Association between intake of red and processed meat and the risk of heart failure: a meta-analysis

Implications of food ultra-processing on cardiovascular risk considering plant origin foods: an analysis of the UK Biobank cohort

Background

Comprehensive research evidence is lacking on the role of ultra-processed foods (UPF) in the relationship between the consumption of plant-sourced foods and their impact on cardiovascular disease (CVD) outcomes. This study aims to assess CVD risk associated with the dietary contribution of food groups that consider both plant or animal origin and food processing categories, within a large cohort of British adults.

Methods

Data from the UK Biobank participants (40-69 y) who completed at least two 24-h dietary recalls between 2009 and 2012 (n = 126,842; median follow-up: 9 y), with subsequent data linkage to hospital and mortality records, were used. Food groups were classified as either plant-sourced or non-plant/animal-sourced foods. These groups were further divided into non-UPF and UPF, and expressed as a percentage of total energy intake.

Findings

Every 10 percentage points increase in plant-sourced non-UPF consumption was associated with a 7% lower risk of CVD (95% CI 0.91-0.95) and a 13% lower risk of CVD mortality (0.80-0.94). Conversely, plant-sourced UPF consumption was associated with a 5% increased risk (1.03-1.07) and a 12% higher mortality (1.05-1.20). The contribution of all UPF was linked to higher CVD risk and mortality, and no evidence for an association between contribution of all plant-sourced foods and CVD incidence and mortality was observed.

Interpretation

The dietary contribution of plant-sourced non-UPF inversely linked to CVD risk, while plant-sourced UPF contribution showed a positive association. Recognizing the role of food processing is crucial for favourable CVD outcomes, even in plant-sourced diets.

Funding

World Cancer Research Fund.

A review of CRISPR-Cas and PCR-based methods for the detection of animal species in the food chain-current challenges and future prospects

Regular testing and systematic investigation play a vital role to ensure product safety. Until now, the existing food authentication techniques have been based on proteins, lipids, and nucleic acid-based assays. Among various deoxyribonucleic acid (DNA)-based methods, the recently developed Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) based bio-sensing is an innovative and fast-expanding technology. The CRISPR/Cas-9 is known as Clustered Regularly Interspaced Short Palindromic Repeats due to the flexibility and simplicity of the CRISPR/Cas9 site-specific editing tool has been applied in many biological research areas such as Gene therapy, cell line development, discovering mechanisms of disease, and drug discovery. Nowadays, the CRISPR-Cas system has also been introduced into food authentication via detecting DNA barcodes of poultry and livestock both in processed and unprocessed food samples. This review documents various DNA based approaches, in an accessible format. Future CRISPR technologies are forecast while challenges are outlined.

Meat and meat products - a scoping review for Nordic Nutrition Recommendations 2023

Meat is not only a source of several nutrients but also a proposed risk factor for several non-communicable diseases. Here, we describe the totality of evidence for the role of meat intake for chronic disease outcomes, discuss potential mechanistic pathways, knowledge gaps, and limitations of the literature. Use of the scoping review is based on a de novo systematic review (SR) and meta-analysis on the association between poultry intake and cardiovascular disease (CVD) and type 2 diabetes (T2D), qualified SRs (as defined in the Nordic Nutrition Recommendations 2023 project) on meat intake and cancer by the World Cancer Research Fund (WCRF), the International Agency for Research on Cancer (IARC), and a systematic literature search of SRs and meta-analyses. The quality of the SRs was evaluated using a modified AMSTAR 2 tool, and the strength of evidence was evaluated based on a predefined criteria developed by the WCRF. The quality of the SRs was on average critically low. Our findings indicate that the evidence is too limited for conclusions for most of the chronic disease outcomes. However, findings from qualified SRs indicate strong evidence that processed meat increases the risk of colorectal cancer and probable evidence that red meat (unprocessed, processed, or both) increases the risk. The evidence suggests that both unprocessed red meat and processed meat (also including processed poultry meat) are probable risk factors for CVD mortality and stroke, and that total red meat and processed meat are risk factors for CHD. We found no sufficient evidence suggesting that unprocessed red meat, processed red meat, total red meat, or processed meat (including red and white meat) would be protective of any chronic disease. There was also no sufficient evidence to conclude on protective effect of poultry on any chronic diseases; effects on the risk of CVD, stroke, and T2D, to any direction, were regarded as unlikely.

Red/processed meat consumption and non-cancer-related outcomes in humans: umbrella review

The associations of red/processed meat consumption and cancer-related health outcomes have been well discussed. The umbrella review aimed to summarise the associations of red/processed meat consumption and various non-cancer-related outcomes in humans. We systematically searched the systematic reviews and meta-analyses of associations between red/processed meat intake and health outcomes from PubMed, Embase, Web of Science and the Cochrane Library databases. The umbrella review has been registered in PROSPERO (CRD 42021218568). A total of 40 meta-analyses were included. High consumption of red meat, particularly processed meat, was associated with a higher risk of all-cause mortality, CVD and metabolic outcomes. Dose-response analysis revealed that an additional 100 g/d red meat intake was positively associated with a 17 % increased risk of type 2 diabetes mellitus (T2DM), 15 % increased risk of CHD, 14 % of hypertension and 12 % of stroke. The highest dose-response/50 g increase in processed meat consumption at 95 % confident levels was 1·37, 95 % CI (1·22, 1·55) for T2DM, 1·27, 95 % CI (1·09, 1·49) for CHD, 1·17, 95 % CI (1·02, 1·34) for stroke, 1·15, 95 % CI (1·11, 1·19) for all-cause mortality and 1·08, 95 % CI (1·02, 1·14) for heart failure. In addition, red/processed meat intake was associated with several other health-related outcomes. Red and processed meat consumption seems to be more harmful than beneficial to human health in this umbrella review. It is necessary to take the impacts of red/processed meat consumption on non-cancer-related outcomes into consideration when developing new dietary guidelines, which will be of great public health importance. However, more additional randomised controlled trials are warranted to clarify the causality.

Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis

AIMS

Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex and setting, however, whether the associations vary by sex and setting remains unclear.

METHODS AND RESULTS

This systematic review and meta-analysis was conducted to summarize the evidence concerning the associations of unprocessed and processed red meat consumption with CVD and its subtypes [coronary heart disease (CHD), stroke, and heart failure], type two diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) and to assess differences by sex and setting (western vs. eastern, categorized based on dietary pattern and geographic region). Two researchers independently screened studies from PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published by 30 June 2022. Forty-three observational studies (N = 4 462 810, 61.7% women) for CVD and 27 observational studies (N = 1 760 774, 64.4% women) for diabetes were included. Red meat consumption was positively associated with CVD [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.05 to 1.16 for unprocessed red meat (per 100 g/day increment); 1.26, 95% CI 1.18 to 1.35 for processed red meat (per 50 g/day increment)], CVD subtypes, T2DM, and GDM. The associations with stroke and T2DM were higher in western settings, with no difference by sex.

CONCLUSION

Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health.

Fake meat or meat with benefits? How Dutch consumers perceive health and nutritional value of plant-based meat alternatives

Animal agriculture has a large impact on the environment. Hence, there is an increasing demand for meat alternatives - more sustainably produced plant-based products that replace meat as meal component. Demands for meat alternatives also seem to be fuelled by consumers' belief that meat alternatives are healthier than meat products. In an online questionnaire study, we examined whether consumers indeed perceived meat alternatives to be healthier, to what degree consumers adequately estimated the nutritional value of meat (alternatives), and whether a nutrition claim could misguide consumers. In a panel of 120 Dutch consumers, it was found that meat alternatives were generally perceived as being healthier than meat products. According to supermarket data, meat alternatives contained less protein and saturated fat, higher levels of fibre and salt compared to meat. Consumers were found to overestimate the protein content of meat alternatives relative to meat products, especially when meat alternatives carry a 'high in protein' claim. The current beliefs about the healthiness and nutritional content of meat and meat alternatives are precarious and a fair, transparent, and understandable environment should be created for the conscious consumer.

Red meat consumption, incident CVD and the influence of dietary quality in the Jackson Heart Study

OBJECTIVES

We investigated the prospective associations between meat consumption and CVD and whether these relationships differ by dietary quality among African American (AA) adults.

DESIGN

Baseline diet was assessed with a regionally specific FFQ. Unprocessed red meat included beef and pork (120 g/serving); processed meat included sausage, luncheon meats and cured meat products (50 g/serving). Incident total CVD, CHD, stroke and heart failure were assessed annually over 9·8 years of follow-up. We characterised dietary quality using a modified Healthy Eating Index-2010 score (m-HEI), excluding meat contributions.

SETTING

Jackson, MS, USA.

PARTICIPANTS

AA adults (n 3242, aged 55 y, 66 % female).

RESULTS

Mean total, unprocessed red and processed meat intakes were 5·7 ± 3·5, 2·3 ± 1·8 and 3·3 ± 2·7 servings/week, respectively. Mostly, null associations were observed between meat categories and CVD or subtypes. However, greater intake of unprocessed red meat (three servings/week) was associated with significantly elevated risk of stroke (hazard ratio = 1·43 (CI: 1·07,1·90)). With the exception of a more positive association between unprocessed meat consumption and stroke among individuals in m-HEI Tertile 2, the strength of associations between meat consumption categories and CVD outcomes did not differ by m-HEI tertile. In formal tests, m-HEI did not significantly modify meat-CVD associations.

CONCLUSIONS

In this cohort of AA adults, total and processed meat were not associated with CVD outcomes, with the exception that unprocessed red meat was related to greater stroke risk. Dietary quality did not modfiy these associations. Research is needed in similar cohorts with longer follow-up and greater meat consumption to replicate these findings.

Friend or Foe? The Role of Animal-Source Foods in Healthy and Environmentally Sustainable Diets

Scientific and political discussions around the role of animal-source foods (ASFs) in healthy and environmentally sustainable diets are often polarizing. To bring clarity to this important topic, we critically reviewed the evidence on the health and environmental benefits and risks of ASFs, focusing on primary trade-offs and tensions, and summarized the evidence on alternative proteins and protein-rich foods. ASFs are rich in bioavailable nutrients commonly lacking globally and can make important contributions to food and nutrition security. Many populations in Sub-Saharan Africa and South Asia could benefit from increased consumption of ASFs through improved nutrient intakes and reduced undernutrition. Where consumption is high, processed meat should be limited, and red meat and saturated fat should be moderated to lower noncommunicable disease risk-this could also have cobenefits for environmental sustainability. ASF production generally has a large environmental impact; yet, when produced at the appropriate scale and in accordance with local ecosystems and contexts, ASFs can play an important role in circular and diverse agroecosystems that, in certain circumstances, can help restore biodiversity and degraded land and mitigate greenhouse gas emissions from food production. The amount and type of ASF that is healthy and environmentally sustainable will depend on the local context and health priorities and will change over time as populations develop, nutritional concerns evolve, and alternative foods from new technologies become more available and acceptable. Efforts by governments and civil society organizations to increase or decrease ASF consumption should be considered in light of the nutritional and environmental needs and risks in the local context and, importantly, integrally involve the local stakeholders impacted by any changes. Policies, programs, and incentives are needed to ensure best practices in production, curb excess consumption where high, and sustainably increase consumption where low.

Consumption of unprocessed or minimally processed foods and their association with cardiovascular events and cardiometabolic risk factors in Brazilians with established cardiovascular events

Consumption of food in its natural form has an inverse relationship with cardiometabolic risk factors; however, the relationship between consumption of unprocessed or minimally processed foods and the presence of cardiovascular diseases (CVD) remains unclear in individuals receiving secondary care for CVD. Thus, we aimed to evaluate the association between the consumption of unprocessed or minimally processed foods and the presence of CVD and cardiometabolic risk factors in individuals with established CVD. Baseline data from 2357 participants in a Brazilian multicentre study showed that the consumption of unprocessed or minimally processed foods corresponded to most of the daily caloric intake (69.3%). Furthermore, regression analyses showed that higher consumption of unprocessed or minimally processed foods (>78.0% of caloric intake) was associated with a lower prevalence of elevated waist circumference (WC1; PR: 0.889; CI: 0.822-0.961; WC2; PR: 0.914; CI: 0.873-0.957) and overweight (PR: 0.930; CI: 0.870-0.994), but also was associated with simultaneous occurrence of coronary and peripheral artery disease and stroke (OR: 2.802; CI: 1.241-6.325) when compared with a lower intake (<62.8% of caloric intake). These findings reinforce the importance of nutritional guidance that considers the profile of the target population and the composition and quality of the meals consumed.

Dietary Habits and Lifestyle, Including Cardiovascular Risk among Vegetarians and Omnivores during the COVID-19 Pandemic in the Polish Population

Background: This study assessed how two food groups—omnivores (OMN) and vegetarians (VEGE)—differ in lifestyle changes, including dietary habits during the COVID-19 pandemic. Materials: A total of 861 persons participated in the survey and were divided into two groups: persons following a mixed diet (n = 489) and vegetarians, including vegans (n = 372). The mean age shows no significant differences. Methods: An online survey was conducted on the Polish population during the COVID-19 pandemic. Data was collected using social media; the survey was intended for adults and included separate sheets for different diets (OMN vs. VEGE). Results: The results in both groups were similar regarding the burden of premature diseases. Most respondents (~90%) did not indicate cardiovascular disease abnormalities. In the OMN group, overweight and obesity occurred more often, and the OMN group also showed a higher percentage of people reporting weight gain (OMN 42.7% vs. VEGE 35.9%). The results disclosed the VEGE group significantly more frequently chose products, i.e., vegetables (p = 0.029), legumes (p < 0.001), and dairy products or their plant substitutes (p = 0.002), compared to the OMN group. Conclusions: The VEGE group revealed the most regularities in dietary habits during the pandemic.

Red Meat Consumption and Risk of Cardio-Cerebrovascular Disease in Chinese Older Adults

Associations between red meat consumption and cardio-cerebrovascular diseases (CCVDs) are mostly studied in Western populations but not in Chinese or elderly. This prospective study investigated adults ≥65 years from the China Kadoorie Biobank (CKB). Associations between red meat consumption and CCVD, ischemic stroke/transient ischemic attack (TIA), CCVD mortality, and all-cause mortality were determined by Cox regression. A total of 59,980 participants were analyzed, 14,715 (24.53%) of whom ate red meat daily, 9,843 (16.41%) ate red meat 4-6 days/week, 23,472 (39.13%) ate red meat 1-3 days/week, and 11,950 (19.92%) ate red meat less than 1 day/week. Average amount of red meat usual consumption was 38 g/day. After adjustment, per 50 g/day higher red meat consumption at baseline was significantly associated with increased incident CCVD (aHR = 1.10) among high-income subjects (≥ 10,000 RMB) and urban residents (aHR = 1.12). Per 50 g/day higher baseline red meat consumption was significantly associated with increased ischemic stroke/TIA in urban residents (aHR = 1.08) but decreased risk in rural residents (aHR = 0.84). Higher baseline red meat consumption was associated with lower CCVD mortality in the poorest (aHR = 0.78) and rural residents (aHR = 0.72) and lower all-cause mortality in the poorest (aHR = 0.82) and rural residents (aHR = 0.80). In general, among older adults in China, higher red meat intake independently predicted increased CCVD among urban and high-income individuals but not poor ones. Higher red meat intake appears to be protective against mortality in rural and low-income subjects. Socioeconomic status is a crucial modifying factor on the association between red meat consumption and adverse cardiovascular outcomes in China.

Dietary Meat, Trimethylamine N-Oxide-Related Metabolites, and Incident Cardiovascular Disease Among Older Adults: The Cardiovascular Health Study

BACKGROUND

Effects of animal source foods (ASF) on atherosclerotic cardiovascular disease (ASCVD) and underlying mechanisms remain controversial. We investigated prospective associations of different ASF with incident ASCVD and potential mediation by gut microbiota-generated trimethylamine N-oxide, its L-carnitine-derived intermediates γ-butyrobetaine and crotonobetaine, and traditional ASCVD risk pathways.

METHODS

Among 3931 participants from a community-based US cohort aged 65+ years, ASF intakes and trimethylamine N-oxide-related metabolites were measured serially over time. Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, other atherosclerotic death) was adjudicated over 12.5 years median follow-up. Cox proportional hazards models with time-varying exposures and covariates examined ASF-ASCVD associations; and additive hazard models, mediation proportions by different risk pathways.

RESULTS

After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01-1.30), 1.22 (1.07-1.39), and 1.18 (1.03-1.34), respectively. Trimethylamine N-oxide-related metabolites together significantly mediated these associations, with mediation proportions (95% CI) of 10.6% (1.0-114.5), 7.8% (1.0-32.7), and 9.2% (2.2-44.5), respectively. Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98-1.25]); intakes of fish, poultry, and eggs were not significantly associated. Among other risk pathways, blood glucose, insulin, and C-reactive protein, but not blood pressure or blood cholesterol, each significantly mediated the total meat-ASCVD association.

CONCLUSIONS

In this large, community-based cohort, higher meat intake associated with incident ASCVD, partly mediated by microbiota-derived metabolites of L-carnitine, abundant in red meat. These novel findings support biochemical links between dietary meat, gut microbiome pathways, and ASCVD.

Association of Adherence to the Mediterranean Diet with All-Cause Mortality in Subjects with Heart Failure

We investigated the associations of adherence to the Mediterranean diet with all-cause and cardiovascular mortality in patients with heart failure. We analyzed the National Health and Nutrition Examination Survey (NHANES) participants from 1999 to 2010, with their vital status confirmed through to the end of 2011. The alternate Mediterranean Diet Index (aMED) was used to assess study participants’ adherence to the Mediterranean diet according to information on dietary questionnaires. We conducted weighted Cox proportional hazards regression models to determine the associations of adherence to the Mediterranean diet (aMED ≥ median vs. <median) with all-cause and cardiovascular mortality in participants with a history of heart failure. A total of 832 participants were analyzed, and the median aMED was 3. After a median follow-up of 4.7 years, 319 participants had died. aMED ≥ 3 (vs. <3) was not associated with a lower risk of all-cause (adjusted HR 0.797, 95% CI 0.599–1.059, p = 0.116) and cardiovascular (adjusted HR 0.911, 95% CI 0.539–1.538, p = 0.724) mortality. The findings were consistent across several subgroup populations. Among the components of aMED, a lower intake of red/processed meat was associated with a higher risk of mortality (adjusted HR 1.406, 95% CI 1.011–1.955, p = 0.043). We concluded that adherence to the Mediterranean diet was not associated with a lower risk of all-cause and cardiovascular mortality in participants with a history of heart failure. The higher risk of mortality associated with a lower intake of red/processed meat deserves further investigation.

Meat and Human Health-Current Knowledge and Research Gaps

Meat is highly nutritious and contributes with several essential nutrients which are difficult to obtain in the right amounts from other food sources. Industrially processed meat contains preservatives including salts, possibly exerting negative effects on health. During maturation, some processed meat products develop a specific microbiota, forming probiotic metabolites with physiological and biological effects yet unidentified, while the concentration of nutrients also increases. Meat is a source of saturated fatty acids, and current WHO nutrition recommendations advise limiting saturated fat to less than ten percent of total energy consumption. Recent meta-analyses of both observational and randomized controlled trials do not support any effect of saturated fat on cardiovascular disease or diabetes. The current evidence regarding the effect of meat consumption on health is potentially confounded, and there is a need for sufficiently powered high-quality trials assessing the health effects of meat consumption. Future studies should include biomarkers of meat intake, identify metabolic pathways and include detailed study of fermented and other processed meats and their potential of increasing nutrient availability and metabolic effects of compounds.

Joint Associations of Multiple Dietary Components With Cardiovascular Disease Risk: A Machine-Learning Approach

The human diet consists of a complex mixture of components. To realistically assess dietary impacts on health, new statistical tools that can better address nonlinear, collinear, and interactive relationships are necessary. Using data from 1,928 healthy participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (1985-2006), we explored the association between 12 dietary factors and 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) using an innovative approach, Bayesian kernel machine regression (BKMR). Employing BKMR, we found that among women, unprocessed red meat was most strongly related to the outcome: An interquartile range increase in unprocessed red meat consumption was associated with a 0.07-unit (95% credible interval: 0.01, 0.13) increase in ASCVD risk when intakes of other dietary components were fixed at their median values (similar results were obtained when other components were fixed at their 25th and 75th percentile values). Among men, fruits had the strongest association: An interquartile range increase in fruit consumption was associated with -0.09-unit (95% credible interval (CrI): -0.16, -0.02), -0.10-unit (95% CrI: -0.16, -0.03), and -0.11-unit (95% CrI: -0.18, -0.04) lower ASCVD risk when other dietary components were fixed at their 25th, 50th (median), and 75th percentile values, respectively. Using BKMR to explore the complex structure of the total diet, we found distinct sex-specific diet-ASCVD relationships and synergistic interaction between whole grain and fruit consumption.

Interventions to reduce meat consumption by appealing to animal welfare: Meta-analysis and evidence-based recommendations

Reducing meat consumption may improve human health, curb environmental damage, and limit the large-scale suffering of animals raised in factory farms. Most attention to reducing consumption has focused on restructuring environments where foods are chosen or on making health or environmental appeals. However, psychological theory suggests that interventions appealing to animal welfare concerns might operate on distinct, potent pathways. We conducted a systematic review and meta-analysis evaluating the effectiveness of these interventions. We searched eight academic databases and extensively searched grey literature. We meta-analyzed 100 studies assessing interventions designed to reduce meat consumption or purchase by mentioning or portraying farm animals, that measured behavioral or self-reported outcomes related to meat consumption, purchase, or related intentions, and that had a control condition. The interventions consistently reduced meat consumption, purchase, or related intentions at least in the short term with meaningfully large effects (meta-analytic mean risk ratio [RR] = 1.22; 95% CI: [1.13, 1.33]). We estimated that a large majority of population effect sizes (71%; 95% CI: [59%, 80%]) were stronger than RR = 1.1 and that few were in the unintended direction. Via meta-regression, we identified some specific characteristics of studies and interventions that were associated with effect size. Risk-of-bias assessments identified both methodological strengths and limitations of this literature; however, results did not differ meaningfully in sensitivity analyses retaining only studies at the lowest risk of bias. Evidence of publication bias was not apparent. In conclusion, animal welfare interventions preliminarily appear effective in these typically short-term studies of primarily self-reported outcomes. Future research should use direct behavioral outcomes that minimize the potential for social desirability bias and are measured over long-term follow-up.

The Importance of a Food Systems Approach to Low and Middle Income Countries and Emerging Economies: A Review of Theories and Its Relevance for Disease Control and Malnutrition

Our review explores the changing food production, distribution and consumption environment in low and middle-income countries and emerging economies as a basis for framing how to study food systems in order to address public health issues of food safety and nutrition. It presents the state of knowledge on existing food systems science and its use in terms of sustainable actions for food safety and public health. The review identifies a knowledge gap in food system mapping and governance, with value chain mapping of key commodities often missing. Despite a number of initiatives, the application of food systems methods is highly variable in scope and quality. Most analyses concentrate on specific commodities, rarely taking into account the need for a whole diet approach when looking at nutrition or the assessment of a range of infectious agents and their interactions when looking at food safety. Of the studies included in the review there is a growing observation of “informal” food systems, a term used inconsistently and one that requires revision. “Informal” food systems link to the formal sector to provide food security, yet with trade-offs between economic efficiencies and food safety. Efforts to improve food safety are hampered by inadequate food safety capacities and a lack of policy coherence leading to: inadequate investment; fragmented food quality control systems; weak or non-existent traceability mechanisms; weak foodborne disease surveillance; obsolete food regulation; and weak regulatory enforcement. In-depth food systems assessments can complement risk analysis to identify risky behaviors and understand institutional settings in order to improve codes of practice and enforcement. Methods for looking at food safety from a food systems perspective are emerging, yet existing nutrition and food systems science are not advancing sufficiently in response to nutritional public health problems. There is an urgency for improved understanding of the structure and drivers of the food systems, for better planning of changes that leads to nutrients access and healthy levels of eating. It is proposed that countries and international institutions provide an atlas of food system maps for the key commodities based on an agreed common methodology and developed by multidisciplinary teams.

Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients’ capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

Exploring Health-Promoting Attributes of Plant Proteins as a Functional Ingredient for the Food Sector: A Systematic Review of Human Interventional Studies

The potential beneficial effects of plant-based diets on human health have been extensively studied. However, the evidence regarding the health effects of extracted plant-based proteins as functional ingredients, other than soya, is scarce. The aim of this review was to compile evidence on the effects of extracted protein from a wide range of traditional and novel plant sources on glycemic responses, appetite, body weight, metabolic, cardiovascular and muscle health. A comprehensive search of PubMed, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL) was conducted through 23 and 27 March 2020 for randomized controlled trials that featured any of the following 18 plant protein sources: alfalfa, duckweed, buckwheat, chickpea, fava bean, hemp, lentil, lupin, mushroom, oat, pea, potato, pumpkin, quinoa, rapeseed, rice, sacha inchi, sunflower. Only interventions that investigated concentrated, isolated or hydrolysed forms of dietary protein were included. Searched health outcome measures were: change in blood glucose, insulin, satiety hormones concentration, subjective assessment of appetite/satiety, change in blood lipids concentration, blood pressure, body weight and muscle health parameters. Acute and sub-chronic studies were considered for inclusion. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach we identified 1190 records. Twenty-six studies met the inclusion criteria. Plant protein sources used in interventions were most often pea (n = 16), followed by lupin (n = 4), fava bean (n = 2), rice (n = 2), oat (n = 2), hemp (n = 2) and lentil (n = 1). Satiety and postprandial glycemic response were the most frequently reported health outcomes (n = 18), followed by blood lipids (n = 6), muscle health (n = 5), body weight (n = 5) and blood pressure (n = 4). No studies on the remaining plant proteins in the extracted form were identified through the search. Most studies confirmed the health-promoting effect of identified extracted plant protein sources across glycemic, appetite, cardiovascular and muscular outcomes when compared to baseline or non-protein control. However, the current evidence is still not sufficient to formulate explicit dietary recommendations. In general, the effects of plant protein were comparable (but not superior) to protein originating from animals. This is still a promising finding, suggesting that the desired health effects can be achieved with more sustainable, plant alternatives. More methodologically homogenous research is needed to formulate and validate evidence-based health claims for plant protein ingredients. The relevance of these findings are discussed for the food sector with supporting market trends.

Dietary patterns and cardiovascular disease in Australian adults: Findings from the 2011-12 Australian Health Survey

BACKGROUND AND AIMS

Great discrepancies exist in results from studies examining the association between dietary patterns and cardiovascular disease (CVD) in different populations. The aim of this study is to examine the relationship between the Australian Dietary Guidelines (ADG) 2013, Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND), Paleolithic and Okinawan dietary patterns and CVD respectively.

METHODS AND RESULTS

In this cross-sectional secondary analysis of the 2011-12 Australian Health Survey, adults who self-reported physician-diagnosed CVD, completed two multiple-pass 24 h recalls and had no missing data on all confounders were analysed (weighted n = 5376; 295 CVD cases). Dietary intake was transformed to represent usual intake by the multiple source method. The score of Healthy Eating Index for Australian Adults (HEIFA-2013) was adopted for ADG 2013, while the scores of MIND, Paleolithic and Okinawan dietary patterns were constructed by separating the intake of each predefined food and nutrient into quintiles. The associations between the dietary patterns (as tertiles of scores) and CVD were examined using binary logistic regression adjusted for significant cardiovascular risk factors. Higher adherence to the Okinawan diet pattern was significantly associated with a reduced prevalence of ischemic heart disease (IHD) (OR per unit increase in dietary pattern score: 0.94, 95%CI: 0.90-0.98). Comparing its extreme tertiles, the OR was 0.49 (95%CI: 0.29-0.82; p_trend < 0.01). The associations between HEIFA-2013, MIND and Paleolithic diet patterns and CVD were insignificant.

CONCLUSION

The findings suggested an inverse association between adherence to Okinawan dietary pattern and prevalence of IHD in Australian adults.

Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality

IMPORTANCE

Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, or fish consumption with CVD and all-cause mortality are still uncertain.

OBJECTIVE

To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019.

EXPOSURES

Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables.

MAIN OUTCOMES AND MEASURES

Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations.

RESULTS

Among the 29 682 participants (mean [SD] age at baseline, 53.7 [15.7] years; 13 168 [44.4%] men; and 9101 [30.7%] self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 [95% CI, 1.04-1.11]; adjusted ARD, 1.74% [95% CI, 0.85%-2.63%]), unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.06]; adjusted ARD, 0.62% [95% CI, 0.07%-1.16%]), or poultry (adjusted HR, 1.04 [95% CI, 1.01-1.06]; adjusted ARD, 1.03% [95% CI, 0.36%-1.70%]) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 [95% CI, 0.98-1.02]; adjusted ARD, 0.12% [95% CI, -0.40% to 0.65%]). Intake of processed meat (adjusted HR, 1.03 [95% CI, 1.02-1.05]; adjusted ARD, 0.90% [95% CI, 0.43%-1.38%]) or unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.05]; adjusted ARD, 0.76% [95% CI, 0.19%-1.33%]) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 [95% CI, 0.97-1.02]; adjusted ARD, -0.28% [95% CI, -1.00% to 0.44%]) or fish (adjusted HR, 0.99 [95% CI, 0.97-1.01]; adjusted ARD, -0.34% [95% CI, -0.88% to 0.20%]) was not significantly associated with all-cause mortality.

CONCLUSIONS AND RELEVANCE

These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.

Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

BACKGROUND AND AIMS

Empirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults.

METHODS AND RESULTS

Adult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30-0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02-2.26). No association was found between the Prudent pattern and CVD outcomes.

CONCLUSION

The variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting.

Reducing meat consumption by appealing to animal welfare: protocol for a meta-analysis and theoretical review

BACKGROUND

Reducing meat consumption may improve human health, curb environmental damage and greenhouse gas emissions, and limit the large-scale suffering of animals raised in factory farms. Previous work has begun to develop interventions to reduce individual meat consumption, often by appealing directly to individual health motivations. However, research on nutritional behavior change suggests that interventions additionally linking behavior to ethical values, identity formation, and existing social movements may be particularly effective and longer-lasting. Regarding meat consumption, preliminary evidence and psychological theory suggest that appeals related to animal welfare may have considerable potential to effectively leverage these elements of human psychology. We aim to conduct a systematic review and quantitative meta-analysis evaluating the effectiveness of animal welfare-related appeals on actual or intended meat consumption or purchasing. Our investigation will critically synthesize the current state of knowledge regarding psychological mechanisms of intervening on individual meat consumption and empirically identify the psychological characteristics underlying the most effective animal welfare-based interventions.

METHODS

We will systematically search eight academic databases and extensively search unpublished grey literature. We will include studies that assess interventions intended to reduce meat consumption or purchase through the mention or portrayal of animal welfare, that measure outcomes related to meat consumption or purchase, and that have a control condition. Eligible studies may recruit from any human population, be written in any language, and be published or released any time. We will meta-analyze the studies, reporting the pooled point estimate and additional metrics that describe the distribution of potentially heterogeneous effects. We will assess studies' risk of bias and conduct sensitivity analyses for publication bias. We describe possible follow-up analyses to investigate hypothesized moderators of intervention effectiveness.

DISCUSSION

The findings of the proposed systematic review and meta-analysis, including any identified methodological limitations of the existing literature, could inform the design of successful evidence-based interventions with broad potential to improve human, animal, and environmental well-being.

SYSTEMATIC REVIEW REGISTRATION

The protocol was preregistered via the Open Science Framework (https://osf.io/d3y56/registrations).