ArticleThe American journal of clinical nutrition2024
Dietary plant-to-animal protein ratio and risk of cardiovascular disease in 3 prospective cohorts.
Article in The American journal of clinical nutrition, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Structural characterization and functional properties of safflower seed protein extracted by natural deep eutectic solvents.Food chemistry: X · 2026Article
- Dietary diversity in Mediterranean countries is characterized by amino acid and fatty acid profiles.European journal of nutrition · 2026Article
- Sustaining Muscle, Cardiovascular Health, and the Environment: Is Plant-Based Protein the Key?Nutrients · 2026Review
- Protein Paradox: Protein Quality Based on Amino Acids Composition is Poorly Associated with Health Outcomes.Current nutrition reports · 2026Review
- Higher plasma serine levels are associated with favorable values of metabolic health markers among middle-aged and older adults in The Maastricht Study.GeroScience · 2026Article
- Article
- Nutritional and Metabolic Interventions to Prevent and Treat Protein-Energy Wasting in Nondialysis CKD-Narrative Review.Nutrients · 2026Review
- Review
- Branched-chain amino acids from plants and the metabolic syndrome: pathways and pharmacological applications.Frontiers in nutrition · 2026Review
- Nutritional Quality, Safety and Environmental Benefits of Alternative Protein Sources-An Overview.Nutrients · 2025Review
- Red Meat Consumption and Hypertension: An Updated Review.Current cardiology reports · 2025Review
- Dietary guidance on plant-based meat alternatives for individuals wanting to increase plant protein intake.Frontiers in nutrition · 2025Article
- Redefining Protein Quality: Integrating Health Outcomes and Environmental Impacts in the Plant-Animal Protein Debate.Foods (Basel, Switzerland) · 2024Article
- Fatty acid profile, vitamin D, and iodine status in Taiwanese vegans, vegetarians, and omnivores.Tzu chi medical journalArticle
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Authors and funding
11 authors.
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Abstract
backgroundDietary guidelines recommend substituting animal protein with plant protein, however, the ideal ratio of plant-to-animal protein (P:A) remains unknown.
objectivesWe aimed to evaluate associations between the P:A ratio and incident cardiovascular disease (CVD), coronary artery disease (CAD), and stroke in 3 cohorts.
methodsMultivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) for CVD outcomes among 70,918 females in the Nurses' Health Study (NHS) (1984-2016), 89,205 females in the NHSII (1991-2017) and 42,740 males from the Health Professionals Follow-up Study (1986-2016). The P:A ratio was based on percent energy from plant and animal protein and assessed using food frequency questionnaires every 4 y.
resultsDuring 30 y of follow-up, 16,118 incident CVD cases occurred. In the pooled multivariable-adjusted models, participants had a lower risk of total CVD [HR: 0.81; 95% confidence interval (CI): 0.76, 0.87; P trend < 0.001], CAD (HR: 0.73; 95% CI: 0.67, 0.79; P trend < 0.001), but not stroke (HR: 0.98; 95% CI: 0.88, 1.09; P trend = 0.71), when comparing highest to lowest deciles of the P:A ratio (ratio: ∼0.76 compared with ∼0.24). Dose-response analyses showed evidence of linear and nonlinear relationships for CVD and CAD, with more marked risk reductions early in the dose-response curve. Lower risk of CVD (HR: 0.72; 95% CI: 0.64, 0.82) and CAD (HR: 0.64; 95% CI: 0.55, 0.75) were also observed with higher ratios and protein density (20.8% energy) combined. Substitution analyses indicated that replacing red and processed meat with several plant protein sources showed the greatest cardiovascular benefit.
conclusionsIn cohort studies of United States adults, a higher plant-to-animal protein ratio is associated with lower risks of CVD and CAD, but not stroke. Furthermore, a higher ratio combined with higher protein density showed the most cardiovascular benefit.
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