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Cited by 371Nutritional Studies and DietMuscle metabolism and nutritionAgriculture Sustainability and Environmental Impact

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: Systematic review and dose-response meta-analysis of prospective cohort studies

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Naghshi, Sina, Sadeghi, Omid, Willett, Walter C, Esmaillzadeh, Ahmad·2020·BMJ
DOI 10.1136/bmj.m2412PMC PMC7374797
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Abstract

Abstract Objective To examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer. Design Systematic review and meta-analysis of prospective cohort studies. Data sources PubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles. Study selection Prospective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older. Data synthesis Random effects models were used to calculate pooled effect sizes and 95% confidence intervals for the highest versus lowest categories of protein intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between protein intake and mortality. Results 32 prospective cohort studies were included in the systematic review and 31 in the meta-analysis. During the follow-up period of 3.5 to 32 years, 113 039 deaths (16 429‬ from cardiovascular disease and 22 303‬ from cancer) occurred among 715 128 participants. Intake of total protein was associated with a lower risk of all cause mortality (pooled effect size 0.94, 95% confidence interval 0.89 to 0.99, I2=58.4%, P<0.001). Intake of plant protein was significantly associated with a lower risk of all cause mortality (pooled effect size 0.92, 95% confidence interval 0.87 to 0.97, I2=57.5%, P=0.003) and cardiovascular disease mortality (pooled hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, I2=63.7%, P=0.001), but not with cancer mortality. Intake of total and animal protein was not significantly associated with risk of cardiovascular disease and cancer mortality. A dose-response analysis showed a significant inverse dose-response association between intake of plant protein and all cause mortality (P=0.05 for non-linearity). An additional 3% energy from plant proteins a day was associated with a 5% lower risk of death from all causes. Conclusions Higher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality. Replacement of foods high in animal protein with plant protein sources could be associated with longevity.

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  • In a recent systematic review and meta-analysis, higher total protein intake was associated with a reduced all-cause mortality risk; stratifying by protein source revealed a lower all-cause mortality risk for those consuming plant protein diets, with no clear association between animal protein intake and mortality but an inverse association between plant protein intake and cardiovascular disease风险

    “These results are consistent with a recent systematic review and meta-analysis on the impact of protein intake on mortality risk [92]. Aligned with other reports highlighting the importance of increased protein intake, especially as we age, higher total protein intake was associated with a reduced all-cause mortality risk. Stratifying data into animal protein intake versus plant protein intake,”

    From Plant Proteins: Assessing Their Nutritional Quality and Effects on Health and Physical Function (2020) · cites this paper as [92]

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Research works printed but not linked: 2

  1. [21]Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons; 2019. https://training.cochrane.org/handbook
  2. [81]National Research Council Diet and health: implications for reducing chronic disease risk. National Academies Press, 1989. 25032333

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Authors
Naghshi, S., Sadeghi, O., Willett, W. C., & Esmaillzadeh, A.
Affiliations
  • Tehran University of Medical Sciences (IR)
  • Brigham and Women's Hospital (US)
  • Isfahan University of Medical Sciences (IR)
Corresponding author
Esmaillzadeh, Ahmad
ORCID
Venue
BMJ
Publisher
BMJ
Published
2020-07-22
Volume
370
Pages
m2412
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.m2412
PMC
PMC7374797
OpenAlex
W3044750036
Cited by
371
References
89
Citations by year
2026: 40 · 2025: 71 · 2024: 78 · 2023: 59 · 2022: 72 · 2021: 42 · 2020: 9
FWCI
7.61
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Tehran University of Medical Sciences and Health Services
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
Keywords
plant proteins, animal protein, dietary protein, all-cause mortality, cardiovascular mortality, cancer mortality, dose-response relationship, energy intake, mortality risk, prospective cohort
MeSH terms
Animal Proteins, Dietary, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Cause of Death, Diet, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Plant Proteins, Prospective Studies, Risk Factors

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