Effects of plant protein and animal protein on lipid profile, body weight and body mass index on patients with hypercholesterolemia: a systematic review and meta-analysis (original) (raw)

Abstract

Objective

We conducted a meta-analysis on the effect of plant protein or animal protein on body weight (BW), body mass index (BMI) and blood lipid profiles in patients with hypercholesterolemia.

Materials and methods

We used subject and free words to search PubMed, Embase and Cochrane Library databases. The risk-of-bias evaluation tool was used to assess literature quality. Data merging and statistical analyses were carried out using Review Manager 5.3 and Stata 13.0. All indicators were expressed as the mean difference (MD) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to _I_2 and Q tests. We used Egger’s test to evaluate publication bias quantitatively.

Results

This was a meta-analysis of intervention trials. Thirty-two studies (1562 patients) were included. The quality of the included studies was acceptable. Compared with consumption of animal protein, plant protein reduced total cholesterol (TC) (MD = − 0.19 mmol/L, 95% CI − 0.26, − 0.12), triglyceride (MD = − 0.07 mmol/L, 95% CI − 0.13, − 0.02), low-density lipoprotein cholesterol (LDL-C) (MD = − 0.19 mmol/L, 95% CI − 0.26, − 0.13), very low-density lipoprotein cholesterol (MD = − 0.05 mmol/L, 95% CI − 0.09, − 0.01), TC/LDL-C ratio (MD = − 0.17, 95% CI − 0.32, − 0.02) and LDL-C/HDL-C ratio (MD = − 0.20, 95% CI − 0.33, − 0.06) significantly and increased high-density lipoprotein cholesterol (HDL-C) (MD = 0.03 mmol/L, 95% CI 0.01, 0.06) levels, but had no effect on BW (MD = − 0.41 kg, 95% CI − 2.14, 1.33) or BMI (MD = 0.11 kg/m2, 95% CI − 0.51, 0.73).

Conclusion

Compared with animal protein, consumption of plant protein could improve lipid profile in patients with hypercholesterolemia.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data availability

The original data can be obtained by email request.

References

  1. Wang KF, Wu CH, Chang CC et al (2017) Determinants of treatment modification in hypercholesterolemic patients. Acta Cardiol Sin 33:156–164
    PubMed PubMed Central Google Scholar
  2. Konishi K, Wada K, Yamakawa M et al (2019) Dietary soy intake is inversely associated with risk of type 2 diabetes in Japanese women but not in men. J Nutr 149:1208–1212
    PubMed Google Scholar
  3. Li SS, Blanco Mejia S, Lytvyn L et al (2017) Effect of plant protein on blood lipids: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc 6:e006659
    PubMed PubMed Central Google Scholar
  4. Hermansen K, Hansen B, Jacobsen R et al (2005) Effects of soy supplementation on blood lipids and arterial function in hypercholesterolaemic subjects. Eur J Clin Nutr 59:843–850
    CAS PubMed Google Scholar
  5. Weisse K, Brandsch C, Zernsdorf B et al (2010) Lupin protein compared to casein lowers the LDL cholesterol:HDL cholesterol-ratio of hypercholesterolemic adults. Eur J Nutr 49:65–71
    CAS PubMed Google Scholar
  6. Wang Y, Jones PJ, Ausman LM, Lichtenstein AH (2004) Soy protein reduces triglyceride levels and triglyceride fatty acid fractional synthesis rate in hypercholesterolemic subjects. Atherosclerosis 173:269–275
    CAS PubMed Google Scholar
  7. Bähr M, Fechner A, Kiehntopf M, Jahreis G (2015) Consuming a mixed diet enriched with lupin protein beneficially affects plasma lipids in hypercholesterolemic subjects: a randomized controlled trial. Clin Nutr 34:7–14
    PubMed Google Scholar
  8. Cuevas AM, Irribarra VL, Castillo OA, Yañez MD, Germain AM (2003) Isolated soy protein improves endothelial function in postmenopausal hypercholesterolemic women. Eur J Clin Nutr 57:889–894
    CAS PubMed Google Scholar
  9. Denysschen CA, Burton HW, Horvath PJ, Leddy JJ, Browne RW (2009) Resistance training with soy vs whey protein supplements in hyperlipidemic males. J Int Soc Sports Nutr 6:8
    PubMed PubMed Central Google Scholar
  10. Desroches S, Mauger JF, Ausman LM, Lichtenstein AH, Lamarche B (2004) Soy protein favorably affects LDL size independently of isoflavones in hypercholesterolemic men and women. J Nutr 134:574–579
    CAS PubMed Google Scholar
  11. Gaddi A, Descovich GC, Noseda G (1987) Hypercholesterolaemia treated by soybean protein diet. Arch Dis Child 62:274–278
    CAS PubMed PubMed Central Google Scholar
  12. Gardner CD, Newell KA, Cherin R, Haskell WL (2001) The effect of soy protein with or without isoflavones relative to milk protein on plasma lipids in hypercholesterolemic postmenopausal women. Am J Clin Nutr 73:728–735
    CAS PubMed Google Scholar
  13. Gardner CD, Messina M, Kiazand A, Morris JL, Franke AA (2007) Effect of two types of soy milk and dairy milk on plasma lipids in hypercholesterolemic adults: a randomized trial. J Am Coll Nutr 26:669–677
    CAS PubMed Google Scholar
  14. Goldberg AP, Lim A, Kolar JB (1982) Soybean protein independently lowers plasma cholesterol levels in primary hypercholesterolemia. Atherosclerosis 43:355–368
    CAS PubMed Google Scholar
  15. Høie LH, Morgenstern ECA, Gruenwald J et al (2005) A double-blind placebo-controlled clinical trial compares the cholesterol-lowering effects of two different soy protein preparations in hypercholesterolemic subjects. Eur J Nutr 44:65–71
    PubMed Google Scholar
  16. Hoie LH, Guldstrand M, Sjoholm A et al (2007) Cholesterol-lowering effects of a new isolated soy protein with high levels of nondenaturated protein in hypercholesterolemic patients. Adv Ther 24:439–447
    CAS PubMed Google Scholar
  17. Hori G, Wang MF, Chan YC et al (2001) Soy protein hydrolyzate with bound phospholipids reduces serum cholesterol levels in hypercholesterolemic adult male volunteers. Biosci Biotechnol Biochem 65:72–78
    CAS PubMed Google Scholar
  18. Huff MW, Giovannetti PM, Wolfe BM (1984) Turnover of very low-density lipoprotein–apoprotein B is increased by substitution of soybean protein for meat and dairy protein in the diets of hypercholesterolemic men. Am J Clin Nutr 39:888–897
    CAS PubMed Google Scholar
  19. Jacques H, Laurin D, Moorjani S et al (1992) Influence of diets containing cow’s milk or soy protein beverage on plasma lipids in children with familial hypercholesterolemia. J Am Coll Nutr 11:69S–73S
    PubMed Google Scholar
  20. Jenkins DJA, Srichaikul K, Wong JMW et al (2010) Supplemental barley protein and casein similarly affect serum lipids in hypercholesterolemic women and men. J Nutr 140:1633–1637
    CAS PubMed Google Scholar
  21. Kurowska EM, Jordan J, Spence JD et al (1997) Effects of substituting dietary soybean protein and oil for milk protein and fat in subjects with hypercholesterolemia. Clin Invest Med 20:162–170
    CAS PubMed Google Scholar
  22. Laurin D, Jacques H, Moorjani S et al (1991) Effects of a soy-protein beverage on plasma lipoproteins in children with familial hypercholesterolemia. Am J Clin Nutr 54:98–103
    CAS PubMed Google Scholar
  23. Lichtenstein AH, Jalbert SM, Adlercreutz H et al (2002) Lipoprotein response to diets high in soy or animal protein with and without isoflavones in moderately hypercholesterolemic subjects. Arterioscler Thromb Vasc Biol 22:1852–1858
    CAS PubMed Google Scholar
  24. Ma Y, Chiriboga D, Olendzki BC, Nicolosi R, Merriam PA, Ockene IS (2005) Effect of soy protein containing isoflavones on blood lipids in moderately hypercholesterolemic adults: a randomized controlled trial. J Am Coll Nutr 24:275–285
    CAS PubMed Google Scholar
  25. Matthan NR, Jalbert SM, Ausman LM, Kuvin JT, Karas RH, Lichtenstein AH (2007) Effect of soy protein from differently processed products on cardiovascular disease risk factors and vascular endothelial function in hypercholesterolemic subjects. Am J Clin Nutr 85:960–966
    CAS PubMed Google Scholar
  26. Padhi EMT, Blewett HJ, Duncan AM et al (2015) Whole soy flour incorporated into a muffin and consumed at 2 doses of soy protein does not lower LDL cholesterol in a randomized, double-blind controlled trial of hypercholesterolemic adults. J Nutr 145:2665–2674
    CAS PubMed PubMed Central Google Scholar
  27. Potter SM, Bakhit RM, Essex-Sorlie DL et al (1993) Depression of plasma cholesterol in men by consumption of baked products containing soy protein. Am J Clin Nutr 58:501–506
    CAS PubMed Google Scholar
  28. Shorey RL, Bazan B, Lo GS, Steinke FH (1981) Determinants of hypocholesterolemic response to soy and animal protein-based diets. Am J Clin Nutr 34:1769–1778
    CAS PubMed Google Scholar
  29. Sirtori CR, Triolo M, Bosisio R et al (2012) Hypocholesterolaemic effects of lupin protein and pea protein/fibre combinations in moderately hypercholesterolaemic individuals. Br J Nutr 107:1176–1183
    CAS PubMed Google Scholar
  30. Teixeira SR, Potter SM, Weigel R, Hannum S, Erdman JW Jr, Hasler CM (2000) Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr 71:1077–1084
    CAS PubMed Google Scholar
  31. Tonstad S, Smerud K, Høie L (2002) A comparison of the effects of 2 doses of soy protein or casein on serum lipids, serum lipoproteins, and plasma total homocysteine in hypercholesterolemic subjects. Am J Clin Nutr 76:78–84
    CAS PubMed Google Scholar
  32. Weghuber D, Widhalm K (2008) Effect of 3-month treatment of children and adolescents with familial and polygenic hypercholesterolaemia with a soya-substituted diet. Br J Nutr 99:281–286
    CAS PubMed Google Scholar
  33. West SG, Hilpert KF, Juturu V et al (2005) Effects of including soy protein in a blood cholesterol-lowering diet on markers of cardiac risk in men and in postmenopausal women with and without hormone replacement therapy. J Womens Health 14:253–262
    Google Scholar
  34. Wong WW, Smith EO, Stuff JE, Hachey DL, Heird WC, Pownell HJ (1998) Cholesterol-lowering effect of soy protein in normocholesterolemic and hypercholesterolemic men. Am J Clin Nutr 68:1385S–1389S
    CAS PubMed Google Scholar
  35. Yildirir A, Tokgozoglu SL, Oduncu T et al (2001) Soy protein diet significantly improves endothelial function and lipid parameters. Clin Cardiol 24:711–716
    CAS PubMed Google Scholar
  36. Monique VN, Feskens EJM, Annemarie R, Els S, Marco M (2014) Partly replacing meat protein with soy protein alters insulin resistance and blood lipids in postmenopausal women with abdominal obesity. J Nutr 144:1423–1429
    Google Scholar
  37. Chalvon-Demersay T, Azzout-Marniche D, Arfsten J et al (2017) A systematic review of the effects of plant compared with animal protein sources on features of metabolic syndrome. J Nutr 147:281–292
    CAS PubMed Google Scholar
  38. Ronis MJ, Ying C, Jamie B, Badger TM (2009) Dietary soy protein isolate attenuates metabolic syndrome in rats via effects on PPAR, LXR, and SREBP signaling. J Nutr 139:1431–1438
    CAS PubMed Google Scholar
  39. Richter CK, Skulas-Ray AC, Champagne CM, Kris-Etherton PM (2015) Plant protein and animal proteins: do they differentially affect cardiovascular disease risk? Adv Nutr 6:712–728
    CAS PubMed PubMed Central Google Scholar
  40. Liron BP, Sabatini DM (2014) Regulation of mTORC1 by amino acids. Trends Cell Biol 24:400–406
    Google Scholar
  41. Mcisaac RS, Lewis KN, Gibney PA, Buffenstein R (2016) From yeast to human: exploring the comparative biology of methionine restriction in extending eukaryotic life span. Ann N Y Acad Sci 1363:155–170
    CAS PubMed Google Scholar
  42. Carter RN, Morton NM (2016) Cysteine and hydrogen sulphide in the regulation of metabolism: insights from genetics and pharmacology. J Pathol 238:321–332
    CAS PubMed Google Scholar
  43. Jobgen WS, Fried SK, Fu WJ, Meininger CJ, Wu G (2006) Regulatory role for the arginine–nitric oxide pathway in metabolism of energy substrates. J Nutr Biochem 17:571–588
    CAS PubMed Google Scholar
  44. Banerji J (2015) Asparaginase treatment side-effects may be due to genes with homopolymeric ASN codons (Review-hypothesis). Int J Mol Med 36:607–626
    CAS PubMed PubMed Central Google Scholar
  45. Virtanen HEK, Voutilainen S, Koskinen TT et al (2019) Dietary proteins and protein sources and risk of death: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 109:1462–1471
    PubMed Google Scholar

Download references

Acknowledgements

We thank Arshad Makhdum, PhD, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Endocrinology Department, Hebei General Hospital, 348, Heping West Road, Shijiazhuang, 050051, Hebei, China
    Hang Zhao & Guangyao Song
  2. Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
    An Song
  3. Pediatric Orthopaedics, Shijiazhuang the Third Hospital, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
    Chong Zheng
  4. Graduate School of North, China University of Science and Technology, 21, Bohai Avenue, Caofeidian New Town, Tangshan, 063210, Hebei, China
    Mengdi Wang

Authors

  1. Hang Zhao
    You can also search for this author inPubMed Google Scholar
  2. An Song
    You can also search for this author inPubMed Google Scholar
  3. Chong Zheng
    You can also search for this author inPubMed Google Scholar
  4. Mengdi Wang
    You can also search for this author inPubMed Google Scholar
  5. Guangyao Song
    You can also search for this author inPubMed Google Scholar

Contributions

GS and HZ contributed to conceptualization. HZ contributed to methodology; AS, CZ and MW provided the software. CZ and MW contributed to data analysis. HZ and AS contributed to writing and preparation of the original draft. GS was involved in supervision.

Corresponding author

Correspondence toGuangyao Song.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This article does not contain any studies with human participants or animals performed by any of the authors.

For this type of study, informed consent is not required.

Additional information

Managed By Massimo Porta.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLS 23 kb)

Figure S1

: Flow chart of included studies. (TIFF 7033 kb)

Figure S2A

: Graph showing the risk of bias. Review authors’ judgements about each item of risk of bias is presented as a percentage across all included studies. (PDF 1111 kb)

Figure S2B

: Summary of the risk of bias. Review authors’ judgements about each item of risk of bias for each included study are shown. (PDF 1267 kb)

Figure S3

: Egger’s plot showing publication bias for total cholesterol. (PDF 615 kb)

Figure S4

: Egger’s plot showing publication bias for triglyceride. (PDF 1127 kb)

Figure S5

: Egger’s plot showing publication bias for high-density lipoprotein cholesterol. (PDF 615 kb)

Figure S6

: Egger’s plot showing publication bias for low-density lipoprotein cholesterol. (PDF 616 kb)

Figure S7

: Forest plot comparing levels of very low-density-lipoprotein cholesterol of plant protein and animal protein groups. (PDF 751 kb)

Figure S8

: Egger’s plot showing publication bias for very low-density-lipoprotein cholesterol. (PDF 612 kb)

Figure S9

: Forest plot comparing the total cholesterol/high-density lipoprotein cholesterol ratio of plant protein and animal protein groups. (PDF 723 kb)

Figure S10

: Egger’s plot showing publication bias plot for the total cholesterol/high-density lipoprotein cholesterol ratio. (PDF 610 kb)

Figure S11

: Forest plot comparing the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio of plant protein and animal protein groups. (PDF 736 kb)

Figure S12

: Egger’s plot showing publication bias for the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. (PDF 611 kb)

Figure S13

: Forest plot comparing levels of body weight of plant protein and animal protein groups. (PDF 699 kb)

Figure S14

: Egger’s plot showing publication bias for body weight. (PDF 611 kb)

Figure S15

: Forest plot comparing levels of body mass index levels of plant protein and animal protein groups. (PDF 630 kb)

Figure S16

: Egger’s plot showing publication bias for body mass index. (PDF 609 kb)

Supplementary material 19 (DOCX 18 kb)

Rights and permissions

About this article

Cite this article

Zhao, H., Song, A., Zheng, C. et al. Effects of plant protein and animal protein on lipid profile, body weight and body mass index on patients with hypercholesterolemia: a systematic review and meta-analysis.Acta Diabetol 57, 1169–1180 (2020). https://doi.org/10.1007/s00592-020-01534-4

Download citation

Keywords