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@ARTICLE{Bajracharya:267550,
      author       = {R. Bajracharya$^*$ and V. Katzke$^*$ and T. Mukama$^*$ and
                      R. Kaaks$^*$},
      title        = {{E}ffect of {I}so-{C}aloric {S}ubstitution of {A}nimal
                      {P}rotein for {O}ther {M}acro {N}utrients on {R}isk of
                      {O}verall, {C}ardiovascular and {C}ancer {M}ortality:
                      {P}rospective {E}valuation in {EPIC}-{H}eidelberg {C}ohort
                      and {S}ystematic {R}eview.},
      journal      = {Nutrients},
      volume       = {15},
      number       = {3},
      issn         = {2072-6643},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2023-00328},
      pages        = {794},
      year         = {2023},
      note         = {#EA:C020#LA:C020#},
      abstract     = {Ecological studies showed correlations between a shift
                      toward animal-protein-rich diets and longer life-expectancy;
                      however, only a few studies examined individual-level
                      association of protein source and mortality risks using
                      appropriate iso-caloric substitution models adjusted for
                      total energy intake. We used EPIC-Heidelberg (European
                      Prospective Investigation into Cancer and nutrition) to
                      create iso-caloric substitution models and determined
                      relative all-cause, cardiovascular and cancer mortality
                      hazards associated with dietary intake of animal protein and
                      other macronutrients, employing Cox proportional hazard
                      models. For comparison with other studies, we also
                      synthesized evidence from a systematic review relating
                      animal protein intake to mortality risk from seven
                      prospective cohort studies in the USA, Europe and Japan.
                      Substitution of $3\%$ of total energy from animal protein
                      for fat (saturated, mono-unsaturated) and carbohydrate
                      (simple, complex) was associated with all-cause mortality
                      (Hazard Ratios [HR] from 1.05 to 1.11), mostly driven by
                      cardiovascular mortality (HR from 1.13 to 1.15).
                      Independently of animal protein, substituting
                      poly-unsaturated fat for saturated fat increased
                      cancer-related mortality risk by 12 percent. The systematic
                      review largely corroborated our findings. Overall, higher
                      proportions of dietary energy from animal protein, combined
                      with low energy intake from either carbohydrate sub-types or
                      dietary fats, increases all-cause and cardiovascular
                      mortality risks, but not cancer-related mortality.},
      keywords     = {animal protein (Other) / cancer mortality (Other) /
                      cardiovascular mortality (Other) / macronutrients (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36771499},
      doi          = {10.3390/nu15030794},
      url          = {https://inrepo02.dkfz.de/record/267550},
}