{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:37Z","timestamp":1783491517538,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The impact of protein quality on lung cancer risk in the U.S. population remains unclear. We conducted a large-scale prospective cohort study with 101,755 American adults enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (1993\u20132001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Healthy Plate Protein Quality Index (HPPQI) was used to assess dietary protein quality. Cox proportional hazards regression was applied to analyze the relationships between HPPQI and lung cancer incidence and mortality. Subgroup and sensitivity analyses were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a mean follow-up of 8.82 \u00b1 1.95 years (897,809 person-years; median 9.40 years), 1,706 lung cancer cases (1,464 NSCLC and 242 SCLC) and 1,217 related deaths (1,005 NSCLC and 212 SCLC) were recorded. Higher HPPQI was significantly linked to lower lung cancer incidence (HR Q4 vs. Q1: 0.63; 95% CI: 0.55\u20130.73;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001 for trend) and mortality (HR Q4 vs. Q1: 0.62; 95% CI: 0.52\u20130.74;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001 for trend), consistent in both NSCLC and SCLC. Sensitivity analysis confirmed the study's robustness across various participant characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adherence to a dietary pattern characterized by a higher HPPQI is associated with reduced lung cancer risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1869028","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:56:42Z","timestamp":1783490202000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adherence to a diet with higher protein quality significantly reduces the risk of lung cancer: results from a population-based prospective study"],"prefix":"10.3389","volume":"14","author":[{"given":"Ningbo","family":"Shu","sequence":"first","affiliation":[{"name":"Gastrointestinal Ward, Department of General Surgery, Dianjiang People's Hospital of Chongqing","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linglong","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxiang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center","place":["Rotterdam, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dazhan","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linghai","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Chongqing Jiulongpo People's Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA."},{"key":"B2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3322\/caac.21871","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"10732748231169596","DOI":"10.1177\/10732748231169596","article-title":"Lung cancer and risk factors in Lebanon: epidemiology, temporal trends, and comparison to countries from different regions in the world","volume":"30","author":"Lakkis","year":"2023","journal-title":"Cancer control."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ccm.2019.10.001","article-title":"Lung cancer 2020: epidemiology, etiology, and prevention","volume":"41","author":"Bade","year":"2020","journal-title":"Clin Chest Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/978-3-319-24223-1_2","article-title":"Epidemiology of lung cancer","volume":"893","author":"Schwartz","year":"2016","journal-title":"Adv Exp Med Biol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2768","DOI":"10.3390\/cancers16152768","article-title":"Real-world survival impact of new treatment strategies for lung cancer: a 2000\u20132020 French cohort","volume":"16","author":"Basse","year":"2024","journal-title":"Cancers."},{"key":"B7","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s10552-022-01566-x","article-title":"Lifestyle factors and lung cancer risk among never smokers in the Canadian partnership for tomorrow's health (CanPath)","volume":"33","author":"Murphy","year":"2022","journal-title":"CCC."},{"key":"B8","first-page":"257","article-title":"A case-control study of dietary factors in patients with lung cancer","volume":"5","author":"Huang","year":"1992","journal-title":"BES."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1001\/jama.294.12.1493","article-title":"Dietary phytoestrogens and lung cancer risk","volume":"294","author":"Schabath","year":"2005","journal-title":"JAMA."},{"key":"B10","first-page":"1542","article-title":"Red and processed meat consumption and the risk of lung cancer: a dose-response meta-analysis of 33 published studies","volume":"7","author":"Xue","year":"2014","journal-title":"Int J Clin Exp Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"4010","DOI":"10.1038\/s41467-024-48017-6","article-title":"Identifying proteomic risk factors for cancer using prospective and exome analyses of 1,463 circulating proteins and risk of 19 cancers in the UK Biobank","volume":"15","author":"Papier","year":"2024","journal-title":"Nat Commun."},{"key":"B12","doi-asserted-by":"publisher","first-page":"m2412","DOI":"10.1136\/bmj.m2412","article-title":"Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies","volume":"370","author":"Naghshi","year":"2020","journal-title":"BMJ."},{"key":"B13","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1093\/aje\/kwt261","article-title":"Red meat and processed meat consumption and all-cause mortality: a meta-analysis","volume":"179","author":"Larsson","year":"2014","journal-title":"Am J Epidemiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3817","DOI":"10.1093\/nar\/gkac189","article-title":"Oxidative stress-CBP axis modulates MOB1 acetylation and activates the Hippo signaling pathway","volume":"50","author":"Jin","year":"2022","journal-title":"Nucleic Acids Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e194107","DOI":"10.1001\/jamaoncol.2019.4107","article-title":"Association of dietary fiber and yogurt consumption with lung cancer risk: a pooled analysis","volume":"6","author":"Yang JJ Yu","year":"2020","journal-title":"JAMA oncology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"4406","DOI":"10.3390\/nu15204406","article-title":"Adherence to data-driven dietary patterns and lung cancer risk: a systematic review and dose-response meta-analysis","volume":"15","author":"Fabiani","year":"2023","journal-title":"Nutrients."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2586","DOI":"10.3390\/nu15112586","article-title":"The causal effect of dietary composition on the risk of breast cancer: a mendelian randomization study","volume":"15","author":"Dong","year":"2023","journal-title":"Nutrients."},{"key":"B18","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.orcp.2023.09.001","article-title":"Macronutrient quality and the incidence of metabolically unhealthy phenotypes in adults with normal weight and overweight\/obesity","volume":"17","author":"Moslehi","year":"2023","journal-title":"Obes Res Clin Pract."},{"key":"B19","doi-asserted-by":"publisher","first-page":"372","DOI":"10.3945\/jn.114.195438","article-title":"Protein digestibility-corrected amino acid scores and digestible indispensable amino acid scores differentially describe protein quality in growing male rats","volume":"145","author":"Rutherfurd","year":"2015","journal-title":"J Nutr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.3945\/ajcn.111.012815","article-title":"Protein requirement of healthy school-age children determined by the indicator amino acid oxidation method","volume":"94","author":"Elango","year":"2011","journal-title":"Am J Clin Nutr."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/s0197-2456(00)00098-2","article-title":"Prostate, lung, colorectal and ovarian cancer screening trial project team. Design of the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial","author":"Prorok","year":"2000","journal-title":"CCT."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1093\/aje\/154.12.1089","article-title":"Comparative validation of the block, willett, and national cancer institute food frequency questionnaires: the eating at America's table study","volume":"154","author":"Subar","year":"2001","journal-title":"Am J Epidemiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.clnesp.2024.08.006","article-title":"de la OV, Mart\u00ednez-Gonz\u00e1lez M\u00c1, Mart\u00edn-Calvo N. Macronutrient quality and its association with micronutrient adequacy in children","volume":"63","author":"Fabios","year":"2024","journal-title":"Clin Nutr ESPEN."},{"key":"B24","doi-asserted-by":"publisher","first-page":"972","DOI":"10.3390\/nu13030972","article-title":"de la OV, Bes-Rastrollo M, Mart\u00ednez-Gonz\u00e1lez M\u00c1","volume":"13","author":"Santiago","year":"2021","journal-title":"Macronutrient quality and all-cause mortality in the SUN cohort. Nutrients."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3517","DOI":"10.1007\/s00394-022-02901-3","article-title":"Macronutrient quality index and cardiovascular disease risk in the Seguimiento Universidad de Navarra (SUN) cohort","volume":"61","author":"Vanegas","year":"2022","journal-title":"Eur J Nutr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"l1451","DOI":"10.1136\/bmj.l1451","article-title":"Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Sant\u00e9)","volume":"365","author":"Srour","year":"2019","journal-title":"BMJ."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.3390\/cancers14071732","article-title":"Colorectal cancer: a review of carcinogenesis, global epidemiology, current challenges, risk factors, preventive and treatment strategies","volume":"14","author":"Hossain","year":"2022","journal-title":"Cancers."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1002\/sim.3841","article-title":"Dose-response analyses using restricted cubic spline functions in public health research","volume":"29","author":"Desquilbet","year":"2010","journal-title":"Stat Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1007\/s10552-013-0201-5","article-title":"Levin B, et al. Meta-analyses of colorectal cancer risk factors","volume":"24","author":"Johnson","year":"2013","journal-title":"CCC."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e551","DOI":"10.1016\/j.cllc.2020.04.001","article-title":"Diabetes, metformin, and lung cancer: retrospective study of the Korean NHIS-HEALS database","volume":"21","author":"Kim","year":"2020","journal-title":"Clin Lung Cancer."},{"key":"B31","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/1471-2407-10-285","article-title":"Lung cancer risk in never-smokers: a population-based case-control study of epidemiologic risk factors","volume":"10","author":"Brenner","year":"2010","journal-title":"BMC Cancer."},{"key":"B32","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1038\/s41586-024-08285-0","article-title":"Ageing limits stemness and tumorigenesis by reprogramming iron homeostasis","volume":"637","author":"Zhuang","year":"2025","journal-title":"Nature."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1183\/13993003.00347-2016","article-title":"Exercise, ageing and the lung","volume":"48","author":"Roman","year":"2016","journal-title":"Eur Respir J."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0223297","DOI":"10.1371\/journal.pone.0223297","article-title":"Disruption of white matter connectivity in chronic obstructive pulmonary disease","volume":"14","author":"Spilling","year":"2019","journal-title":"PLoS ONE."},{"key":"B35","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.cell.2023.12.004","article-title":"Proteogenomic characterization of small cell lung cancer identifies biological insights and subtype-specific therapeutic strategies","volume":"187","author":"Liu","year":"2024","journal-title":"Cell."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1158\/1940-6207.CAPR-11-0241","article-title":"Prospective investigation of poultry and fish intake in relation to cancer risk","volume":"4","author":"Daniel","year":"2011","journal-title":"Cancer Prev Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"338","DOI":"10.3390\/antiox12020338","article-title":"Association between dietary and supplemental antioxidants intake and lung cancer risk: evidence from a cancer screening trial","volume":"12","author":"Yang","year":"2023","journal-title":"Antioxidants."},{"key":"B38","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1186\/s12885-018-4361-2","article-title":"Dietary patterns, BCMO1 polymorphisms, and primary lung cancer risk in a Han Chinese population: a case-control study in Southeast China","volume":"18","author":"He","year":"2018","journal-title":"BMC Cancer."},{"key":"B39","doi-asserted-by":"publisher","first-page":"2301720","DOI":"10.1183\/13993003.01720-2023","article-title":"Associations of combined phenotypic ageing and genetic risk with incidence of chronic respiratory diseases in the UK Biobank: a prospective cohort study","volume":"63","author":"Wang","year":"2024","journal-title":"Eur Respir J."},{"key":"B40","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/oxfordjournals.aje.a009849","article-title":"Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements","volume":"149","author":"Hu","year":"1999","journal-title":"Am J Epidemiol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1607522","DOI":"10.3389\/fnut.2025.1607522","article-title":"Adherence to the Mediterranean diet and mortality in cancer survivors: a Nationwide study with mediation and subgroup analyses","volume":"12","author":"Zha","year":"2025","journal-title":"Front Nutr."},{"key":"B42","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.1093\/ajcn\/nqab298","article-title":"Diet and risk of incident lung cancer: a large prospective cohort study in UK biobank","volume":"114","author":"Wei","year":"2021","journal-title":"Am J Clin Nutr."},{"key":"B43","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s10552-021-01400-w","article-title":"Dietary quality using four dietary indices and lung cancer risk: the Golestan cohort study (GCS)","volume":"32","author":"Wang","year":"2021","journal-title":"CCC."},{"key":"B44","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1093\/oxfordjournals.aje.a114086","article-title":"Reproducibility and validity of a semiquantitative food frequency questionnaire","volume":"122","author":"Willett","year":"1985","journal-title":"Am J Epidemiol."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1869028\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:56:44Z","timestamp":1783490204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1869028\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2026.1869028"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1869028","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1869028"}}