High dietary protein intake is associated with an increased body weight and total death risk

  • Pablo Hernández-Alonso
    Affiliations
    Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain
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  • Jordi Salas-Salvadó
    Correspondence
    Corresponding authors. Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201 Reus, Spain. Tel.: +34 977759312; fax: +34 977759322.
    Affiliations
    Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain

    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain
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  • Miguel Ruiz-Canela
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Primary Health Care, Servicio Navarro de Salud, Health Care Centre of Azpilagaña, Pamplona, Spain
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  • Dolores Corella
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Department of Preventive Medicine, University of Valencia, València, Spain
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  • Ramón Estruch
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Department of Internal Medicine, Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
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  • Montserrat Fitó
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Cardiovascular Risk and Nutrition Research Group (Regicor Study Group), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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  • Fernando Arós
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Department of Cardiology, University Hospital Txagorritxu, Vitoria, Spain
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  • Enrique Gómez-Gracia
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Department of Preventive Medicine, University of Malaga, Malaga, Spain
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  • Miquel Fiol
    Affiliations
    Health Research Institute of Palma (IdISPa). Hospital Son Espases, Palma de Mallorca, Spain
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  • José Lapetra
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Centro de Salud San Pablo, Sevilla, Spain
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  • Josep Basora
    Affiliations
    Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain

    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain
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  • Lluis Serra-Majem
    Affiliations
    Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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  • Miguel Ángel Muñoz
    Affiliations
    Primary Health Care Division and Research, Instituto de Investigaciones Biomédicas August Pi i Sunyer-Jordi Gol, Barcelona, Spain
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  • Pilar Buil-Cosiales
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Primary Health Care, Servicio Navarro de Salud, Health Care Centre of Azpilagaña, Pamplona, Spain
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  • Carmen Saiz
    Affiliations
    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain

    Department of Preventive Medicine, University of Valencia, València, Spain
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  • Mònica Bulló
    Correspondence
    Corresponding authors. Human Nutrition Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201 Reus, Spain. Tel.: +34 977759312; fax: +34 977759322.
    Affiliations
    Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain

    CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain
    Search for articles by this author
Published:April 07, 2015DOI:https://doi.org/10.1016/j.clnu.2015.03.016

      Highlights

      • Higher protein intake is related to a high risk of weight gain and death at long-term.
      • Higher animal protein intake is related to fatal and non-fatal cardiovascular outcomes.
      • No association was found between protein intake and abdominal obesity.

      Summary

      Background & aims

      High dietary protein diets are widely used to manage overweight and obesity. However, there is a lack of consensus about their long-term efficacy and safety. Therefore, the aim of this study was to assess the effect of long-term high-protein consumption on body weight changes and death outcomes in subjects at high cardiovascular risk.

      Methods

      A secondary analysis of the PREDIMED trial was conducted. Dietary protein was assessed using a food-frequency questionnaire during the follow-up. Cox proportional hazard models were used to estimate the multivariate-adjusted hazard ratio (HR) and 95% confidence intervals (95%CI) for protein intake in relation to the risk of body weight and waist circumference changes, cardiovascular disease, cardiovascular death, cancer death and total death.

      Results

      Higher total protein intake, expressed as percentage of energy, was significantly associated with a greater risk of weight gain when protein replaced carbohydrates (HR: 1.90; 95%CI: 1.05, 3.46) but not when replaced fat (HR: 1.69; 95%CI: 0.94, 3.03). However, no association was found between protein intake and waist circumference. Contrary, higher total protein intake was associated with a greater risk of all-cause death in both carbohydrate and fat substitution models (HR: 1.59; 95%CI: 1.08, 2.35; and HR: 1.66; 95%CI: 1.13, 2.43, respectively). A higher consumption of animal protein was associated with an increased risk of fatal and non-fatal outcomes when protein substituted carbohydrates or fat.

      Conclusions

      Higher dietary protein intake is associated with long-term increased risk of body weight gain and overall death in a Mediterranean population at high cardiovascular risk.

      Keywords

      Abbreviations:

      BMI (body mass index), BW (body weight), CI (confidence interval), CVD (cardiovascular disease), E% (percentage of energy), EPIC (European Prospective Investigation into Cancer and Nutrition), FFQ (food frequency questionnaire), g prot/kg BW/d (g protein/kg body weight/day), HDL (high-density lipoprotein), HPD (high-protein diet), HPFS (Health Professionals' Follow-up Study), HR (hazard ratio), LC (low carbohydrate), LCHP (LC-high protein), LDL (low-density lipoprotein), LPD (low-protein diet), NHS (Nurses' Health Study), q-trend (quadratic-trend), RCT (randomized controlled trial), T2D (type 2 diabetes), WC (waist circumference)
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