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Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Open accessAbstract
Background: There is a heightened interest in plant‐based diets for cardiovascular disease prevention. Although plant protein is thought to mediate such prevention through modifying blood lipids, the effect of plant protein in specific substitution for animal protein on blood lipids remains unclear. To assess the effect of this substitution on established lipid targets for cardiovascular risk reduction, we conducted a systematic review and meta‐analysis of randomized controlled trials using the Grading of Recommendations Assessment, Development, and Evaluation system. Methods and Results: MEDLINE , EMBASE , and the Cochrane Registry were searched through September 9, 2017. We included randomized controlled trials of ≥3 weeks comparing the effect of plant protein in substitution for animal protein on low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, and apolipoprotein B. Two independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences with 95% confidence intervals. Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The overall quality (certainty) of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. One‐hundred twelve randomized controlled trials met the eligibility criteria. Plant protein in substitution for animal protein decreased low‐density lipoprotein cholesterol by 0.16 mmol/L (95% confidence interval, −0.20 to −0.12 mmol/L; P <0.00001; I 2 =55%; moderate‐quality evidence), non–high‐density lipoprotein cholesterol by 0.18 mmol/L (95% confidence interval, −0.22 to −0.14 mmol/L; P <0.00001; I 2 =52%; moderate‐quality evidence), and apolipoprotein B by 0.05 g/L (95% confidence interval, −0.06 to −0.03 g/L; P <0.00001; I 2 =30%; moderate‐quality evidence). Conclusions: Substitution of plant protein for animal protein decreases the established lipid targets low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, and apolipoprotein B. More high‐quality randomized trials are needed to improve our estimates. Clinical Trial Registration: URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02037321.
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![Figure 2 Primary analyses. Pooled effect estimates for each end point (squares) shown. Paired analyses were applied to all crossover trials. Data are expressed as mean differences (95% confidence intervals [CIs]), using generic inverse‐variance random‐effects models. Interstudy heterogeneity was tested using the Cochran Q statistic (χ2) at a significance level of P<0.10 and quantified by I2; levels of ≥50% represented substantial heterogeneity. All outcomes had significant pooled effect estimates. Heterogeneity was significant and substantial for low‐density lipoprotein cholesterol (LDL‐C) and non–high‐density lipoprotein cholesterol (HDL‐C), and significant but not substantial for apolipoprotein B (Apo‐B).](/paper-figures/b09b59bb91174ac68683eab5c26d0b9f/effect-of-plant-protein-on-blood-lipids-a-systematic-review-and-metaanalysis-of-figure-2.jpg)
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“A larger body of evidence from randomized clinical trials suggests that vegetarian and other plant-based dietary patterns lower weight29,30,31 and improve lipid management,30,32,33 glucose metabolism,33,34 blood pressure,35,36,37 and cardiometabolic health.38”
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In the citing paper
“In this systematic review and meta-analysis of 112 randomized clinical trials across adults with and without hyperlipidemia, the authors demonstrated reduced markers of cardiovascular disease in favor of plant protein over animal protein consumption [72].”
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Metadata
- Authors
- Li, S. S., Blanco Mejia, S., Lytvyn, L., Stewart, S. E., Viguiliouk, E., Ha, V., de Souza, R. J., Leiter, L. A., Kendall, C. W. C., Jenkins, D. J. A., & Sievenpiper, J. L.
- Affiliations
- St. Michael's Hospital (CA)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Corresponding author
- Sievenpiper, John L.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2017-12-02
- Volume
- 6
- Issue
- 12
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC5779002
- OpenAlex
- W2776826800
- Cited by
- 139
- References
- 189
- Citations by year
- 2026: 12 · 2025: 21 · 2024: 23 · 2023: 20 · 2022: 20 · 2021: 19 · 2020: 10 · 2019: 11 · 2018: 3
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- PepsiCo
- World Health Organization
- General Mills
- Coca-Cola Foundation
- Danone
- Almond Board of California
- Advanced Foods and Materials Network
- McMaster University
- Saskatchewan Pulse Growers
- Diabetes Canada
- Canadian Nutrition Society
- Canola Council of Canada
- Loblaw Companies Limited
- Danish Cancer Society Research Center
- Peanut Institute
- Government of Canada
- Canadian Foundation for Dietetic Research
- European Foundation for the Study of Diabetes
- European Association for the Study of Diabetes
- International Nut and Dried Fruit Council
- Health Canada
- Canadian Institutes of Health Research (129920)
- Agriculture and Agri-Food Canada
- Institute of Nutrition, Metabolism and Diabetes (129920)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
- Keywords
- plant proteins, serum lipids, LDL cholesterol, non-HDL cholesterol, apolipoprotein B, cardiovascular disease prevention, plant-based diet, dietary intervention, cardiovascular risk reduction, dyslipidemia, hypertriglyceridemia, hypercholesterolemia, hyperhomocysteinemia, homocysteine
- MeSH terms
- Cardiovascular Diseases, Humans, Lipids, Plant Proteins, Randomized Controlled Trials as Topic
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