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Cited by 139Nutritional Studies and DietLipoproteins and Cardiovascular HealthAgriculture Sustainability and Environmental Impact

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Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

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Li, Siying S., Blanco Mejia, Sonia, Lytvyn, Lyubov, Stewart, Sarah E., Viguiliouk, Effie, Ha, Vanessa, de Souza, Russell J., Leiter, Lawrence A., Kendall, Cyril W. C., Jenkins, David J. A., Sievenpiper, John L.·2017·Journal of the American Heart Association
DOI 10.1161/jaha.117.006659PMC PMC5779002
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Abstract

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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Crossref · 10.1161/jaha.117.006659

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Figure 1 Search summary.
Figure 1 Search summary.CC BY-NC · PubMed Central
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).
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).CC BY-NC · PubMed Central

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Research works printed but not linked: 8

  1. 10.1016/S0025-6196(11)63144-3 · DOI
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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
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-12-02
Volume
6
Issue
12
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.117.006659
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
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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