Glenn Andrea J, Wang Fenglei, Tessier Anne-Julie, Manson JoAnn E, Rimm Eric B, Mukamal Kenneth J, Sun Qi, Willett Walter C, Rexrode Kathryn M, Jenkins David Ja, Hu Frank B
Department of Nutrition and Food Studies, New York University, New York, NY, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Am J Clin Nutr. 2024 Dec;120(6):1373-1386. doi: 10.1016/j.ajcnut.2024.09.006.
Dietary guidelines recommend substituting animal protein with plant protein, however, the ideal ratio of plant-to-animal protein (P:A) remains unknown.
We aimed to evaluate associations between the P:A ratio and incident cardiovascular disease (CVD), coronary artery disease (CAD), and stroke in 3 cohorts.
Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) for CVD outcomes among 70,918 females in the Nurses' Health Study (NHS) (1984-2016), 89,205 females in the NHSII (1991-2017) and 42,740 males from the Health Professionals Follow-up Study (1986-2016). The P:A ratio was based on percent energy from plant and animal protein and assessed using food frequency questionnaires every 4 y.
During 30 y of follow-up, 16,118 incident CVD cases occurred. In the pooled multivariable-adjusted models, participants had a lower risk of total CVD [HR: 0.81; 95% confidence interval (CI): 0.76, 0.87; P trend < 0.001], CAD (HR: 0.73; 95% CI: 0.67, 0.79; P trend < 0.001), but not stroke (HR: 0.98; 95% CI: 0.88, 1.09; P trend = 0.71), when comparing highest to lowest deciles of the P:A ratio (ratio: ∼0.76 compared with ∼0.24). Dose-response analyses showed evidence of linear and nonlinear relationships for CVD and CAD, with more marked risk reductions early in the dose-response curve. Lower risk of CVD (HR: 0.72; 95% CI: 0.64, 0.82) and CAD (HR: 0.64; 95% CI: 0.55, 0.75) were also observed with higher ratios and protein density (20.8% energy) combined. Substitution analyses indicated that replacing red and processed meat with several plant protein sources showed the greatest cardiovascular benefit.
In cohort studies of United States adults, a higher plant-to-animal protein ratio is associated with lower risks of CVD and CAD, but not stroke. Furthermore, a higher ratio combined with higher protein density showed the most cardiovascular benefit.
饮食指南建议用植物蛋白替代动物蛋白，然而，植物蛋白与动物蛋白的理想比例（P:A）仍不清楚。
我们旨在评估3个队列中P:A比例与心血管疾病（CVD）、冠状动脉疾病（CAD）和中风发病之间的关联。
使用多变量调整的Cox比例风险模型来估计护士健康研究（NHS，1984 - 2016年）中70,918名女性、NHSII（1991 - 2017年）中89,205名女性以及健康专业人员随访研究（1986 - 2016年）中42,740名男性发生CVD结局的风险比（HRs）。P:A比例基于植物蛋白和动物蛋白提供的能量百分比，并每4年使用食物频率问卷进行评估。
在30年的随访期间，共发生16,118例CVD事件。在汇总的多变量调整模型中，与P:A比例最低十分位数（比例约为0.24）相比，最高十分位数（比例约为0.76）的参与者发生总CVD的风险较低[HR：0.81；95%置信区间（CI）：0.76，0.87；P趋势<0.001]，CAD风险较低（HR：0.73；95%CI：0.67，0.79；P趋势<0.001），但中风风险无差异（HR：0.98；95%CI：0.88，1.09；P趋势=0.71）。剂量反应分析显示CVD和CAD存在线性和非线性关系的证据，在剂量反应曲线早期风险降低更为明显。较高的P:A比例与较高的蛋白质密度（能量的20.8%）相结合时，也观察到CVD（HR：0.72；95%CI：0.64，0.82）和CAD（HR：0.64；95%CI：0.55，0.75）风险较低。替代分析表明，用几种植物蛋白来源替代红肉和加工肉类对心血管健康益处最大。
在美国成年人的队列研究中，较高的植物蛋白与动物蛋白比例与较低的CVD和CAD风险相关，但与中风风险无关。此外，较高的比例与较高的蛋白质密度相结合对心血管健康益处最大。
