Objective

伊朗德黑兰医科大学的SinaNaghshi、Omid Sadeghi和美国哈佛大学陈曾熙公共卫生学院营养与流行病学系的Walter C Willett等人研究的目的是研究和量化总蛋白质、动物和植物蛋白质的摄入量与全因死亡率、心血管疾病死亡率和癌症死亡率的风险之间的潜在剂量-反应关系。

Design

对前瞻性队列研究的系统综述和荟萃分析。

Data sources

截至2019年12月,PubMed、Scopus和ISIWeb of Science的数据来源,以及检索到的相关文章的参考文献。

Study selection

前瞻性队列研究报告了18岁及以上的成年人的全因死亡率、心血管疾病死亡率和癌症死亡率的风险评估。

Data synthesis

利用数据合成随机效应模型计算最高和最低蛋白质摄入量的混合效应的大小和95%置信区间并纳入研究之间的差异。进行了线性和非线性剂量-反应分析,以评估蛋白质摄入量与死亡率之间的剂量-反应关系。

Results

32 项前瞻性队列研究被纳入系统综述,31项被纳入荟萃分析。在3.5~32 年的随访期内,715 128 名参与者中有113 039 人死亡(其中16 429 人归因于心血管疾病,22 303 人归因于癌症)。总蛋白质摄入量与较低的全因死亡率风险相关(混合效应为0.94,95%置信区间为0.89~0.99,I2 = 58.4%,P<0.001)。植物蛋白质摄入量与较低的全因死亡率(混合效应为0.92,95%置信区间为0.87~0.97,I 2 = 57.5%,P=0.003)和心血管疾病死亡率的风险显著相关(混合效应为0.88,95%置信区间为0.80~0.96,I2 = 63.7%,P=0.001),但与癌症死亡率无关。总蛋白质、动物蛋白质的摄入量与心血管疾病死亡率和癌症死亡率的风险并无显著相关。剂量-反应分析显示,植物蛋白摄入量与全因死亡率之间存在显著的剂量-反应负相关性(非线性,P= 0.05)。每天从植物蛋白中补充3%的额外能量可使全因死亡风险降低5%。

Conclusions

总蛋白质摄入量越高,全因死亡率越低,植物蛋白摄入量与较低的全因死亡率和心血管疾病死亡率的风险有关。用植物蛋白源代替动物蛋白含量高的食物可能与长寿有关。

Abstract

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

Sina Naghshi, Omid Sadeghi, Walter C Willett, Ahmad Esmaillzadeh

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 metaanalysis. 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.

该文章《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》于《BMJ》2020年7月出版。