Is there a non-linear relationship between dietary protein intake and prostate-specific antigen: proof from the national health and nutrition examination survey (2003-2010)

Background Growing evidence demonstrated that dietary protein intake may be a risk factor for prostate cancer and elevate the level of prostate-specific antigen (PSA). However, proof for the correlation between dietary protein intake and PSA in American adults without prostate tumor history is limited. Our goal was to investigate the association of dietary protein intake with PSA using the National Health and Nutrition Examination Survey (NHANES) (2003-2010) database. Methods After the screening, 6403 participants were included in the study. The interested independent is the dietary protein intake, and the dependent variable is PSA levels, the covariates included demographic, dietary, biological data, and physical examination variables. A weighted linear model and a weighted linear regression model were used to examine the distribution of variables in the covariate differences between the different independent groups according to quartiles. Four models were used to survey the association between dietary protein intake and PSA. We also attempted to find a nonlinear relationship between dietary protein intake and PSA using the GAM model and the penalty spline method and further solved the nonlinear problem using weighted two-piecewise linear model. Results The weighted multivariate linear regression analysis demonstrated that dietary protein intake was not independently associated with PSA levels after adjusting potential confounders (beta = 0.015, 95%CI:-0.024, 0.055). However, we found the non-linear relationship between dietary protein intake and PSA, whose point was 18.18 g (per 10 g change). The magnitude and confidence intervals for the left and right inflection points are - 0.03 (- 0.09, 0.02) and 0.22 (0.07, 0.36), respectively. On the right side of the inflection point, one gram of increment in protein intake was associated with increased PSA levels by 0.22 (log2 transformation: 0.22, 95%CI: 0.07, 0.36). Conclusions After adjusting for potential covariates, the non-linear correlation between dietary protein intake and PSA was observed. When dietary protein intake exceeded the threshold of 181.8 g, dietary protein intake was positively correlated with elevated PSA levels.