Zheng Ju-Sheng, Steur Marinka, Imamura Fumiaki, Freisling Heinz, Johnson Laura, van der Schouw Yvonne T, Tong Tammy Yn, Weiderpass Elisabete, Bajracharya Rashmita, Crous-Bou Marta, Dahm Christina C, Heath Alicia K, Ibsen Daniel B, Jannasch Franziska, Katzke Verena, Masala Giovanna, Moreno-Iribas Conchi, Sacerdote Carlotta, Schulze Matthias B, Sieri Sabina, Wareham Nicholas J, Danesh John, Butterworth Adam S, Forouhi Nita G
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; School of Life Sciences, Westlake University, Hangzhou, China.
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.
Am J Clin Nutr. 2024 May;119(5):1164-1174. doi: 10.1016/j.ajcnut.2024.03.006. Epub 2024 Mar 11.
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.
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.
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.
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.
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.
流行病学证据表明，膳食蛋白质摄入量与心血管疾病（CVD）之间的潜在关联可能取决于蛋白质来源，即植物性或动物性，但过去的研究有限且尚无定论。
评估膳食中植物性或动物性蛋白质摄入量与CVD风险及其组成部分缺血性心脏病（IHD）和中风之间的关联。
在欧洲癌症与营养前瞻性调查（EPIC）-CVD病例队列研究中的这项分析纳入了来自7个欧洲国家的16244例新发CVD病例（10784例IHD和6423例中风病例）以及15141名队列成员。我们使用多变量调整的Prentice加权Cox回归研究了估计的膳食蛋白质摄入量与CVD、IHD和中风（总体、致命和非致命）之间的关联。我们估计了用植物性或动物性蛋白质替代脂肪和碳水化合物以及用植物蛋白替代特定食物的动物蛋白的等热量替代情况。测试了膳食蛋白质与预先指定变量之间的相乘交互作用。
在未进行或进行了宏量营养素指定替代分析的调整分析中，植物性和动物性蛋白质摄入量均与新发CVD、IHD或中风无关。较高的植物性蛋白质摄入量与从不吸烟者中总中风发病率降低22%相关[风险比（HR）0.78，95%置信区间（CI）：0.62，0.99]，但在当前吸烟者中不相关（HR 1.08，95%CI：0.83，1.40，P交互作用 = 0.004）。此外，当用植物性蛋白质替代红肉蛋白质（HR 0.52，95%CI：0.31，0.88）、加工肉蛋白质（HR 0.39，95%CI：0.17，0.90）和乳制品蛋白质（HR 0.54，95%CI：0.30，0.98）时，较高的植物性蛋白质（每总能量的3%）与致命性中风发病率较低相关。
植物性或动物性蛋白质摄入量与总体CVD无关。然而，植物性蛋白质消费与非吸烟者中总中风发病率较低以及致命性中风发病率较低之间的关联突出了研究CVD亚型和潜在相互作用的重要性。这些观察结果值得在具有不同宏量营养素摄入量和饮食模式的不同人群中进一步研究。
