Table 3.
Risk for Cardiovascular Disease, Coronary Heart Disease, and Stroke Mortality According to Quintile of Dietary Protein Sources Consumption
| Dietary protein sources | Quintile of intake | p trend | 3 servings/week | ||||
|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |||
| Total red meat | |||||||
| Cardiovascular disease | |||||||
| Median intake, serving/day | 0.02 | 0.07 | 0.13 | 0.23 | 0.43 | ||
| No. of deaths/person-year | 339/65,241 | 271/67,685 | 295/68,133 | 291/68,990 | 271/69,818 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.86 (0.73, 1.01) | 0.99 (0.85, 1.16) | 1.00 (0.86, 1.17) | 0.96 (0.82, 1.13) | 0.74 | 1.03 (0.94, 1.13) |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.93 (0.79, 1.09) | 1.11 (0.94, 1.31) | 1.12 (0.95, 1.33) | 1.07 (0.90, 1.28) | 0.20 | 1.04 (0.95, 1.15) |
| Coronary heart disease | |||||||
| No. of deaths/person-year | 153/65,241 | 145/67,685 | 170/68,133 | 143/68,990 | 153/69,818 | ||
| Age-adjusted HR (95% CI)a | 1 | 1.01 (0.80, 1.27) | 1.24 (1.00, 1.55) | 1.07 (0.85, 1.34) | 1.17 (0.94, 1.47) | 0.19 | 1.08 (0.96, 1.21) |
| Multivariate-adjusted HR (95% CI)b | 1 | 1.09 (0.86, 1.38) | 1.37 (1.09, 1.73) | 1.16 (0.91, 1.48) | 1.22 (0.95, 1.56) | 0.29 | 1.04 (0.91, 1.18) |
| Stroke | |||||||
| No. of deaths/person-year | 131/65,241 | 90/67,685 | 96/68,133 | 102/68,990 | 88/69,818 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.75 (0.58, 0.99) | 0.86 (0.66, 1.12) | 0.94 (0.73, 1.23) | 0.85 (0.65, 1.11) | 0.71 | 0.99 (0.83, 1.18) |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.78 (0.60, 1.03) | 0.96 (0.73, 1.26) | 1.07 (0.81, 1.41) | 1.00 (0.74, 1.34) | 0.41 | 1.05 (0.89, 1.24) |
| Poultry | |||||||
| Cardiovascular disease | |||||||
| Median intake, serving/day | 0.11 | 0.33 | 0.54 | 0.78 | 1.33 | ||
| No. of deaths/person-year | 310/70,172 | 277/68,732 | 295/67,769 | 266/67,029 | 319/66,165 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.92 (0.78, 1.08) | 0.98 (0.83, 1.15) | 0.87 (0.73, 1.02) | 0.92 (0.79, 1.08) | 0.33 | 0.97 (0.93, 1.03) |
| Multivariate, adjusted HR (95% CI)b | 1 | 0.93 (0.79, 1.10) | 1.04 (0.89, 1.22) | 0.95 (0.80, 1.12) | 1.03 (0.87, 1.21) | 0.63 | 1.01 (0.96, 1.07) |
| Coronary heart disease | |||||||
| No. of deaths/person-year | 164/70,172 | 131/68,732 | 162/67,769 | 140/67,029 | 167/66,165 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.82 (0.65, 1.03) | 1.02 (0.82, 1.26) | 0.87 (0.69, 1.08) | 0.93 (0.75, 1.16) | 0.79 | 0.99 (0.92, 1.06) |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.83 (0.66, 1.04) | 1.06 (0.85, 1.32) | 0.92 (0.73, 1.15) | 0.97 (0.77, 1.22) | 0.90 | 1.00 (0.93, 1.08) |
| Stroke | |||||||
| No. of deaths/person-year | 109/70,172 | 93/68,732 | 97/67,769 | 96/67,029 | 112/66,165 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.88 (0.66, 1.15) | 0.91 (0.69, 1.19) | 0.88 (0.67, 1.16) | 0.89 (0.68, 1.16) | 0.53 | 0.97 (0.89, 1.06) |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.89 (0.68, 1.18) | 0.98 (0.75, 1.30) | 0.99 (0.75, 1.31) | 1.06 (0.80, 1.39) | 0.47 | 1.03 (0.94, 1.13) |
| Fishc | |||||||
| Cardiovascular disease | |||||||
| Median intake, serving/day | 0 | 0.01 | 0.06 | 0.19 | |||
| No. of deaths/person-year | 386/68,316 | 396/90,608 | 356/90,242 | 329/90,701 | |||
| Age-adjusted HR (95% CI)a | 1 | 0.89 (0.77, 1.02) | 0.86 (0.74, 0.99) | 0.83 (0.71, 0.96) | 0.04 | 0.73 (0.54, 0.99) | |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.95 (0.82, 1.09) | 0.95 (0.82, 1.10) | 0.96 (0.82, 1.13) | 0.88 | 0.98 (0.70, 1.36) | |
| Coronary heart disease | |||||||
| No. of deaths/person-year | 198/68,316 | 192/90,608 | 188/90,242 | 186/90,701 | |||
| Age-adjusted HR (95% CI)a | 1 | 0.83 (0.68, 1.01) | 0.86 (0.70, 1.05) | 0.89 (0.72, 1.08) | 0.72 | 0.93 (0.61, 1.40) | |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.85 (0.70, 1.04) | 0.90 (0.73, 1.10) | 0.93 (0.75, 1.16) | 0.94 | 1.02 (0.65, 1.59) | |
| Stroke | |||||||
| No. of deaths/person-year | 131/68,316 | 145/90,608 | 129/90,242 | 102/90,701 | |||
| Age-adjusted HR (95% CI)a | 1 | 0.99 (0.78, 1.25) | 0.95 (0.74, 1.21) | 0.79 (0.61, 1.03) | 0.05 | 0.58 (0.34, 1.00) | |
| Multivariate-adjusted HR (95% CI)b | 1 | 1.11 (0.87, 1.41) | 1.15 (0.89, 1.47) | 1.03 (0.78, 1.36) | 0.90 | 0.96 (0.54, 1.70) | |
| Eggsc | |||||||
| Cardiovascular disease | |||||||
| Median intake, serving/day | 0 | 0.06 | 0.18 | 0.48 | |||
| No. of deaths/person-year | 396/69,165 | 374/82,907 | 348/95,280 | 349/92,515 | |||
| Age-adjusted HR (95% CI)a | 1 | 0.95 (0.82, 1.09) | 0.88 (0.76, 1.02) | 0.93 (0.80, 1.07) | 0.41 | 0.95 (0.84, 1.07) | |
| Multivariate-adjusted HR (95% CI)b | 1 | 1.01 (0.87, 1.16) | 0.93 (0.80, 1.08) | 0.92 (0.79, 1.07) | 0.22 | 0.92 (0.81, 1.05) | |
| Coronary heart disease | |||||||
| No. of deaths/person-year | 190/69,165 | 192/82,907 | 193/95,280 | 189/92,515 | |||
| Age-adjusted HR (95% CI)a | 1 | 1.00 (0.82, 1.22) | 0.98 (0.80, 1.20) | 1.01 (0.82, 1.24) | 0.90 | 1.01 (0.86, 1.20) | |
| Multivariate-adjusted HR (95% CI)b | 1 | 1.03 (0.84, 1.26) | 0.99 (0.80, 1.21) | 0.92 (0.74, 1.14) | 0.31 | 0.91 (0.77, 1.09) | |
| Stroke | |||||||
| No. of deaths/person-year | 152/69,165 | 134/82,907 | 104/95,280 | 117/92,515 | |||
| Age-adjusted HR (95% CI)a | 1 | 0.91 (0.72, 1.14) | 0.72 (0.56, 0.92) | 0.86 (0.67, 1.09) | 0.27 | 0.89 (0.72, 1.10) | |
| Multivariate-adjusted HR (95% CI)b | 1 | 1.00 (0.79, 1.26) | 0.80 (0.62, 1.04) | 0.94 (0.73, 1.21) | 0.56 | 0.94 (0.75, 1.17) | |
| Legumes | |||||||
| Cardiovascular disease | |||||||
| Median intake, serving/day | 0.03 | 0.08 | 0.12 | 0.17 | 0.26 | ||
| No. of deaths/person-year | 330/69,186 | 279/68,484 | 247/67,714 | 285/67,013 | 326/67,470 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.93 (0.80, 1.09) | 0.83 (0.70, 0.98) | 0.96 (0.82, 1.12) | 0.97 (0.83, 1.13) | 0.98 | 1.00 (0.76, 1.31) |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.99 (0.84, 1.16) | 0.89 (0.76, 1.06) | 1.03 (0.88, 1.21) | 1.05 (0.89, 1.23) | 0.40 | 1.13 (0.85, 1.51) |
| Coronary heart disease | |||||||
| No. of deaths/person-year | 160/69,186 | 155/68,484 | 127/67,714 | 149/67,013 | 173/67,470 | ||
| Age-adjusted HR (95% CI)a | 1 | 1.06 (0.85, 1.32) | 0.87 (0.69, 1.10) | 1.02 (0.82, 1.28) | 1.06 (0.86, 1.32) | 0.57 | 1.12 (0.77, 1.62) |
| Multivariate-adjusted HR (95% CI)b | 1 | 1.10 (0.88, 1.37) | 0.92 (0.72, 1.16) | 1.06 (0.85, 1.33) | 1.08 (0.86, 1.36) | 0.57 | 1.12 (0.75, 1.67) |
| Stroke | |||||||
| No. of deaths/person-year | 120/69,186 | 86/68,484 | 88/67,714 | 109/67,013 | 104/67,470 | ||
| Age-adjusted HR (95% CI)a | 1 | 0.81 (0.61, 1.06) | 0.83 (0.63, 1.09) | 1.02 (0.79, 1.33) | 0.84 (0.65, 1.09) | 0.58 | 0.88 (0.55, 1.39) |
| Multivariate-adjusted HR (95% CI)b | 1 | 0.86 (0.65, 1.14) | 0.91 (0.69, 1.20) | 1.15 (0.88, 1.50) | 0.99 (0.75, 1.30) | 0.55 | 1.16 (0.71, 1.89) |
a
Age-adjusted model was adjusted for age (years).
b
Multivariate-adjusted model was adjusted for gender; age (years); ethnicity (Turkmen, Persian, others); education (illiterate, ≤5 years, 6–8 years, high school, academic); marital status (married, other); residency (rural, urban); smoking (never, former, current <20 p/year, current 20–30 p/year, current ≥30 p/year); opium use (user, non-user); alcohol (user, non-user); BMI (<18.5,18.5 to <20.0, 20.0 to <22.5, 22.5 to <25.0, 25.0 to <30.0, 30 to <35.0, ≥35.0); systolic blood pressure (quintile); occupational physical activity (sedentary, standing or occasional walking, causing mild increase in heart rate and sweating, causing significant increase in heart rate and sweating); family history of cancer (yes, no); wealth score (quintile); medication (using a fixed-dose combination pill consisting of aspirin, valsartan, atorvastatin, and hydrochlorothiazide; yes/no); and energy intake (quintile).
c
Quartile.
HR, hazard ratio.