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Diabetes, Metabolic Syndrome and... 2020Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia. Proteins in plant sources that enable the maintenance of the glycemic profile may be of interest in... (Review)
Review
Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia. Proteins in plant sources that enable the maintenance of the glycemic profile may be of interest in the context of T2DM. However, their mechanisms of action are unclear, unlike other bioactive compounds. This systematic review identified and described the mechanisms of action of isolated and purified proteins and peptides extracted from vegetables on the reduction of blood glucose in T2DM in experimental studies. The research was done in PubMed, ScienceDirect, Scopus, Web of Science, Embase and Virtual Health Library (VHL) databases in March 2019. The initial search retrieved 916 articles, and, after reading the title, abstract and keywords, 24 articles were eligible for full reading. Then, five articles were eligible to build this systematic review. The evaluation of the evidence and the strength of the recommendations of the studies was evaluated with the SYstematic Review Center for Laboratory animal Experimentation - SYRCLE. Studies with proteins or peptides extracted from soybean (), corn (), peas (), costus () and ginseng () were found, and all of them decreased glycemia but not by the same mechanisms. The mechanism of action of proteins extracted from were similar, acting in the insulin-mediated pathways. The peptide derived from increased GLP-1 expression, and the peptide from reduced NF-kB signaling, both resulting in stimulating the release of insulin. Therefore, bioactive proteins and peptides of plant sources act through biochemical pathways, in the modulation of insulin resistance and the hyperglycemic state. These compounds are promising in scientific research on T2DM, because there is a probable similarity of these proteins with insulin, which enables them to act as insulin-like molecules.
PubMed: 33061503
DOI: 10.2147/DMSO.S256883 -
Sports Medicine (Auckland, N.Z.) Dec 2023Protein supplements are important to maintain optimum health and physical performance, particularly in athletes and active individuals to repair and rebuild their...
Effect of Soy Protein Supplementation on Muscle Adaptations, Metabolic and Antioxidant Status, Hormonal Response, and Exercise Performance of Active Individuals and Athletes: A Systematic Review of Randomised Controlled Trials.
BACKGROUND
Protein supplements are important to maintain optimum health and physical performance, particularly in athletes and active individuals to repair and rebuild their skeletal muscles and connective tissues. Soy protein (SP) has gained popularity in recent years as an alternative to animal proteins.
OBJECTIVES
This systematic review evaluates the evidence from randomised controlled clinical trials of the effects of SP supplementation in active individuals and athletes in terms of muscle adaptations, metabolic and antioxidant status, hormonal response and exercise performance. It also explores the differences in SP supplementation effects in comparison to whey protein.
METHODS
A systematic search was conducted in PubMed, Embase and Web of Science, as well as a manual search in Google Scholar and EBSCO, on 27 June 2023. Randomised controlled trials that evaluated the applications of SPs supplementation on sports and athletic-related outcomes that are linked with exercise performance, adaptations and biomarkers in athletes and physically active adolescents and young adults (14 to 39 years old) were included, otherwise, studies were excluded. The risk of bias was assessed according to Cochrane's revised risk of bias tool.
RESULTS
A total of 19 eligible original research articles were included that investigated the effect of SP supplementation on muscle adaptations (n = 9), metabolic and antioxidant status (n = 6), hormonal response (n = 6) and exercise performance (n = 6). Some studies investigated more than one effect. SP was found to provide identical increases in lean mass compared to whey in some studies. SP consumption promoted the reduction of exercise-induced metabolic/blood circulating biomarkers such as triglycerides, uric acid and lactate. Better antioxidant capacity against oxidative stress has been seen with respect to whey protein in long-term studies. Some studies reported testosterone and cortisol fluctuations related to SP; however, more research is required. All studies on SP and endurance performance suggested the potential beneficial effects of SP supplementation (10-53.3 g) on exercise performance by improving high-intensity and high-speed running performance, enhancing maximal cardiac output, delaying fatigue and improving isometric muscle strength, improving endurance in recreational cyclists, increasing running velocity and decreasing accumulated lactate levels; however, studies determining the efficacy of soy protein on VOmax provided conflicted results.
CONCLUSION
It is possible to recommend SP to athletes and active individuals in place of conventional protein supplements by assessing their dosage and effectiveness in relation to different types of training. SP may enhance lean mass compared with other protein sources, enhance the antioxidant status, and reduce oxidative stress. SP supplementation had an inconsistent effect on testosterone and cortisol levels. SP supplementation may be beneficial, especially after muscle damage, high-intensity/high-speed or repeated bouts of strenuous exercise.
Topics: Adolescent; Adult; Humans; Young Adult; Antioxidants; Athletes; Biomarkers; Dietary Supplements; Hydrocortisone; Lactates; Muscle, Skeletal; Soybean Proteins; Testosterone; Whey Proteins; Randomized Controlled Trials as Topic
PubMed: 37603200
DOI: 10.1007/s40279-023-01899-w -
Food Research International (Ottawa,... Sep 2023Common oilseeds, such as soybean, peanut, rapeseed, sunflower seed, sesame seed and chia seed, are key sources of edible vegetable oils. Their defatted meals are... (Review)
Review
Common oilseeds, such as soybean, peanut, rapeseed, sunflower seed, sesame seed and chia seed, are key sources of edible vegetable oils. Their defatted meals are excellent natural sources of plant proteins that can meet consumers' demand for health and sustainable substitutes for animal proteins. Oilseed proteins and their derived peptides are also associated with many health benefits, including weight loss and reduced risks of diabetes, hypertension, metabolic syndrome and cardiovascular events. This review summarizes the current status of knowledge on the protein and amino acid composition of common oilseeds as well as the functional properties, nutrition, health benefits and food applications of oilseed protein. Currently, oilseeds are widely applied in the food industry regarding for their health benefits and good functional properties. However, most oilseed proteins are incomplete proteins and their functional properties are not promising compared to animal proteins. They are also limited in the food industry due to their off-flavor, allergenic and antinutritional factors. These properties can be improved by protein modification. Therefore, in order to make better use of oilseed proteins, methods for improving their nutrition value, bioactive activity, functional and sensory characteristics, as well as the strategies for reducing their allergenicity were also discussed in this paper. Finally, examples for the application of oilseed proteins in the food industry are presented. Limitations and future perspectives for developing oilseed proteins as food ingredients are also pointed out. This review aims to foster thinking and generate novel ideas for future research. It will also provide novel ideas and broad prospects for the application of oilseeds in the food industry.
Topics: Animals; Plant Oils; Plant Proteins; Peptides; Amino Acids
PubMed: 37330842
DOI: 10.1016/j.foodres.2023.113061 -
Nutrients May 2021Proteins, especially plant proteins, may reduce inflammation among adults with chronic kidney disease (CKD). This systematic review and meta-analysis were conducted to... (Meta-Analysis)
Meta-Analysis Review
Proteins, especially plant proteins, may reduce inflammation among adults with chronic kidney disease (CKD). This systematic review and meta-analysis were conducted to evaluate the effect protein types (animal or plant) have on inflammation markers (CRP, IL-6, TNF-α) among adults with varying stages of CKD. The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was conducted to identify articles from inception until January 2021, utilizing six databases. Controlled trials that compared the effects of different protein types were analyzed using random-effects meta-analysis. Quality assessment and risk of bias of the included articles were assessed by using Cochrane risk of bias instrument and ROBINS-I. Out of the 10 studies that met the criteria, there was a decreasing trend in CRP levels when consuming plant proteins compared to animal proteins among non-dialysis participants. There was a statistically significant decrease when comparing animal proteins to unspecified proteins in CRP levels among dialysis participants [Hedges' g = 2.11; 95% CI 1.12, 3.11; ≤ 0.001], favoring unspecified proteins. Furthermore, animal proteins (eggs, red meat) showed increasing trends in CRP levels compared to whey protein isolate. Caution must be considered regarding these results as controlled, non-randomized, trials were included in the analysis, which may have contributed to high risk of bias. Future research should focus on protein types and the impact they have on kidney disease progression and inflammation markers.
Topics: Adult; Animals; Biomarkers; Databases, Factual; Humans; Inflammation; Proteins; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 34068841
DOI: 10.3390/nu13051660 -
Appetite Apr 2021Consumers' dietary patterns have a significant impact on planetary and personal health. To address health and environmental challenges one of the many possible solutions... (Review)
Review
Consumers' dietary patterns have a significant impact on planetary and personal health. To address health and environmental challenges one of the many possible solutions is to substitute meat consumption with alternative protein sources. This systematic review identifies 91 articles with a focus on the drivers of consumer acceptance of five alternative proteins: pulses, algae, insects, plant-based alternative proteins, and cultured meat. This review demonstrates that acceptance of the alternative proteins included here is relatively low (compared to that of meat); acceptance of insects is lowest, followed by acceptance of cultured meat. Pulses and plant-based alternative proteins have the highest acceptance level. In general, the following drivers of acceptance consistently show to be relevant for the acceptance of various alternative proteins: motives of taste and health, familiarity, attitudes, food neophobia, disgust, and social norms. However, there are also differences in relevance between individuals and between alternative proteins. For example, for insects and other novel alternative proteins the drivers of familiarity and affective processes of food neophobia and disgust seem more relevant. As part of gaining full insight in relevant drivers of acceptance, the review also shows an overview of the intervention studies that were included in the 91 articles of the review, providing implications on how consumer acceptance can be increased. The focal areas of the intervention studies included here do not fully correspond with the current knowledge of drivers. To date, intervention studies have mainly focussed on conscious deliberations, whereas familiarity and affective factors have also been shown to be key drivers. The comprehensive overview of the most relevant factors for consumer acceptance of various categories of alternative proteins thus shows large consistencies across bodies of research. Variations can be found in the nuances showing different priorities of drivers for different proteins and different segments, showing the relevance of being context and person specific for future research.
Topics: Animals; Consumer Behavior; Food Preferences; Humans; Insecta; Meat; Taste
PubMed: 33276014
DOI: 10.1016/j.appet.2020.105058 -
The Cochrane Database of Systematic... Oct 2018Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. This condition... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. This condition appears to be more frequent in the first six weeks of life (prevalence range of 17% to 25%), depending on the specific location reported and definitions used, and it usually resolves by three months of age. The aetiopathogenesis of infantile colic is unclear but most likely multifactorial. A number of psychological, behavioural and biological components (food hypersensitivity, allergy or both; gut microflora and dysmotility) are thought to contribute to its manifestation. The role of diet as a component in infantile colic remains controversial.
OBJECTIVES
To assess the effects of dietary modifications for reducing colic in infants less than four months of age.
SEARCH METHODS
In July 2018 we searched CENTRAL, MEDLINE, Embase , 17 other databases and 2 trials registers. We also searched Google, checked and handsearched references and contacted study authors.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of dietary modifications, alone or in combination, for colicky infants younger than four months of age versus another intervention or placebo. We used specific definitions for colic, age of onset and the methods for performing the intervention. We defined 'modified diet' as any diet altered to include or exclude certain components.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Our primary outcome was duration of crying, and secondary outcomes were response to intervention, frequency of crying episodes, parental/family quality of life, infant sleep duration, parental satisfaction and adverse effects.
MAIN RESULTS
We included 15 RCTs involving 1121 infants (balanced numbers of boys and girls) aged 2 to 16 weeks. All studies were small and at high risk of bias across multiple design factors (e.g. selection, attrition). The studies covered a wide range of dietary interventions, and there was limited scope for meta-analysis. Using the GRADE approach, we assessed the quality of the evidence as very low.Low-allergen maternal diet versus a diet containing known potential allergens: one study (90 infants) found that 35/47 (74%) of infants responded to a low-allergen maternal diet, compared with 16/43 (37%) of infants on a diet containing known potential allergens.Low-allergen diet or soy milk formula versus dicyclomine hydrochloride: one study (120 infants) found that 10/15 (66.6%) breastfed babies responded to dicyclomine hydrochloride, compared with 24/45 (53.3%) formula-fed babies. There was little difference in response between breastfed babies whose mother changed their diet (10/16; 62.5%) and babies who received soy milk formula (29/44; 65.9%).Hydrolysed formula versus standard formula: two studies (64 infants) found no difference in duration of crying, reported as a dichotomous outcome: risk ratio 2.03, 95% confidence interval (CI) 0.81 to 5.10; very low-quality evidence. The author of one study confirmed there were no adverse effects. One study (43 infants) reported a greater reduction in crying time postintervention with hydrolysed formula (104 min/d, 95% CI 55 to 155) than with standard formula (3 min/d, 95% CI -63 to 67).Hydrolysed formula versus another hydrolysed formula: one study (22 infants) found that two types of hydrolysed formula were equally effective in resolving symptoms for babies who commenced with standard formula (Alimentum reduced crying to 2.21 h/d (standard deviation (SD) 0.40) and Nutramigen to 2.93 h/d (SD 0.70)).Hydrolysed formula or dairy- and soy-free maternal diet versus addition of parental education or counselling: one study (21 infants) found that crying time decreased to 2.03 h/d (SD 1.03) in the hydrolysed or dairy- and soy-free group compared with 1.08 h/d (SD 0.7) in the parent education or counselling group, nine days into the intervention.Partially hydrolysed, lower lactose, whey-based formulae containing oligosaccharide versus standard formula with simethicone: one study (267 infants) found that both groups experienced a decrease in colic episodes (secondary outcome) after seven days (partially hydrolysed formula: from 5.99 episodes (SD 1.84) to 2.47 episodes (SD 1.94); standard formula: from 5.41 episodes (SD 1.88) to 3.72 episodes (SD 1.98)). After two weeks the difference between the two groups was significant (partially hydrolysed: 1.76 episodes (SD 1.60); standard formula: 3.32 episodes (SD 2.06)). The study author confirmed there were no adverse effects.Lactase enzyme supplementation versus placebo: three studies (138 infants) assessed this comparison, but none reported data amenable to analysis for any outcome. There were no adverse effects in any of the studies.Extract of Foeniculum vulgare, Matricariae recutita, and Melissa officinalis versus placebo: one study (93 infants) found that average daily crying time was lower for infants given the extract (76.9 min/d (SD 23.5), than infants given placebo (169.9 min/d (SD 23.1), at the end of the one-week study. There were no adverse effects.Soy protein-based formula versus standard cows' milk protein-based formula: one study (19 infants) reported a mean crying time of 12.7 h/week (SD 16.4) in the soy formula group versus 17.3 h/week (SD 6.9) in the standard cows' milk group, and that 5/10 (50%) responded in the soy formula group versus 0/9 (0%) in the standard cows' milk group.Soy protein formula with polysaccharide versus standard soy protein formula: one study (27 infants) assessed this comparison but did not provide disaggregated data for the number of responders in each group after treatment.No study reported on our secondary outcomes of parental or family quality of life, infant sleep duration per 24 h, or parental satisfaction.
AUTHORS' CONCLUSIONS
Currently, evidence of the effectiveness of dietary modifications for the treatment of infantile colic is sparse and at significant risk of bias. The few available studies had small sample sizes, and most had serious limitations. There were insufficient studies, thus limiting the use of meta-analysis. Benefits reported for hydrolysed formulas were inconsistent.Based on available evidence, we are unable to recommend any intervention. Future studies of single interventions, using clinically significant outcome measures, and appropriate design and power are needed.
Topics: Allergens; Colic; Crying; Diet Therapy; Female; Humans; Infant; Infant Formula; Lactase; Male; Randomized Controlled Trials as Topic; Soybean Proteins; Time Factors
PubMed: 30306546
DOI: 10.1002/14651858.CD011029.pub2 -
Critical Reviews in Food Science and... 2022Previous findings assessing the association between long-term protein intake and cardiovascular diseases (CVDs) are inconsistent. This study aimed to summarize previous... (Meta-Analysis)
Meta-Analysis
Dietary intake of total, animal and plant proteins and the risk of coronary heart disease and hypertension: a systematic review and dose-response meta-analysis of prospective cohort studies.
BACKGROUND & OBJECTIVES
Previous findings assessing the association between long-term protein intake and cardiovascular diseases (CVDs) are inconsistent. This study aimed to summarize previous investigations on the association between total, animal and plant proteins intake and the risk of coronary heart disease (CHD) and hypertension (HTN) in adults.
METHODS
Related papers were found by searching through PubMed/Medline, Scopus, and Google Scholar up to April 2020. Prospective cohort studies examined the association between consumption of the dietary protein from different sources and the risk of CHD and HTN in general population, were included. The random-effects model was used to pool the reported relative risks (RR). Dose-response associations were modeled by restricted cubic splines.
RESULTS
Thirteen prospective studies, in total, including 547,303 participants- 11,590 cases with total CHD and 5,620 with HTN- were included. Dietary intake of total protein was not significantly associated with the risk of total CHD (RR: 0.97; 95%CI: 0.90-1.05) and HTN (RR: 1.01; 95% CI: 0.90-1.14). Moreover, consumption of both dietary plant and animal protein was not related to the risk of total CHD and HTN. Dose-response analysis indicated that the risk of CHD and HTN did not change significantly with increasing dietary total protein intake from 10% to 25% of total calorie intake.
CONCLUSIONS
Dietary protein intake from different sources had no significant association with risk of CHD and HTN. Further high-quality research is needed to examine the potential mechanistic links between dietary protein intake and health outcomes.
Topics: Animals; Coronary Disease; Dietary Proteins; Eating; Humans; Hypertension; Plant Proteins; Prospective Studies; Risk Factors
PubMed: 33131293
DOI: 10.1080/10408398.2020.1841730 -
Nutrients Sep 2023Maintaining muscle mass, strength, and function is crucial for our aging population. Exercise and dietary protein intake are recommended strategies; however, animal... (Review)
Review
Effects of Plant-Based Protein Interventions, with and without an Exercise Component, on Body Composition, Strength and Physical Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Maintaining muscle mass, strength, and function is crucial for our aging population. Exercise and dietary protein intake are recommended strategies; however, animal proteins have been the most studied. Plant-based protein sources have lower digestibility and incomplete amino acid profiles. However new innovative plant-based proteins and products may have overcome these issues. Therefore, this systematic review aimed to synthesize the current research and evaluate the effects of plant-based protein interventions compared to placebo on body composition, strength, and physical function in older adults (≥60 years old). The secondary aim was whether exercise improved the effectiveness of plant-based protein on these outcomes. Randomized controlled trials up to January 2023 were identified through Medline, EMBASE, CINAHL, and Cochrane Library databases. Studies contained a plant-protein intervention, and assessed body composition, strength, and/or physical function. Thirteen articles were included, all using soy protein (0.6-60 g daily), from 12 weeks to 1 year. Narrative summary reported positive effects on muscle mass over time, with no significant differences compared to controls (no intervention, exercise only, animal protein, or exercise + animal protein interventions). There was limited impact on strength and function. Meta-analysis showed that plant-protein interventions were comparable to controls, in all outcomes. In conclusion, plant-protein interventions improved muscle mass over time, and were comparable to other interventions, warranting further investigation as an anabolic stimulus in this vulnerable population.
PubMed: 37764843
DOI: 10.3390/nu15184060 -
Food & Nutrition Research 2023To systematically review the evidence on the effect of replacing the intake of animal protein with plant protein on cardiovascular disease (CVD) and type 2 diabetes... (Review)
Review
Animal versus plant-based protein and risk of cardiovascular disease and type 2 diabetes: a systematic review of randomized controlled trials and prospective cohort studies.
OBJECTIVES
To systematically review the evidence on the effect of replacing the intake of animal protein with plant protein on cardiovascular disease (CVD) and type 2 diabetes (T2D) and their intermediate risk factors.
METHODS
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 12th May 2022 for randomized controlled trials (RCTs) or prospective cohort studies that investigated replacement of animal protein with plant protein from foods. Outcomes were CVDs, T2D, and in RCTs also the effects on blood lipids, glycemic markers, and blood pressure. Risk of bias was evaluated with the Cochrane's RoB2, ROBINS-I, and USDA's RoB-NObS tools. Random-effects meta-analyses assessed the effects of plant vs. animal proteins on blood lipids in RCTs. The evidence was appraised according to the World Cancer Research Fund's criteria.
RESULTS
After screening 15,090 titles/abstracts, full text of 124 papers was scrutinized in detail, from which 13 RCTs and seven cohort studies were included. Eight of the RCTs had either some concern or high risk of bias, while the corresponding evaluation of cohort studies resulted in moderate risk of bias for all seven. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference -0.11 mmol/L; 95% CI -0.22, -0.01) and low-density lipoprotein cholesterol (-0.14 mmol/L; 95% CI -0.25, -0.02) by replacing animal protein with plant protein. The substitution of animal protein with plant protein (percentage of energy intake) in cohort studies was associated with lower CVD mortality ( = 4) and lower T2D incidence ( = 2). The evidence was considered for both outcomes.
CONCLUSION
Evidence that the substitution of animal protein with plant protein reduces risk of both CVD mortality and T2D incidence is . Replacing animal protein with plant protein for aspects of sustainability may also be a public health strategy to lower the risk of CVD mortality and T2D.
PubMed: 37050925
DOI: 10.29219/fnr.v67.9003 -
Circulation Apr 2019Findings among randomized controlled trials evaluating the effect of red meat on cardiovascular disease risk factors are inconsistent. We provide an updated... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Findings among randomized controlled trials evaluating the effect of red meat on cardiovascular disease risk factors are inconsistent. We provide an updated meta-analysis of randomized controlled trials on red meat and cardiovascular risk factors and determine whether the relationship depends on the composition of the comparison diet, hypothesizing that plant sources would be relatively beneficial.
METHODS
We conducted a systematic PubMed search of randomized controlled trials published up until July 2017 comparing diets with red meat with diets that replaced red meat with a variety of foods. We stratified comparison diets into high-quality plant protein sources (legumes, soy, nuts); chicken/poultry/fish; fish only; poultry only; mixed animal protein sources (including dairy); carbohydrates (low-quality refined grains and simple sugars, such as white bread, pasta, rice, cookies/biscuits); or usual diet. We performed random-effects meta-analyses comparing differences in changes of blood lipids, apolipoproteins, and blood pressure for all studies combined and stratified by specific comparison diets.
RESULTS
Thirty-six studies totaling 1803 participants were included. There were no significant differences between red meat and all comparison diets combined for changes in blood concentrations of total, low-density lipoprotein, or high-density lipoprotein cholesterol, apolipoproteins A1 and B, or blood pressure. Relative to the comparison diets combined, red meat resulted in lesser decreases in triglycerides (weighted mean difference [WMD], 0.065 mmol/L; 95% CI, 0.000-0.129; P for heterogeneity <0.01). When analyzed by specific comparison diets, relative to high-quality plant protein sources, red meat yielded lesser decreases in total cholesterol (WMD, 0.264 mmol/L; 95% CI, 0.144-0.383; P<0.001) and low-density lipoprotein (WMD, 0.198 mmol/L; 95% CI, 0.065-0.330; P=0.003). In comparison with fish, red meat yielded greater decreases in low-density lipoprotein (WMD, -0.173 mmol/L; 95% CI, -0.260 to -0.086; P<0.001) and high-density lipoprotein (WMD, -0.065 mmol/L; 95% CI, -0.109 to -0.020; P=0.004). In comparison with carbohydrates, red meat yielded greater decreases in triglycerides (WMD, -0.181 mmol/L; 95% CI, -0.349 to -0.013).
CONCLUSIONS
Inconsistencies regarding the effects of red meat on cardiovascular disease risk factors are attributable, in part, to the composition of the comparison diet. Substituting red meat with high-quality plant protein sources, but not with fish or low-quality carbohydrates, leads to more favorable changes in blood lipids and lipoproteins.
Topics: Adult; Aged; Cardiovascular Diseases; Diet; Diet, Healthy; Dietary Carbohydrates; Female; Fish Proteins; Humans; Male; Middle Aged; Nutritive Value; Plant Proteins, Dietary; Protective Factors; Randomized Controlled Trials as Topic; Red Meat; Risk Factors; Seafood; Young Adult
PubMed: 30958719
DOI: 10.1161/CIRCULATIONAHA.118.035225