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Background/Introduction The role of dietary protein on cardiometabolic health remains complex influenced by concomitant changes in overall diet composition. The quality of protein sources is currently suggested as more detrimental than the level of consumption itself. Purpose The association between different protein-rich dietary patterns and 10-year transition to metabolically unhealthy status in a sample from Greece was evaluated. Methods A prospective study was conducted during 2001–2012 studying n=1,514 men and n=1,528 women (&amp;gt;18 years old) free of CVD. Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. Baseline dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Dietary protein was calculated through standardized food database. Follow-up cardiometabolic assessment (2011–2012) was achieved in n=2,020 participants. Protein-rich dietary patterns were derived through factor analysis in the subsample of participants with high daily protein intake (&amp;gt;15% of total energy intake corresponding to the median consumption level). Patterns were named according to food scores that correlated most with the factor (scores&amp;gt;0.5). Results Overall, six of ten participants lost their metabolically healthy status within a decade. Multiadjusted analysis revealed an inverse yet non-significant association between total energy-standardized protein intake and transition to metabolically unhealthy status [Odds ratio (OR) (high vs. low protein intake)=0.59, 95% Confidence Interval (95% CI) (0.32, 1.10), p=0.09]. Factor analysis extracted three protein-rich dietary patterns, explained 55% of the total variation in intake. Factor A was characterized by increased consumption of processed meet, unprocessed red meat and eggs, factor B was characterized by increased consumption of nuts and seeds, legumes, whole grain products and fish while factor C was characterized by increased consumption of dairy products, poultry and vegetables. Multiadjusted logistic regression analysis revealed that factor B had the strongest protective effect against 10-year transition to metabolically unhealthy status [ORper 1 point increase in factor B score=0.74, 95% CI (0.60, 0.85), p=0.01] followed by a marginally protective effect of factor C [ORper 1 point increase in factor C score=0.89, 95% CI (0.73, 1.05), p=0.07]. Participants with higher adherence to factor A had an increased likelihood to lose their metabolically healthy status [ORper 1 point increase in factor A score=1.15, 95% CI (1.02, 1.30), p=0.04]. Conclusions The present work confirms that within an increased level of dietary protein intake, different cardiometabolic outcomes were observed according to the quality of protein food sources consumed. Funding Acknowledgement Type of funding sources: None.

european heart journal

A-posteriori protein-rich dietary patterns and their association with ten-year transition to metabolically unhealthy status: highlights from a population-based cohort study