Table 4. Risk of Overall and Cause-Specific Mortality Associated With Substitution of 3% Dietary Energy Intake From Plant Protein for Various Animal Protein Sources Among 237 036 Men and 179 068 Women^a.

Animal protein source	Men		Women
	HR (95% CI)b	P value	HR (95% CI)b	P value
Total animal protein
Overall	0.90 (0.88-0.93)	<.001c	0.90 (0.87-0.93)	<.001c
Cancer	0.97 (0.92-1.02)	.19	0.93 (0.88-0.99)	.02
CVD	0.89 (0.85-0.94)	<.001c	0.88 (0.82-0.94)	<.001c
Heart disease	0.91 (0.86-0.96)	<.001c	0.90 (0.84-0.98)	.01
Stroke	0.78 (0.68-0.90)	<.001c	0.81 (0.70-0.94)	.007
Respiratory disease	0.92 (0.82-1.03)	.14	0.92 (0.82-1.04)	.18
Infection	0.99 (0.85-1.14)	.86	0.81 (0.68-0.97)	.02
Injury and accident	0.82 (0.71-0.95)	.008	0.89 (0.72-1.11)	.30
Other causes combined	0.83 (0.78-0.88)	<.001c	0.90 (0.83-0.97)	.005
Red meat protein
Overall	0.87 (0.85-0.90)	<.001c	0.85 (0.81-0.88)	<.001c
Cancer	0.93 (0.88-0.98)	.004	0.89 (0.83-0.95)	<.001c
CVD	0.88 (0.83-0.93)	<.001c	0.82 (0.76-0.89)	<.001c
Heart disease	0.89 (0.84-0.94)	<.001c	0.84 (0.77-0.92)	<.001c
Stroke	0.79 (0.68-0.91)	.001c	0.75 (0.63-0.89)	<.001c
Respiratory disease	0.83 (0.74-0.94)	.003	0.80 (0.70-0.91)	.001c
Infection	0.94 (0.81-1.10)	.47	0.75 (0.62-0.92)	.006
Injury and accident	0.80 (0.69-0.94)	.005	0.90 (0.71-1.16)	.42
Other causes combined	0.80 (0.75-0.86)	<.001c	0.85 (0.78-0.92)	<.001c
White meat protein
Overall	0.98 (0.94-1.01)	.11	0.95 (0.91-0.98)	.005
Cancer	1.02 (0.97-1.08)	.40	0.93 (0.87-0.99)	.02
CVD	0.95 (0.90-1.01)	.07	0.94 (0.87-1.02)	.12
Heart disease	0.97 (0.91-1.03)	.27	0.97 (0.89-1.05)	.41
Stroke	0.83 (0.71-0.96)	.01	0.90 (0.76-1.06)	.20
Respiratory disease	1.17 (1.03-1.33)	.02	1.06 (0.93-1.21)	.40
Infection	1.06 (0.90-1.25)	.52	0.88 (0.72-1.07)	.20
Injury and accident	0.91 (0.77-1.07)	.23	0.99 (0.78-1.26)	.96
Other causes combined	0.90 (0.84-0.97)	.004	0.90 (0.84-0.97)	.004
Dairy protein
Overall	0.92 (0.89-0.95)	<.001c	0.92 (0.89-0.95)	<.001c
Cancer	1.01 (0.96-1.06)	.73	0.97 (0.91-1.03)	.31
CVD	0.89 (0.84-0.94)	<.001c	0.88 (0.82-0.95)	<.001c
Heart disease	0.91 (0.86-0.97)	.003c	0.92 (0.84-0.99)	.03
Stroke	0.77 (0.66-0.89)	<.001c	0.80 (0.69-0.94)	.006
Respiratory disease	0.94 (0.83-1.06)	.31	0.97 (0.85-1.10)	.60
Infection	0.98 (0.84-1.15)	.79	0.80 (0.67-0.97)	.02
Injury and accident	0.83 (0.71-0.98)	.02	0.88 (0.70-1.10)	.25
Other causes combined	0.83 (0.78-0.89)	<.001c	0.90 (0.83-0.97)	.008
Egg protein
Overall	0.76 (0.72-0.80)	<.001c	0.79 (0.73-0.85)	<.001c
Cancer	0.85 (0.78-0.93)	<.001c	0.83 (0.73-0.93)	.002c
CVD	0.74 (0.67-0.82)	<.001c	0.72 (0.63-0.83)	<.001c
Heart disease	0.76 (0.69-0.85)	<.001c	0.72 (0.62-0.85)	<.001c
Stroke	0.67 (0.52-0.88)	.003	0.75 (0.55-1.03)	.08
Respiratory disease	0.61 (0.50-0.74)	<.001c	0.66 (0.53-0.83)	<.001c
Infection	0.94 (0.71-1.25)	.66	0.80 (0.55-1.17)	.25
Injury and accident	0.71 (0.53-0.94)	.02	0.67 (0.43-1.05)	.08
Other causes combined	0.71 (0.63-0.80)	<.001c	0.92 (0.78-1.08)	.28

Abbreviations: CVD, cardiovascular disease; HR, hazard ratio.

^aPlant, animal and total protein were modeled as percentages of energy, using energy from the specific protein divided by total energy intake, and the leave-1-out model was used as the substitution approach: to evaluate the substitution of 3% energy from plant protein for an individual component of animal protein (red meat protein, white meat protein, dairy protein and egg protein), energy from plant protein, total protein, and other 3 components of animal protein were simultaneously included in the model. The HRs represent the relative risk of overall mortality with 3% energy from plant protein substituted for the excluded animal protein energy.

^bAdjusted as indicated in note c of Table 2, and for women, the risk estimates were additionally adjusted for postmenopausal hormone replacement therapy (yes vs no).

^cAchieved Bonferroni-corrected threshold (.05/18 = .0028).