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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 4.

Risk of all-cause and cardiovascular mortality according to percent of energy from animal and plant protein intake among participants with healthy and unhealthy lifestyle*

Category 1 Category 2 Category 3 Category 4 Category 5 HR (95% CI) per certain increment Ptrend Pinteraction†
Animal protein
Intake category ≤ 10 % >10, ≤12 % >12, ≤15 % >15, ≤18 % >18 % Per 10% increment
All-cause mortality
 Healthy-lifestyle group
  No. of deaths 626 978 1,712 1,012 587
  HR (95% CI)‡ 1 (referent) 0.99 (0.88–1.10) 0.97 (0.87–1.08) 1.01 (0.89–1.14) 0.94 (0.81–1.09) 0.96 (0.86–1.07) 0.46 <0.001
 Unhealthy-lifestyle group
  No. of deaths 3,110 5,107 10,046 7,234 5,206
  HR (95% CI)‡ 1 (referent) 1.01 (0.96–1.05) 1.01 (0.97–1.06) 1.01 (0.96–1.06) 1.03 (0.98–1.09) 1.03 (0.99–1.07) 0.16
Cardiovascular mortality
 Healthy-lifestyle group
  No. of deaths 172 246 369 219 134
  HR (95% CI)‡ 1 (referent) 0.90 (0.72–1.12) 0.81 (0.65–1.01) 1.00 (0.77–1.29) 0.95 (0.70–1.29) 0.96 (0.76–1.20) 0.72 0.04
Unhealthy-lifestyle group
  No. of deaths 793 1,273 2,569 1,742 1,249
  HR (95% CI)‡ 1 (referent) 0.99 (0.90–1.08) 1.07 (0.98–1.16) 1.05 (0.95–1.16) 1.10 (0.98–1.23) 1.08 (1.00–1.17) 0.04
Plant protein
Intake category ≤3 % >3, ≤4 % >4, ≤5 % >5, ≤6 % >6 % Per 3% increment
All-cause mortality
Healthy-lifestyle group
  No. of deaths 467 997 1,312 1,210 929
  HR (95% CI)‡ 1 (referent) 1.07 (0.95–1.21) 1.05 (0.91–1.21) 0.98 (0.83–1.16) 0.95 (0.78–1.16) 0.95 (0.83–1.08) 0.44 <0.001
Unhealthy-lifestyle group
  No. of deaths 5,556 8,497 8,801 5,344 2,505
  HR (95% CI)‡ 1 (referent) 0.97 (0.94–1.01) 0.95 (0.90–0.99) 0.91 (0.86–0.96) 0.89 (0.83–0.96) 0.90 (0.85–0.95) <0.001
Cardiovascular mortality
  Healthy-lifestyle group
  No. of deaths 75 182 329 318 236
  HR (95% CI)‡ 1 (referent) 1.03 (0.76–1.39) 0.98 (0.70–1.37) 0.81 (0.55–1.19) 0.69 (0.44–1.07) 0.76 (0.57–1.01) 0.06 0.01
Unhealthy-lifestyle group
  No. of deaths 1,159 1,913 2,293 1,487 774
  HR (95% CI)‡ 1 (referent) 0.93 (0.86–1.01) 0.89 (0.81–0.98) 0.82 (0.73–0.92) 0.86 (0.74–1.00) 0.88 (0.79–0.98) 0.02

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

*

Healthy lifestyle was defined as never smoking or ever smoking with pack-years of <5, never or moderate alcohol drinking (<14 g/day in women, <28 g/day in men), BMI ≥ 18.5 and <27.5 kg/m2, and physical activity of ≥ 150-min/week at moderate level or ≥ 75 min/week at vigorous level (equivalent to ≥ 7.5 MET-hours/week).

†

Likelihood ratio test was used to calculate the P for interaction, by comparing the model with the product term between protein intake (continuous) and healthy lifestyle (binary) to the model without this term.

‡

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