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@ARTICLE{Zheng:288986,
      author       = {J.-S. Zheng and M. Steur and F. Imamura and H. Freisling
                      and L. Johnson and Y. T. van der Schouw and T. Y. N. Tong
                      and E. Weiderpass and R. Bajracharya$^*$ and M. Crous-Bou
                      and C. C. Dahm and A. K. Heath and D. B. Ibsen and F.
                      Jannasch and V. Katzke$^*$ and G. Masala and C.
                      Moreno-Iribas and C. Sacerdote and M. B. Schulze and S.
                      Sieri and N. J. Wareham and J. Danesh and A. S. Butterworth
                      and N. G. Forouhi},
      title        = {{D}ietary intake of plant- and animal-derived protein and
                      incident cardiovascular diseases: the pan-{E}uropean
                      {EPIC}-{CVD} case-cohort study.},
      journal      = {The American journal of clinical nutrition},
      volume       = {119},
      number       = {5},
      issn         = {0095-9871},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2024-00533},
      pages        = {1164-1174},
      year         = {2024},
      note         = {2024 May;119(5):1164-1174},
      abstract     = {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.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.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.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.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     = {animal-derived protein (Other) / cardiovascular disease
                      (Other) / coronary heart disease (Other) / plant-derived
                      protein (Other) / stroke (Other)},
      cin          = {C020},
      ddc          = {570},
      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:38479550},
      doi          = {10.1016/j.ajcnut.2024.03.006},
      url          = {https://inrepo02.dkfz.de/record/288986},
}