ars.els-cdn.com · Web viewSupplementary appendix tables and figures: Fig. S 1. Protein intake from...

Supplementary appendix tables and figures:

Fig. S1. Protein intake from different food subgroups per 1% of energy and changes in waist

circumference over 11 years (n=5,324).

Fig. S2. Protein intake from different food subgroups per 1% of energy and changes in

systolic blood pressure over 11 years (n=5,324).

Fig. S3. Protein from different food subgroups per 1% energy and changes in diastolic blood

pressure over 11 years (n=5,324).

Fig. S4. Protein from different food subgroups per 1% energy and changes in plasma

cholesterol over 11 years (n=5,324).

Fig. S5. Protein from different food subgroups per 1% energy and changes in weight over 11

years (n=5,322).

Fig. S6. Each 5% energy increment from total, animal and plant protein intakes and changes

in waist circumference (n=18,359), cholesterol (n=18,098), and systolic blood pressure

(n=15,175) over 11 years.

Table S1. List of food categories for the calculation of protein intake from different food

sources.

Table S2. Comparison of nutrients intakes, physical measures, and lifestyle at baseline

between specific groups.

Note: Since results for the association of protein intakes from different food subgroups per

1% of energy with changes in MetSyn components and weight in the population with a large

sample were similar as those in 5,324 participants included in the main analysis, we just

reported the results of those in 5,324 participants (Fig. S1-S5).

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Fig. S1. Protein from different food subgroups per 1% energy and changes in waist

circumference over 11 years (n=5,324).

Multivariate-model adjusted for age (in years), gender, waist circumference (continuous),

body mass index (continuous), follow-up period (in years), ethnicity (Australia/New Zealand,

Greece, Italy, or UK/Malta), socio-economic status (quintiles), physical activity (0, 1-3, 4 or

5, and 6 or more), smoking (never, former, or current), alcohol intake (0 g/day, 1-39 g/day,

40-59 g/day and 60 or more g/day for male and 0 g/day, 1-19 g/day, 20-39 g/day and 40 or

more g/day for female), glycemic index (continuous) and consumption of energy

(continuous), fibre (continuous), sodium (continuous), potassium (continuous), magnesium

(continuous), vitamin C (continuous), vitamin E (continuous), saturated fat (continuous),

monounsaturated fat (continuous), polyunsaturated fat (continuous), and trans fat

(continuous).

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Fig. S2. Protein from different food subgroups per 1% energy and changes in systolic

blood pressure over 11 years (n=5,324).

Multivariate-model adjusted for age (in years), gender, systolic blood pressure (continuous),









(continuous).

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Fig. S3. Protein from different food subgroups per 1% energy and changes in diastolic

blood pressure over 11 years (n=5,324).

Multivariate-model adjusted for age (in years), gender, diastolic blood pressure (continuous),









(continuous).

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Fig. S4. Protein from different food subgroups per 1% energy and changes in plasma

cholesterol over 11 years (n=5,324).

Multivariate-model adjusted for age (in years), gender, plasma cholesterol (continuous), body

mass index (continuous), follow-up period (in years), ethnicity (Australia/New Zealand,








(continuous).

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Fig. S5. Protein from different food subgroups per 1% energy and changes in weight

over 11 years (n=5,322).

Multivariate-model adjusted for age (in years), gender, body mass index (continuous),

follow-up period (in years), ethnicity (Australia/New Zealand, Greece, Italy, or UK/Malta),

socio-economic status (quintiles), physical activity (0, 1-3, 4 or 5, and 6 or more), smoking

(never, former, or current), alcohol intake (0 g/day, 1-39 g/day, 40-59 g/day and 60 or more

g/day for male and 0 g/day, 1-19 g/day, 20-39 g/day and 40 or more g/day for female),

glycemic index (continuous) and consumption of energy (continuous), fibre (continuous),

sodium (continuous), potassium (continuous), magnesium (continuous), vitamin C

(continuous), vitamin E (continuous), saturated fat (continuous), monounsaturated fat

(continuous), polyunsaturated fat (continuous), and trans fat (continuous).

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Fig. S6. Each 5% energy increment from total, animal and plant protein intakes and

changes in waist circumference (n=18,359), cholesterol (n=18,098), and systolic blood

pressure (n=15,175) over 11 years.

Panels A, B, C and D show protein intakes associated with cumulative changes in waist

circumference, plasma cholesterol, systolic blood pressure and diastolic blood pressure,

respectively.

Multivariate-model adjusted for age (in years), gender, baseline component measurement

(continuous), body mass index (continuous), follow-up period (in years), ethnicity

(Australia/New Zealand, Greece, Italy, or UK/Malta), socio-economic status (quintiles),

physical activity (0, 1-3, 4 or 5, and 6 or more), smoking (never, former, or current), alcohol

intake (0 g/day, 1-39 g/day, 40-59 g/day and 60 or more g/day for male and 0 g/day, 1-19

g/day, 20-39 g/day and 40 or more g/day for female), glycemic index (continuous) and

consumption of energy (continuous), fibre (continuous), sodium (continuous), potassium

(continuous), magnesium (continuous), vitamin C (continuous), vitamin E (continuous),

saturated fat (continuous), monounsaturated fat (continuous), polyunsaturated fat

(continuous), and trans fat (continuous).

Table S1. List of food categories for the calculation of protein intake from different food

sources.

Food item Food group Animal/Plant

Wheatgerm Grains Plant

Muesli Grains Plant

Whole wheat or rye bread Grains Plant

Other breakfast cereals Grains Plant

Pasta or noodles Grains Plant

Fruit bread Grains Plant

White bread Grains Plant

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Rice boiled Grains Plant

Fried rice Grains Plant

Mixed dishes with rice Grains Plant

Dry biscuits Grains Plant

Sweet biscuits Grains Plant

Pies or savoury pastries Grains Plant

Creamed soup Vegetables Plant

Other soup or broth Vegetables Plant

Pickled vegetables Vegetables Plant

Tomato Vegetables Plant

Capscium Vegetables Plant

Lettuce, endive or other salad greens Vegetables Plant

Cucumber Vegetables Plant

Celery or fennel Vegetables Plant

Beetroot Vegetables Plant

Coleslaw Vegetables Plant

Carrot Vegetables Plant

Cabbage or brussels sprouts Vegetables Plant

Cauliflower Vegetables Plant

Broccoli Vegetables Plant

Silverbeet, spinach or other leafy

greens

Vegetables Plant

Pumpkin Vegetables Plant

Onion or leeks Vegetables Plant

Mushrooms Vegetables Plant

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Sweet corn Vegetables Plant

Zucchini, squash or eggplant Vegetables Plant

Cooked mixed vegetable dish Vegetables Plant

Potato fried or roasted Vegetables Plant

Potato cooked without fat Vegetables Plant

Green beans or peas Vegetables Plant

Beans, pea or lentil soup Legumes and nuts Plant

Cooked dried bean, chick pea dish Legumes and nuts Plant

Peanuts or peanut butter Legumes and nuts Plant

Other nuts Legumes and nuts Plant

Soya milk from cereal Legumes and nuts Plant

Soya milk from beverage Legumes and nuts Plant

Dried apricots or peaches Fruits Plant

Other dried fruits Fruits Plant

Fruit salad Fruits Plant

Oranges or mandarins Fruits Plant

Apples Fruits Plant

Bananas Fruits Plant

Peaches or nectarines Fruits Plant

Pears Fruits Plant

Cantaloupe or honeydew melon Fruits Plant

Watermelon Fruits Plant

Strawberries Fruits Plant

Plums Fruits Plant

Apricots Fruits Plant

Grapefruit Fruits Plant

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Pineapple Fruits Plant

Avocado Fruits Plant

Olives Fruits Plant

Fig Fruits Plant

Grapes Fruits Plant

Chocolate confectionery Snacks Plant

Other confectionery Snacks Plant

Dip Snacks Plant

Corn chips, potato chips Snacks Plant

Vegemite Other protein sources Plant

Margarine Other protein sources Plant

Orange or lemon juice Other protein sources Plant

Other fruit juice Other protein sources Plant

Diet (low-calorie) soft drink Other protein sources Plant

Soft drink Other protein sources Plant

Tea Other protein sources Plant

Herbal tea Other protein sources Plant

Coffee Other protein sources Plant

Coffee substitute Other protein sources Plant

Water Other protein sources Plant

Jam, honey or syrups Other protein sources Plant

Butter Other protein sources Animal

Cottage cheese Dairy Animal

Ricotta cheese Dairy Animal

Fetta cheese Dairy Animal

Low fat, low cholesterol cheese Dairy Animal

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Hard grating cheeses Dairy Animal

Cream cheese Dairy Animal

Cheddar or similar cheeses Dairy Animal

Icecream Dairy Animal

Custard Dairy Animal

Cream or sour cream Dairy Animal

Yoghurt Dairy Animal

Milk drink Dairy Animal

Eggs, boiled or poached Eggs Animal

Eggs, fried or scrambled Eggs Animal

Mixed dishes with egg Eggs Animal

Veal or beef schnitzel Red meat Animal

Beef or veal roast Red meat Animal

Beef steak Red meat Animal

Rissoles or meatloaf Red meat Animal

Mixed dishes with beef Red meat Animal

Lamb, chops or roast Red meat Animal

Mixed dishes with lamb Red meat Animal

Pork, chops or roast Red meat Animal

Rabbit or other game Red meat Animal

Liver Red meat Animal

Other offal meats Red meat Animal

Salami or continental sausages Red meat Animal

Sausages or frankfurters Red meat Animal

Bacon Red meat Animal

Ham Red meat Animal

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Corned beef (silverside) Red meat Animal

Manufactured luncheon meats Red meat Animal

Pizza Red meat Animal

Chicken, roast or fried Chicken Animal

Chicken, boiled or steamed Chicken Animal

Mixed dishes with chicken Chicken Animal

Fish, steamed, grilled or baked Fish Animal

Fish, fried Fish Animal

Fish, smoked Fish Animal

Canned fish Fish Animal

Seafood Fish Animal

Full milk from cereal Dairy Animal

Fat reduced milk from cereal Dairy Animal

Fat skim milk from cereal Dairy Animal

Full milk from beverage Dairy Animal

Fat reduced milk from beverage Dairy Animal

Fat skim milk from beverage Dairy Animal

Cakes or sweet pastries Sweet baked products Plant/animal(with cream/butter)

Puddings Sweet baked products Plant/animal(with cream/butter)

Dim sims or spring rolls Savoury cereal products Plant/animal (with meat)

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Besides 121 food frequency questionnaire items, 8 items regarding milk from beverages and

cereal were also included in the analysis. Pizza was included in the animal category because

its major protein source came from meat. For other foods including cakes or sweet pastries,

puddings, and dim sims or spring rolls that might contain both animal and plant protein, half

of the protein was calculated as animal protein and the other half as plant protein. Other food

sources such as juices, vegemite and butter contributed very small amount of protein, so that

they were not analysed as a group but did contribute to the total plant or animal comparison.

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Table S2. Comparison of baseline characteristics between specific groups.*

With

Chronic disease

With any elevated metabolic

syndrome components

Any missing metabolic

syndromecomponent

Included in

the final analysis

No. of participants 13,956 18,471 2,889 5,324

Female 8,211 (59)a 9,821 (53)b 2,084 (72)c 3,840 (72)d

Country of birth

Australia/New Zealand 9,655 (69) a 12,094 (65) b 1,832 (63) c 4,445 (83) d

Greece 1,408 (10) 2,350 (13) 453 (16) 141 (2.6)

Italy 1,947 (14) 2,649 (14) 387 (13) 291 (5.5)

UK/Malta 936 (6.7) 1378 (7.5) 227 (7.8) 447 (8.4)

Socio-ecnomic status†

Missing 38 (0.3) 63 (0.3) 10 (0.3) 19 (0.4)

1st Quintile 2,364 (17) a 2,676 (14) b 378 (13) c 484 (9.1) d

2nd Quintile 3,181 (23) 3,893 (21) 554 (19) 754 (14)

3rd Quintile 2,648 (19) 3,414 (18) 557 (19) 892 (17)

4th Quintile 2,655 (19) 3,785 (20) 641 (22) 1,218 (23)

5th Quintile 3,060 (22) 4640 (25) 759 (26) 1,957 (37)

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Smoking

Current 1336 (9.6) a 2257 (12)b 472 (16)c 459 (8.6)d

Former 4750 (34) 5799 (31) 708 (24) 1522 (29)

Never 7860 (56) 10414 (56) 1719 (59) 3343 (63)

Alcohol intake

0 g (male and female) 5321 (38)a 5554 (30)b 1035 (36)c 1227 (23)d

1-39 g (male), 1-19 g (female) 6851 (49) 10225 (55) 1597 (55) 3473 (65)

40-59 g (male), 20-39 g

(female)

1116 (8.0) 1751 (9.5) 193 (6.7) 504 (9.5)

≥60 g (male), ≥40 g (female) 658 (4.7) 941 (5.1) 74 (2.6) 120 (2.3)

Physical activity score‡

0 3,060 (22)a 4,361 (24)b 674 (23)c 899 (17)d

1-3 2,814 (20) 3,743 (20) 570 (20) 1,021 (19)

4 or 5 5,463 (39) 6,349 (34) 970 (33) 1,689 (32)

≥6 2,609 (19) 4,018 (22) 685 (24) 1,715 (32)

Follow-up (years) 11.94 ± 0.02a 11.89 ± 0.01b 13.08 ± 0.05c 11.20 ± 0.02d

Body mass index (kg/m2) 28.04 ± 0.04a 27.22 ± 0.03b 24.76 ± 0.08c 24.09 ± 0.06d

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Waist circumference (cm) 89.5 ± 0.1a 87.3 ± 0.1b 80.8 ± 0.2c 79.8 ± 0.1d

Diastolic blood pressure (mmHg) 80 ± 0.1a 78.1 ± 0.1b 69.2 ± 0.2c 69.1 ± 0.1c

Systolic blood pressure (mmHg) 143.7 ± 0.1a 139.1 ± 0.1b 121.7 ± 0.3c 122.2 ± 0.2c

Plasma total cholesterol (mmol/L) 5.55 ± 0.01a 5.61 ± 0.01b 5.33 ± 0.02c 5.23 ± 0.01d

Dietary energy (kj/d) 9210 ± 26a 9366 ± 22b 9188 ± 57c 9541 ± 43d

Fibre (g/d) 30.86 ± 0.11a 30.77 ± 0.09a 31.24 ± 0.23a 32.75 ± 0.17b

Sodium (mg/d) 3173 ± 9a 3180 ± 8a 3095 ± 20b 3167 ± 15a

Potassium (mg/d) 3858 ± 15a 3871 ± 13a 3902 ± 32a 4134 ± 24b

Vitamin C (mg/d) 202.1 ± 1a 202.6 ± 0.8a 204.5 ± 2.2a 214.1 ± 1.6b

Vitamin E (mg/d) 8.12 ± 0.03a 8.17 ± 0.03a 8.26 ± 0.07a 8.61 ± 0.05b

Saturated fat (%energy) 13.13 ± 0.02a 13.42 ± 0.02b 13.29 ± 0.05ab 13.44 ± 0.04b

Monounsaturated fat (%energy) 12.1 ± 0.02a 12.22 ± 0.02b 12.14 ± 0.05ab 11.63 ± 0.04c

Polyunsaturated fat (%energy) 5.33 ± 0.01a 5.17 ± 0.01b 5.17 ± 0.03b 5.17 ± 0.02b

Trans fat (%energy) 0.043 ± 0.00a 0.045 ± 0.000b 0.044 ± 0.001ab 0.037 ± 0.001c

Dietary glycemic index§ 49.2 ± 0a 49.4 ± 0b 49.2 ± 0.1ab 48.8 ± 0.1c

Protein sources (% energy)

Total 18.39 ± 0.03a 18.02 ± 0.02b 18.09 ± 0.06b 17.72 ± 0.04c

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Animal 11.81 ± 0.03a 11.59 ± 0.02b 11.52 ± 0.06b 11.04 ± 0.05c

Plant 6.58 ± 0.01a 6.44 ± 0.01b 6.57 ± 0.03a 6.68 ± 0.02c

Grains 3.82 ± 0.01a 3.73 ± 0.01b 3.74 ± 0.03c 3.83 ± 0.02a

Vegetables 1.44 ± 0.01a 1.39 ± 0.01b 1.42 ± 0.01abc 1.45 ± 0.01ac

Fruits 0.55 ± 0a 0.56 ± 0a 0.61 ± 0.01b 0.6 ± 0.01b

Legumes and nuts 0.43 ± 0a 0.43 ± 0a 0.48 ± 0.01b 0.46 ± 0.01b

Dairy 2.85 ± 0.02a 2.81 ± 0.01a 2.97 ± 0.03b 3.1 ± 0.02c

Eggs 0.45 ± 0a 0.47 ± 0b 0.45 ± 0.01a 0.44 ± 0.01a

Red meat 5.24 ± 0.02a 5.27 ± 0.02a 5.03 ± 0.05b 4.65 ± 0.03b

Chicken 1.74 ± 0.01a 1.61 ± 0.01b 1.61 ± 0.02b 1.52 ± 0.02c

Fish 1.46 ± 0.01a 1.34 ± 0.01b 1.38 ± 0.02b 1.23 ± 0.02c

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*Plus-minus values are age- and gender-adjusted means ± SDs, which were calculated using

generalised linear model. Tukey’s multiple comparisons tests were used to compare the

differences between groups. Means in a row or one categorical variable with different

superscripts differ, P<0.01.

†Socio-economic status was attributed using the Index of Relative Socio-economic

Disadvantage with the lowest quintile representing the greatest socio-economic disadvantage

[1].

‡Physical activity was assessed using questions based on those developed by the National

Heart Foundation and Australian Institute of Health with higher score representing higher

physical activity [2].

§Glycemic index was calculated for all the participants using data from Foster-Powell et al.

[3].

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References

[1] (ABS) ABoS. Information Paper, 1996 Census of Population and Housing, Socio-

Economic Indexes for Areas. Canberra: Australian Bureau of Statistics. 1998;Cat. No.

2039.0.

[2] Health NHFaAIo. Risk Factor Prevalence Study No. 3 1989. Canberra: National Heart

Foundation & Australian Institute of Health. 1990.

[3] Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and

glycemic load values: 2002. Am J Clin Nutr. 2002;76:5-56.

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