Substitution of unprocessed and processed red meat with poultry or fish and total and cause-specific mortality

Replacing red and processed meat with lean or fatty fish and all-cause and cause-specific mortality in Norwegian women. The Norwegian Women and Cancer Study (NOWAC): a prospective cohort study

Nordic Nutrition Recommendations recommend reducing red and processed meat and increasing fish consumption, but the impact of this replacement on mortality is understudied. This study investigated the replacement of red and processed meat with fish in relation to mortality. Of 83 304 women in the Norwegian Women and Cancer Study (NOWAC) study, 9420 died during a median of 21·0 years of follow-up. The hazard ratios (HR) for mortality were estimated using Cox proportional hazards regression with analyses stratified on red and processed meat intake due to non-linearity. Higher processed meat (> 30 g/d), red and processed meat (> 50 g/d), and fatty fish consumption were associated with higher mortality, while red meat and lean fish consumption were neutral or beneficial. Among women with higher processed meat intake (> 30 g/d), replacing 20 g/d with lean fish was associated with lower all-cause (HR 0·92, 95 % CI 0·89, 0·96), cancer (HR 0·92, 95 % CI 0·88, 0·97) and CVD mortality (HR 0·82, 95 % CI 0·74, 0·90), while replacing with fatty fish was associated with lower CVD mortality (HR 0·87, 95 % CI 0·77, 0·97), but not with all-cause or cancer mortality. Replacing processed meat with fish among women with lower processed meat intake (≤ 30 g/d) or replacing red meat with fish was not associated with mortality. Replacing processed meat with lean or fatty fish may lower the risk of premature deaths in Norwegian women, but only in women with high intake of processed meat. These findings suggest that interventions to reduce processed meat intake should target high consumers.

Substitution analyses of foods with varying fat quality and the associations with all-cause mortality and impact of the FADS-1 genotype in elderly men

PURPOSE

To investigate associations between substitutions of foods varying in fat quality and all-cause mortality in elderly Swedish men and to examine effect measure modification by a gene involved in fatty acid desaturation (rs174550 FADS1).

METHODS

Using Cox-regression models in the ULSAM cohort (n = 1133 men aged 71), we aimed to investigate; (1) Associations between the substitution of a nutrient or food for another on all-cause mortality (primary outcome) and CVD (secondary outcome) and (2) Associations between the addition of various fat-rich foods to the habitual diet and all-cause mortality and CVD. Subgroup analyses based on the rs174550 FADS1 genotype were conducted.

RESULTS

Over a mean follow-up of 11.6-13.7 years, n = 774 died and n = 494 developed CVD, respectively. No clear associations were observed for the vast majority of substitution nor addition models. Adding saturated fatty acids (SFA) on top of the habitual diet was however associated with an increased risk of mortality in men with the CT/CC-genotype [HR (95% CI) 1.44 (1.05, 1.97)]. Post-hoc analyses showed an inverse association of substituting SFA with carbohydrates [HR (95% CI) 0.79 (0.65, 0.97)], which was somewhat stronger in men with the CT/CC-genotype compared to men carrying the TT-genotype.

CONCLUSIONS

Few associations were observed between diet and all-cause mortality and CVD in this population. However, substituting SFA with carbohydrates was associated with lower mortality in post-hoc analyses and adding SFA to the habitual diet increased mortality in men with the CT/CC-genotype. The latter observation is novel and warrants further investigation in larger cohort studies including women.

Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies

BACKGROUND

There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis.

METHODS

We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach.

RESULTS

In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality.

CONCLUSIONS

Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.

Isocaloric Substitution of Plant-Based Protein for Animal-Based Protein and Cardiometabolic Risk Factors in a Multiethnic Asian Population

BACKGROUND

Evidence is accumulating that intake of animal-based and plant-based proteins has different effects on cardiometabolic health, but less is known about the health effect of isocaloric substitution of animal-based and plant-based proteins. Data from Asian populations are limited.

OBJECTIVES

This study aimed to evaluate the effects of isocaloric substitution of total plant-based proteins for total and various animal-based protein food groups and to evaluate the effects of substituting protein from legumes and pulses for various animal-based protein food groups on cardiovascular disease (CVD) risk factors and predicted 10-y CVD risk.

METHODS

We conducted a cross-sectional analysis using data collected from 9211 Singapore residents (aged 21-75 y) from the Singapore Multi-Ethnic Cohort. Data on sociodemographic and lifestyle factors were collected using questionnaires. Dietary intakes were assessed using a validated FFQ. BMI, waist circumference, and blood pressure were measured during a physical examination, and blood samples were collected to measure lipid profiles. Associations were assessed by substitution models using a multiple linear regression analysis.

RESULTS

Isocaloric substitution of total plant-based proteins for total and all specific animal-based protein food groups were associated with lower BMI (β: -0.30; 95% CI: -0.38, -0.22), waist circumference (β: -0.85; 95% CI: -1.04, -0.66), and LDL cholesterol concentrations (β: -0.06; 95% CI: -0.08, -0.05) (P < 0.0056). Replacement of processed meat and processed seafood proteins with total plant-based proteins was associated with improvement in most CVD risk factors and predicted 10-y CVD risk. Replacement of oily fish with legume proteins was associated with lower HDL cholesterol and higher TG concentrations.

CONCLUSIONS

The substitution of plant-based proteins for animal-based proteins, especially from processed meat and processed seafood, was inversely associated with the established CVD risk factors such as BMI, waist circumference, and lipid concentrations and predicted 10-y CVD risk. These findings warrant further investigation in independent studies in other Asian populations.

Total and cause-specific mortality associated with meat intake in a large cohort study in Korea

Background

Asia has experienced a large increase in meat intake in the past decade, yet the health impact of meat intake is not well studied.

Objective

We examined the association of meat intake with all-cause, cancer and cardiovascular disease (CVD) mortality in an Asian country.

Methods

Participants were 113,568 adults with dietary data at recruitment (2004–2013) of the Health Examinees-Gem (HEXA-G) study, a prospective cohort study conducted in 8 regions of Korea. Participants were followed until 31 December 2020. Total, red, white, and organ meat intake were computed based on a 106-item questionnaire. Multivariable Cox proportional hazard models were implemented using the lowest quintile of meat intake as the reference category.

Findings

For 1,205,236 person-years, 3,454 deaths were recorded. High intake of processed red meat was positively associated with all-cause mortality [men: hazard ratio (HR) 1.21, 95% confidence interval (95% CI) 1.07–1.37; women: HR 1.32, 95% CI 1.12–1.56]. Increased risk of all-cause mortality (HR 1.21, 95% CI 1.05–1.39) and cancer mortality (HR 1.24, 95% CI 1.03–1.50) was observed in women with high intake of organ meat. Moderate intake of pork belly was associated with reduced risk of all-cause mortality in men (HR 0.76, 95% CI 0.62–0.93) and women (HR 0.83, 95% 0.69–0.98) but high intake was associated with increased risk of CVD mortality in women (HR 1.84, 95% CI 1.20–2.82). Low beef intake decreased the risk of CVD mortality in men (HR 0.58, 95% CI 0.40–0.84), but roasted pork increased cancer mortality in women (HR 1.26, 95% CI 1.05–1.52).

Conclusion

There was increased risk of all-cause mortality associated with intake of processed red meat in men and women, increased risk of all-cause and cancer mortality with intake of organ meat in women, and increased risk of cancer mortality with intake of roasted pork intake in women. High intake of pork belly increased the risk of CVD mortality in women, but moderate intake was inversely associated with mortality from all-causes in both men and women.

The association between meat consumption and muscle strength index in young adults: the mediating role of total protein intake and lean mass percentage

PURPOSE

The aim of this study was to analyse the associations between the consumption of different types of meat and the muscle strength index (MSI) and to examine whether this relationship is mediated by total protein intake (TPI) and lean mass percentage (LM%) in young adults.

METHODS

We conducted a cross-sectional study with first-year university students from Castilla-La Mancha, Spain. Different types of meat consumption (total, red, processed, and white and fish) were separately evaluated using a Food-Frequency Questionnaire. MSI was determined from the handgrip and standing long jump tests. ANCOVA models were used to test the mean differences in MSI by categories of meat consumption. Serial multiple mediation models were used to explore the mediating role of TPI and LM% in the relationship between meat consumption and MSI. All analyses were adjusted for age, sex, and socioeconomic level, identified through a directed acyclic graph. Additional analyses were performed with a small subsample including alcohol intake, tobacco smoking, physical activity, cardiorespiratory fitness, and total energy intake as covariates in the multiple mediation models.

RESULTS

A total of 230 students (mean age 21.1 ± 2.1 years, 66.5% women) were included in the analysis. Young adults with higher meat consumption (total, red, and white and fish) had higher MSI adjusted means than their peers with lower meat consumption (p < 0.05). These associations did not remain after controlling for TPI and LM%. In adjusted mediation analyses, a significant indirect effect was observed through TPI and LM% in the associations between each of the types of meat consumption and MSI. In the additional analyses, a greater effect of white and fish meat consumption on muscle strength through mediation of TPI and LM% was reported compared to red or processed meat consumption, and no significant effects were observed between processed meat consumption and MSI.

CONCLUSION

Higher consumption of total, red, and white and fish meat was associated with increased MSI in young adults. TPI and LM% mediated this relationship.

Greenhouse gas emissions in the food system: Current and alternative dietary scenarios

BACKGROUND: There is a growing interest in diets due to the high contribution to greenhouse gas emissions (GHGE). OBJECTIVE: The study was aimed to estimate the impact on GHGE of replacing the current diet with eight alternative diets, which would be associated with GHGE, to contribute to the discussion of how dietary changes affect the GHGE. METHODS: The latest National Nutrition and Health Survey was utilized to determine the nutrient composition of Turkey’s current diet, with eight dietary scenarios designed to meet the National Dietary Guidelines. RESULTS: The current diet had the highest GHGE with 3254.50 g CO2eq/person/day with beef, lamb, and cheese products accounting for the majority of emissions (18.61%, 17.15%, and 10.89%, respectively). The Model diet had a GHGE of 2994.18 g CO2eq/person/day, whereas vegetarian diets had the lowest (lacto-ovo vegetarian diet with 1944.95 g CO2eq/person/day and vegan diet with 1166.80 g CO2eq/person/day). Low energy efficiencies were associated with high diet-related GHGE levels. CONCLUSION: When evaluating future dietary guidelines for a sustainable diet, our study highlighted the need of integrating both health and environmental aspects. The present study found that dietary changes would significantly contribute to lowering GHGE. These findings will be beneficial in informing Turkey’s nutrition, agriculture, and public policymakers.