title: High dietary protein intake is associated with an increased body weight and total death risk.
abstract: OBJECTIVE
  High dietary protein diets are widely used to manage overweight and obesity. However, there is a lack of consensus about their long-term efficacy and safety. Therefore, the aim of this study was to assess the effect of long-term high-protein consumption on body weight changes and death outcomes in subjects at high cardiovascular risk.
  
  
  METHODS
  A secondary analysis of the PREDIMED trial was conducted. Dietary protein was assessed using a food-frequency questionnaire during the follow-up. Cox proportional hazard models were used to estimate the multivariate-adjusted hazard ratio (HR) and 95% confidence intervals (95%CI) for protein intake in relation to the risk of body weight and waist circumference changes, cardiovascular disease, cardiovascular death, cancer death and total death.
  
  
  RESULTS
  Higher total protein intake, expressed as percentage of energy, was significantly associated with a greater risk of weight gain when protein replaced carbohydrates (HR: 1.90; 95%CI: 1.05, 3.46) but not when replaced fat (HR: 1.69; 95%CI: 0.94, 3.03). However, no association was found between protein intake and waist circumference. Contrary, higher total protein intake was associated with a greater risk of all-cause death in both carbohydrate and fat substitution models (HR: 1.59; 95%CI: 1.08, 2.35; and HR: 1.66; 95%CI: 1.13, 2.43, respectively). A higher consumption of animal protein was associated with an increased risk of fatal and non-fatal outcomes when protein substituted carbohydrates or fat.
  
  
  CONCLUSIONS
  Higher dietary protein intake is associated with long-term increased risk of body weight gain and overall death in a Mediterranean population at high cardiovascular risk.
authors.affiliation: Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Hernández-Alonso
authors.affiliation: Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain; CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain. Electronic address: jordi.salas@urv.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Primary Health Care, Servicio Navarro de Salud, Health Care Centre of Azpilagaña, Pamplona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Department of Preventive Medicine, University of Valencia, València, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Department of Internal Medicine, Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Estruch
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Cardiovascular Risk and Nutrition Research Group (Regicor Study Group), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fitó
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Department of Cardiology, University Hospital Txagorritxu, Vitoria, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gracia
authors.affiliation: Health Research Institute of Palma (IdISPa). Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Centro de Salud San Pablo, Sevilla, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.affiliation: Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain; CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Basora
authors.affiliation: Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: Primary Health Care Division and Research, Instituto de Investigaciones Biomédicas August Pi i Sunyer-Jordi Gol, Barcelona, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Muñoz
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Primary Health Care, Servicio Navarro de Salud, Health Care Centre of Azpilagaña, Pamplona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Buil-Cosiales
authors.affiliation: CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain; Department of Preventive Medicine, University of Valencia, València, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Saiz
authors.affiliation: Human Nutrition Unit from the Department of Biochemistry and Biotechnology, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain; CIBER de la Fisiopatología de Obesidad y la Nutrición (ciberobn), Instituto de Salud Carlos III, Spain. Electronic address: monica.bullo@urv.cat.
authors.forename: Mònica
authors.initials: M
authors.lastname: Bulló
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects*; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015596:Nutrition Assessment; D009765:Obesity / Q000150:complications / Q000178:diet therapy; D050177:Overweight / Q000150:complications / Q000178:diet therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D015430:Weight Gain
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D014280:Triglycerides; D002784:Cholesterol
keywords: Body weight; Cardiovascular; Death; Protein; Risk