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. Author manuscript; available in PMC: 2017 Oct 1.
Published in final edited form as: JAMA Intern Med. 2016 Oct 1;176(10):1453–1463. doi: 10.1001/jamainternmed.2016.4182

Table 2.

Risk of all-cause and cause-specific mortality according to percent of energy from animal and plant protein intake

Category 1 Category 2 Category 3 Category 4 Category 5 HR (95% CI) per certain increment Ptrend
Animal protein
Intake category ≤ 10 % >10, ≤ 12 % >12, ≤ 15 % >15, ≤ 18 % >18 % Per 10% increment
Median intake (% energy) 8.9 11 14 16 20
Person-years 317,851 544,922 1,171,916 893,047 613,056
All-cause mortality
 No. of deaths 3,770 6,151 11,909 8,401 5,884
 Age-adjusted HR (95% CI)* 1 (referent) 0.97 (0.93–1.01) 0.97 (0.93–1.00) 0.98 (0.94–1.02) 1.01 (0.96–1.06) 1.03 (1.00–1.06) 0.09
 Multivariable-adjusted HR (95% CI)† 1 (referent) 1.01 (0.97–1.05) 1.03 (0.99–1.07) 1.03 (0.98–1.07) 1.03 (0.98–1.08) 1.02 (0.98–1.05) 0.33
Cardiovascular mortality
 No. of deaths 974 1,527 2,967 1,987 1,396
 Age-adjusted HR (95% CI)* 1 (referent) 0.94 (0.87–1.02) 1.01 (0.94–1.09) 1.07 (0.99–1.17) 1.19 (1.09–1.30) 1.20 (1.12–1.28) <0.001
 Multivariable-adjusted HR (95% CI)† 1 (referent) 0.98 (0.90–1.07) 1.05 (0.97–1.14) 1.06 (0.97–1.16) 1.09 (0.99–1.20) 1.08 (1.01–1.16) 0.04
Cancer mortality
 No. of deaths 1,322 2,176 4,325 3,136 2,200
 Age-adjusted HR (95% CI)* 1 (referent) 0.96 (0.89–1.02) 0.94 (0.88–1.00) 0.93 (0.87–1.00) 0.94 (0.87–1.02) 0.96 (0.91–1.01) 0.15
 Multivariable-adjusted HR (95% CI)† 1 (referent) 1.00 (0.93–1.07) 1.01 (0.94–1.08) 1.01 (0.94–1.09) 1.02 (0.94–1.11) 1.00 (0.95–1.06) 0.91
Other mortality
 No. of deaths 1,474 2,448 4,617 3,278 2,288
 Age-adjusted HR (95% CI)* 1 (referent) 0.99 (0.92–1.05) 0.96 (0.90–1.02) 0.96 (0.90–1.02) 0.97 (0.90–1.05) 0.99 (0.95–1.04) 0.80
 Multivariable-adjusted HR (95% CI)† 1 (referent) 1.04 (0.97–1.11) 1.02 (0.96–1.09) 1.01 (0.94–1.08) 0.99 (0.92–1.07) 0.99 (0.94–1.05) 0.80
Plant protein
Intake category ≤ 3 % >3, ≤ 4 % >4, ≤ 5 % >5, ≤ 6 % >6 % Per 3% increment
Median intake (% energy) 2.6 3.5 4.5 5.4 6.6
Person-years 710,592 1,060,873 929,193 550,015 290,118
All-cause mortality
 No. of deaths 6,160 9,661 10,235 6,602 3,457
 Age-adjusted HR (95% CI)* 1 (referent) 0.92 (0.89–0.96) 0.85 (0.82–0.89) 0.72 (0.69–0.76) 0.67 (0.63–0.70) 0.73 (0.70–0.75) <0.001
 Multivariable-adjusted HR (95% CI)† 1 (referent) 0.97 (0.94–1.01) 0.95 (0.91–0.99) 0.91 (0.86–0.96) 0.89 (0.84–0.96) 0.90 (0.86–0.95) <0.001
Cardiovascular mortality
 No. of deaths 1,260 2,126 2,638 1,811 1,016
 Age-adjusted HR (95% CI)* 1 (referent) 0.88 (0.82–0.95) 0.78 (0.72–0.85) 0.63 (0.57–0.69) 0.60 (0.53–0.67) 0.67 (0.62–0.72) <0.001
 Multivariable-adjusted HR (95% CI)† 1 (referent) 0.93 (0.86–1.01) 0.90 (0.82–0.99) 0.83 (0.74–0.93) 0.85 (0.74–0.97) 0.88 (0.80–0.97) 0.007
Cancer mortality
 No. of deaths 2,372 3,678 3,664 2,330 1,115
 Age-adjusted HR (95% CI)* 1 (referent) 0.98 (0.92–1.03) 0.93 (0.87–0.99) 0.83 (0.77–0.90) 0.72 (0.65–0.79) 0.80 (0.75–0.85) <0.001
 Multivariable-adjusted HR (95% CI)† 1 (referent) 1.02 (0.97–1.08) 1.02 (0.95–1.09) 1.01 (0.92–1.10) 0.92 (0.82–1.03) 0.97 (0.90–1.05) 0.46
Other mortality
 No. of deaths 2,528 3,857 3,933 2,461 1,326
 Age-adjusted HR (95% CI)* 1 (referent) 0.90 (0.85–0.95) 0.82 (0.78–0.88) 0.69 (0.64–0.74) 0.66 (0.60–0.72) 0.70 (0.66–0.74) <0.001
 Multivariable-adjusted HR (95% CI)† 1 (referent) 0.95 (0.90–1.00) 0.91 (0.86–0.98) 0.86 (0.79–0.94) 0.89 (0.80–0.99) 0.86 (0.79–0.92) <0.001

Abbreviations: CI, confidence interval; HR, hazard ratio.

*

Cox proportional hazards model with age as the time scale was stratified by sex and calendar time, and adjusted for total caloric intake, and percent of energy from saturated fat, polyunsaturated fat, monounsaturated fat, and trans fat (all continuous).

†

Multivariable model was further adjusted for multivitamin use (yes or no), smoking status (never, past smokers, current smokers 1–14, and 15+ cigarettes/day), pack-years of smoking (in women: ≤15, 16–25, 26–45, >45; in men: <10, 11–24, 25–44, ≥45), body mass index (<23.0, 23.0–24.9, 25.0–26.9, 27.0–29.9, 30.0–34.9, ≥35 kg/m2), physical activity (quintiles), alcohol consumption (in women: 0, 0.1–5.0, 5.1–15.0, and >15.0 g/d; in men: 0, 0.1–10.0, 10.1–20.0, and >20.0 g/d), history of hypertension diagnosis (yes or no), glycemic index (in quintiles), and intake of whole grains, total fiber, fruits, and vegetables (all in quintiles). Mutual adjustment was conducted for animal protein and plant protein analysis.