title: Dietary Protein Sources and All-Cause and Cause-Specific Mortality: The Golestan Cohort Study in Iran.
abstract: BACKGROUND
  Dietary protein comes from foods with greatly different compositions that may not relate equally with mortality risk. Few cohort studies from non-Western countries have examined the association between various dietary protein sources and cause-specific mortality. Therefore, the associations between dietary protein sources and all-cause, cardiovascular disease, and cancer mortality were evaluated in the Golestan Cohort Study in Iran.
  
  
  METHODS
  Among 42,403 men and women who completed a dietary questionnaire at baseline, 3,291 deaths were documented during 11 years of follow up (2004-2015). Cox proportional hazards models estimated age-adjusted and multivariate-adjusted hazard ratios (HRs) and 95% CIs for all-cause and disease-specific mortality in relation to dietary protein sources. Data were analyzed from 2015 to 2016.
  
  
  RESULTS
  Comparing the highest versus the lowest quartile, egg consumption was associated with lower all-cause mortality risk (HR=0.88, 95% CI=0.79, 0.97, ptrend=0.03). In multivariate analysis, the highest versus the lowest quartile of fish consumption was associated with reduced risk of total cancer (HR=0.79, 95% CI=0.64, 0.98, ptrend=0.03) and gastrointestinal cancer (HR=0.75, 95% CI=0.56, 1.00, ptrend=0.02) mortality. The highest versus the lowest quintile of legume consumption was associated with reduced total cancer (HR=0.72, 95% CI=0.58, 0.89, ptrend=0.004), gastrointestinal cancer (HR=0.76, 95% CI=0.58, 1.01, ptrend=0.05), and other cancer (HR=0.66, 95% CI=0.47, 0.93, ptrend=0.04) mortality. Significant associations between total red meat and poultry intake and all-cause, cardiovascular disease, or cancer mortality rate were not observed among all participants.
  
  
  CONCLUSIONS
  These findings support an association of higher fish and legume consumption with lower cancer mortality, and higher egg consumption with lower all-cause mortality.
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Digestive Disease Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: mfarvid@hsph.harvard.edu.
authors.forename: Maryam S
authors.initials: MS
authors.lastname: Farvid
authors.affiliation: Digestive Disease Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Oncology Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Akbar F
authors.initials: AF
authors.lastname: Malekshah
authors.affiliation: Digestive Disease Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
authors.affiliation: Digestive Oncology Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Poustchi
authors.affiliation: Digestive Disease Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Oncology Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sadaf G
authors.initials: SG
authors.lastname: Sepanlou
authors.affiliation: Digestive Disease Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Sharafkhah
authors.affiliation: Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Khoshnia
authors.affiliation: Independent researcher, Linnaeus University, Växjö, Sweden.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Farvid
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.affiliation: Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland.
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland.
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.affiliation: Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.affiliation: Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Pharoah
authors.affiliation: Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Digestive Disease Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Oncology Research Center, Digestive Disease, Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: malek@tums.ac.ir.
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002318:Cardiovascular Diseases / Q000401:mortality*; D004034:Diet Surveys / Q000706:statistics & numerical data*; D004044:Dietary Proteins; D004531:Eggs; D007887:Fabaceae; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality*; D011202:Poultry Products; D016016:Proportional Hazards Models; D011446:Prospective Studies; D000069466:Red Meat; D012307:Risk Factors
chemical_list: D004044:Dietary Proteins