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Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort.
JAMA Intern Med. 2019 11 01; 179(11):1509-1518.JIM

Abstract

Importance

Epidemiological evidence regarding the long-term effects of higher dietary protein intake on mortality outcomes in the general population is not clear.

Objective

To evaluate the associations between animal and plant protein intake and all-cause and cause-specific mortality.

Design, Setting, and Participants

This prospective cohort study included 70 696 participants in the Japan Public Health Center-based Prospective Cohort who were aged 45 to 74 years and had no history of cancer, cerebrovascular disease, or ischemic heart disease at study baseline. Data were collected from January 1, 1995, through December 31, 1999, with follow-up completed December 31, 2016, during which 12 381 total deaths were documented. Dietary intake information was collected through a validated food frequency questionnaire and used to estimate protein intake in all participants. Participants were grouped into quintile categories based on their protein intake, expressed as a percentage of total energy. Data were analyzed from July 18, 2017, through April 10, 2019.

Main Outcomes and Measures

Hazard ratios (HRs) and 95% CIs for all-cause and cause-specific mortality were estimated using Cox proportional hazards regression models with adjustment for potential confounding factors.

Results

Among the 70 696 participants, 32 201 (45.5%) were men (mean [SD] age, 55.6 [7.6] years) and 38 495 (54.5%) were women (mean [SD] age, 55.8 [7.7] years). Intake of animal protein showed no clear association with total or cause-specific mortality. In contrast, intake of plant protein was associated with lower total mortality, with multivariable-adjusted HRs of 0.89 (95% CI, 0.83-0.95) for quintile 2; 0.88 (95% CI, 0.82-0.95) for quintile 3; 0.84 (95% CI, 0.77-0.92) for quintile 4; and 0.87 (95% CI, 0.78-0.96) for quintile 5, with quintile 1 as the reference category (P = .01 for trend). For cause-specific mortality, this association with plant protein intake was evident for cardiovascular disease (CVD)-related mortality (HRs, 0.84 [95% CI, 0.73-0.96] to 0.70 [95% CI, 0.59-0.83]; P = .002 for trend). Isocaloric substitution of 3% energy from plant protein for red meat protein was associated with lower total (HR, 0.66; 95% CI, 0.55-0.80), cancer-related (HR, 0.61; 95% CI, 0.45-0.82), and CVD-related (HR, 0.58; 95% CI, 0.39-0.86) mortality; substitution for processed meat protein was associated with lower total (HR, 0.54; 95% CI, 0.38-0.75) and cancer-related (HR, 0.50; 95% CI, 0.30-0.85) mortality.

Conclusions and Relevance

In this large prospective study, higher plant protein intake was associated with lower total and CVD-related mortality. Although animal protein intake was not associated with mortality outcomes, replacement of red meat protein or processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality.

Authors+Show Affiliations

Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Department of Food and Life Science, Azabu University, Kanagawa, Japan.Department of Food Science and Nutrition, Faculty of Human Life and Environment, Nara Women's University, Nara, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31682257

Citation

Budhathoki, Sanjeev, et al. "Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort." JAMA Internal Medicine, vol. 179, no. 11, 2019, pp. 1509-1518.
Budhathoki S, Sawada N, Iwasaki M, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort. JAMA Intern Med. 2019;179(11):1509-1518.
Budhathoki, S., Sawada, N., Iwasaki, M., Yamaji, T., Goto, A., Kotemori, A., Ishihara, J., Takachi, R., Charvat, H., Mizoue, T., Iso, H., & Tsugane, S. (2019). Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort. JAMA Internal Medicine, 179(11), 1509-1518. https://doi.org/10.1001/jamainternmed.2019.2806
Budhathoki S, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort. JAMA Intern Med. 2019 11 1;179(11):1509-1518. PubMed PMID: 31682257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort. AU - Budhathoki,Sanjeev, AU - Sawada,Norie, AU - Iwasaki,Motoki, AU - Yamaji,Taiki, AU - Goto,Atsushi, AU - Kotemori,Ayaka, AU - Ishihara,Junko, AU - Takachi,Ribeka, AU - Charvat,Hadrien, AU - Mizoue,Tetsuya, AU - Iso,Hiroyasu, AU - Tsugane,Shoichiro, AU - ,, PY - 2020/08/26/pmc-release PY - 2019/11/5/entrez PY - 2019/11/5/pubmed PY - 2020/6/12/medline SP - 1509 EP - 1518 JF - JAMA internal medicine JO - JAMA Intern Med VL - 179 IS - 11 N2 - Importance: Epidemiological evidence regarding the long-term effects of higher dietary protein intake on mortality outcomes in the general population is not clear. Objective: To evaluate the associations between animal and plant protein intake and all-cause and cause-specific mortality. Design, Setting, and Participants: This prospective cohort study included 70 696 participants in the Japan Public Health Center-based Prospective Cohort who were aged 45 to 74 years and had no history of cancer, cerebrovascular disease, or ischemic heart disease at study baseline. Data were collected from January 1, 1995, through December 31, 1999, with follow-up completed December 31, 2016, during which 12 381 total deaths were documented. Dietary intake information was collected through a validated food frequency questionnaire and used to estimate protein intake in all participants. Participants were grouped into quintile categories based on their protein intake, expressed as a percentage of total energy. Data were analyzed from July 18, 2017, through April 10, 2019. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for all-cause and cause-specific mortality were estimated using Cox proportional hazards regression models with adjustment for potential confounding factors. Results: Among the 70 696 participants, 32 201 (45.5%) were men (mean [SD] age, 55.6 [7.6] years) and 38 495 (54.5%) were women (mean [SD] age, 55.8 [7.7] years). Intake of animal protein showed no clear association with total or cause-specific mortality. In contrast, intake of plant protein was associated with lower total mortality, with multivariable-adjusted HRs of 0.89 (95% CI, 0.83-0.95) for quintile 2; 0.88 (95% CI, 0.82-0.95) for quintile 3; 0.84 (95% CI, 0.77-0.92) for quintile 4; and 0.87 (95% CI, 0.78-0.96) for quintile 5, with quintile 1 as the reference category (P = .01 for trend). For cause-specific mortality, this association with plant protein intake was evident for cardiovascular disease (CVD)-related mortality (HRs, 0.84 [95% CI, 0.73-0.96] to 0.70 [95% CI, 0.59-0.83]; P = .002 for trend). Isocaloric substitution of 3% energy from plant protein for red meat protein was associated with lower total (HR, 0.66; 95% CI, 0.55-0.80), cancer-related (HR, 0.61; 95% CI, 0.45-0.82), and CVD-related (HR, 0.58; 95% CI, 0.39-0.86) mortality; substitution for processed meat protein was associated with lower total (HR, 0.54; 95% CI, 0.38-0.75) and cancer-related (HR, 0.50; 95% CI, 0.30-0.85) mortality. Conclusions and Relevance: In this large prospective study, higher plant protein intake was associated with lower total and CVD-related mortality. Although animal protein intake was not associated with mortality outcomes, replacement of red meat protein or processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/31682257/Association_of_Animal_and_Plant_Protein_Intake_With_All_Cause_and_Cause_Specific_Mortality_in_a_Japanese_Cohort_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2019.2806 DB - PRIME DP - Unbound Medicine ER -