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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),
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. 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),
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. 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,
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. 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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