|Nutrition Evidence Library|
What is the relationship between the intake of animal protein products and blood pressure?
Moderate evidence found no clear association between intake of animal protein products and blood pressure in prospective cohort studies.
Overall strength of the available supporting evidence: Strong; Moderate; Limited; Expert Opinion Only; Grade not assignable For additional information regarding how to interpret grades, click here.
Evidence Summary Overview
This review included six articles (Alonso, 2006; Miura, 2004; Steffen, 2005; Wagemakers, 2009; Wang, 2008a; Wang, 2008b) representing prospective cohorts from the US, United Kingdom and Spain published since 2000. No relationship between intake of animal protein and hypertension (HTN) was observed in the Seguimiento Universidad de Navarra (SUN) cohort in Spain (Alonso, 2006). Similarly, no association between intake of animal protein and systolic or diastolic blood pressure (SBP and DBP) was observed in the PREMIER Study (Wang, 2008a) and no association between the intake of red or processed meat and SBP and DBP was observed in a cohort in the UK (Wagemakers, 2009).
In contrast, in the Women’s Health Study (Wang, 2008b), total red meat intake was positively associated with risk of developing HTN. In addition, each individual unprocessed and processed red meat item, including hot dogs, hamburgers and bacon, beef or lamb as a main dish were positively associated with the risk of developing HTN. Similarly, the CARDIA study (Steffen, 2005) found a positive association between consumption of total meat and red and processed meat (combined) and risk of developing elevated blood pressure (BP). The Chicago Western Electric Study also showed a positive association between SBP and DBP and red meat, but observed no association with processed meat.
Differences in dietary assessment methodology likely affected the results in this review. Assessment methods included 24-hour recalls, five-day diaries, diet histories, interviews and food frequency questionnaires (FFQ). Studies that used 24-hour recalls (Wang, 2008a) and five-day diaries (Wagemakers, 2009) observed no associations between animal protein products and SBP and DBP.
Evidence Summary Paragraphs
Alonso et al, 2006 (positive quality) prospectively assessed the role of different nutritional factors, especially protein and fiber from different sources, on the risk of incident HTN in 5,880 adults (61% female; age>20 years) from the Seguimiento Universidad de Navarra (SUN) Follow-up Study in Spain. New cases of medically diagnosed HTN were identified through responses to a mailed questionnaire after at least two years from recruitment. Dietary intake over the previous year was assessed at baseline with a 136-item semi-quantitative FFQ validated in a Spanish population. Over a median follow-up of 28 months, 180 new cases of HTN were ascertained. Animal protein was not associated with the risk of HTN (multivariate HR between extreme quintiles=1.0; 95% CI: 0.6, 1.8; P for trend=0.70).The authors concluded that animal protein did not show any association with the incidence of HTN in this cohort of adults.
Wang et al, 2008a (positive quality) examined the association of dietary protein intake with BP and particularly, the independent relationship of animal and plant protein with BP over 18 months of follow-up. Participants were 810 adults (62% female; age 25 to 79 years) from the PREMIER Trial (US). Blood pressure measurements were obtained by study personnel at baseline, six and 18 months. Two 24-hour recalls, one on a weekday and the other on a weekend day, were obtained at baseline, six and 18 months. No significant association was found between animal protein intake and SBP or DBP at any time-point.
Miura et al, 2004 (positive quality) examined relations of food intake, including meat intake, to seven-year BP change in 1,710 men (age 41 to 57 years) from the Chicago Western Electric Study in the US. Blood pressure was measured annually by study personnel from 1958-1959 through 1966. Dietary intake information was obtained at the first (1957-1958) and second (1958-1959) examinations, one year apart, by study personnel using standardized interviews and questionnaires. Baseline nutrient intake data are means from these two examinations. Specific meats included in analyses were beef-veal-lamb (less than eight, eight to 20, >20 120-gram portions per month), pork-ham-bacon (less than four, four to eight, more than eight 120-gram portions per month) and poultry (less than four, four to eight, more than eight 120-gram portions per month). Average SBP/DBP increase was 1.9/0.3mmHg per year. Beef-veal-lamb and poultry intakes were related directly to a greater SBP/DBP increase (P<0.05). Men who reported eight to 20 or >20 servings of 120-gram portions of meat had a 5.4mmHg or 6.0mmHg, respectively, greater increase in SBP over seven years compared with men who reported less than eight servings per month. In all models, men whose poultry intake was the highest (more than eight portions per month) had a significantly greater rise in SBP. In the fully adjusted model, there was no significant (NS) association between pork intake and SBP. Men with the highest intake of beef-veal-lamb had a significantly greater increase in DBP (P<0.05). Higher poultry intake was also associated with a greater increase in DBP (P<0.05). However, there was no significant association between pork and DBP in any of the models. The authors concluded that men with a higher intake of red meat had a significantly greater increase in BP; also, men with a higher poultry intake had a significantly greater annual increase in BP, independent of other factors.
Steffen et al, 2005 (positive quality) evaluated associations of dietary intake, including meat intake, with the 15-year incidence of elevated BP among 4,304 adults (883 black men, 1,249 black women, 989 white men and 1,183 white women; age 18 to 30 years) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study in the US. Blood pressure was assessed at six clinic exams at years zero, two, five, seven, 10 and 15. Dietary intake was assessed with an interviewer-administered diet history at years zero and seven. The analyses were conducted by using the average of year zero and year seven dietary data. Meat as a group as well as red and processed meat, poultry and eggs were considered. Over 15 years, 23.2% of study participants experienced incident elevated blood pressure (EBP), of whom 13.7% had HTN and 9.4% had high-normal BP. Consumption of meat (meat, poultry, eggs, fish and seafood) was positively related with the risk of developing EBP, even after adjustment for possible explanatory factors (HR between extreme quintiles=1.67; 95% CI: 1.21, 2.30; P for trend=0.003). There was no association between poultry and EBP (P for trend=0.19). However, consumption of red and processed meat was positively associated with EBP (HR between extreme quintiles=1.39; 95% CI: 1.05, 1.82; P for trend=0.006), whereas egg intake was inversely associated with EBP (HR between extreme quintiles=0.79; 95% CI: 0.64, 0.98; P for trend=0.05). Further adjustment of these foods for body mass index (BMI) attenuated these relations slightly (data not provided). The authors concluded that greater plant food intakes and lower meat intakes may prevent the development of EBP when consumed by free-living black and white men and women as part of a habitual diet.
Wagemakers et al, 2009 (neutral quality) investigated whether a high consumption of red or processed meat is associated with coronary heart disease (CHD) risk factors in a cohort of British adults (N=1,152; 55% female; age 43 at baseline) followed from 1989 to 1999 in the Medical Research Council National Survey of Health and Development. Blood pressure was measured in 1999. Systolic blood pressure and DBP were measured twice by study personnel and means of duplicate measurements were used in analyses. Food intake was self-recorded using five-day diaries in 1989 and 1999. Meat consumption was estimated by adding individual meat portions to the meat fractions of composite dishes. Red meat, processed meat, and combined red and processed meat intake were considered. There was no significant (NS) association between red or processed meat consumption in 1989 or 1999 and SBP or DBP measured in 1999. There was also no significant association between combined intake of red and processed meat in 1989 and SBP or DBP measured in 1999. However, among men only, the combined intake of red and processed meat in 1999 had a significant positive association with SBP (P=0.014) and DBP (P=0.009) measured in 1999. The authors concluded that red or processed meat consumption measured 10 years earlier does not predict an increased risk of cardiovascular disease (CVD) as indicated by BP.
Wang et al, 2008b (positive quality) investigated the association of total red meat, types of red meat and poultry intake with the incidence of HTN over 10 years of follow-up among 28,766 women (age ≥45 years) in the Women’s Health Study (US). Incident HTN was self-reported on annual follow-up questionnaires. Baseline red meat and poultry intake were assessed from a 131-item validated semi-quantitative FFQ. Total red meat (including unprocessed and processed red meat), total poultry and individual red meat items were considered. During 10 years of follow-up, 8,693 incident cases of HTN were identified. Total red meat intake was significantly and positively associated with the risk of developing HTN (multivariate RR between extreme quintiles=1.13; 95% CI: 1.04, 1.23; P for trend=0.008). No association between intake of poultry and incident HTN was found. Comparing women who consumed more than one serving per week of a specific red meat product with those who consumed no red meat, the multivariate RRs of HTN were 1.33 for hot dogs, 1.27 for bacon, 1.26 for other processed red meats, 1.31 for beef or lamb as main dish, 1.22 for pork as main dish, 1.28 for beef, pork or lamb as sandwich or mixed dish and 1.27 for hamburgers (all P<0.05). The authors concluded that red meat intake was positively associated, whereas poultry intake was unassociated, with the risk of HTN in middle-aged and older women.
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Research Design and Implementation Rating Summary
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Alonso A, Beunza JJ, Bes-Rastrollo M, Pajares RM, Martínez-González MA. Vegetable protein and fiber from cereal are inversely associated with the risk of hypertension in a Spanish cohort. Arch Med Res. 2006 Aug; 37 (6): 778-786.
Miura K, Greenland P, Stamler J, Liu K, Daviglus ML, Nakagawa H. Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004;159: 572-580.
Steffen LM, Kroenke CH, Yu X, Pereira MA, Slattery ML, Van Horn L, Gross MD, Jacobs DR Jr. Associations of plant food, dairy product and meat intakes with 15-year incidence of elevated blood pressure in young black and white adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr. 2005 Dec; 82 (6): 1,169-1,177.
Wagemakers JJMF, Prynne CJ, Stephen AM, Wadsworth MFJ. Consumption of red or processed meat does not predict risk factors for coronary heart disease; results from a cohort of British adults in 1989 and 1999. Eur J Clin Nutr 2009;63:303-311.
Wang L, Manson JE, Buring JE, Sesso HD. Meat intake and the risk of hypertension in middle-aged and older women. J Hypertens. 2008 Feb; 26(2): 215-222.
Wang YF, Yancy WS Jr, Yu D, Champagne C, Appel LJ, Lin PH. The relationship between dietary protein intake and blood pressure: Results from the PREMIER study. J Hum Hypertens. 2008 Nov; 22 (11): 745-754.