Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study

Ju-Sheng Zheng; Marinka Steur; Fumiaki Imamura; Heinz Freisling; Laura Johnson; Yvonne T van der Schouw; Tammy Y N Tong; Elisabete Weiderpass; Rashmita Bajracharya; Marta Crous-Bou; Christina C Dahm; Alicia K Heath; Daniel B Ibsen; Franziska Jannasch; Verena Katzke; Giovanna Masala; Conchi Moreno-Iribas; Carlotta Sacerdote; Matthias B Schulze; Sabina Sieri; Nicholas J Wareham; John Danesh; Adam S Butterworth; Nita G Forouhi

doi:10.1016/j.ajcnut.2024.03.006

Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study

Ju-Sheng Zheng, Marinka Steur, Fumiaki Imamura, Heinz Freisling, Laura Johnson, Yvonne T van der Schouw, Tammy Y N Tong, Elisabete Weiderpass, Rashmita Bajracharya, Marta Crous-Bou, Christina C Dahm, Alicia K Heath, Daniel B Ibsen, Franziska Jannasch, Verena Katzke, Giovanna Masala, Conchi Moreno-Iribas, Carlotta Sacerdote, Matthias B Schulze, Sabina SieriNicholas J Wareham, John Danesh, Adam S Butterworth, Nita G Forouhi^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

BACKGROUND: Epidemiological evidence suggests that a potential association between dietary protein intake and cardiovascular disease (CVD) may depend on the protein source, i.e. plant- or animal- derived, but past research was limited and inconclusive.

OBJECTIVE: To evaluate the association of dietary plant- or animal-derived protein consumption with risk of CVD, and its components coronary heart disease (CHD) and stroke.

METHODS: This analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD case-cohort study included 16244 incident CVD cases (10784 CHD and 6423 stroke cases) and 15141 subcohort members from seven European countries. We investigated the association of estimated dietary protein intake with CVD, CHD and stroke (total, fatal and non-fatal) using multivariable-adjusted Prentice-weighted Cox regression. We estimated isocaloric substitutions of replacing fats and carbohydrates with plant- or animal-derived protein and replacing food-specific animal protein with plant protein. Multiplicative interactions between dietary protein and pre-specified variables were tested.

RESULTS: Neither plant- nor animal-derived protein intake was associated with incident CVD, CHD or stroke in adjusted analyses without or with macronutrient-specified substitution analyses. Higher plant-derived protein intake was associated with 22% lower total stroke incidence among never smokers (HR 0.78, 95%CI: 0.62, 0.99), but not among current smokers (HR 1.08, 95%CI: 0.83, 1.40, p-interaction=0.004). Moreover, higher plant-derived protein (per 3% total energy) when replacing red meat protein (HR 0.52, 95%CI: 0.31, 0.88), processed meat protein (HR 0.39, 95%CI:0.17, 0.90) and dairy protein (HR 0.54, 95%CI:0.30, 0.98) was associated with lower incidence of fatal stroke.

CONCLUSION: Plant- or animal-derived protein intake was not associated with overall CVD. However, the association of plant-derived protein consumption with lower total stroke incidence among non-smokers, and with lower incidence of fatal stroke highlights the importance of investigating CVD sub-types and potential interactions. These observations warrant further investigation in diverse populations with varying macronutrient intakes and dietary patterns.

Original language	English
Journal	The American Journal of Clinical Nutrition
Volume	119
Issue	5
Pages (from-to)	1164-1174
Number of pages	11
ISSN	0002-9165
DOIs	https://doi.org/10.1016/j.ajcnut.2024.03.006
Publication status	Published - May 2024

Keywords

plant-derived protein
animal-derived protein
cardiovascular disease
stroke
coronary heart disease
ischemic heart disease
Prospective Studies
Cardiovascular Diseases/epidemiology
Humans
Middle Aged
Risk Factors
Male
Plant Proteins, Dietary/administration & dosage
Case-Control Studies
Incidence
Diet
Europe/epidemiology
Adult
Female
Stroke/epidemiology
Aged
Animal Proteins, Dietary/administration & dosage
Dietary Proteins/administration & dosage
Cohort Studies

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Zheng, J.-S., Steur, M., Imamura, F., Freisling, H., Johnson, L., van der Schouw, Y. T., Tong, T. Y. N., Weiderpass, E., Bajracharya, R., Crous-Bou, M., Dahm, C. C., Heath, A. K., Ibsen, D. B., Jannasch, F., Katzke, V., Masala, G., Moreno-Iribas, C., Sacerdote, C., Schulze, M. B., ... Forouhi, N. G. (2024). Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study. The American Journal of Clinical Nutrition, 119(5), 1164-1174. https://doi.org/10.1016/j.ajcnut.2024.03.006

@article{86cf8b50fb4d4502a02d477265876c81,

title = "Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study",

abstract = "BACKGROUND: Epidemiological evidence suggests that a potential association between dietary protein intake and cardiovascular disease (CVD) may depend on the protein source, i.e. plant- or animal- derived, but past research was limited and inconclusive.OBJECTIVE: To evaluate the association of dietary plant- or animal-derived protein consumption with risk of CVD, and its components coronary heart disease (CHD) and stroke.METHODS: This analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD case-cohort study included 16244 incident CVD cases (10784 CHD and 6423 stroke cases) and 15141 subcohort members from seven European countries. We investigated the association of estimated dietary protein intake with CVD, CHD and stroke (total, fatal and non-fatal) using multivariable-adjusted Prentice-weighted Cox regression. We estimated isocaloric substitutions of replacing fats and carbohydrates with plant- or animal-derived protein and replacing food-specific animal protein with plant protein. Multiplicative interactions between dietary protein and pre-specified variables were tested.RESULTS: Neither plant- nor animal-derived protein intake was associated with incident CVD, CHD or stroke in adjusted analyses without or with macronutrient-specified substitution analyses. Higher plant-derived protein intake was associated with 22% lower total stroke incidence among never smokers (HR 0.78, 95%CI: 0.62, 0.99), but not among current smokers (HR 1.08, 95%CI: 0.83, 1.40, p-interaction=0.004). Moreover, higher plant-derived protein (per 3% total energy) when replacing red meat protein (HR 0.52, 95%CI: 0.31, 0.88), processed meat protein (HR 0.39, 95%CI:0.17, 0.90) and dairy protein (HR 0.54, 95%CI:0.30, 0.98) was associated with lower incidence of fatal stroke.CONCLUSION: Plant- or animal-derived protein intake was not associated with overall CVD. However, the association of plant-derived protein consumption with lower total stroke incidence among non-smokers, and with lower incidence of fatal stroke highlights the importance of investigating CVD sub-types and potential interactions. These observations warrant further investigation in diverse populations with varying macronutrient intakes and dietary patterns.",

keywords = "plant-derived protein, animal-derived protein, cardiovascular disease, stroke, coronary heart disease, ischemic heart disease, Prospective Studies, Cardiovascular Diseases/epidemiology, Humans, Middle Aged, Risk Factors, Male, Plant Proteins, Dietary/administration & dosage, Case-Control Studies, Incidence, Diet, Europe/epidemiology, Adult, Female, Stroke/epidemiology, Aged, Animal Proteins, Dietary/administration & dosage, Dietary Proteins/administration & dosage, Cohort Studies",

author = "Ju-Sheng Zheng and Marinka Steur and Fumiaki Imamura and Heinz Freisling and Laura Johnson and {van der Schouw}, {Yvonne T} and Tong, {Tammy Y N} and Elisabete Weiderpass and Rashmita Bajracharya and Marta Crous-Bou and Dahm, {Christina C} and Heath, {Alicia K} and Ibsen, {Daniel B} and Franziska Jannasch and Verena Katzke and Giovanna Masala and Conchi Moreno-Iribas and Carlotta Sacerdote and Schulze, {Matthias B} and Sabina Sieri and Wareham, {Nicholas J} and John Danesh and Butterworth, {Adam S} and Forouhi, {Nita G}",

year = "2024",

month = may,

doi = "10.1016/j.ajcnut.2024.03.006",

language = "English",

volume = "119",

pages = "1164--1174",

journal = "The American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "Elsevier B.V.",

number = "5",

}

Zheng, J-S, Steur, M, Imamura, F, Freisling, H, Johnson, L, van der Schouw, YT, Tong, TYN, Weiderpass, E, Bajracharya, R, Crous-Bou, M, Dahm, CC, Heath, AK, Ibsen, DB, Jannasch, F, Katzke, V, Masala, G, Moreno-Iribas, C, Sacerdote, C, Schulze, MB, Sieri, S, Wareham, NJ, Danesh, J, Butterworth, AS & Forouhi, NG 2024, 'Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study', The American Journal of Clinical Nutrition, vol. 119, no. 5, pp. 1164-1174. https://doi.org/10.1016/j.ajcnut.2024.03.006

Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study. / Zheng, Ju-Sheng; Steur, Marinka; Imamura, Fumiaki et al.
In: The American Journal of Clinical Nutrition, Vol. 119, No. 5, 05.2024, p. 1164-1174.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases

T2 - the pan-European EPIC-CVD case-cohort study

AU - Zheng, Ju-Sheng

AU - Steur, Marinka

AU - Imamura, Fumiaki

AU - Freisling, Heinz

AU - Johnson, Laura

AU - van der Schouw, Yvonne T

AU - Tong, Tammy Y N

AU - Weiderpass, Elisabete

AU - Bajracharya, Rashmita

AU - Crous-Bou, Marta

AU - Dahm, Christina C

AU - Heath, Alicia K

AU - Ibsen, Daniel B

AU - Jannasch, Franziska

AU - Katzke, Verena

AU - Masala, Giovanna

AU - Moreno-Iribas, Conchi

AU - Sacerdote, Carlotta

AU - Schulze, Matthias B

AU - Sieri, Sabina

AU - Wareham, Nicholas J

AU - Danesh, John

AU - Butterworth, Adam S

AU - Forouhi, Nita G

PY - 2024/5

Y1 - 2024/5

N2 - BACKGROUND: Epidemiological evidence suggests that a potential association between dietary protein intake and cardiovascular disease (CVD) may depend on the protein source, i.e. plant- or animal- derived, but past research was limited and inconclusive.OBJECTIVE: To evaluate the association of dietary plant- or animal-derived protein consumption with risk of CVD, and its components coronary heart disease (CHD) and stroke.METHODS: This analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD case-cohort study included 16244 incident CVD cases (10784 CHD and 6423 stroke cases) and 15141 subcohort members from seven European countries. We investigated the association of estimated dietary protein intake with CVD, CHD and stroke (total, fatal and non-fatal) using multivariable-adjusted Prentice-weighted Cox regression. We estimated isocaloric substitutions of replacing fats and carbohydrates with plant- or animal-derived protein and replacing food-specific animal protein with plant protein. Multiplicative interactions between dietary protein and pre-specified variables were tested.RESULTS: Neither plant- nor animal-derived protein intake was associated with incident CVD, CHD or stroke in adjusted analyses without or with macronutrient-specified substitution analyses. Higher plant-derived protein intake was associated with 22% lower total stroke incidence among never smokers (HR 0.78, 95%CI: 0.62, 0.99), but not among current smokers (HR 1.08, 95%CI: 0.83, 1.40, p-interaction=0.004). Moreover, higher plant-derived protein (per 3% total energy) when replacing red meat protein (HR 0.52, 95%CI: 0.31, 0.88), processed meat protein (HR 0.39, 95%CI:0.17, 0.90) and dairy protein (HR 0.54, 95%CI:0.30, 0.98) was associated with lower incidence of fatal stroke.CONCLUSION: Plant- or animal-derived protein intake was not associated with overall CVD. However, the association of plant-derived protein consumption with lower total stroke incidence among non-smokers, and with lower incidence of fatal stroke highlights the importance of investigating CVD sub-types and potential interactions. These observations warrant further investigation in diverse populations with varying macronutrient intakes and dietary patterns.

AB - BACKGROUND: Epidemiological evidence suggests that a potential association between dietary protein intake and cardiovascular disease (CVD) may depend on the protein source, i.e. plant- or animal- derived, but past research was limited and inconclusive.OBJECTIVE: To evaluate the association of dietary plant- or animal-derived protein consumption with risk of CVD, and its components coronary heart disease (CHD) and stroke.METHODS: This analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD case-cohort study included 16244 incident CVD cases (10784 CHD and 6423 stroke cases) and 15141 subcohort members from seven European countries. We investigated the association of estimated dietary protein intake with CVD, CHD and stroke (total, fatal and non-fatal) using multivariable-adjusted Prentice-weighted Cox regression. We estimated isocaloric substitutions of replacing fats and carbohydrates with plant- or animal-derived protein and replacing food-specific animal protein with plant protein. Multiplicative interactions between dietary protein and pre-specified variables were tested.RESULTS: Neither plant- nor animal-derived protein intake was associated with incident CVD, CHD or stroke in adjusted analyses without or with macronutrient-specified substitution analyses. Higher plant-derived protein intake was associated with 22% lower total stroke incidence among never smokers (HR 0.78, 95%CI: 0.62, 0.99), but not among current smokers (HR 1.08, 95%CI: 0.83, 1.40, p-interaction=0.004). Moreover, higher plant-derived protein (per 3% total energy) when replacing red meat protein (HR 0.52, 95%CI: 0.31, 0.88), processed meat protein (HR 0.39, 95%CI:0.17, 0.90) and dairy protein (HR 0.54, 95%CI:0.30, 0.98) was associated with lower incidence of fatal stroke.CONCLUSION: Plant- or animal-derived protein intake was not associated with overall CVD. However, the association of plant-derived protein consumption with lower total stroke incidence among non-smokers, and with lower incidence of fatal stroke highlights the importance of investigating CVD sub-types and potential interactions. These observations warrant further investigation in diverse populations with varying macronutrient intakes and dietary patterns.

KW - plant-derived protein

KW - animal-derived protein

KW - cardiovascular disease

KW - stroke

KW - coronary heart disease

KW - ischemic heart disease

KW - Prospective Studies

KW - Cardiovascular Diseases/epidemiology

KW - Humans

KW - Middle Aged

KW - Risk Factors

KW - Male

KW - Plant Proteins, Dietary/administration & dosage

KW - Case-Control Studies

KW - Incidence

KW - Diet

KW - Europe/epidemiology

KW - Adult

KW - Female

KW - Stroke/epidemiology

KW - Aged

KW - Animal Proteins, Dietary/administration & dosage

KW - Dietary Proteins/administration & dosage

KW - Cohort Studies

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U2 - 10.1016/j.ajcnut.2024.03.006

DO - 10.1016/j.ajcnut.2024.03.006

M3 - Journal article

C2 - 38479550

SN - 0002-9165

VL - 119

SP - 1164

EP - 1174

JO - The American Journal of Clinical Nutrition

JF - The American Journal of Clinical Nutrition

IS - 5

ER -

Dietary intake of plant- and animal-derived protein and incident cardiovascular diseases: the pan-European EPIC-CVD case-cohort study

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