protein factor (highest vs lowest quintile of factor scores). No significant associations were found for the 'Grains', 'Processed Foods' and 'Legumes, Fruits & Vegetables' protein factors. Additional adjustments for the participants' vegetarian dietary pattern and nutrients related to cardiovascular disease outcomes did not change the results.
Associations between the 'Meat' and 'Nuts & Seeds' protein factors and cardiovascular outcomes were strong and could not be ascribed to other associated nutrients considered to be important for cardiovascular health. Healthy diets can be advocated based on protein sources, preferring low contributions of protein from meat and higher intakes of plant protein from nuts and seeds.
目前的证据表明，植物蛋白和动物蛋白与特定的大型营养簇密切相关，这些营养簇可能部分解释了它们与心血管健康复杂关系的原因。我们旨在评估特定蛋白质摄入模式与心血管死亡率之间的关系。
我们从 Adventist Health Study-2 中选择了 81337 名男性和女性。通过使用经过验证的食物频率问卷，在 2002 年至 2007 年期间评估了饮食情况。基于参与者的蛋白质消耗，通过因子分析得出了蛋白质摄入模式。使用 Cox 回归分析来估计多变量调整后的危险比 (HR)，这些 HR 调整了社会人口统计学和生活方式因素以及饮食成分。
在平均 9.4 年的随访期间，发生了 2276 例心血管死亡。心血管死亡率的 HR 为 1.61 [98.75%置信区间 (CI)，1.12-2.32; P 趋势 < 0.001]，用于“肉类”蛋白质因子和 0.60 (98.75%CI，0.42-0.86; P 趋势 < 0.001)，用于“坚果和种子”蛋白质因子（最高五分位数与最低五分位数的因子得分）。对于“谷物”、“加工食品”和“豆类、水果和蔬菜”蛋白质因子，未发现显著关联。对参与者的素食饮食模式和与心血管疾病结果相关的营养素进行额外调整并没有改变结果。
“肉类”和“坚果和种子”蛋白质因子与心血管结局之间的关联是强烈的，不能归因于其他被认为对心血管健康很重要的相关营养素。可以根据蛋白质来源来倡导健康饮食，优先选择肉类蛋白质的低摄入量，增加坚果和种子等植物蛋白质的摄入量。
