Estimation of the burden of disease attributable to red meat consumption in France: Influence on colorectal cancer and cardiovascular diseases

Cancer awareness, diagnosis and treatment needs in Mizoram, India: evidence from 18 years trends (2003-2020)

Background

Despite being the second least populated state, Mizoram exhibits the highest incidence rate of cancer in India. Its inhabitants, constituting an endogamous and isolated population, have embraced their own distinct culture, way of life and dietary preferences, setting them apart from the rest of mainland India. In 2003, the Mizoram Population Based Cancer Registry (PBCR) was established under the auspices of the National Centre for Disease Informatics and Research (NCDIR), a division of the Indian Council of Medical Research (ICMR), in collaboration with the Department of Health & Family Welfare of the Government of Mizoram, India.

Methods

Cancer incidence and mortality data were extracted from the Mizoram PBCR spanning the years 2003-2020. The Age Standardized Incidence Rate (ASIR) and Age Standardized Mortality Rate (ASMR) were computed per 100,000 individuals, utilizing Segi's World Standard Population as the benchmark. The trajectory of these changes was analysed employing the Joinpoint Regression Analysis Program, Version 4.9.1.0.13, to unveil the Annual Percent Change (APC) with a 95% Confidence Interval and a Significance test (p < 0.05) using Monte Carlo Permutation. The resulting graphical visualizations were generated using Flourish Studio.15.

Findings

The overall ASIR for all cancer sites among men was 197.2 per 100,000, while for women, it was 164.9 per 100,000. Among men, the most prevalent cancer site was the Stomach (ASIR = 41.4), followed by Head & Neck, Lung, Oesophagus, Colorectal, Liver, Urinary, Non-Hodgkin's Lymphoma and Prostate cancers. Conversely, among women, Lung cancer exhibited the highest incidence (ASIR = 26.7), succeeded by Cervical, Breast, Stomach, Head & Neck, Colorectal, Oesophagus, Liver and Ovarian cancers. Stomach cancer emerged as the leading cause of death among men (ASMR = 22.6) and among women, Lung cancer held the highest ASMR (15.9). Joinpoint regression analysis revealed a rising trend in incidence and mortality over time for overall cancer sites. Among the primary cancer sites contributing to incidence and mortality, an increase in APC was observable for all, except Stomach cancer, in both men and women. The diagnostic approach, except for cases of cancer with unknown primary sites, involved a microscopic method.

Interpretation

This cross-sectional study examines PBCR reports spanning from 2003 to 2020, shedding light on a consistent uptick in cancer incidence and mortality trends in Mizoram. Stomach cancer emerges as the most prevalent and primary cause of cancer-related deaths among men, while Lung cancer takes a parallel role in women. The elevated cancer incidence and the growing trend among younger generations might stem from the static lifestyle and dietary patterns prevalent within the endogamous tribal population, potentially contributing to a genetic predisposition. The escalation in mortality rates could be attributed to a dearth of specialized diagnostic facilities and skilled human resources, treatment strategies guided by genomic research and transportation challenges. This underscores the urgent requirement for comprehensive scientific exploration across diverse facets. The implementation of easily accessible diagnostic facilities in proximity and genetic testing for pharmacogenomics to enhance prognoses would also aid in mitigating the burden and advancing the healthcare system's effectiveness.

Funding

Population Based Cancer Registry (PBCR) was supported by National Centre for Disease Informatics and Research (NCDIR) of the Indian Council of Medical Research (ICMR), India.

Burden of disease attributable to risk factors in European countries: a scoping literature review

OBJECTIVES

Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods.

METHODS

We searched multiple literature databases, including grey literature websites and targeted public health agencies websites.

RESULTS

A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available.

CONCLUSIONS

Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates.

REGISTRATION

The study protocol has been registered on PROSPERO, CRD42020177477 (available at: https://www.crd.york.ac.uk/PROSPERO/ ).

Impact of Reducing Intake of Red and Processed Meat on Colorectal Cancer Incidence in Germany 2020 to 2050-A Simulation Study

BACKGROUND

According to the International Agency for Research on Cancer (IARC), there is sufficient evidence for the carcinogenicity of processed meat consumption in humans, specifically regarding colorectal cancer (CRC) risk. Evidence for the carcinogenicity of red meat consumption is more limited but points in the same direction.

METHODS

A macro-simulation approach was used to calculate age- and sex-specific potential impact fractions in a 30-year period (2020-2050).

AIMS

We estimated numbers and proportions of future CRC cases preventable under different scenarios of reducing the intake of processed and red meat in the German population.

RESULTS

Eliminating processed meat intake could reduce the burden of CRC by approximately 205,000 cases in Germany (9.6%) in 2020-2050, 2/3 among males (145,000) and 1/3 among females (60,000). Without red meat intake, approximately 63,000 CRC cases could be avoided (2.9%), 39,000 among males and 24,000 among females. Reductions in the mean consumption of both processed and red meat by one or two servings (each 11 or 22 g) per day would be expected to reduce CRC case numbers by 68,000 (3.1%) and 140,000 (6.5%), respectively.

CONCLUSION

A reduction in red and processed meat intake might substantially reduce the incidence of CRC in Germany. The means of achieving such a reduction might include price and taxation policies, food labeling, and clearer risk communication aiming to reduce individual intake.

Three decades of household food availability according to NOVA - Brazil, 1987-2018

OBJECTIVE

To evaluate the trend of household food acquisition according to the NOVA classification in Brazil between 1987-1988 and 2017-2018.

METHODS

We used household food acquisition data from five editions of the Pesquisas de Orçamentos Familiares (Household Budget Surveys), conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), in the years 1987-1988, 1995-1996, 2002-2003, 2008-2009, and 2017-2018. All reported foods were categorized according to the NOVA classification. The household availability of food groups and subgroups was expressed through their share (%) in total calories, for all Brazilian families, by household situation (urban or rural), for each of the five geographic regions of the country, by fifths of the household income per capita distribution (2002-2003, 2008-2009 and 2017-2018 surveys), and for the 11 main urban regions of the country (1987-1988, 1995-1996, 2002-2003, 2008-2009 and 2017-2018 surveys). Linear regression models were used to assess the trend of increasing or decreasing food purchases.

RESULTS

The diet of the Brazilian population is still composed predominantly of foods in natura or minimally processed and processed culinary ingredients. However, our findings point to trends of increasing share of ultra-processed foods in the diet. This increase of 0.4 percentage points per year between 2002 and 2009 slowed down to 0.2 percentage points between 2008 and 2018. The consumption of ultra-processed food was higher among households with higher income, in the South and Southeast regions, in urban areas, and in metropolitan regions.

CONCLUSION

Our results indicate an increase in the share of ultra-processed foods in the diet of Brazilians. This is a worrisome scenario, since the consumption of such foods is associated with the development of diseases and the loss of nutritional quality of the diet.

Maternal heme-enriched diet promotes a gut pro-oxidative status associated with microbiota alteration, gut leakiness and glucose intolerance in mice offspring

Maternal environment, including nutrition and microbiota, plays a critical role in determining offspring's risk of chronic diseases such as diabetes later in life. Heme iron requirement is amplified during pregnancy and lactation, while excessive dietary heme iron intake, compared to non-heme iron, has shown to trigger acute oxidative stress in the gut resulting from reactive aldehyde formation in conjunction with microbiota reshape. Given the immaturity of the antioxidant defense system in early life, we investigated the extent to which a maternal diet enriched with heme iron may have a lasting impact on gut homeostasis and glucose metabolism in 60-day-old C3H/HeN mice offspring.

As hypothesized, the form of iron added to the maternal diet differentially governed the offspring's microbiota establishment despite identical fecal iron status in the offspring. Importantly, despite female offspring was unaffected, oxidative stress markers were however higher in the gut of male offspring from heme enriched-fed mothers, and were accompanied by increases in fecal lipocalin-2, intestinal para-cellular permeability and TNF-α expression. In addition, male mice displayed blood glucose intolerance resulting from impaired insulin secretion following oral glucose challenge. Using an integrated approach including an aldehydomic analysis, this male-specific phenotype was further characterized and revealed close covariations between unidentified putative reactive aldehydes and bacterial communities belonging to Bacteroidales and Lachnospirales orders.

Our work highlights how the form of dietary iron in the maternal diet can dictate the oxidative status in gut offspring in a sex-dependent manner, and how a gut microbiota-driven oxidative challenge in early life can be associated with gut barrier defects and glucose metabolism disorders that may be predictive of diabetes development.

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Maternal heminic vs. non-heminic iron intake differentially and persistently imprints the offspring's fecal microbiota.

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Males from heme-fed dams exhibit increased gut lumen reactive aldehydes in absence of direct dietary exposure to heme iron.

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Some of the increased reactive aldehydes closely covariated with Orders belonging to Bacteroidales and Lachnospirales.

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Maternal exposure to dietary heme iron impairs gut barrier and glucose tolerance in male offspring.

Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019

This study objective was to describe the distribution of food consumption markers in Brazil per sociodemographic characteristics and its evolution from 2013 to 2019. Healthy food consumption markers (regular consumption of beans, fruits, vegetables, and fish, recommended consumption of red meat, and never replacing meals with snacks) and unhealthy food consumption markers (regular consumption of sweetened beverages and confectionery and excessive salt intake) were studied for adult participants of the Brazilian National Health Survey. The prevalence of food consumption markers was estimated according to sociodemographic characteristics and compared to data of 2013 and 2019. Most of the population regularly consumes beans, fruits, and vegetables, they also follows the recommendation to limit red meat consumption, and never replaces meals with snacks. The percentage of people who regularly consume sweetened beverages and perceive their salt intake as excessive is relatively low. The distribution of food consumption markers was associated with sex, age, income, race/skin color, area of dwelling, and schooling level. From 2013 to 2019, the prevalence of most food consumption markers declined, except for the regular consumption of fruits and recommended consumption of red meat, that increased 8.5% and 18.5%, respectively, and the regular consumption of vegetables, which did not vary. Healthy and unhealthy food consumption markers should be monitored to evaluate the effect of healthy eating policies implemented in the country.

Application of emerging technologies to obtain legume protein isolates with improved techno-functional properties and health effects

Current demand of consumers for healthy and sustainable food products has led the industry to search for different sources of plant protein isolates and concentrates. Legumes represent an excellent nonanimal protein source with high-protein content. Legume species are distributed in a wide range of ecological conditions, including regions with drought conditions, making them a sustainable crop in a context of global warming. However, their use as human food is limited by the presence of antinutritional factors, such as protease inhibitors, lectins, phytates, and alkaloids, which have adverse nutritional effects. Antitechnological factors, such as fiber, tannins, and lipids, can affect the purity and protein extraction yield. Although most are removed or reduced during alkaline solubilization and isoelectric precipitation processes, some remain in the resulting protein isolates. Selection of appropriate legume genotypes and different emerging and sustainable facilitating technologies, such as high-power ultrasound, pulsed electric fields, high hydrostatic pressure, microwave, and supercritical fluids, can be applied to increase the removal of unwanted compounds. Some technologies can be used to increase protein yield. The technologies can also modify protein structure to improve digestibility, reduce allergenicity, and tune technological properties. This review summarizes recent findings regarding the use of emerging technologies to obtain high-purity protein isolates and the effects on techno-functional properties and health.

The health impact of substituting unprocessed red meat by pulses in the Danish diet

BACKGROUND

Diets consisting of high amounts of animal-based protein have been associated with adverse public health effects and are often deemed environmentally unsustainable. Therefore, replacing red meat by pulses has been proposed to reduce the adverse impact on human health and environment. However, unprocessed red meat is an important source of nutrients, such as vitamin B₁₂, iron, zinc and selenium, and the substitution may have negative impact on nutrient adequacy.

METHOD

Using a risk-benefit assessment (RBA) approach, we, therefore, estimated the health impact of substituting unprocessed red meat by pulses on the burden of non-communicable diseases in Denmark, using Disability-Adjusted Life Years (DALY). Furthermore, we assessed the impact of the substitution on nutrient adequacy.

RESULTS

We found that 187 (95% UI: 209; 168) healthy years of life could be gained per 100,000 individuals per year by substituting 100% of unprocessed red meat by pulses in the Danish diet. We found a decrease in the intake of vitamin B₁₂, zinc and selenium due to the substitution. An additional 10% of the Danish population will become at risk of vitamin B₁₂ and selenium inadequacy, and an additional 20% will be at risk of zinc inadequacy due to the substitution. For iron, a small decrease in the proportion at risk of inadequacy was found.

CONCLUSION

Substitution of unprocessed red meat by pulses was estimated to provide a beneficial health impact on the burden of non-communicable disease, expressed in DALY. Additionally, it was found that the complete substitution will lead to a higher risk of nutrient inadequacies.

Public health risk-benefit assessment of red meat in France: Current consumption and alternative scenarios

Consumption of red meat has been associated with the risks of colorectal cancer (CRC), cardiovascular disease (CVD), foodborne-pathogen related diseases and with the potential benefit obtained by reduction of iron deficiency anemia (IDA). Based on probabilistic models, current risks and benefit for the French population were aggregated into a single metric, the disability adjusted life years (DALY). In France, per 100,000 people, current red meat consumption was responsible for a mean of 19 DALYs due to CRC, 21 DALYs to CVD and 7 DALYs to foodborne diseases. Current consumption of iron throughout the diet led to a mean of 15 DALYs due to IDA. To mitigate the risks, scenarios were built per sub-population of age and gender. Among adult and elderly population, the big meat eaters would benefit to adhere to the current recommendation (less than 500 g/w): the risks of CRC and CVD would decrease. Regarding IDA (scenario built with fixed ground beef amount), for young population, a consumption of 375g/w would be sufficient to eliminate the burden while for 25-44 years-old females, 455g/w would reduce IDA, but not entirely. This study highlighted the importance of assessing health risk-benefit per sub-populations and the necessity of communicating the results accordingly.

Association between Neu5Gc carbohydrate and serum antibodies against it provides the molecular link to cancer: French NutriNet-Santé study

BACKGROUND

High consumption of red and processed meat is commonly associated with increased cancer risk, particularly colorectal cancer. Antibodies against the red meat-derived carbohydrate N-glycolylneuraminic acid (Neu5Gc) exacerbate cancer in "human-like" mice. Human anti-Neu5Gc IgG and red meat are both independently proposed to increase cancer risk, yet how diet affects these antibodies is largely unknown.

METHODS

We used world global data to demonstrate that colorectal cancer incidence and mortality are associated with increased national meat consumption. In a well-defined large cohort, we used glycomics to measure daily Neu5Gc intake from red meat and dairy, and investigated serum as well as affinity-purified anti-Neu5Gc antibodies. Based on 24-h dietary records, daily Neu5Gc intake was calculated for 19,621 subjects aged ≥ 18 years of the NutriNet-Santé study. Serum and affinity-purified anti-Neu5Gc antibodies were evaluated by ELISA and glycan microarrays in representative 120 individuals, each with at least eighteen 24-h dietary records (aged 45-60, Q1-Q4; aged > 60, Q1 and Q4; 10 men/women per quartile).

RESULTS

We found that high-Neu5Gc diet, gender, and age affect the specificity, levels, and repertoires of anti-Neu5Gc IgG immune responses, but not their affinity. Men consumed more Neu5Gc than women, mostly from red meat (p = 0.0015), and exhibited higher overall serum anti-Neu5Gc IgG levels by ELISA (3.94 ng/μl versus 2.22 ng/μl, respectively; p = 0.039). Detailed glycan microarray analysis against 56 different glycans revealed high Neu5Gc-specificity with increased anti-Neu5Gc IgG and altered repertoires, associated with higher consumption of Neu5Gc from red meat and cow dairy. Affinity purification of serum anti-Neu5Gc antibodies revealed increased levels and biased array repertoire patterns, without an increase in antibody affinity, in individuals consuming higher Neu5Gc levels. Furthermore, in a high-meat diet, antibody diversity patterns on glycan microarrays shifted towards Neu5Gcα3-linked glycans, increasing the α3/α6-glycans ratio score.

CONCLUSIONS

We found a clear link between the levels and repertoire of serum anti-Neu5Gc IgG and Neu5Gc intake from red meat and dairy. These precise rational methodologies allowed to develop a Gcemic index to simplify the assessment of Neu5Gc in foods that could potentially be adapted for dietary recommendations to reduce cancer risk.

Meat consumption: Which are the current global risks? A review of recent (2010-2020) evidences

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Consumption of fatty meats may increase risks of cardiovascular diseases and cancer.

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Production of red meats increases greenhouse gases (GHG) emissions contributing to the global warming.

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Consumption of wild meats can pose some serious risks of transmission of viruses from animals to humans.

Meat consumption has been increasing since the 1960s, but especially from the 1980s decade to today. Although meat means an important source of nutrients, it is also evident that a great consumption of this source of proteins has also a negative environmental impact. Livestock production does not only have a negative influence on GHG emissions, but also on the water footprint, water pollution, and water scarcity. With respect to human health, in 2015 the International Agency for Research on Cancer (IARC) stated that red meat was a probable carcinogen to humans (Group 2A), while consumption of processed meat was carcinogenic to humans (Group 1). Most environmental contaminants (PCDD/Fs, PCBs, PBDEs, PCNs, etc.) that are frequently found in meats are highly soluble in fats. Therefore, avoiding ingesting fats from red meats and meat products, doubtless would help in the prevention, not only of the well-known cardiovascular diseases derived of fats consumption, but also of certain kinds of cancers, mainly colorectal cancer. On the other hand, consumption of meat – especially wild meat – is related to virus infections, as many viruses have been found in wild meat trade markets. Based on the scientific literature here reviewed, we have noted that the results of the investigations conducted after the statement of the IARC, have corroborated the recommendation of reducing significantly the consumption of red meats and meat products. In turn, the reduction of meat consumption should contribute to the reduction of GHG emissions and their considerable impact on global warming and climate change. It seems evident that human dietary habits regarding meat consumption in general, and red meats and wild meats in particular, should be significantly modified downward, as much and as soon as possible.

Estimation of the Burden of Iron Deficiency Anemia in France from Iron Intake: Methodological Approach

: Dietary iron deficiency (ID) is the first nutritional deficiency in the world, in terms of disability adjusted life years (DALY). This nutritional deficiency may lead to anemia, especially among children, adolescents, and adult women. The aim of this study was to build an original probabilistic model to quantitatively assess the ID, the iron deficiency anemia (IDA) and the subsequent health burden in France expressed in DALY, per age class and gender. The model considered the distribution of absorbed iron intake, the iron requirement distribution established by the European Food Safety Authority and the iron status in France. Uncertainty due to lack of data and variability due to biological diversity were taken into account and separated using a second-order Monte Carlo procedure. A total of 1290 (95% CI = 1230-1350) IDA cases corresponding to 16 (95% CI = 11-20) DALY were estimated per 100,000 individuals per year. The major contributors to IDA burden were menstruating females aged from 25 to 44 years old. Then, a consumption scenario was built with ground beef as intake, an increase in red meat consumption to 100 g/d would not eliminate entirely the IDA burden. The quantitative methodology applied here for France could be reused for other populations.