Specific Dietary Protein Sources Are Associated with Cardiometabolic Risk Factors in the Boston Puerto Rican Health Study



      Puerto Rican adults residing in the US mainland experience a high prevalence of metabolic syndrome (MetS). A diet containing healthy protein-rich sources may help control risk factors for MetS.


      This study aimed to evaluate 2-year longitudinal associations between intake of various protein-rich foods and changes in the six MetS components.


      This is a secondary analysis of a longitudinal cohort study using data from the baseline (2004–2007) and 2-year follow-up visits (2006–2011) in the Boston Puerto Rican Health Study.


      Participants were self-identified Puerto Ricans, aged 45 to 75 years, residing in Boston, Massachusetts, or the surrounding area (n = 1,126).

      Main outcome measures

      MetS components were fasting glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, systolic and diastolic blood pressures, and waist circumference.

      Statistical analysis

      Baseline intake of foods reported in a semiquantitative food frequency questionnaire were expressed as servings/day, and protein-rich foods were categorized as unprocessed white meat, unprocessed red meat, processed meat, milk and yogurt, cheese, fish and seafood, beans, nuts, and eggs. Associations between each continuous protein food group and continuous 2-year change in MetS components were assessed using linear mixed models adjusted for socioeconomic and behavioral factors, and other dietary sources.


      The top contributors to total protein intake were unprocessed red meat (13.3%) and unprocessed poultry (13.0%), and the lowest were eggs (2.92%) and nuts (0.91%). Higher intake of processed meats was associated with an increase in waist circumference over 2 years (β = 1.28; standard error [SE] = 0.63), whereas higher intake of fish and seafood was associated with a decrease in waist circumference (β = −3.47; SE = 1.39). Intake of unprocessed poultry was associated with a decrease in triglycerides (β = −24.5; SE = 9.13). No other significant associations were observed between protein sources and 2-year changes in MetS components.


      Consuming less processed meat and more fish and seafood and unprocessed poultry was associated with decreases in waist circumference and triglycerides among US mainland Puerto Ricans. Other dietary protein sources were not related to cardiometabolic health.


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        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • et al.
        Diagnosis and management of the metabolic syndrome.
        Circulation. 2005; 112: 2735-2752
        • Saklayen M.G.
        The global epidemic of the metabolic syndrome.
        Curr Hypertens Rep. 2018; 20: 12
        • Pérez C.M.
        • Guzmán M.
        • Ortiz A.P.
        • et al.
        Prevalence of the metabolic syndrome in San Juan, Puerto Rico.
        Ethn Dis. 2008; 18: 434-441
        • Heiss G.
        • Snyder M.L.
        • Teng Y.
        • et al.
        Prevalence of metabolic syndrome among Hispanics/Latinos of diverse background: the Hispanic Community Health Study/Study of Latinos.
        Diabetes Care. 2014; 37: 2391-2399
      1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017.
        (Accessed May 13th, 2021)
        • Daviglus M.L.
        • Talavera G.A.
        • Avilés-Santa M.L.
        • et al.
        Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States.
        JAMA. 2012; 308: 1775-1784
        • Mozaffarian D.
        Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review.
        Circulation. 2016; 133: 187-225
        • Kempf K.
        • Schloot N.C.
        • Gärtner B.
        • Keil R.
        • Schadewaldt P.
        • Martin S.
        Meal replacement reduces insulin requirement, HbA1c and weight long-term in type 2 diabetes patients with >100 U insulin per day.
        J Hum Nutr Diet Off J Br Diet Assoc. 2014; 27: 21-27
        • Richter C.K.
        • Skulas-Ray A.C.
        • Champagne C.M.
        • Kris-Etherton P.M.
        Plant protein and animal proteins: do they differentially affect cardiovascular disease risk?.
        Adv Nutr. 2015; 6: 712-728
        • Astrup A.
        • Raben A.
        • Geiker N.
        The role of higher protein diets in weight control and obesity-related comorbidities.
        Int J Obes 2005. 2015; 39: 721-726
        • Wolk A.
        Potential health hazards of eating red meat.
        J Intern Med. 2017; 281: 106-122
        • Tian S.
        • Xu Q.
        • Jiang R.
        • Han T.
        • Sun C.
        • Na L.
        Dietary protein consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies.
        Nutrients. 2017; 9: 982
        • Sluijs I.
        • Beulens J.W.J.
        • van der A.D.L.
        • Spijkerman A.M.W.
        • Grobbee D.E.
        • van der Schouw Y.T.
        Dietary intake of total, animal, and vegetable protein and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL study.
        Diabetes Care. 2010; 33: 43-48
        • Rouhani M.H.
        • Salehi-Abargouei A.
        • Surkan P.J.
        • Azadbakht L.
        Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies.
        Obes Rev. 2014; 15: 740-748
        • Wang X.
        • Lin X.
        • Ouyang Y.Y.
        • et al.
        Red and processed meat consumption and mortality: dose–response meta-analysis of prospective cohort studies.
        Public Health Nutr. 2016; 19: 893-905
        • Chuang S.-Y.
        • Chiu T.H.T.
        • Lee C.-Y.
        • et al.
        Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study.
        J Hypertens. 2016; 34: 2164-2171
        • Bujnowski D.
        • Xun P.
        • Daviglus M.L.
        • Van Horn L.
        • He K.
        • Stamler J.
        Longitudinal association between animal and vegetable protein intake and obesity among adult males in the United States: the Chicago Western Electric Study.
        J Am Diet Assoc. 2011; 111: 1150-1155.e1
        • Malik V.S.
        • Li Y.
        • Tobias D.K.
        • Pan A.
        • Hu F.B.
        Dietary protein intake and risk of type 2 diabetes in US men and women.
        Am J Epidemiol. 2016; 183: 715-728
        • Pedersen A.N.
        • Kondrup J.
        • Børsheim E.
        Health effects of protein intake in healthy adults: a systematic literature review.
        Food Nutr Res. 2013; 57
        • Bergeron N.
        • Chiu S.
        • Williams P.T.
        • M King S.
        • Krauss R.M.
        Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial.
        Am J Clin Nutr. 2019; 110: 24-33
        • Wang Lu
        • Manson J.E.
        • Buring J.E.
        • Lee I.-M.
        • Sesso H.D.
        Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women.
        Hypertension. 2008; 51: 1073-1079
        • Rautiainen S.
        • Wang L.
        • Lee I.-M.
        • Manson J.E.
        • Buring J.E.
        • Sesso H.D.
        Dairy consumption in association with weight change and risk of becoming overweight or obese in middle-aged and older women: a prospective cohort study.
        Am J Clin Nutr. 2016; 103: 979-988
        • Richard C.
        • Cristall L.
        • Fleming E.
        • et al.
        Impact of egg consumption on cardiovascular risk factors in individuals with type 2 diabetes and at risk for developing diabetes: a systematic review of randomized nutritional intervention studies.
        Can J Diabetes. 2017; 41: 453-463
        • Shang X.
        • Scott D.
        • Hodge A.
        • et al.
        Dietary protein from different food sources, incident metabolic syndrome and changes in its components: an 11-year longitudinal study in healthy community-dwelling adults.
        Clin Nutr. 2017; 36: 1540-1548
        • Jakobsen M.U.
        • Due K.M.
        • Dethlefsen C.
        • et al.
        Fish consumption does not prevent increase in waist circumference in European women and men.
        Br J Nutr. 2012; 108: 924-931
        • Karlsson T.
        • Rosendahl-Riise H.
        • Dierkes J.
        • Drevon C.A.
        • Tell G.S.
        • Nygård O.
        Associations between fish intake and the metabolic syndrome and its components among middle-aged men and women: the Hordaland Health Study.
        Food Nutr Res. 2017; 61: 1347479
        • Mangano K.M.
        • Noel S.E.
        • Sahni S.
        • Tucker K.L.
        Higher dairy intakes are associated with higher bone mineral density among adults with sufficient vitamin D status: results from the Boston Puerto Rican Osteoporosis study.
        J Nutr. 2019; 149: 139-148
        • Mattei J.
        • Tamez M.
        • Bigornia S.J.
        • et al.
        Dietary intake and its determinants among adults living in the metropolitan area of Puerto Rico.
        Nutrients. 2019; 11: 1598
        • Siega-Riz A.M.
        • Pace N.D.
        • Butera N.M.
        • et al.
        How well do U.S. Hispanics adhere to the Dietary Guidelines for Americans? Results from the Hispanic Community Health Study/Study of Latinos.
        Health Equity. 2019; 3: 319-327
        • Mattei J.
        • Sotres-Alvarez D.
        • Daviglus M.L.
        • et al.
        Diet quality and its association with cardiometabolic risk factors vary by Hispanic and Latino ethnic background in the Hispanic Community Health Study/Study of Latinos123.
        J Nutr. 2016; 146: 2035-2044
        • Tucker K.L.
        • Mattei J.
        • Noel S.E.
        • et al.
        The Boston Puerto Rican Health Study, a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities.
        BMC Public Health. 2010; 10: 107
        • Tucker K.L.
        • Bianchi L.A.
        • Maras J.
        • Bermudez O.I.
        Adaptation of a food frequency questionnaire to assess diets of Puerto Rican and Non-Hispanic adults.
        Am J Epidemiol. 1998; 148: 507-518
        • Gao X.
        • Wilde P.E.
        • Lichtenstein A.H.
        • Bermudez O.I.
        • Tucker K.L.
        The maximal amount of dietary alpha-tocopherol intake in U.S. adults (NHANES 2001-2002).
        J Nutr. 2006; 136: 1021-1026
        • Kwan L.L.
        • Bermudez O.I.
        • Tucker K.L.
        Low vitamin B-12 intake and status are more prevalent in Hispanic older adults of Caribbean origin than in neighborhood-matched non-Hispanic whites.
        J Nutr. 2002; 132: 2059-2064
        • Bermudez O.I.
        • Ribaya-Mercado J.D.
        • Talegawkar S.A.
        • Tucker K.L.
        Hispanic and non-Hispanic white elders from Massachusetts have different patterns of carotenoid intake and plasma concentrations.
        J Nutr. 2005; 135: 1496-1502
      2. Nutrition Data System for Research. University of Minnesota Nutrition Coordinating Center, v2007.∼:text=Nutrition%20Data%20System%20for%20Research,report%20and%20analysis%20file%20formats. Accessed May 13th, 2021.

        • Lapuente M.
        • Estruch R.
        • Shahbaz M.
        • Casas R.
        Relation of fruits and vegetables with major cardiometabolic risk factors, markers of oxidation, and inflammation.
        Nutrients. 2019; 11: 2381
        • Mozaffarian D.
        • Wu J.H.Y.
        Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events.
        J Am Coll Cardiol. 2011; 58: 2047-2067
        • Chiavaroli L.
        • Viguiliouk E.
        • Nishi S.K.
        • et al.
        DASH dietary pattern and cardiometabolic outcomes: an umbrella review of systematic reviews and meta-analyses.
        Nutrients. 2019; 11: 338
        • Whelton P.
        • Appel L.
        • Sacco R.
        • et al.
        Sodium, blood pressure, and cardiovascular disease.
        Circulation. 2012; 126: 2880-2889
        • Samson S.L.
        • Garber A.J.
        Metabolic syndrome.
        Endocrinol Metab Clin North Am. 2014; 43: 1-23
        • Chumlea W.C.
        • Guo S.S.
        • Wholihan K.
        • Cockram D.
        • Kuczmarski R.J.
        • Johnson C.L.
        Stature prediction equations for elderly non-Hispanic white, non-Hispanic black, and Mexican-American persons developed from NHANES III data.
        J Am Diet Assoc. 1998; 98: 137-142
        • Tropp L.R.
        • Erkut S.
        • Coll C.G.
        • Alarcón O.
        • Vázquez García H.A.
        Psychological acculturation: development of a new measure for Puerto Ricans on the U.S. mainland.
        Educ Psychol Meas. 1999; 59: 351-367
        • Paffenbarger R.S.
        • Wing A.L.
        • Hyde R.T.
        Physical activity as an index of heart attack risk in college alumni.
        Am J Epidemiol. 1978; 108: 161-175
        • Paffenbarger R.S.
        • Hyde R.T.
        • Wing A.L.
        • Lee I.M.
        • Jung D.L.
        • Kampert J.B.
        The association of changes in physical-activity level and other lifestyle characteristics with mortality among men.
        N Engl J Med. 1993; 328: 538-545
        • McLean R.M.
        • Farmer V.L.
        • Nettleton A.
        • Cameron C.M.
        • Cook N.R.
        • Campbell N.R.C.
        Assessment of dietary sodium intake using a food frequency questionnaire and 24-hour urinary sodium excretion: a systematic literature review.
        J Clin Hypertens. 2017; 19: 1214-1230
        • Richter M.
        • Baerlocher K.
        • Bauer J.M.
        • et al.
        Revised reference values for the intake of protein.
        Ann Nutr Metab. 2019; 74: 242-250
      3. SAS. Cary, NC: SAS Institute.

      4. Stata. College Station, TX: StataCorp.

        • Halkjær J.
        • Tjønneland A.
        • Overvad K.
        • Sørensen T.I.A.
        Dietary predictors of 5-year changes in waist circumference.
        J Am Diet Assoc. 2009; 109: 1356-1366
        • Tørris C.
        • Molin M.
        • Småstuen M.C.
        Lean fish consumption is associated with beneficial changes in the metabolic syndrome components: a 13-year follow-up study from the Norwegian Tromsø Study.
        Nutrients. 2017; 9: 247
        • Singh P.N.
        • Jaceldo-Siegl K.
        • Shih W.
        • et al.
        Plant-based diets are associated with lower adiposity levels among Hispanic/Latino Adults in the adventist multi-ethnic nutrition (AMEN) study.
        Front Nutr. 2019; 6: 34
        • Nesheim M.C.
        • Oria M.
        • Yih P.T.
        • et al.
        Dietary Recommendations for Fish Consumption. National Academies Press (US); 2015.
        • Nettleton J.A.
        • Follis J.L.
        • Ngwa J.S.
        • et al.
        Gene × dietary pattern interactions in obesity: analysis of up to 68 317 adults of European ancestry.
        Hum Mol Genet. 2015; 24: 4728-4738
        • Rouhani M.H.
        • Mirseifinezhad M.
        • Omrani N.
        • Esmaillzadeh A.
        • Azadbakht L.
        Fast food consumption, quality of diet, and obesity among Isfahanian adolescent girls.
        J Obes. 2012; 2012e597924
        • Xu F.
        • Yin X.M.
        • Tong S.L.
        Association between excess bodyweight and intake of red meat and vegetables among urban and rural adult Chinese in Nanjing, China.
        Asia Pac J Public Health. 2007; 19: 3-9
        • Liaset B.
        • Øyen J.
        • Jacques H.
        • Kristiansen K.
        • Madsen L.
        Seafood intake and the development of obesity, insulin resistance and type 2 diabetes.
        Nutr Res Rev. 2019; 32: 146-167
        • Micallef M.
        • Munro I.
        • Phang M.
        • Garg M.
        Plasma n-3 polyunsaturated fatty acids are negatively associated with obesity.
        Br J Nutr. 2009; 102: 1370-1374
        • Davidson M.H.
        • Hunninghake D.
        • Maki K.C.
        • Kwiterovich P.O.
        • Kafonek S.
        Comparison of the effects of lean red meat vs lean white meat on serum lipid levels among free-living persons with hypercholesterolemia: a long-term, randomized clinical trial.
        Arch Intern Med. 1999; 159: 1331
        • Guasch-Ferre M.
        • Satija A.
        • Blondin S.A.
        • et al.
        Meta-analysis of randomized controlled trials of red meat consumption in comparison with various comparison diets on cardiovascular risk factors [miscellaneous article].
        Circulation. 2019; 139: 1828-1845
        • Marangoni F.
        • Corsello G.
        • Cricelli C.
        • et al.
        Role of poultry meat in a balanced diet aimed at maintaining health and wellbeing: an Italian consensus document.
        Food Nutr Res. 2015; 59
        • Clifton P.
        Metabolic syndrome: role of dietary fat type and quantity.
        Nutrients. 2019; 11
        • Mollard R.C.
        • Luhovyy B.L.
        • Panahi S.
        • Nunez M.
        • Hanley A.
        • Anderson G.H.
        Regular consumption of pulses for 8 weeks reduces metabolic syndrome risk factors in overweight and obese adults.
        Br J Nutr. 2012; 108: S111-S122
        • Li H.
        • Li X.
        • Yuan S.
        • Jin Y.
        • Lu J.
        Nut consumption and risk of metabolic syndrome and overweight/obesity: a meta-analysis of prospective cohort studies and randomized trials.
        Nutr Metab. 2018; 15: 46
        • Drouin-Chartier J.-P.
        • Chen S.
        • Li Y.
        • et al.
        Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis.
        BMJ. 2020; : 368
        • Mattei J.
        • Hu F.B.
        • Campos H.
        A higher ratio of beans to white rice is associated with lower cardiometabolic risk factors in Costa Rican adults.
        Am J Clin Nutr. 2011; 94: 869-876
        • Zhou B.
        • Ichikawa R.
        • Parnell L.D.
        • et al.
        Metabolomic links between sugar-sweetened beverage intake and obesity.
        J Obes. 2020; 2020: 7154738
        • Sotos-Prieto M.
        • Bhupathiraju S.N.
        • Falcón L.M.
        • Gao X.
        • Tucker K.L.
        • Mattei J.
        A healthy lifestyle score is associated with cardiometabolic and neuroendocrine risk factors among Puerto Rican adults123.
        J Nutr. 2015; 145: 1531-1540
        • Bombelli M.
        • Facchetti R.
        • Sega R.
        • et al.
        Impact of body mass index and waist circumference on the long-term risk of diabetes mellitus, hypertension, and cardiac organ damage.
        Hypertens Dallas Tex 1979. 2011; 58: 1029-1035
        • Marston N.A.
        • Giugliano R.P.
        • Im K.
        • et al.
        Association between triglyceride lowering and reduction of cardiovascular risk across multiple lipid-lowering therapeutic classes: a systematic review and meta-regression analysis of randomized controlled trials.
        Circulation. 2019; 140: 1308-1317
        • Delimaris I.
        Adverse effects associated with protein intake above the recommended dietary allowance for adults.
        ISRN Nutr. 2013; 2013: 126929


      E. Riseberg is a Research Assistant, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA.


      A. Lopez-Cepero is a postdoctoral fellow, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.


      K. M. Mangano is an assistant professor, Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA.


      K. L. Tucker is a professor, Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA.


      J. Mattei is a Donald and Sue Pritzker Associate Professor of Nutrition, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.