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

AbstractObjectiveTo 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.DesignSystematic review and meta-analysis of prospective cohort studies.Data sourcesPubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles.Study selectionProspective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older.Data synthesisRandom 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.Results32 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.ConclusionsHigher 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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Abstract MP48: Whole Grain Intake is Inversely Associated with Mortality From All Causes, Cardiovascular Disease, and Cancer in a Dose-response Manner, a Meta-analysis of Prospective Cohort Studies

Circulation ◽

10.1161/circ.133.suppl_1.mp48 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Geng Zong ◽

Alisa Gao ◽

Frank Hu ◽

Qi Sun

Keyword(s):

Cohort Studies ◽

Dose Response ◽

Cancer Mortality ◽

Prospective Cohort ◽

Meta Analysis ◽

Multiple Chronic Conditions ◽

Whole Grain ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Cvd Mortality

Introduction: Whole grain intake has been associated with lower risks of multiple chronic conditions, but its association with mortality warrants further evaluation. Hypothesis: We performed a meta-analysis of prospective cohort studies on the association of whole grain intake with all-cause and cause-specific mortality, and tested the hypothesis that they followed inverse dose-response pattern. Methods: Published studies reporting relative risks (RRs) between whole grain consumption and mortality from Medline and Embase through August, 2015. Original results from National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2004 were included. Whole grain ingredients (gram/day) were estimated among studies reporting RRs for ≥3 categories of whole grain intake. Results: Fourteen unique analyses were included, which consisted of 786,076 participants, 97,867 all-cause deaths, 23,957 CVD deaths, and 37,492 cancer deaths. Pooled RRs (95% confidence intervals) comparing high with low whole grain categories were 0.84 (0.80, 0.88; P <0.001, I2=74%, P heterogeneity<0.001) for all-cause mortality, 0.82 (0.79, 0.85; P <0.001, I2=0%, P heterogeneity=0.53) for CVD mortality, and 0.88(0.83, 0.94; P <0.001, I2=54%, P heterogeneity=0.02) for cancer mortality. Whole grain consumption was <50 grams/day among most studies. Dose-response meta-analysis showed strong monotonic associations between whole grain and mortality (All P nonlinearity > 0.05): RRs (95%CIs) for each 16 grams/day increase (approximately 1 serving/day) in whole grain were 0.93(0.92, 0.94) for all-cause mortality, 0.91(0.90, 0.93) for CVD mortality, and 0.95(0.94, 0.96) for cancer mortality. These findings were robust in several stratified analyses and/or sensitivity analyses. Egger’s test did not suggest significant publication bias. Conclusions: Our findings supported health benefit of increasing current whole grain intake of <1 serving/day to ≥3 servings/day as recommended by current Dietary Guidelines for Americans.

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Dietary intake and biomarkers of alpha linolenic acid and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of cohort studies

BMJ ◽

10.1136/bmj.n2213 ◽

2021 ◽

pp. n2213 ◽

Cited By ~ 1

Author(s):

Sina Naghshi ◽

Dagfinn Aune ◽

Joseph Beyene ◽

Sara Mobarak ◽

Masoomeh Asadi ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Dose Response ◽

Cancer Mortality ◽

Prospective Cohort ◽

Lower Risk ◽

Meta Analysis ◽

Response Analysis ◽

Prospective Cohort Studies ◽

Risk Of Cancer

Abstract Objective To examine the associations between dietary intake and tissue biomarkers of alpha linolenic acid (ALA) and risk of mortality from all causes, cardiovascular disease (CVD), and cancer. Design Systematic review and meta-analysis of prospective cohort studies. Data sources PubMed, Scopus, ISI Web of Science, and Google Scholar to 30 April 2021. Study selection Prospective cohort studies that reported the risk estimates for death from all causes, CVD, and cancer. Data synthesis Summary relative risks and 95% confidence intervals were calculated for the highest versus lowest categories of ALA intake using random effects and fixed effects models. Linear and non-linear dose-response analyses were conducted to assess the dose-response associations between ALA intake and mortality. Results 41 articles from prospective cohort studies were included in this systematic review and meta-analysis, totalling 1 197 564 participants. During follow-up ranging from two to 32 years, 198 113 deaths from all causes, 62 773 from CVD, and 65 954 from cancer were recorded. High intake of ALA compared with low intake was significantly associated with a lower risk of deaths from all causes (pooled relative risk 0.90, 95% confidence interval 0.83 to 0.97, I 2 =77.8%, 15 studies), CVD (0.92, 0.86 to 0.99, I 2 =48.2%, n=16), and coronary heart disease (CHD) (0.89, 0.81 to 0.97, I 2 =5.6%, n=9), and a slightly higher risk of cancer mortality (1.06, 1.02 to 1.11, I 2 =3.8%, n=10). In the dose-response analysis, a 1 g/day increase in ALA intake (equivalent to one tablespoon of canola oil or 0.5 ounces of walnut) was associated with a 5% lower risk of all cause (0.95, 0.91 to 0.99, I 2 =76.2%, n=12) and CVD mortality (0.95, 0.91 to 0.98, I 2 =30.7%, n=14). The pooled relative risks for the highest compared with lowest tissue levels of ALA indicated a significant inverse association with all cause mortality (0.95, 0.90 to 0.99, I 2 =8.2%, n=26). Also, based on the dose-response analysis, each 1 standard deviation increment in blood concentrations of ALA was associated with a lower risk of CHD mortality (0.92, 0.86 to 0.98, I 2 =37.1%, n=14). Conclusions The findings show that dietary ALA intake is associated with a reduced risk of mortality from all causes, CVD, and CHD, and a slightly higher risk of cancer mortality, whereas higher blood levels of ALA are associated with a reduced risk of all cause and CHD mortality only. Systematic review registration PROSPERO CRD42021229487.

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The association between napping and the risk of cardiovascular disease and all-cause mortality: a systematic review and dose-response meta-analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2818 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Z Pan ◽

M Huang ◽

J Huang ◽

Z Yao

Keyword(s):

Cardiovascular Disease ◽

Cohort Studies ◽

Dose Response ◽

Prospective Cohort ◽

Meta Analysis ◽

Random Effect ◽

Response Analysis ◽

Night Sleep ◽

Prospective Cohort Studies ◽

All Cause Mortality

Abstract Background Napping is a habit prevalent worldwide and occurs from an early age. Some sleep specialists have suggested it as a potential public health tool due to the prevalence of sleep disorder. However, the association between napping and the risk of cardiovascular disease (CVD) and all-cause mortality remains unclear. Purpose To assess the association between napping and the risk of CVD and all-cause mortality. Methods We conducted a systematic search of Medline, Embase and Cochrane databases from inception through December 2019 for prospective cohort studies investigating the association between napping and the risk of CVD and/or all-cause mortality. Overall estimates were calculated using random effect models with inverse variance weighting. Dose-response meta-analysis was performed using restricted cubic spline models. The results were reported as hazard ratio (HR) and 95% confidence interval (CI). Results A total of 313651 participants (57.8% female, 38.9% took naps) from 20 cohort studies were included in the analysis. Overall, pooled analysis detected no association between daytime nap and CVD (HR 1.13, 95% CI 0.99–1.28). However, in subgroup analysis including only participants who were female (HR 1.31, 95% CI 1.09–1.58), older (age>65 years) (HR 1.36, 95% CI 1.07–1.72), or took a longer nap (nap time>60 minutes) (HR 1.34, 95% CI 1.05–1.63), napping was significantly associated with a higher risk of CVD comparing to not napping. All-cause mortality was associated with napping overall (HR 1.19, 95% CI 1.12–1.26), and effect sizes were even more pronounced in females (HR 1.22, 95% CI 1.13–1.31), older participants (HR 1.27, 95% CI 1.11–1.45) and those who took a long nap (HR 1.30, 95% CI 1.12–1.47). Furthermore, after stratifying participants by night sleep time (<6 and >6h/day), no significant association was detected except those who slept >6h/day at night and took a long nap (HR 1.13, 95% CI 1.03–1.24). Dose-response analysis showed a J-curve relation between nap time and CVD (Figure 1). The HR decreased from 0 to 25 min/day, followed by a sharp increase in the risk at longer times. A positive linear relationship between nap time and all-cause mortality was also observed. Conclusion Long napping over 60 minutes per day is associated with increased risks of CVD and all-cause mortality. Night sleep duration may play a role in the relation between napping and all-cause mortality. Further, large-scale prospective cohort studies need to confirm our conclusion and investigate the underlying mechanisms driving these associations. Funding Acknowledgement Type of funding source: None

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Dose–Response Relation between Tea Consumption and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis of Population-Based Studies

Advances in Nutrition ◽

10.1093/advances/nmaa010 ◽

2020 ◽

Vol 11 (4) ◽

pp. 790-814 ◽

Cited By ~ 4

Author(s):

Mei Chung ◽

Naisi Zhao ◽

Deena Wang ◽

Marissa Shams-White ◽

Micaela Karlsen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Studies ◽

Prospective Cohort ◽

Lower Risk ◽

Meta Analysis ◽

Risk Of Bias ◽

Tea Consumption ◽

All Cause Mortality ◽

Specific Mortality ◽

Cvd Mortality

ABSTRACT Tea flavonoids have been suggested to offer potential benefits to cardiovascular health. This review synthesized the evidence on the relation between tea consumption and risks of cardiovascular disease (CVD) and all-cause mortality among generally healthy adults. PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Food Science and Technology Abstracts, and Ovid CAB Abstract databases were searched to identify English-language publications through 1 November 2019, including randomized trials, prospective cohort studies, and nested case-control (or case-cohort) studies with data on tea consumption and risk of incident cardiovascular events (cardiac or peripheral vascular events), stroke events (including mortality), CVD-specific mortality, or all-cause mortality. Data from 39 prospective cohort publications were synthesized. Linear meta-regression showed that each cup (236.6 mL) increase in daily tea consumption (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of CVD mortality, a 2% lower risk of CVD events, a 4% lower risk of stroke, and a 1.5% lower risk of all-cause mortality. Subgroup meta-analysis results showed that the magnitude of association was larger in elderly individuals for both CVD mortality (n = 4; pooled adjusted RR: 0.89; 95% CI: 0.83, 0.96; P = 0.001), with large heterogeneity (I2 = 72.4%), and all-cause mortality (n = 3; pooled adjusted RR: 0.92; 95% CI: 0.90, 0.94; P < 0.0001; I2 = 0.3%). Generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias. Strength of evidence was rated as low and moderate (depending on study population age group) for CVD-specific mortality outcome and was rated as low for CVD events, stroke, and all-cause mortality outcomes. Daily tea intake as part of a healthy habitual dietary pattern may be associated with lower risks of CVD and all-cause mortality among adults.

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