Red meat and poultry intakes and risk of total and cause-specific mortality: results from cohort studies of Chinese adults in Shanghai

Guidelines to restrict consumption of red meat to under 350 g/wk based on colorectal cancer risk are not consistent with health evidence

BACKGROUND

The Nordic Nutrition Recommendations of 2023 (NNR2023) incorporate sustainability, health, and nutrition in their food-based dietary guidelines (FBDGs). NNR2023 recommends a consumption of ≤350 g/wk of unprocessed red meat (RM) based on association with colorectal cancer (CRC). This recommendation is lower than other FBDGs such as the World Cancer Research Fund (WCRF) recommendation it is based on (350-500 g/wk).

OBJECTIVE

To evaluate the empirical evidence and models cited by the NNR2023 to support the RM guidance.

METHODS

We fitted least-assumption (LA) dose-response (DR) models to the studies included in two systematic reviews (SRs) selected by NNR2023 on the RM and CRC association. We compared them against six parametric models reported in the two SRs. We evaluated the statistical significance of modeled relative risks (RR) at different consumption levels.

RESULTS

Twenty-one studies (20,604,188 patient-years) were analyzed. We found no significant association (RR = 1.04, 0.99-1.09) between 350g/wk of RM and CRC using the LA models, in agreement with the least restrictive models reported by Lescinsky et al., 2022 (RR = 1.11[0.89-1.38]) and WCRF (RR= 1.01[0.96-1.07]). The association was significant at 350 g/wk only under restricting assumptions such as monotonicity RR=1.3[1.01-1.64], and linearity RR = 1.06 [1.00-1.12]. No significant empirical association is observed under 567 g/wk based on evidence used by NNR2023.

CONCLUSIONS

The sources cited by NNR2023 do not support a consumption restriction of ≤350 g/wk of RM due to CRC, and other studies omitted by NNR2023 do not support association between RM and CRC. We show that model assumptions rather than empirical evidence drive this recommendation. Model uncertainty should be explicitly incorporated in FBDGs.

Observational Dose-Response Meta-Analysis Methods May Bias Risk Estimates at Low Consumption Levels: The Case of Meat and Colorectal Cancer

Observational studies of foods and health are susceptible to bias, particularly from confounding between diet and other lifestyle factors. Common methods for deriving dose-response meta-analysis (DRMA) may contribute to biased or overly certain risk estimates. We used DRMA models to evaluate the empirical evidence for colorectal cancer (CRC) association with unprocessed red meat (RM) and processed meats (PM), and the consistency of this association for low and high consumers under different modeling assumptions. Using the Global Burden of Disease project's systematic reviews as a start, we compiled a data set of studies of PM with 29 cohorts contributing 23,522,676 person-years and of 23 cohorts for RM totaling 17,259,839 person-years. We fitted DRMA models to lower consumers only [consumption < United States median of PM (21 g/d) or RM (56 g/d)] and compared them with DRMA models using all consumers. To investigate impacts of model selection, we compared classical DRMA models against an empirical model for both lower consumers only and for all consumers. Finally, we assessed if the type of reference consumer (nonconsumer or mixed consumer/nonconsumer) influenced a meta-analysis of the lowest consumption arm. We found no significant association with consumption of 50 g/d RM using an empirical fit with lower consumption (relative risk [RR] 0.93 (0.8-1.02) or all consumption levels (1.04 (0.99-1.10)), while classical models showed RRs as high as 1.09 (1.00-1.18) at 50g/day. PM consumption of 20 g/d was not associated with CRC (1.01 (0.87-1.18)) when using lower consumer data, regardless of model choice. Using all consumption data resulted in association with CRC at 20g/day of PM for the empirical models (1.07 (1.02-1.12)) and with as little as 1g/day for classical models. The empirical DRMA showed nonlinear, nonmonotonic relationships for PM and RM. Nonconsumer reference groups did not affect RM (P = 0.056) or PM (P = 0.937) association with CRC in lowest consumption arms. In conclusion, classical DRMA model assumptions and inclusion of higher consumption levels influence the association between CRC and low RM and PM consumption. Furthermore, a no-risk limit of 0 g/d consumption of RM and PM is inconsistent with the evidence.

White meat consumption and risk of cardiovascular disease and type 2 diabetes: a systematic review and meta-analysis

Objectives

The aim was to systematically review the associations among white meat consumption, cardiovascular diseases (CVD), and type 2 diabetes (T2D).

Methods

Databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials and Scopus were searched (15th October 2021) for randomized intervention trials (RCTs, ≥ 4 weeks of duration) and prospective cohort studies (≥12 month of follow-up) assessing the consumption of white meat as the intervention/exposure. Eligible outcomes for RCTs were cardiometabolic risk factors and for cohorts, fatal and non-fatal CVD and incident T2D. Risk of bias was estimated using the Cochrane's RoB2 and Risk of Bias for Nutrition Observational Studies. Meta-analysis was conducted in case of ≥3 relevant intervention studies or ≥5 cohort studies using random-effects models. The strength of evidence was evaluated using the World Cancer Research Fund's criteria.

Results

The literature search yielded 5,795 scientific articles, and after screening 43 full-text articles, 23 cohort studies and three intervention studies were included. All included intervention studies matched fat content of intervention and control diets, and none of them showed any significant effects on the selected outcomes of white meat when compared to red meat. Findings from the cohort studies generally did not support any associations between white meat intake and outcomes. Meta-analyses were conducted for CVD mortality (RR: 0.95, 95% CI: 0.87-1.02, P = 0.23, I2 = 25%) and T2D incidence (RR: 0.98, 95% CI: 0.87-1.11, P = 0.81, I2 = 82%).

Conclusion

The currently available evidence does not indicate a role, beneficial or detrimental, of white meat consumption for CVD and T2D. Future studies investigating potentially different health effects of processed versus unprocessed white meat and substitution of red meat with white meat are warranted.Registration: Prospero registration CRD42022295915.

Poultry Consumption and Human Cardiometabolic Health-Related Outcomes: A Narrative Review

Poultry meats, in particular chicken, have high rates of consumption globally. Poultry is the most consumed type of meat in the United States (US), with chicken being the most common type of poultry consumed. The amounts of chicken and total poultry consumed in the US have more than tripled over the last six decades. This narrative review describes nutritional profiles of commonly consumed chicken/poultry products, consumption trends, and dietary recommendations in the US. Overviews of the scientific literature pertaining to associations between, and effects of consuming chicken/poultry on, body weight and body composition, cardiovascular disease (CVD), and type II diabetes mellitus (T2DM) are provided. Limited evidence from randomized controlled trials indicates the consumption of lean unprocessed chicken as a primary dietary protein source has either beneficial or neutral effects on body weight and body composition and risk factors for CVD and T2DM. Apparently, zero randomized controlled feeding trials have specifically assessed the effects of consuming processed chicken/poultry on these health outcomes. Evidence from observational studies is less consistent, likely due to confounding factors such as a lack of a description of and distinctions among types of chicken/poultry products, amounts consumed, and cooking and preservation methods. New experimental and observational research on the impacts of consuming chicken/poultry, especially processed versions, on cardiometabolic health is sorely needed.

How to Keep the Balance between Red and Processed Meat Intake and Physical Activity Regarding Mortality: A Dose-Response Meta-Analysis

BACKGROUND

Non-communicable diseases have become a major threat to public health, with cardiovascular diseases (CVDs) and cancer being the top two causes of death each year.

OBJECTIVE

Our objective is to evaluate the balanced association between the effect of red and processed meat intake on the risk of death and the effect of physical activity on the risk of mortality, where the risk of death includes all causes, CVDs, and cancers.

METHODS

We searched electronic databases, including PubMed, ISI Web of Science, Embase, and the Cochrane Library, for prospective studies reporting risk estimates for the association between the intake of red and processed meat, walking, and muscle-strengthening activity (MSA) and the risk of mortality from all causes, CVDs, and cancer. We extracted fully adjusted effect estimates from original studies and performed a summary analysis using the fixed and random-effect models.

RESULTS

A conventional meta-analysis showed that red meat and processed meat were positively associated with the risk of mortality, and daily steps and MSA were negatively associated with the risk of death. Further analysis of the dose-response relationship showed that a risk reduction (20%) from 39.5 min/week of MSA or 4100 steps/d was equivalent to an increased risk of all-cause mortality from a daily intake of 103.4 g/d of red meat or 50 g/d of processed meat. The risk was further decreased as the number of steps per day increased, but the risk reversed when the MSA exceeded the threshold (39.5 min/week).

CONCLUSIONS

Adherence to physical activity is an effective way to reduce the risk of mortality due to meat intake. However, the total intake of red meat and processed meat should be controlled, especially the latter. Walking is recommended as the main daily physical activity of choice, while MSAs are preferred when time is limited, but it should be noted that longer MSAs do not provide additional benefits.

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.

Exploration of Metabolic Biomarkers Linking Red Meat Consumption to Ischemic Heart Disease Mortality in the UK Biobank

Growing evidence suggests that red meat consumption is a risk factor for cardiovascular health, with potential sex disparity. The metabolic mechanisms have not been fully understood. Using the UK Biobank, first we examined the associations of unprocessed red meat and processed meat with ischemic heart disease (IHD) mortality overall and by sex using logistic regression. Then, we examined the overall and sex-specific associations of red meat consumption with metabolites using multivariable regression, as well as the associations of selected metabolites with IHD mortality using logistic regression. We further selected metabolic biomarkers that are linked to both red meat consumption and IHD, with concordant directions. Unprocessed red meat and processed meat consumption was associated with higher IHD mortality overall and in men. Thirteen metabolites were associated with both unprocessed red meat and IHD mortality overall and showed a consistent direction, including triglycerides in different lipoproteins, phospholipids in very small very-low-density lipoprotein (VLDL), docosahexaenoic acid, tyrosine, creatinine, glucose, and glycoprotein acetyls. Ten metabolites related to triglycerides and VLDL were positively associated with both unprocessed red meat consumption and IHD mortality in men, but not in women. Processed meat consumption showed similar results with unprocessed red meat. Triglycerides in lipoproteins, fatty acids, and some nonlipid metabolites may play a role linking meat consumption to IHD. Triglycerides and VLDL-related lipid metabolism may contribute to the sex-specific associations. Sex differences should be considered in dietary recommendations.

Stroke mortality attributable to high red meat intake in China and South Korea: An age-period-cohort and joinpoint analysis

The high intake of red meat is well recognized as a major health concern worldwide. It has been recognized as a risk factor for several non-communicable chronic diseases, including stroke. However, previously published studies have not performed a comprehensive analysis of the long-time trend of stroke mortality attributable to high red meat intake in China and South Korea, two countries with similar dietary patterns and changing trends. Therefore, this study aimed to reveal the influence of age, time period, and birth cohort on long-term trends of stroke mortality attributable to high red meat intake and relative gender differences in China and South Korea. Data were obtained from the Global Burden of Disease 2019 database. The age–period–cohort model was used to estimate the effect of age, time period, and birth cohort. The average and annual percent changes were estimated using the joinpoint regression analysis. Results indicated that the overall attributable age-standardized mortality rates of stroke in China decreased by 1.0% (P < 0.05) for female and 0.1% (P > 0.05) for male individuals, compared with a decrease of 4.9% for female and 3.7% for male individuals in South Korea (both P < 0.05). Age–period–cohort analysis revealed that the attributable stroke mortality decreased along with the time period, and increased along with age. Significant gender differences were observed, male individuals in both countries were at higher risk than their female counterparts, especially in China. Joinpoint analysis suggested that the attributable stroke mortality for both genders in South Korea and female individuals in China showed a decreasing trend, while it is stable for male individuals in China. Although prominent reductions were observed during the past decades, the attributable stroke mortality risk in China and South Korea is still high. Our findings indicate that controlling the intake of red meat may be a cost-effective strategy to reduce stroke mortality risk and the corresponding disease burden, especially for Chinese male individuals.

Health effects associated with consumption of unprocessed red meat: a Burden of Proof study

Characterizing the potential health effects of exposure to risk factors such as red meat consumption is essential to inform health policy and practice. Previous meta-analyses evaluating the effects of red meat intake have generated mixed findings and do not formally assess evidence strength. Here, we conducted a systematic review and implemented a meta-regression-relaxing conventional log-linearity assumptions and incorporating between-study heterogeneity-to evaluate the relationships between unprocessed red meat consumption and six potential health outcomes. We found weak evidence of association between unprocessed red meat consumption and colorectal cancer, breast cancer, type 2 diabetes and ischemic heart disease. Moreover, we found no evidence of an association between unprocessed red meat and ischemic stroke or hemorrhagic stroke. We also found that while risk for the six outcomes in our analysis combined was minimized at 0 g unprocessed red meat intake per day, the 95% uncertainty interval that incorporated between-study heterogeneity was very wide: from 0-200 g d-1. While there is some evidence that eating unprocessed red meat is associated with increased risk of disease incidence and mortality, it is weak and insufficient to make stronger or more conclusive recommendations. More rigorous, well-powered research is needed to better understand and quantify the relationship between consumption of unprocessed red meat and chronic disease.

Effect of Consuming Beef with Varying Fatty Acid Compositions as a Major Source of Protein in Volunteers under a Personalized Nutritional Program

Beef is an excellent source of nutrients; unfortunately, most nutritional recommendations suggest limiting or even avoiding it. Studies have shown that the fatty acid composition of meat influences weight loss. This randomized controlled clinical trial evaluated the anthropometric and serum lipid changes after a food intervention that included frequent beef consumption (120 g consumed four days/week for four weeks). Volunteers were randomly assigned to the commercial or Wagyu-Cross beef groups, with the latter beef possessing higher fat and MUFA contents. Both groups exhibited reductions in body measurements and lipid profiles; however, the Wagyu-Cross group exhibited greater changes in weight (-3.75 vs. -2.90 kg) and BMI (-1.49 vs. -1.03) than the commercial group, without a significant difference between them. No significant group differences in lipid profiles were observed; however, the Wagyu-Cross group exhibited a more favorable change in decreasing the TC concentration (-7.00 mg/dL) and LDL-C concentration (-12.5 mg/dL). We suggest that high MUFA beef could be included in weight-loss programs since it does not affect weight loss and hasn't a negative influence on lipid metabolism.

Associations of the consumption of unprocessed red meat and processed meat with the incidence of cardiovascular disease and mortality, and the dose-response relationship: A systematic review and meta-analysis of cohort studies

OBJECTIVES

The aim of this study was to examine the associations of unprocessed red meat and processed meat consumption with cardiovascular disease (CVD) incidence and mortality, and the dose-response relationship.

METHODS

Published literature was retrieved through a structured search of 10 electronic databases: MEDLINE/PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, Cochrane (CENTRAL), WHOLIS, PAHO and Embase, without language or year of publication restrictions. In addition, we searched the references of published studies. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes: The PRISMA Statement.

RESULTS

Twenty-one prospective cohort studies were included in the systematic review. The CVDs evaluated in the inserted studies were stroke, heart failure (HF) and coronary heart disease (CHD). Considering the heterogeneity found in the studies, for the meta-analysis, 9 articles were included. The results presented in the meta-analysis of the association of consumption of unprocessed red meat and CVD indicated that there was a significant association with total stroke incidence (RR 1.10; 95%; CI 1.01 to 1.19; p = 0.02). There was no association with Ischemic stroke incidence, nor CHD Mortality with consumption of unprocessed red meat. However, for Hemorrhagic Stroke Mortality the assessment in the consumption of unprocessed red meat showed an association of protection for women (RR 0.64; 95%; CI 0.45 to 0.91; p = 0.01). As for the results of the meta-analysis of the association between consumption of processed meat and CVD, they indicated that there was a significant association with total stroke incidence (RR 1.17; 95%; CI 1.08 to 1.26; p < 0.0001). There was no association with Ischemic stroke, nor with CHD Mortality with consumption of processed meat. Some studies that showed no association of risk, presented a significant linear trend dose response for the association of the consumption of unprocessed red meat (Bernstein et al. 2010; Nagao et al. 2012) or processed meat (Bernstein et al. 2012) and CVD.

CONCLUSION

According to the results found in the meta-analysis, the consumption of unprocessed red meat and processed meat are associated with the incidence of stroke, however, no positive association was observed in relation to mortality from CVD. This systematic review and meta-analysis protocol was registered on the PROSPERO (number: CRD42019100914).

Are Front-of-Pack Labels a Health Policy Tool?

To stem the increasing incidence of non-communicable diseases (NCDs) and obesity, front-of-pack labels (FOPLs) have been developed since 1989. Whereas several countries have already adopted one voluntarily, the European Community wants to harmonize an FOPL system that will be mandatory for all member states. The purpose of this narrative review is to describe what could be achieved or not by FOPLs, and to discuss if there is enough evidence to establish whether such labels are effective in modifying purchasing behavior, in directing individual dietary patterns towards a healthy and sustainable diet, and in reformulating food products by the food industry. Non-directive FOPLs, which are still under study, appear to be informative and well-accepted by consumers even if they require a cognitive effort. Conversely, directive FOPLs are supported by several studies, but they are mostly conducted in simulated scenarios and/or performed as retrospective studies. Nevertheless, directive FOPLs are rated as an intuitive tool, and they have demonstrated a high capacity to help consumers rank food products as more or less healthy. In conclusion, directive and non-directive FOPLs convey different messages. No FOPL individually can be considered exhaustive in relation to all the objectives outlined in this narrative review, and therefore, the development of a model synthesizing both messages is advisable. Many questions remain open, such as the possibility of reformulating pre-packaged products, how to deal with traditional products, and the impact on the incidence of NCDs and obesity. In the light of the complexity of factors that condition consumption choices and health, none of the current FOPLs can be considered a health policy tool on its own. The possibility of development remains open, but as the state of the art, these tools do not seem to be able to achieve all the European Community goals together. We can speculate that they could meet these goals only if they are integrated into a multi-tiered, structured health policy intervention.

Red and processed meat consumption and risk of incident cardiovascular disease and mortality: Isfahan cohort study

To investigate the cardiovascular risks associated with red and/or processed meat intake in a large population-based cohort study in Iran. A total of 5432 participants from the Isfahan Cohort Study (ICS) were enrolled. Diet was assessed using a validated, 48-item food frequency questionnaire. Cox proportional hazards regression models were applied to calculate hazard ratios (HRs) for the CVD risk associated with red and processed meat intake. Median follow-up was 11.2 years. Compared to the first tertile, the highest tertile of red meat intake, either alone or in combination with processed meat was associated with a 50% reduced risk of stroke (95% CI: 0.31-0.77; 95% CI: 0.33-0.82, respectively), but increased risk of CVD mortality with corresponding HRs of 1.58 (95% CI: 1.06-2.35) and 1.47 (95% CI: 1.02-2.08), respectively. Red meat and red plus processed meat intake were inversely associated with stroke risk, but positively linked with CVD mortality.

Association of poultry consumption with cardiovascular diseases and all-cause mortality: a systematic review and dose response meta-analysis of prospective cohort studies

According to previous cohort studies it is suggested that a high intake of poultry does not adversely affect cardiovascular disease (CVD) risk. Therefore, the aim of this systematic review and meta-analysis is to summarize and analyze the association between dietary poultry intake and the risk for CVDs, coronary heart disease (CHD), stroke and all-cause mortality (ACM). Twenty-four cohort studies were included, and the results showed a trivial inverse association for the highest vs. lowest intake category between poultry and ACM (risk ratio [RR] = 0.96; 95% CI: 0.93, 0.98; I² = 5%). For all other outcomes no association was observed in the high vs. low intake meta-analysis. The results from the primary pooled data for each 100 g/d increase in poultry intake indicated no association for all outcomes. Further, the non-linear dose-response analysis showed some evidence for non-linearity between poultry consumption and risk for CVD and ACM. Additionally, substituting red and/or processed meat with poultry was inversely associated with the risk for ACM, CVDs, CHD and stroke. The certainty of evidence was rated as very low or low. This meta-analysis suggests that based upon the results from the substitution analyses poultry could be a healthier alternative to red and processed meat.

Meat consumption and risk of ischemic heart disease: A systematic review and meta-analysis

There is uncertainty regarding the association between unprocessed red and processed meat consumption and the risk of ischemic heart disease (IHD), and little is known regarding the association with poultry intake. The aim of this systematic review and meta-analysis was to quantitatively assess the associations of unprocessed red, processed meat, and poultry intake and risk of IHD in published prospective studies. We systematically searched CAB Abstract, MEDLINE, EMBASE, Web of Science, bioRxiv and medRxiv, and reference lists of selected studies and previous systematic reviews up to June 4, 2021. All prospective cohort studies that assessed associations between 1(+) meat types and IHD risk (incidence and/or death) were selected. The meta-analysis was conducted using fixed-effects models. Thirteen published articles were included (n_total = 1,427,989; n_cases = 32,630). Higher consumption of unprocessed red meat was associated with a 9% (relative risk (RR) per 50 g/day higher intake, 1.09; 95% confidence intervals (CI), 1.06 to 1.12; n_studies = 12) and processed meat intake with an 18% higher risk of IHD (1.18; 95% CI, 1.12 to 1.25; n_studies = 10). There was no association with poultry intake (n_studies = 10). This study provides substantial evidence that unprocessed red and processed meat, though not poultry, might be risk factors for IHD.

Apolipoprotein E Genotype, Meat, Fish, and Egg Intake in Relation to Mortality Among Older Adults: A Longitudinal Analysis in China

Introduction: The interactions between apolipoprotein E (APOE) genotype and diet pattern changes were found significant in several trials, implying that APOE gene may modify the effect of animal protein-rich food on health outcomes. We aim to study the interaction of APOE genotype with the effect of meat, fish and egg intake on mortality.

Methods: This population-based study enrolled 8,506 older adults (mean age: 81.7 years, 52.3% female) from the Chinese Longitudinal Healthy Longevity Study. The intake frequency of meat, fish and egg was assessed by 3-point questions at baseline. Cox regression was conducted to calculate the hazard ratios for all-cause mortality of intake levels of meat, fish and egg. The analyses were stratified by APOE genotype and sex. The analyses were performed in 2020.

Results: In the multivariable-adjusted models, meat and fish intake was associated with all-cause mortality (high vs. low intake: meat: HR: 1.14, 95% CI: 1.01, 1.28; fish: HR: 0.83, 95% CI: 0.73, 0.95). APOE genotype have significant interactions with meat and fish intake (Ps < 0.05). Compared with low fish intake, high fish intake was associated with lower risk of mortality (HR: 0.74, 95% CI: 0.56–0.98) only among the APOE ε4 carriers. High meat intake was significantly associated with higher risks of mortality (HR: 1.13, 95% CI: 1.04–1.25) only among the APOE ε4 non-carriers. The interactive relationship was restricted among the male. No significant findings were observed between egg and mortality among carriers or non-carriers.

Conclusions: Among Chinese older adults, the significance of associations of mortality with reported meat or fish intake depended on APOE-E4 carriage status. If validated by other studies, our findings provide evidence for gene-based “precision” lifestyle recommendations.

Inverse Association of Poultry, Fish, and Plant Protein Consumption with the Incidence of Cardiovascular Disease

Cardiovascular disease (CVD) remains a major cause of death and disability worldwide and food intake plays an important role in its onset or prevention. It is also well known that consumption of red meat (processed and unprocessed) is associated with an increased incidence of CVD, coronary heart disease (CHD), and premature death. However, little is known about the association of consumption of poultry, fish, and plant protein with the incidence of CVD, CHD, and mortality. Several recent studies, reviews and meta-analyses have shown an inverse association of consumption of these foods with the incidence of CVD, CHD, and death. In order to get a better perspective about the current consumption of these foods, a focused Medline search of the English language literature was conducted between 2010 and 2020 using the terms poultry, fish, plant protein consumption, cardiovascular disease, coronary heart disease, mortality; 28 papers with pertinent information were retrieved. The analysis of data from these papers suggest an inverse relationship between the consumption of these foods and the incidence of de novo CVD or worsening of preexisting CVD. They also demonstrate that the consumption of these foods is still low and that great effort should be made to inform the public about the benefits of switching from red meat to an increased consumption of poultry, fish, and plant protein. All the data from the retrieved papers regarding the consumption of these foods, together with collateral literature, will be discussed in this review.

Identification of risk factors for retinal vascular events in a population-based cross-sectional study in Rumoi, Japan

We conducted a population-based, cross-sectional study in Japan to identify risk factors for retinal vascular events separately by gender. Forty years or older participants were recruited. Fundus photographs were taken, and lifestyle and health characteristics were determined through a questionnaire and physical examinations. We compared the group of those who had retinal vascular events and those who did not. A total of 1689 participants (964 men) were deemed eligible for the study and retinal vascular events were seen in 59 subjects (3.7% of the men, 3.2% of the women). Self-reported diabetes mellitus was significantly associated with the vascular events in each gender [odds ratio (OR) = 6.97, 6.19 (men, women); 95% confidence interval (CI) 3.02–15.9, 2.25–17.0; p < 0.001]. Higher systolic blood pressure (OR = 1.03; 95% CI 1.01–1.04; p = 0.006) and lower frequency of meat consumption (OR = 0.73; 95% CI 0.54–0.99; p = 0.04) were independently associated with the vascular events in men. In women, while vascular events were associated with self-reported hypertension (OR = 2.64; 95% CI 1.03–6.74; p = 0.04), no association was seen with systolic blood pressure. Women with hypertension may need extra care, not only for blood pressure.

Associations of meat consumption and changes with all-cause mortality in hypertensive patients during 11.4-year follow-up: Findings from a population-based nationwide cohort

BACKGROUND & AIMS

Accumulating evidence has linked distinct associations of red/processed and white meat consumption with chronic diseases and longevity among the general population. However, the associations of meat consumption and changes with mortality among hypertensive patients remain unknown. We aimed to assess the associations of red and white meat consumption with all-cause mortality among hypertensive patients in China.

METHODS

We followed 8095 hypertensive patients from the China Health and Nutrition Survey between 1991 and 2015. In each survey year, 3-day 24-h dietary records were used to collect dietary data. Cumulative averages of dietary meat intake after the diagnosis of hypertension were calculated. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.

RESULTS

Overall 927 deaths were documented among these hypertensive patients during an average of 11.4 years of follow-up. Red meat consumption was positively associated with all-cause mortality after multivariable adjustment [HR (95% CI) comparing the highest versus lowest quartile: 1.29 (1.05-1.57), P trend = 0.02]. White meat intake was associated with lower all-cause mortality [HR (95% CI) comparing the highest tertile with non-consumers: 0.77 (0.63-0.94), P trend = 0.002]. Increasing red meat consumption from before to after hypertension diagnosis was significantly associated with higher all-cause mortality [HR (95% CI): 1.55 (1.05-2.28), P trend = 0.04]. Theoretically replacing 1 ounce/day of red meat with the equivalent amount of white meat or eggs was associated with 5% and 10% lower all-cause mortality, respectively.

CONCLUSIONS

High consumption of red meat, especially after hypertension diagnosis, is associated with higher mortality among hypertensive patients. Our findings suggest replacing red meat consumption with healthy alternative foods for long-term survival among hypertensive patients.

White Meat Consumption, All-Cause Mortality, and Cardiovascular Events: A Meta-Analysis of Prospective Cohort Studies

The association of meat consumption with mortality and morbidity for non-communicable diseases has been extensively studied. However, the relation of white meat consumption with health outcomes remains controversial. The present meta-analysis was conducted to comprehensively analyze the available evidence on the consistency and strength of the association between the consumption of white meat, death from any cause and incidence of fatal and non-fatal cardiovascular (CV) events. PubMed, Web of Science, Scopus and Embase databases were searched for articles published up to April 30, 2020. We included prospective cohort studies reporting relative risks and pertinent 95% confidence intervals (CI) for all-cause mortality and/or CV events (fatal or non-fatal). A total of 22 studies were included in the meta-analysis. Eleven studies (14 data sets) reported data on all-cause mortality, 10 studies (15 datasets) on cardiovascular disease (CVD) mortality and 10 studies (11 datasets) on non-fatal CV events. When comparing the highest versus the lowest consumption of white meat, the pooled OR and pertinent 95% CI were 0.94 (0.90, 0.97, p < 0.001) for all-cause mortality, 0.95 (0.89, 1.01, p = 0.13) for CV mortality, and 0.99 (0.95, 1.02, p = 0.48) for non-fatal CV events. In conclusion, the study shows for the first time a robust and inverse association between white meat consumption and all-cause mortality and a neutral association with CV mortality and morbidity. This highlights the importance of differentiating the meat types for what concerns their health effects and suggests that white meat might be a healthier alternative to read and processed meat consumption.

Association between meat and saturated fatty acid intake and lung cancer risk: The Japan Public Health Center-based prospective study

Red meat or saturated fatty acid (SFA) intake has been reported to increase lung cancer (LC) risk in several western countries. However, in Asia, studies on the relationship between meat and SFA intake with LC incidence are still relatively insufficient, and their conclusions are inconsistent. We investigated the association of meat and SFA intake with LC incidence in a population-based prospective cohort study in Japan. Cox regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for LC risk according to meat intake and SFA intake. A total of 73 187 participants (32 934 men and 40 253 women) aged 45 to 74 years participated in our study. During the follow-up period of 1 151 839 person-years (median, 16.0 year) from 1995 to 2013 for Cohort I and from 1998 to 2013 for Cohort II, 1315 (901 men and 414 women) newly diagnosed cases of LC were identified. In men, we found an adverse association between total red meat intake (HR and 95% CI: 1.25 [1.02-1.53]; P_trend = .008) and LC risk. Additionally, borderline statistically significant elevated risks of LC were seen with high intake of unprocessed red meat and processed red meat. However, no positive association between total red meat intake and LC risk was observed in women. In contrast, poultry and fish intake were not associated with LC risk in either men or women. We concluded that a high total intake of total red meat was associated with moderately elevated LC risk in men.

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

OBJECTIVE

To examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer.

DESIGN

Systematic review and meta-analysis of prospective cohort studies.

DATA SOURCES

PubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles.

STUDY SELECTION

Prospective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older.

DATA SYNTHESIS

Random effects models were used to calculate pooled effect sizes and 95% confidence intervals for the highest versus lowest categories of protein intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between protein intake and mortality.

RESULTS

32 prospective cohort studies were included in the systematic review and 31 in the meta-analysis. During the follow-up period of 3.5 to 32 years, 113 039 deaths (16 429‬ from cardiovascular disease and 22 303‬ from cancer) occurred among 715 128 participants. Intake of total protein was associated with a lower risk of all cause mortality (pooled effect size 0.94, 95% confidence interval 0.89 to 0.99, I2=58.4%, P<0.001). Intake of plant protein was significantly associated with a lower risk of all cause mortality (pooled effect size 0.92, 95% confidence interval 0.87 to 0.97, I2=57.5%, P=0.003) and cardiovascular disease mortality (pooled hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, I2=63.7%, P=0.001), but not with cancer mortality. Intake of total and animal protein was not significantly associated with risk of cardiovascular disease and cancer mortality. A dose-response analysis showed a significant inverse dose-response association between intake of plant protein and all cause mortality (P=0.05 for non-linearity). An additional 3% energy from plant proteins a day was associated with a 5% lower risk of death from all causes.

CONCLUSIONS

Higher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality. Replacement of foods high in animal protein with plant protein sources could be associated with longevity.

Evidence-based clinical advice for nutrition and dietary weight loss strategies for the management of NAFLD and NASH

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and affects approximately one third of adults in the United States. The disease is becoming a global epidemic as a result of the rising rates of obesity and metabolic disease. Emerging data suggest weight loss of ≥10% overall body weight is beneficial in resolving steatosis and reversing fibrosis. Prospective trials comparing various diets are limited by lack of sufficient power as well as pre- and post-treatment histopathology, and therefore no specific diet is recommended at this time. In this narrative review we examine the pathophysiology behind specific macronutrient components that can either promote or reverse NAFLD to help inform more specific dietary recommendations. Overall, the data supports reducing saturated fat, refined carbohydrates, and red and processed meats in the diet, and increasing the consumption of plant-based foods. Diets that incorporate these recommendations include plant-based diets such as the Dietary Approaches to Stop Hypertension, Mediterranean, vegetarian, and vegan diets.

Influence of Alcohol and Red Meat Consumption on Life Expectancy: Results of 164 Countries from 1992 to 2013

Background: High consumption of red meat, which is carcinogenic to humans, and misuse or abuse of alcohol drinking increase premature death and shortened life expectancy. The aim of this study was to examine the association of alcohol and red meat consumption with life expectancy (LE) by analyzing data from 164 countries using an ecological approach. Design: This was a longitudinal ecological study using data from the United Nation’s (UN) Food and Agriculture Organization (FAO) for 164 countries over the period 1992–2013. In regression analysis, the relationship of alcohol and red meat consumption with LE was estimated using a pooled ordinary least squares regression model. Alcohol and red meat consumption were measured every 5 years. Results: The consumption of alcohol and red meat in high-income countries (HIC) was about 4 times (36.8–143.0 kcal/capita/day) and 5 times (11.2–51.9 kcal/capita/day) higher than that in low-income countries (LIC). Red meat and alcohol consumption had a negative estimated effect on LE in HIC (b = −1.616 p = < 0.001 and b = −0.615, p = 0.003). Alcohol consumption was negatively associated with LE for all income groups, while positive relationships were found for all estimates associated with gross national income (GNI). Conclusions: Red meat and alcohol consumption appeared to have a negative impact on LE in high-income countries (HIC) and upper-middle-income countries (UMIC), although it had no significant association with LE in low-income countries (LIC) or lower-middle-income countries (LMIC). This study suggests reviewing the policies on the gradual reduction of alcohol abuse and the high consumption of red meat, particularly HIC and UMIC.

Relevance of physical function in the association of red and processed meat intake with all-cause, cardiovascular, and cancer mortality

BACKGROUND AND AIMS

Intake of red and processed meat has been associated with a higher risk of morbidity and mortality; it is unknown whether these associations are modified by overall physical health. This study examined the associations of red and processed meat consumption with all-cause, cardiovascular, and cancer mortality and investigated whether markers of physical function modified the associations.

METHODS AND RESULTS

This observational cohort study used UK Biobank data derived from 419,075 participants free from cancer and cardiovascular disease. Cox models assessed the association of red and processed meat consumption (obtained from a baseline food frequency questionnaire) with mortality, adjusted for potential confounders. Objectively measured handgrip strength and self-reported walking pace were used as interaction terms. The median age was 57 (interquartile range, 49-63) years and 54.9% were women. Over 7 years of follow-up, 8586 all-cause, 1660 cardiovascular, and 4812 cancer deaths occurred. Each additional serving per week of red and processed meat was associated with a hazard ratio (HR) of 1.037 (95% CI: 1.028-1.047) for all-cause; 1.030 (1.009-1.051) for cardiovascular; and 1.029 (1.016-1.042) for cancer mortality. The association of red and processed meat consumption was modified by walking pace, with brisk walkers having the lowest risk per additional serving for all-cause and cancer mortality (HR 1.025; 1.006-1.045 and 1.015; 0.990-1.040, respectively); no interaction was observed for handgrip strength.

CONCLUSION

The known risk of mortality associated with red and processed meat consumption may be lower in those with high physical function.

Evidence Collection and Evaluation for the Development of Dietary Guidelines and Public Policy on Nutrition

Dietary guidelines and recommendations, usually developed by government bodies or large authoritative organizations, have major downstream effects on public policy. A growing body of evidence supports the notion that there are serious deficiencies in the methods used to develop dietary guidelines. Such deficiencies include the failure to access or conduct comprehensive systematic reviews, a lack of systematic or rigorous evaluation of the quality of the evidence, a failure to acknowledge the limitations of the evidence base underlying recommendations, and insufficiently stringent management of conflicts of interest. These issues may be addressed by adhering to international standards for guideline development, including adopting systematic review methodology and using rigorous systems to evaluate the certainty of the evidence and to move from evidence to recommendations, of which the GRADE approach (Grading of Recommendations Assessment,Development and Evaluation) is the most rigorous and fully developed. Improving the methods by which dietary guidelines are produced has considerable potential to substantially improve public policy decision-making.

Red meat, processed meat, and other dietary protein sources and risk of overall and cause-specific mortality in The Netherlands Cohort Study

Processed meat and red meat have been associated with increased mortality, but studies are inconsistent and few have investigated substitution by other protein sources. The relationship of overall and causes-specific mortality with red meat, processed meat, and other dietary protein sources was investigated in The Netherlands Cohort Study. In 1986, 120,852 men and women aged 55-69 years provided information on dietary and lifestyle habits. Mortality follow-up until 1996 consisted of linkage to statistics Netherlands. Multivariable case-cohort analyses were based on 8823 deaths and 3202 subcohort members with complete data on diet and confounders. Red meat (unprocessed) intake was not associated with overall and cause-specific mortality. Processed meat intake was significantly positively related to overall mortality: HR (95% CI) comparing highest versus lowest quintile, 1.21 (1.02-1.44) with Ptrend = 0.049. Significant associations were observed for cardiovascular [HR Q5 vs. Q1, 1.26 (1.01-1.26)] and respiratory [HR = 1.79 (1.19-2.67)], but not cancer mortality [HR = 1.16 (0.97-1.39)]. Adjustment for nitrite intake attenuated these associations which became nonsignificant: HRs Q5 versus Q1 (95% CI) were: 1.10 (0.77-1.55) for total, 1.09 (0.71-1.67) for cardiovascular, 1.44 (0.68-3.05) for respiratory, and 1.11 (0.78-1.58) for cancer mortality. Nitrite was significantly associated with overall, CVD and respiratory mortality. Poultry intake was significantly inversely related to cancer and overall mortality. While fish intake showed positive associations, nut intake showed inverse associations with all endpoints. Replacing processed meat with a combination of poultry, eggs, fish, pulses, nuts and low-fat dairy was associated with lower risks of overall, cardiovascular and respiratory mortality. Processed meat was related to increased overall, CVD and respiratory mortality, potentially due to nitrite. Substituting processed meat with other protein sources was associated with lower mortality risks.

Red and Processed Meat and Mortality in a Low Meat Intake Population

Associations of low-to-moderate consumption of red and processed meat with mortality would add to the evidence of possible adverse effects of these common foods. This study aims to investigate the association of red and processed meat intake with mortality. The Adventist Health Study-2 (AHS-2) is a prospective cohort study of ~96,000 Seventh-day Adventist men and women recruited in the US and Canada between 2002 and 2007. The final analytic sample after exclusions was 72,149. Cox proportional hazards regression was used and hazard ratios (HR) and confidence intervals (CI) were obtained. Diet was assessed by a validated quantitative food frequency questionnaire (FFQ), calibrated using six 24-h dietary recalls. Mortality outcome data were obtained from the National Death Index. During a mean follow-up of 11.8 years, there were 7961 total deaths, of which 2598 were Cardiovascular diseases (CVD) deaths and 1873 were cancer deaths. Unprocessed red meat was associated with risk of all-cause mortality (HR: 1.18; 95% CI: 1.07–1.31) and CVD mortality (HR: 1.26; 95% CI: 1.05–1.50). Processed meat alone was not significantly associated with risk of mortality. The combined intake of red and processed meat was associated with all-cause mortality (HR: 1.23; 95% CI: 1.11–1.36) and CVD mortality (HR: 1.34; 95% CI: 1.12–1.60). These findings suggest moderately higher risks of all-cause and CVD mortality associated with red and processed meat in a low meat intake population.

Substitution of Fish for Red Meat or Poultry and Risk of Ischemic Stroke

We investigated the risk of ischemic stroke and its subtypes when red meat or poultry was substituted with fish. A total of 57,053 participants aged 50⁻65 years at baseline were included in the Danish Diet, Cancer and Health study. All participants filled in a food-frequency questionnaire at recruitment. Potential ischemic stroke cases were identified by linkage to the Danish National Patient Register, and all cases were validated and subclassified. Substitutions were investigated as 150 g/week of fish for 150 g/week of red meat or of poultry using multivariable Cox proportional hazard regression models. During 13.5 years of follow-up, 1879 participants developed an ischemic stroke. Replacing red meat or poultry with fish was not associated with the rate of total ischemic stroke, but there was a statistically significant lower rate of large artery atherosclerosis when fish replaced processed (hazard ratio (HR): 0.78; 95% confidence interval (CI): 0.67; 0.90) and unprocessed (HR: 0.87; 95% CI: 0.75; 0.99) red meat. A statistically significant higher rate of cardioembolism was found when poultry was replaced by total fish (HR: 1.42; 95% CI: 1.04; 1.93). When fatty fish replaced unprocessed red meat, a statistically significant lower rate of small-vessel occlusion was found (HR: 0.88; 95% CI: 0.77; 0.99). In conclusion, replacing red meat with fish was not associated with risk of total ischemic stroke but was associated with a lower risk of subtypes of ischemic stroke.

Diet quality and its association with type 2 diabetes and major cardiometabolic risk factors among adults in China

AIM

We examined the association between diet quality and diabetes and major cardiometabolic risks among adults in China.

METHODS AND RESULTS

We developed the China Dietary Guideline Index (CDGI) based on the 2007 Chinese dietary guidelines and tailored the Alternate Healthy Eating Index 2010 (which we call the tAHEI) to assess diet quality. Our analysis linked the dietary intake and covariates measured in 2006 with CM risk factors measured in 2009. We used diet data the longitudinal China Health and Nutrition Survey 2006 collected in 3 consecutive 24-h recalls from 4440 adults aged 18 to 65 to calculate both the tAHEI and the CDGI scores. We performed multivariable logistic regressions to analyze the association of each 2006 score with diabetes, abdominal obesity, elevated blood pressure, and lipid-related cardiometabolic risk factors in 2009. After we adjusted for potential confounders, adults in the top quintile compared with the bottom quintile of the tAHEI scores showed 36% lower odds of high low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.46, 0.90] in men and 33% lower odds (OR 0.67; 95% CI 0.49, 0.91) in women, while the CDGI scores showed 35% lower odds of high LDL-C (OR 0.65; 95% CI 0.46, 0.92) in men only. Further, the CDGI scores indicated 55% lower odds of diabetes in the top versus the bottom quintile (OR 0.45; 95% CI 0.23, 0.87) in men only, whereas a null association was observed for the tAHEI scores for both sexes. Both index scores showed null associations with other cardiometabolic risk factors.

CONCLUSIONS

Chinese diets that scored high on both the CDGI and the tAHEI showed similarly negative associations with high LDL-C risk, whereas only CDGI score was negatively related to diabetes risk in men.

High-Carbohydrate Diets and Food Patterns and Their Associations with Metabolic Disease in the Korean Population

PURPOSE

Although an Asian diet is typically high in carbohydrate and low in fat, there has been a steady increase in the rate of cardiometabolic disease in Asian countries over the past decade. We evaluated food patterns of a high-carbohydrate diet and examined their associations with metabolic disease.

MATERIALS AND METHODS

Using data from the 2013-2015 Korean National Health and Nutrition Examination Survey, we included a total of 13106 subjects aged 20 years or older in this study. Diet was divided into seven groups according to the percentage of energy from carbohydrates. Food patterns were evaluated as individual servings per food group. Multivariate logistic regression was conducted to estimate odds ratios (OR) for metabolic disease.

RESULTS

The proportions of men and women exceeding the recommended range of carbohydrate intake were 58.0% and 60.0%, respectively. A higher carbohydrate diet was associated with intake of low energy and saturated fats, with more grains and fruit, but less meat, fish, egg, bean (MFEB), and dairy consumption. Carbohydrate intake decreased by 3.0-3.4% per serving of MFEB and milk. In men, the highest carbohydrate group showed an OR of 1.35 [95% confidence interval (CI), 0.91 to 1.99] for metabolic syndrome, although this failed to show statistical significance. In women, the highest carbohydrate group had an OR of 1.38 (95% CI, 1.06 to 1.80) for a reduced level of high-density lipoprotein cholesterol.

CONCLUSION

This study suggests that a very-high-carbohydrate diet for the Korean population is attributable to lower consumption of MFEB and dairy products and is associated with several metabolic risk factors. The appropriate distribution of macronutrients for the prevention and management of metabolic disease should be explored.

Food Patterns and Framingham Risk Score in Iranian Adults: Tehran Lipid and Glucose Study: 2005-2011

BACKGROUND

Healthy dietary habits can prevent cardiovascular diseases (CVD). The aim of this study was to investigate the association between dietary patterns and predicted risk of CVD development using Framingham Risk Score (FRS) in Iranian population over 6 years of follow-up.

METHODS

In this prospective study, 2333 individuals aged 30-74 years with a 10-year predicted risk <10% and without a CVD diagnosis at baseline were recruited from participants in the third survey of Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a validated semiquantitative food frequency questionnaire. Dietary patterns were identified using factor analysis. The risk of developing CVD was evaluated using FRS questionnaire. The association between dietary patterns and risk of development of CVD was evaluated using binary logistic regression models.

RESULTS

Three major dietary patterns were identified, which explained 32% of total variance in dietary intake of participants. The healthy dietary pattern was characterized by high intake of fruits, fruit juices, vegetables, liquid oils, and nuts and lower intake of refined grains. The western dietary pattern was characterized by high intake of fast foods, soft drinks, sweets and sugars, and red meat, organ meat, and egg. The traditional dietary pattern was characterized by high intake of legumes and vegetables and low intake of high-fat dairy products. After adjustment for all confounding factors, participants in the highest tertile of the healthy dietary pattern had a lower risk of CVD development (odds ratio [OR]: 0.67; 95% CI: 0.51-0.87, P-trend: 0.003).

CONCLUSION

Our findings in a large cohort of Iranian population confirm the current recommendation regarding consuming healthy dietary pattern for primary prevention of CVDs.

Poultry and Fish Consumption in Relation to Total Cancer Mortality: A Meta-Analysis of Prospective Studies

Observational studies on the association between fish and poultry intake and the risk of total cancer mortality have been reported with mixed results. Thus, we aimed to assess this association by conducting a meta-analysis of prospective studies. We performed a literature search on PubMed database through February 1, 2017 to identify relative prospective studies. A random-effects model was used to calculate the summary estimates. We identified fourteen prospective studies involving 2,378,204 participants and 96,712 cancer mortality events. Comparing the highest category of consumption with lowest category, pooled relative risk (RR) of total cancer mortality was 0.99 (95% confidence interval [CI], 0.94-1.05) for fish (10 studies) and 0.96 (95% CI, 0.93-1.00) for poultry (8 studies), respectively. However, we failed to identify any dose-response association based on a limited number of eligible studies, with a pooled RR of 0.98 (95% CI, 0.92-1.05) and 0.97 (95% CI, 0.88-1.07) for each 100 g per day increment in fish and poultry consumption, respectively. In summary, this meta-analysis indicates that consumption of either fish or poultry is not substantially associated with lower risk of total cancer mortality. The observed weak inverse association for high poultry consumption needs to be verified in additional large prospective studies.

Dietary poultry intake and the risk of stroke: A dose-response meta-analysis of prospective cohort studies

BACKGROUND & AIMS

We performed a meta-analysis to illuminate and quantify the potential relationship between poultry intake and risk of stroke through summarizing available evidence using a dose-response meta-analysis of prospective cohort studies.

METHODS

Pertinent prospective cohort studies attained using electronic searches through PubMed, and Scopus up to September 25th, 2017. Relative risks (RR) s with corresponding 95% confidence intervals (CIs) of the highest versus the lowest for cohort studies were evaluated using DerSimonian and Laird random-effects models to find combined RRs. We also assessed the dose-response effect of this relationship.

RESULTS

A total of 7 studies involving 354 718 participants were met inclusion criteria. The pooled RR of total stroke risk was [RR = 0.92 95% CI, 0.82, 1.03, I² = 19.8%, P_{heterogeneity} = 0.28] for the highest versus lowest categories of poultry intake. Subgroup analysis showed an inverse associations for the US people [RR = 0.86 95% CI, 0.77, 0.95, I² = 0.0%, P_{heterogeneity} = 0.38] and women [RR = 0.83, 95% CI, 0.72, 0.93, I² = 0.0%, P_{heterogeneity} = 0.63]. We did not obtain any significant association in the subtypes of strokes with highest versus lowest poultry intake [Ischemic stroke (RR = 0.91; 95% CI: 0.79, 1.02, I² = 0.0%, p = 0.93), Hemorrhagic (RR = 0.82; 95% CI: 0.59, 1.04, I² = 20.5%, P_{heterogeneity} = 0.28)]. One serving per week increment in poultry intake was not associated with the risk of stroke (RR: 1.00, 95% CI: 0.96, 1.03, I² = 69.0%, P_{heterogeneity} = 0.004). Nonlinear dose-response meta-analysis showed lower risk of stroke at consumption ∼1 serving/week.

CONCLUSION

Our meta-analysis revealed that poultry intake is not associated with total stroke risk; furthermore, an inverse relationship in US population and females must be interpreted with caution.

Red meat intake is positively associated with non-fatal acute myocardial infarction in the Costa Rica Heart Study

The adverse effect of red meat consumption on the risk for CVD is a major population health concern, especially in developing Hispanic/Latino countries in which there are clear trends towards increased consumption. This population-based case–control study examined the associations between total, processed and unprocessed red meat intakes and non-fatal acute myocardial infarction (MI) in Costa Rica. The study included 2131 survivors of a first non-fatal acute MI and 2131 controls individually matched by age, sex and area of residence. Dietary intake was assessed with a FFQ. OR were estimated by using conditional logistic regression. Higher intakes of total and processed red meat were associated with increased odds of acute MI. The OR were 1·31 (95 % CI 1·04, 1·65) and 1·29 (95 % CI 1·01, 1·65) for the highest quintiles of total red meat (median: 110·8 g or 1 serving/d) and processed red meat intake (median: 36·1 g or 5 servings/week), respectively. There were increasing trends in the odds of acute MI with higher total (Ptrend=0·01) and processed (Ptrend=0·02) red meat intakes. Unprocessed red meat intake was not associated with increased odds of acute MI. Substitutions of 50 g of alternative foods (fish, milk, chicken without skin and chicken without fat) for 50 g of total, processed and unprocessed red meat were associated with lower odds of acute MI. The positive association between red meat intake and acute MI in Costa Rica highlights the importance of reducing red meat consumption in middle-income Hispanic/Latino populations.

Role of Total, Red, Processed, and White Meat Consumption in Stroke Incidence and Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Background

Previous meta‐analyses on meat intake and risk of stroke did not report the effect of white meat (poultry meat, excluding fish) and did not examine stroke incidence and mortality separately. We aimed to investigate the relationship of total (red and processed meat), red (unprocessed or fresh red meat), and processed (processed red meat) consumption along with white meat on risk of stroke incidence and mortality.

Methods and Results

Articles were identified from databases and reference lists of relevant studies up to October 28, 2016. We selected prospective cohort studies on meat consumption specified by types of meat and stroke incidence and mortality reporting relative risks and 95% confidence intervals. The pooled relative risk was estimated using the random‐effects model. Based on the inclusion criteria, 10 articles containing 15 studies (5 articles with 7 studies including 9522 cases of stroke incidence and 254 742 participants and 5 articles with 8 studies containing 12 999 cases of stroke mortality and 487 150 participants) were selected for quantitative synthesis. The pooled relative risks (95% confidence intervals) for total, red, processed and white meat consumption and total stroke incidence were 1.18 (1.09–1.28), 1.11 (1.03–1.20), 1.17 (1.08–1.25), and 0.87 (0.78–0.97), respectively. Total meat consumption (0.97 [0.85–1.11]) and red meat consumption 0.87 (0.64–1.18) were not significantly associated with stroke‐related death.

Conclusions

The relationship between meat intake and risk of stroke may differ by type of meat. Recommendations for replacing proportions of red and processed meats to white meat for the prevention of stroke may be considered in clinical practice.

Should we recommend reductions in saturated fat intake or in red/processed meat consumption? The SUN prospective cohort study

BACKGROUND & AIMS

While most studies have shown increased mortality associated with excessive red/processed meat consumption, the association of saturated fatty acids (SFA) intake with mortality is less homogeneous. We aimed to prospectively assess the association of both, meat consumption (red, processed, red + processed, and total) and SFA intake, with the risk of all-cause death.

METHODS

We assessed 18,540 participants of the SUN (Seguimiento Universidad de Navarra) cohort, followed-up for a mean of 9.5 years. A validated 136-item FFQ was administered at baseline. We used Cox models adjusted for potential confounders.

RESULTS

We observed 255 deaths during 176,916 person-years of follow-up. Age modified the association between meat consumption and all-cause mortality (p for interaction = 0.027, 0.075, and 0.013, for red, total, and processed meat, respectively). Among participants aged >45 years the fully-adjusted HRs (95% CIs) for one additional serving/d of red, total, and red + processed meat consumption were 1.47 (1.06, 2.04), 1.23 (1.05, 1.45), and 1.32 (1.05, 1.65), respectively, with significant linear trends (P for trend 0.022, 0.012, and 0.018, respectively). In these participants, SFA intake was non-significantly associated with mortality. However, isocaloric replacement of monounsaturated fat or carbohydrates by SFA resulted in significantly higher mortality risk. Likewise, replacing 100 g of vegetables, fruits & nuts or cereals by 100 g of red meat resulted in higher mortality risk. No association of meat consumption or SFA with all-cause mortality was observed in participants younger than 46 years.

CONCLUSIONS

Among highly educated persons, aged >45 years, a high consumption of red, total, and red + processed meat was related to increased all-cause mortality, compared with those with low consumption, whereas no significant associations were found for SFA intake. Dietary guidelines should specifically limit meat consumption and not relying only in limiting SFA intake.

Unprocessed Meat Consumption and Incident Cardiovascular Diseases in Korean Adults: The Korean Genome and Epidemiology Study (KoGES)

Meat consumption has been shown to be associated with cardiovascular disease (CVD) risk in Western societies; however, epidemiological data are limited on the Korean population. Therefore, we examined the associations between unprocessed meat consumption and CVD incidence in Korea. Data were derived from the Ansung-Ansan cohort (2001-2012), including 9370 adults (40-69 years) without CVD or cancer at baseline. Total unprocessed meat consumption was estimated as the sum of unprocessed red meat (beef, pork, and organ meat) and poultry consumption. In the fully adjusted Cox regression model, the relative risks of CVD across increasing quintiles of total unprocessed meat intake were 1.0 (reference), 0.72 (95% confidence interval (CI): 0.55, 0.95), 0.57 (95% CI: 0.42, 0.78), 0.69 (95% CI: 0.51, 0.95), and 0.69 (95% CI: 0.48, 0.97), but no significant linear trend was detected (p for trend = 0.14). Frequent poultry consumption was significantly associated with a decreased CVD risk; this association showed a dose-response relationship (p for trend = 0.04). This study showed that a moderate intake of total unprocessed meat was inversely associated with CVD risk. A significant inverse association between poultry consumption and incident CVD was observed in Korean adults, requiring further confirmation in other populations.

Dietary Patterns Are Associated with Metabolic Outcomes among Adult Samoans in a Cross-Sectional Study

Background: The Samoan population has been undergoing a nutrition transition toward more imported and processed foods and a more sedentary lifestyle.Objectives: We aimed to identify dietary patterns in Samoa and to evaluate their associations with metabolic outcomes.Methods: The sample of this cross-sectional study includes 2774 Samoan adults recruited in 2010 (1104 with metabolic syndrome compared with 1670 without). Principal component analysis on food items from a 104-item food-frequency questionnaire was used to identify dietary patterns. Adjusted least squares means of each component of metabolic syndrome were estimated by quintiles of factor scores for each dietary pattern. Metabolic syndrome status was regressed on quintiles of scores by using log-binomial models to obtain prevalence ratios.Results: We identified a modern pattern, a mixed-traditional pattern, and a mixed-modern pattern. The modern pattern included a high intake of imported and processed foods, including pizza, cheeseburgers, margarine, sugary drinks, desserts, snacks, egg products, noodles, nuts, breads, and cakes and a low intake of traditional agricultural products and fish. The mixed-traditional pattern had a high intake of neotraditional foods, including fruits, vegetables, soup, poultry, and fish, and imported and processed foods, including dairy products, breads, and cakes. The mixed-modern pattern was loaded with imported and processed foods, including pizza, cheeseburgers, red meat, egg products, noodles, and grains, but also with neotraditional foods, such as seafood and coconut. It also included a low intake of fish, tea, coffee, soup, and traditional agricultural staples. Higher adherence to the mixed-modern pattern was associated with lower abdominal circumference (P-trend < 0.0001), lower serum triglycerides (P-trend = 0.03), and higher serum HDL cholesterol (P-trend = 0.0003). The mixed-modern pattern was inversely associated with prevalence of metabolic syndrome (the highest quintile: prevalence ratio = 0.79; 95% CI: 0.69, 0.91; P-trend = 0.006).Conclusion: Mixed dietary patterns containing healthier foods, rather than a largely imported and processed modern diet, may help prevent metabolic syndrome in Samoa.

Diet and biliary tract cancer risk in Shanghai, China

Trends in biliary tract cancer incidence rates have increased in Shanghai, China. These trends have coincided with economic and developmental growth, as well as a shift in dietary patterns to a more Westernized diet. To examine the effect of dietary changes on incident disease, we evaluated associations between diet and biliary tract cancers amongst men and women from a population-based case-control study in Shanghai, China. Biliary tract cancer cases were recruited from 42 collaborating hospitals in urban Shanghai, and population-based controls were randomly selected from the Shanghai Household Registry. Food frequency questionnaire data were available for 225 gallbladder, 190 extrahepatic bile duct, and 68 ampulla of Vater cancer cases. A total of 39 food groups were created and examined for associations with biliary tract cancer. Interestingly, only four food groups demonstrated a suggested association with gallbladder, extrahepatic bile duct, or ampulla of Vater cancers. The allium food group, consisting of onions, garlic, and shallots showed an inverse association with gallbladder cancer (OR: 0.81, 95% CI: 0.68-0.97). Similar trends were seen in the food group containing seaweed and kelp (OR: 0.79, 95% CI: 0.67-0.96). In contrast, both preserved vegetables and salted meats food groups showed positive associations with gallbladder cancer (OR:1.27, 95% CI: 1.06-1.52; OR: 1.18, 95% CI: 1.02-1.37, respectively). Each of these four food groups showed similar trends for extrahepatic bile duct and ampulla of Vater cancers. The results of our analysis suggest intake of foods with greater anti-inflammatory properties may play a role in decreasing the risk of biliary tract cancers. Future studies should be done to better understand effects of cultural changes on diet, and to further examine the impact diet and inflammation have on biliary tract cancer incidence.

Dietary Protein Sources and All-Cause and Cause-Specific Mortality: The Golestan Cohort Study in Iran

INTRODUCTION

Dietary protein comes from foods with greatly different compositions that may not relate equally with mortality risk. Few cohort studies from non-Western countries have examined the association between various dietary protein sources and cause-specific mortality. Therefore, the associations between dietary protein sources and all-cause, cardiovascular disease, and cancer mortality were evaluated in the Golestan Cohort Study in Iran.

METHODS

Among 42,403 men and women who completed a dietary questionnaire at baseline, 3,291 deaths were documented during 11 years of follow up (2004-2015). Cox proportional hazards models estimated age-adjusted and multivariate-adjusted hazard ratios (HRs) and 95% CIs for all-cause and disease-specific mortality in relation to dietary protein sources. Data were analyzed from 2015 to 2016.

RESULTS

Comparing the highest versus the lowest quartile, egg consumption was associated with lower all-cause mortality risk (HR=0.88, 95% CI=0.79, 0.97, ptrend=0.03). In multivariate analysis, the highest versus the lowest quartile of fish consumption was associated with reduced risk of total cancer (HR=0.79, 95% CI=0.64, 0.98, ptrend=0.03) and gastrointestinal cancer (HR=0.75, 95% CI=0.56, 1.00, ptrend=0.02) mortality. The highest versus the lowest quintile of legume consumption was associated with reduced total cancer (HR=0.72, 95% CI=0.58, 0.89, ptrend=0.004), gastrointestinal cancer (HR=0.76, 95% CI=0.58, 1.01, ptrend=0.05), and other cancer (HR=0.66, 95% CI=0.47, 0.93, ptrend=0.04) mortality. Significant associations between total red meat and poultry intake and all-cause, cardiovascular disease, or cancer mortality rate were not observed among all participants.

CONCLUSIONS

These findings support an association of higher fish and legume consumption with lower cancer mortality, and higher egg consumption with lower all-cause mortality.

Substitution of meat and fish with vegetables or potatoes and risk of myocardial infarction

Red meat has been suggested to be adversely associated with risk of myocardial infarction (MI), whereas vegetable consumption has been found to be protective. The aim of this study was to investigate substitutions of red meat, poultry and fish with vegetables or potatoes for MI prevention. We followed up 29 142 women and 26 029 men in the Danish Diet, Cancer and Health study aged 50-64 years with no known history of MI at baseline. Diet was assessed by a validated 192-item FFQ at baseline. Adjusted Cox proportional hazard models were used to calculate hazard ratios (HR) and 95 % CI for MI associated with specified food substitutions of 150 g/week. During a median follow-up of 13·6 years, we identified 656 female and 1694 male cases. Among women, the HR for MI when replacing red meat with vegetables was 0·94 (95 % CI 0·90, 0·98). Replacing fatty fish with vegetables was associated with a higher risk of MI (HR 1·23; 95 % CI 1·05, 1·45), whereas an inverse, statistically non-significant association was found for lean fish (HR 0·93; 95 % CI 0·83, 1·05). Substituting poultry with vegetables was not associated with risk of MI (HR 1·00; 95 % CI 0·90, 1·11). Findings for substitution with potatoes were similar to findings for vegetables. Among men, a similar pattern was observed, but the associations were weak and mostly statistically non-significant. This study suggests that replacing red meat with vegetables or potatoes is associated with a lower risk of MI, whereas replacing fatty fish with vegetables or potatoes is associated with a higher risk of MI.

High red meat intake and all-cause cardiovascular and cancer mortality: is the risk modified by fruit and vegetable intake?

BACKGROUND

High red meat consumption is associated with a shorter survival and higher risk of cardiovascular disease (CVD), cancer, and all-cause mortality. Fruit and vegetable (FV) consumption is associated with a longer survival and lower mortality risk. Whether high FV consumption can counterbalance the negative impact of high red meat consumption is unknown.

OBJECTIVE

We evaluated 2 large prospective cohorts of Swedish men and women (the Swedish Mammography Cohort and the Cohort of Swedish Men) to determine whether the association between red meat consumption and the risk of all-cause, CVD, and cancer-specific mortality differs across amounts of FV intake.

DESIGN

The study population included 74,645 Swedish men and women. Red meat and FV consumption were assessed through a self-administered questionnaire. We estimated HRs of all-cause, CVD, and cancer mortality according to quintiles of total red meat consumption. We next investigated possible interactions between red meat and FV consumption and evaluated the dose-response associations at low, medium, and high FV intake.

RESULTS

Compared with participants in the lowest quintile of total red meat consumption, those in the highest quintile had a 21% increased risk of all-cause mortality (HR: 1.21; 95% CI: 1.13, 1.29), a 29% increased risk of CVD mortality (HR: 1.29; 95% CI: 1.14, 1.46), and no increase in the risk of cancer mortality (HR: 1.00; 95% CI: 0.88, 1.43). Results were remarkably similar across amounts of FV consumption, and no interaction between red meat and FV consumption was detected.

CONCLUSION

High intakes of red meat were associated with a higher risk of all-cause and CVD mortality. The increased risks were consistently observed in participants with low, medium, and high FV consumption. The Swedish Mammography Cohort and the Cohort of Swedish Men were registered at clinicaltrials.gov as NCT01127698 and NCT01127711, respectively.

Meat Consumption and Risk of Developing Type 2 Diabetes in the SUN Project: A Highly Educated Middle-Class Population

BACKGROUND

Meat consumption has been consistently associated with the risk of diabetes in different populations. The aim of our study was to investigate the incidence of type 2 diabetes according to baseline total meat consumption in a longitudinal assessment of a middle-aged Mediterranean population.

METHODS

We followed 18,527 participants (mean age: 38 years, 61% women) in the SUN Project, an open-enrolment cohort of a highly educated population of middle-class Spanish graduate students. All participants were initially free of diabetes. Diet was assessed at baseline using a semi-quantitative food frequency questionnaire of 136-items previously validated. Incident diabetes was defined according to the American Diabetes Association's criteria.

RESULTS

We identified 146 incident cases of diabetes after a maximum of 14 years of follow-up period (mean: 8.7 years). In the fully adjusted model, the consumption of ≥3 servings/day of all types of meat was significantly associated with a higher risk of diabetes (HR: 1.85; 95% CI: 1.03-3.31; p for trend = 0.031) in comparison with the reference category (<2 servings/day). When we separated processed from non-processed meat, we observed a non-significant higher risk associated with greater consumption of processed meat and a non-significant lower risk associated with non-processed meat consumption (p for trend = 0.123 and 0.487, respectively). No significant difference was found between the two types of meat (p = 0.594).

CONCLUSIONS

Our results suggest that meat consumption, especially processed meat, was associated with a higher risk of developing diabetes in our young Mediterranean cohort.