Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies
Objectives: To systematically review the evidence on the effect of replacing the intake of animal protein with plant protein on cardiovascular disease (CVD) and type 2 diabetes (T2D) and their intermediate risk factors. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Tr...
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| Format: | Article |
| Language: | English |
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Swedish Nutrition Foundation
2023-03-01
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| Series: | Food & Nutrition Research |
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| Online Access: | https://foodandnutritionresearch.net/index.php/fnr/article/view/9003/15478 |
| _version_ | 1827970834783797248 |
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| author | Christel Lamberg-Allardt Linnea Bärebring Erik Kristoffer Arnesen Bright I. Nwaru Birna Thorisdottir Alfons Ramel Fredrik Söderlund Jutta Dierkes Agneta Åkesson |
| author_facet | Christel Lamberg-Allardt Linnea Bärebring Erik Kristoffer Arnesen Bright I. Nwaru Birna Thorisdottir Alfons Ramel Fredrik Söderlund Jutta Dierkes Agneta Åkesson |
| author_sort | Christel Lamberg-Allardt |
| collection | DOAJ |
| description | Objectives: To systematically review the evidence on the effect of replacing the intake of animal protein with plant protein on cardiovascular disease (CVD) and type 2 diabetes (T2D) and their intermediate risk factors. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 12th May 2022 for randomized controlled trials (RCTs) or prospective cohort studies that investigated replacement of animal protein with plant protein from foods. Outcomes were CVDs, T2D, and in RCTs also the effects on blood lipids, glycemic markers, and blood pressure. Risk of bias was evaluated with the Cochrane’s RoB2, ROBINS-I, and USDA’s RoB-NObS tools. Random-effects meta-analyses assessed the effects of plant vs. animal proteins on blood lipids in RCTs. The evidence was appraised according to the World Cancer Research Fund’s criteria. Results: After screening 15,090 titles/abstracts, full text of 124 papers was scrutinized in detail, from which 13 RCTs and seven cohort studies were included. Eight of the RCTs had either some concern or high risk of bias, while the corresponding evaluation of cohort studies resulted in moderate risk of bias for all seven. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference -0.11 mmol/L; 95% CI -0.22, -0.01) and low-density lipoprotein cholesterol (-0.14 mmol/L; 95% CI -0.25, -0.02) by replacing animal protein with plant protein. The substitution of animal protein with plant protein (percentage of energy intake) in cohort studies was associated with lower CVD mortality (n = 4) and lower T2D incidence (n = 2). The evidence was considered limited-suggestive for both outcomes. Conclusion: Evidence that the substitution of animal protein with plant protein reduces risk of both CVD mortality and T2D incidence is limited-suggestive. Replacing animal protein with plant protein for aspects of sustainability may also be a public health strategy to lower the risk of CVD mortality and T2D. |
| first_indexed | 2024-04-09T18:59:33Z |
| format | Article |
| id | doaj.art-bce22183ec6946ff920ab1d94843544b |
| institution | Directory Open Access Journal |
| issn | 1654-661X |
| language | English |
| last_indexed | 2024-04-09T18:59:33Z |
| publishDate | 2023-03-01 |
| publisher | Swedish Nutrition Foundation |
| record_format | Article |
| series | Food & Nutrition Research |
| spelling | doaj.art-bce22183ec6946ff920ab1d94843544b2023-04-08T15:52:39ZengSwedish Nutrition FoundationFood & Nutrition Research1654-661X2023-03-016712110.29219/fnr.v67.90039003Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studiesChristel Lamberg-Allardt0Linnea Bärebring1Erik Kristoffer Arnesen2Bright I. Nwaru3Birna Thorisdottir4Alfons Ramel5Fredrik Söderlund6Jutta Dierkes7Agneta Åkesson8Department of Food and Nutrition, University of Helsinki, FinlandDepartment of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SwedenDepartment of Nutrition, Institute of Basic Medical Sciences, University of Oslo, NorwayKrefting Research Centre, Institute of Medicine, University of Gothenburg, SwedenHealth Science Institute, University of Iceland, IcelandFaculty of Food Science and Nutrition, University of Iceland, IcelandUnit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, the Karolinska Institute, SwedenCentre for Nutrition, Department of Clinical Medicine, University of Bergen, Norway and Department of Laboratory Medicine and Pathology, Haukeland University Hospital, NorwayUnit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, the Karolinska Institute, SwedenObjectives: To systematically review the evidence on the effect of replacing the intake of animal protein with plant protein on cardiovascular disease (CVD) and type 2 diabetes (T2D) and their intermediate risk factors. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 12th May 2022 for randomized controlled trials (RCTs) or prospective cohort studies that investigated replacement of animal protein with plant protein from foods. Outcomes were CVDs, T2D, and in RCTs also the effects on blood lipids, glycemic markers, and blood pressure. Risk of bias was evaluated with the Cochrane’s RoB2, ROBINS-I, and USDA’s RoB-NObS tools. Random-effects meta-analyses assessed the effects of plant vs. animal proteins on blood lipids in RCTs. The evidence was appraised according to the World Cancer Research Fund’s criteria. Results: After screening 15,090 titles/abstracts, full text of 124 papers was scrutinized in detail, from which 13 RCTs and seven cohort studies were included. Eight of the RCTs had either some concern or high risk of bias, while the corresponding evaluation of cohort studies resulted in moderate risk of bias for all seven. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference -0.11 mmol/L; 95% CI -0.22, -0.01) and low-density lipoprotein cholesterol (-0.14 mmol/L; 95% CI -0.25, -0.02) by replacing animal protein with plant protein. The substitution of animal protein with plant protein (percentage of energy intake) in cohort studies was associated with lower CVD mortality (n = 4) and lower T2D incidence (n = 2). The evidence was considered limited-suggestive for both outcomes. Conclusion: Evidence that the substitution of animal protein with plant protein reduces risk of both CVD mortality and T2D incidence is limited-suggestive. Replacing animal protein with plant protein for aspects of sustainability may also be a public health strategy to lower the risk of CVD mortality and T2D.https://foodandnutritionresearch.net/index.php/fnr/article/view/9003/15478dietary proteinplant proteincardiovascular disease mortalityincidence of type 1 diabetesblood lipids |
| spellingShingle | Christel Lamberg-Allardt Linnea Bärebring Erik Kristoffer Arnesen Bright I. Nwaru Birna Thorisdottir Alfons Ramel Fredrik Söderlund Jutta Dierkes Agneta Åkesson Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies Food & Nutrition Research dietary protein plant protein cardiovascular disease mortality incidence of type 1 diabetes blood lipids |
| title | Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies |
| title_full | Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies |
| title_fullStr | Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies |
| title_full_unstemmed | Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies |
| title_short | Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies |
| title_sort | animal versus plant based protein and risk of cardiovascular disease and type 2 diabetes a systematic review of randomized controlled trials and prospective cohort studies |
| topic | dietary protein plant protein cardiovascular disease mortality incidence of type 1 diabetes blood lipids |
| url | https://foodandnutritionresearch.net/index.php/fnr/article/view/9003/15478 |
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