ArticlePDF Available

Meat intake and cause-specific mortality: A pooled analysis of Asian prospective cohort studies

Authors:

Abstract and Figures

Total or red meat intake has been shown to be associated with a higher risk of mortality in Western populations, but little is known of the risks in Asian populations. We examined temporal trends in meat consumption and associations between meat intake and all-cause and cause-specific mortality in Asia. We used ecological data from the United Nations to compare country-specific meat consumption. Separately, 8 Asian prospective cohort studies in Bangladesh, China, Japan, Korea, and Taiwan consisting of 112,310 men and 184,411 women were followed for 6.6 to 15.6 y with 24,283 all-cause, 9558 cancer, and 6373 cardiovascular disease (CVD) deaths. We estimated the study-specific HRs and 95% CIs by using a Cox regression model and pooled them by using a random-effects model. Red meat consumption was substantially lower in the Asian countries than in the United States. Fish and seafood consumption was higher in Japan and Korea than in the United States. Our pooled analysis found no association between intake of total meat (red meat, poultry, and fish/seafood) and risks of all-cause, CVD, or cancer mortality among men and women; HRs (95% CIs) for all-cause mortality from a comparison of the highest with the lowest quartile were 1.02 (0.91, 1.15) in men and 0.93 (0.86, 1.01) in women. Ecological data indicate an increase in meat intake in Asian countries; however, our pooled analysis did not provide evidence of a higher risk of mortality for total meat intake and provided evidence of an inverse association with red meat, poultry, and fish/seafood. Red meat intake was inversely associated with CVD mortality in men and with cancer mortality in women in Asian countries.
Content may be subject to copyright.
See corresponding editorial on page 865.
Meat intake and cause-specific mortality: a pooled analysis of Asian
prospective cohort studies
1–3
Jung Eun Lee, Dale F McLerran, Betsy Rolland, Yu Chen, Eric J Grant, Rajesh Vedanthan, Manami Inoue,
Shoichiro Tsugane, Yu-Tang Gao, Ichiro Tsuji, Masako Kakizaki, Habibul Ahsan, Yoon-Ok Ahn, Wen-Harn Pan,
Kotaro Ozasa, Keun-Young Yoo, Shizuka Sasazuki, Gong Yang, Takashi Watanabe, Yumi Sugawara, Faruque Parvez,
Dong-Hyun Kim, Shao-Yuan Chuang, Waka Ohishi, Sue K Park, Ziding Feng, Mark Thornquist, Paolo Boffetta, Wei Zheng,
Daehee Kang, John Potter, and Rashmi Sinha
ABSTRACT
Background: Total or red meat intake has been shown to be asso-
ciated with a higher risk of mortality in Western populations, but
little is known of the risks in Asian populations.
Objective: We examined temporal trends in meat consumption and
associations between meat intake and all-cause and cause-specific
mortality in Asia.
Design: We used ecological data from the United Nations to com-
pare country-specific meat consumption. Separately, 8 Asian pro-
spective cohort studies in Bangladesh, China, Japan, Korea, and
Taiwan consisting of 112,310 men and 184,411 women were fol-
lowed for 6.6 to 15.6 y with 24,283 all-cause, 9558 cancer, and 6373
cardiovascular disease (CVD) deaths. We estimated the study-
specific HRs and 95% CIs by using a Cox regression model and
pooled them by using a random-effects model.
Results: Red meat consumption was substantially lower in the Asian
countries than in the United States. Fish and seafood consumption
was higher in Japan and Korea than in the United States. Our pooled
analysis found no association between intake of total meat (red meat,
poultry, and fish/seafood) and risks of all-cause, CVD, or cancer
mortality among men and women; HRs (95% CIs) for all-cause mor-
tality from a comparison of the highest with the lo west quartile were
1.02 (0.91, 1.15) in men and 0.93 (0.86, 1.01) in women.
Conclusions: Ecological data indicate an increase in meat intake in
Asian countries; however, our pooled analysis did not provide ev-
idence of a higher risk of mortality for total meat intake and pro-
vided evidence of an inverse association with red meat, poultry, and
fish/seafood. Red meat intake was inversely associated with CVD
mortality in men and with cancer mortality in women in Asian
countries. Am J Clin Nutr 2013;98:1032–41.
INTRODUCTION
Asia is experiencing marked changes in lifestyle and disease
patterns, similar to those seen in Western countries (1, 2), with
projected increases in the proportions of deaths from cancer,
ischemic heart disease, and cardiovascular disease (CVD)
4
(3).
Therefore, it is important to identify modifiable risk factors,
such as diet, which may be responsible for the rising rates of
chronic disease in Asian populations.
Meat intake varies across regions and countries in Asia, with
relatively low consumption in certain countries compared with
others in the continent (4). Meat intake, specifically red meat, has
been associated with an increased risk of mortality in Western
populations (5, 6), although further studies are warranted in
populations that consume different quantities and types of meat
and have dissimilar confounding factors. Many mechanisms
1
From the Department of Food and Nutrition, Sookmyung Women’s Uni-
versity, Seoul, South Korea (JEL); the Division of Public Health Sciences,
Fred Hutchinson Cancer Research Center, Seattle, WA (DFM, BR, RV, MT,
and JP); the Department of Environmental Medicine, New York University
School of Medicine, New York, NY (YC); the Department of Epidemiology,
Radiation Effects Research Foundation, Hiroshima, Japan (EJG and KO); the
Epidemiology and Prevention Division, Research Center for Cancer Preven-
tion and Screening, National Cancer Center, Tokyo, Japan (MI, ST, and SS);
the Department of Epidemiology, Shanghai Cancer Institute, Shanghai,
China (Y-TG); the Division of Epidemiology, Department of Public Health
and Forensic Medicine, Tohoku University Graduate School of Medicine,
Miyagi, Japan (IT, MK, TW, and YS); the Departments of Health Studies,
Medicine, and Human Genetics, Comprehensive Cancer Center, The Uni-
versity of Chicago, Chicago, IL (HA); the Department of Preventive Med-
icine, Seoul National University College of Medicine, Seoul, South Korea
(Y-OA, K-YY, SKP, and DK); the Division of Preventive Medicine and
Health Services Research, Institute of Population Health Sciences, National
Health Research Institutes, Miaoli, Taiwan (W-HP and S-YC); Institute of
Biomedical Sciences, Academia Sinica, Taipei, Taiwan (W-HP); Graduate
Institute of Epidemiology and Preventive Medicine, College of Public
Health, National Taiwan University, Taipei, Taiwan (W-HP); the Division
of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center,
Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine,
Nashville, TN (GY and WZ); the Division of Epidemiology, Department of
Public Health and Forensic Medicine, Tohoku University Graduate School of
Medicine, Miyagi, Japan (TW and YS); the Department of Environmental
Health Sciences, Mailman School of Public Health, Columbia University,
New York, NY (FP); the Department of Social and Preventive Medicine,
Hallym University College of Medicine, Chuncheon, South Korea (D-HK);
the Department of Clinical Studies, Radiation Effects Research Foundation,
Hiroshima, Japan (WO); the Section of Early Cancer Detection and Bio-
markers, The University of Texas, MD Anderson Cancer Center, Houston,
TX (ZF); The Tisch Cancer Institute and Institute for Translational Epide-
miology, Mount Sinai School of Medicine, New York, NY (PB); the Centre
for Public Health Research, Massey University, Wellington, New Zealand
(JP); and the Division of Cancer Epidemiology and Genetics, National Can-
cer Institute, Bethesda, MD (RS).
Received March 21, 2013. Accepted for publication June 28, 2013.
First published online July 31, 2013; doi: 10.3945/ajcn.113.062638.
1032 Am J Clin Nutr 2013;98:1032–41. Printed in USA. Ó 2013 American Society for Nutrition
supporting a detrimental effect of meat have been proposed in
relation to specific outcomes: an adverse lipid profile and free
radical generation as a result of high intakes of SFA and iron,
mutagens generated by high-temperature cooking (7, 8), and N-
nitroso compounds formed in processed meat and endogenously
from heme iron (9). The different rates of change and economic
development in Asian countries provide a fertile environment
for conducting etiologic research on chronic disease, because it
provides a large range of exposures and a variety of endpoints.
We initiated the Asia Cohort Consortium (ACC) to understand
chronic disease etiology in Asia, where the association between
dietary factors and chronic diseases has not been extensively
studied. In the current study, we 1) compared ecological trends
in meat intake over the past 37 y between Asia and the United
States and 2) assessed whether meat intake was associated with
all-cause, cancer and CVD mortality by using individual, pro-
spective data from a pooled analysis of Asian cohort studies
involving 296,721 men and women.
SUBJECTS AND METHODS
Meat consumption in Asia
We compared temporal trends in meat consumption in Ban-
gladesh, China, Japan, South Korea, and the United States with
the use of the FAO database (10). We compared meat con-
sumption in Asia with that in the United States because of high
meat consumption in the United States and supportive evidence
for high mortality with high meat intake in a large US cohort
study (5, 6). The FAO Statistical Database, the world’s largest
online agricultural database (available at http://faostat.fao.org/,
accessed 1 3 June 2012), details historical and chronologic
population-based production and disappearance data (referred to
as food availability). For livestock production and product
consumption, FA O has compiled relev ant data—including agricul-
tural production, fish production, trade, food supply, food balance
sheets, supply utilization accounts, and population size—sub-
mitted by member countries in the form of replies to FAO
questionnaires (11). The FAO Statistical Database provides data
on per capita consumption of meat, beef, pork, poultry, and fish
and seafood and defines total meat (excluding fish) as the sum of
beef, poultry, pork, mutton, goat, and game. Per capita con-
sumption (kcal/person per year) is the total amount of food in
each commodity available for each individual in the total pop-
ulation during the period 1970–2007, representing the average
amount available for the population as a whole.
Study population
The ACC was described elsewhere (12). For the meat and
mortality analysis, a total of 8 prospective cohort studies from
Bangladesh, mainland China, Japan, Korea, and Taiwan were
included. We excluded participants who did not provide food-
frequency questionnaires (FFQs) (n = 8177) and those for whom
time under study was missing (n = 467). A total of 296,721
(112,310 men and 184,411 women) were included in this
analysis. Each cohort collected cause-specific deaths through
linkage to death registries or active follow-up. The study was
reviewed and approved by the ethics committee for all partici-
pating cohort studies and by the institutional review board of
Fred Hutchinson Cancer Research Center.
Assessment of dietary and nondietary factors
Each study assessed food intake with a validated FFQ con-
sisting of the frequency of intake, further qualified as specified
portions (weights, numbers, or servings) or serving sizes (eg,
a half bowl, one bowl) (13–18). The number of items for red
meat, poultry, and fish varied from 6 to 17 across studies (see
Supplemental Table 1 under “Supplemental data” in the online
issue). We quantified food-group intake in grams per day or
servings per day using the reported frequency of intake of each
relevant food item and study-specific portion sizes. Data on age,
education, alcohol intake, tobacco smoking, and residence were
collected through self-administered questionnaire or interview.
Height and weight were self-reported or directly measured. BMI
was calculated by dividing weight (in kg) by the square of height
(in m).
Statistical analysis
Using individual-level data, we calculated study-specific HRs
and 95% CIs using a Cox proportional hazards model; age was
used as the time metric. Person-years of follow-up were estimated
from the baseline entry date until the date of death, loss to follow-
up (if applicable), or end of follow-up, whichever came first.
Baseline age (,40, 40–49, 50–59, 60–69, 70–79, and $80 y),
educational level (less than secondary, secondary, and more than
secondary school graduate), alcohol intake (continuous), urban
or rural residence, total energy intake (continuous), fruit and
vegetable intake (continuous), BMI (in kg/m
2
; ,18.5, 18.5–
1 9.9 , 20.0–24.9, 25.0–29.9, and $30.0), and tobacco smoking
(never smoked, former smoker, current with ,20 pack-years of
smoking, and current with $20 pack-years of smoking) were
adjusted for as potential confounding factors in the multivariate
analyses. Outcomes of interest included all-cause mortality and
cancer and CVD mortality. Because the number of food items
2
Supported by the National Cancer Institute, NIH (intramural funding),
and by the Fred Hutchinson Cancer Research Center. The cohorts partici-
pating in the pooled analysis were supported by the following grants: Japan
Public Health Center–Based Study 1 and Japan Public Health Center–Based
Study 2: National Cancer Center Research and Development Fund; Grant-in-
Aid for Cancer Research; Grant for Health Services and Grant for Compre-
hensive Research on Cardiovascular and Life-Style Related Diseases from
the Ministry of Health, Labour and Welfare, Japan; and Grant for the Sci-
entific Research from the Ministry of Education, Culture, Sports, Science
and Technology, Japan. The Radiation Effects Research Foundation, Hirosh-
ima and Nagasaki, Japan, is a private, nonprofit foundation funded by the
Japanese Ministry of Health, Labour and Welfare and the US Department of
Energy. This publication was supported by RERF Research Protocol RP-A3-
11; Shanghai Women’s Health Study: NIH (R37CA70867); CardioVascular
Disease risk FACtor Two-township Study: Department of Health, Taiwan
(DOH80-27, DOH81-021, DOH8202-1027, DOH83-TD-015, and DOH84-
TD-006); The Korea Multi-Center Cancer Cohort: Ministry of Education,
Science and Technology, Korea (2009-0087452); National Research Foun-
dation of Korea (2009-0087452); Health Effects of Arsenic Longitudinal
Study: NIH (P42ES010349, R01CA102484, and R01CA107431); Seoul
Male Cohort: National Research Grant for Basic Medical Sciences, Korea
and National Research Foundation of Korea, 1992-2011.
3
Address correspondence to R Sinha, NIH, National Cancer Institute, Di-
vision of Cancer Epidemiology and Genetics, 9609 Medical Center Drive,
RM 6E336 MSC 9768, Bethesda, MD 20892. E-mail: sinhar@mail.nih.gov.
4
Abbreviations used: ACC, Asia Cohort Consortium; CVD, cardiovascular
disease; FFQ, food-frequency questionnaire.
MEAT INTAKE AND MORTALITY IN ASIA 1033
varied across studies, in the main analysis, we obtained HRs and
95% CIs using study- and sex-specific quartiles of grams per day
of each food group. For males and females separately, cohort-
specific HRs were pooled to compute cross-cohort estimates by
using a random-effects model. The random-effects model also
produced a trend test for pooled HR estimates. Tertiles rather
than quartiles of poultry intake were used to ensure an adequate
number of cases in each category. In supplemental analyses, we
computed pooled cohort HRs from cohort-specific estimates
computed by using uniform cutoffs rather than cohort-specific
cutoffs to construct intake quartiles and tertiles. In other sup-
plemental analyses, we included 2 additional cohort studies that
offered nonquantitative dietary intake data: 1) the Korean Multi-
Center Cancer Cohort Study (19) and 2) the Radiation Effects
Research Foundation in Hiroshima and Nagasaki, the Life Span
Study cohort (20), which had assessed diet by using non-
quantitative FFQs (data on frequency of intake only). We tested
for heterogeneity across studies using a likelihood ratio test that
compared random- and fixed-effect models for pooled cohort
effect estimates. Because socioeconomic status may be related
to meat intake and disease pattern in Asian populations and
because meat intake varies over time, we also examined whether
FIGURE 1. Meat (A–D) and seafood (E) consumption (FAO data) in Bangladesh, China, Japan, South Korea, and the United States. Meat (A) includes
beef, poultry, pork, mutton, goat, and game.
1034 LEE ET AL
the associations varied by educational level. Also, we examined
whether BMI, smoking status, or baseline period modified the
associations. All statistical tests were 2-sided and P values
,0.05 were considered to be statistically significant. We used
SAS version 9.3 (SAS Institute) for the analyses.
RESULTS
Consumption trends using ecologic data
We examined temporal trends in per capita consumption of
meat, beef, pork, poultry, and fish/seafood with the use of the
international FAO database (Figure 1 and Figure 2). We com-
pared meat-consumption patterns between the United States and
Asian populations because there have been numerous meat- and
chronic disease–related studies conducted in the United States
(5, 6, 21–23). Ecological data indicate an increase in meat intake
in Asian countries. Per capita consumption of meat (excluding
fish) in the United States was .2 times that in China, Japan, and
South Korea and .33 times that in Bangladesh in the 1990s and
2000s (Figure 1). In 2007, average meat consumption in the
United States was 122.8 kg/y, whereas consumption in China,
Japan, and South Korea ranged from 46.1 to 55.9 kg/y. Per
capita beef consumption has decreased to some degree in the
past decade in the United States but still remains substantially
higher than that in Asian countries. Beef consumption increased
in China, Japan, and Korea from 1970 to 2007. Although beef
consumption in the United States remains higher, the gap with
Japan or Korea has progressively decreased; in 1970, the dif-
ference was 18-fold; in 1980, it was 10-fold; in 1990, it was 5-
fold; and in 2007, it was 4-fold. Per capita consumption of pork
has continued to rise in China, Japan, and Korea; consumption
in China and Korea has now surpassed consumption in the
United States. Per capita consumption of poultry has been rising
in China, Japan, South Korea, and the United States, but the
difference between the United States and Asian countries re-
mained substantial. Per capita consumption of fish and seafood
in Japan and Korea has remained higher than that in the United
States; consumption in China has risen to a level similar to that
in the United States but that is still substantially lower than that
in Japan and Korea.
When we compared the proportions of per capita consumption
of beef, pork, poultry, and fish/seafood in Bangladesh, China,
Japan, and Korea with those in the United States, using the 2000
FAO database, the proportions of fish/seafood consumption in
Asian countries were higher than those in the United States
(34%–85% compared with 15%), whereas total meat con-
sumption (largely beef and poultry, totaling 64%) in the United
States was higher than that in Asian countries (Figure 2). China
consumed the highest proportion of pork (45%) and Bangladesh
and Japan consumed the highest proportion of fish/seafood (85%
in Bangladesh and 60% in Japan).
Individual consumption and mortality
In our pooled analysis of the ACC data, the mean follow-up
period ranged from 6.6 to 15.6 y. Most studies began enrollment in
the early to mid 1990s (Table 1). Mean intakes of red meat and
poultry in men were 14.2–92.3 and 4.6–22.3 g/d, respectively
(Table 2). In women, mean intakes of red meat ranged from a low
of 9.9 g/d in the Ohsaki National Health Insurance Cohort Study
to 50.9 g/d in the Shanghai Women’s Health Study. Poultry intake
ranged from 2.8 to 15.4 g/d in women. Mean fish and seafood
intake was .45 g/d in men and .36 g/d in women.
Higher total meat intake was not associated with a higher risk
of all-cause, cancer, or CVD mortality in either men or women
(Table 3). In men, HRs (95% CIs) for the comparison of the highest
with the lowest quartile were 1.02 (0.91, 1.15; P-t rend = 0.82) for
FIGURE 2. Percentages of per capita consumption in 2000 in Bangladesh, China, Japan, South Korea, and the United States.
MEAT INTAKE AND MORTALITY IN ASIA 1035
all mortality, 1.11 (0.94, 1.30; P-trend = 0.25) for cancer mortality ,
and 0.91 (0.78, 1.05; P-trend = 0.29) for CVD mortality . In women,
HRs (95% CIs) for the comparison of the highest with the lowest
quartile were 0.93 (0.86, 1.01; P-trend = 0.25) for all mortality, 0.90
(0.78, 1.04; P-trend = 0.27) for cancer mortality , and 1.02 (0.89,
1.18; P-trend = 0.80) for CVD mortality. Red meat intake appeared
TABLE 1
Baseline characteristics of the cohort studies included
1
Enrollment year,
study, and sex
Follow-up
period
2
Baseline
cohort size
Age range
at entry
Total energy
intake
3
No. of
all deaths
No. of
cancer deaths
No. of
CVD deaths
y kcal/d
1990–1992
JPHC1 (males) 14.2 6 3.7 20,595 40–59 2124 (879) 2300 953 600
JPHC1 (females) 14.7 6 3.1 22,443 40–59 1398 (440) 1128 541 284
1992–1995
JPHC2 (males) 11.2 6 3.2 26,721 40–69 1675 (684) 3662 1621 882
JPHC2 (females) 11.7 6 2.6 29,690 40–69 1087 (330) 1805 784 478
1990
Miyagi (males) 12.6 6 2.7 21,536 40–64 1885 (886) 2335 838 424
Miyagi (females) 12.9 6 2.3 23,430 40–64 1307 (438) 1152 421 202
1995
Ohsaki (males) 9.8 6 3.8 23,462 40–80 1757 (829) 4605 1649 1305
Ohsaki (females) 10.0 6 3.8 25,443 40–80 1266 (461) 2606 769 919
2000–2002
HEALS (males) 6.6 6 1.1 4884 20–75 2806 (967) 284 45 130
HEALS (females) 6.6 6 0.8 6512 17–61 2431 (850) 107 14 41
1992–1993
Seoul (males) 14.7 6 1.7 13,600 25–82 2397 (497) 808 424 145
1996–2000
SWHS (females) 8.6 6 1.2 74,933 40–71 1634 (496) 2908 1346 804
1990–1992
CVDFACTS (males) 14.9 6 3.6 1512 18–92 2325 (943) 332 80 93
CVDFACTS (females) 15.6 6 2.7 1960 18–87 1716 (667) 251 73 66
Total 24,283 9558 6373
1
CVD, cardiovascular disease; CVDFACTS, Cardiovascular Diseases Risk Factor Two-Township Study; HEALS, Health Effects of Arsenic Longitudinal
Study; JPHC, Japan Public Health Center-Based Prospective Study; Miyagi, Miyagi Cohort Study; Ohsaki, Ohsaki National Health Insurance Cohort Study;
Seoul, Seoul Male Cohort Study; SWHS, Shanghai Women’s Health Study.
2
All values are means 6 SDs.
3
All values are medians; IQRs in parentheses.
TABLE 2
Meat intake and number of food items in the cohort studies included
1
Study and sex Red meat
2
Number of
food items Poultry
2
No. of
food items
Fish and
seafood
2
No. of
food items
g/d g/d g/d
JPHC1 (males) 33.8 6 19.8 4 12.7 6 9.0 1 52.8 6 34.3 4
JPHC1 (females) 26.9 6 17.0 11.3 6 7.6 45.3 6 29.7
JPHC2 (males) 17.8 6 11.8 4 8.5 6 8.1 1 58.1 6 38.3 6
JPHC2 (females) 15.1 6 10.2 7.1 6 6.6 45.1 6 28.8
Miyagi (males) 14.7 6 12.0 4 7.9 6 8.3 1 58.7 6 35.3 3
Miyagi (females) 11.1 6 9.1 6.5 6 6.2 52.5 6 30.1
Ohsaki (males) 14.2 6 12.0 4 8.7 6 8.4 1 62.8 6 35.7 3
Ohsaki (females) 9.9 6 8.7 6.9 6 6.3 55.7 6 30.6
HEALS (males) 19.1 6 33.0 1 4.6 6 14.0 1 60.3 6 42.0 4
HEALS (females) 12.2 6 19.8 2.8 6 9.7 51.2 6 38.1
Seoul (males) 92.3 6 109.1 7 4.9 6 9.0 1 50.6 6 58.8 9
SWHS (females) 50.9 6 36.7 9 15.3 6 17.8 2 38.0 6 36.8 5
CVDFACTS (males) 67.1 6 67.0 8 22.3 6 34.9 2 45.2 6 53.7 3
CVDFACTS (females) 45.0 6 39.7 15.4 6 21.4 36.6 6 37.2
Total
1
CVDFACTS, Cardiovascular Diseases Risk Factor Two-Township Study; HEALS, Health Effects of Arsenic Longitudinal Study; JPHC, Japan Public
Health Center-Based Prospective Study; Miyagi, Miyagi Cohort Study; Ohsaki, Ohsaki National Health Insurance Cohort Study; Seoul, Seoul Male Cohort
Study; SWHS, Shanghai Women’s Health Study.
2
All values are means 6 SDs.
1036 LEE ET AL
to be related to all-cause mortality in men and women with the
lo west risk in the third quartile. A significant inverse trend with red
meat intake was observed for CVD mortality in men (P-trend =
0.04) and cancer mortality in women (P-trend , 0.01). An inv erse
association with poultry intake was observed for risk of all-cause
mortality in men (P-trend = 0.02) and women (P-tren d = 0.03) and
for risk of cancer mortality in women (P-trend , 0.01). Fish/sea-
food intake was inv ersely associated with risks of all-cause and
CVD mortality in women (P-trend = 0.05 and 0.04, respectively).
In further analyses, we included 2 more cohort studies (Korean
Multi-Center Cancer Cohort Study and Radiation Effects Re-
search Foundation), which assessed diet using nonquantitative
TABLE 3
HRs and 95% CIs for all-cause, cancer, and CVD mortality by meat intake
1
HR (95% CI)
All-cause mortality Cancer mortality CVD mortality
Men
No. of deaths 14,326 5610 3579
Total meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.95 (0.89, 1.01) 0.99 (0.91, 1.08) 0.87 (0.75, 1.00)
Q3 0.93 (0.85, 1.03)* 1.01 (0.91, 1.13) 0.91 (0.79, 1.04)
Q4 1.02 (0.91, 1.15)
y
1.11 (0.94, 1.30)
y
0.91 (0.78, 1.05)
P-trend 0.82 0.25 0.29
Red meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.94 (0.88, 1.00) 0.95 (0.85, 1.05) 0.89 (0.79, 0.99)
Q3 0.86 (0.80, 0.93) 0.87 (0.78, 0.96) 0.87 (0.79, 0.97)
Q4 0.93 (0.84, 1.02)
y
0.90 (0.77, 1.05)* 0.87 (0.78, 0.98)
P-trend 0.06 0.09 0.04
Poultry
T1 1.00 (ref) 1.00 (ref) 1.00 (ref)
T2 0.88 (0.83, 0.93) 0.93 (0.84, 1.02) 0.82 (0.66, 1.02)*
T3 0.89 (0.81, 0.98) 0.91 (0.80, 1.04) 0.82 (0.64, 1.06)*
P-trend 0.02 0.17 0.14
Fish
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.98 (0.89, 1.08)* 1.02 (0.90, 1.15) 0.99 (0.82, 1.20)*
Q3 0.98 (0.89, 1.08)* 1.04 (0.96, 1.13) 0.96 (0.79, 1.15)*
Q4 1.05 (0.95, 1.16)
y
1.14 (1.04, 1.26) 0.95 (0.80, 1.13)
P-trend 0.43 0.02 0.50
Women
No. of deaths 9957 3948 2794
Total meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.88 (0.82, 0.94) 0.92 (0.78, 1.08) 0.88 (0.78, 0.99)
Q3 0.91 (0.82, 1.02) 0.96 (0.79, 1.17)* 0.88 (0.74, 1.04)
Q4 0.93 (0.86, 1.01) 0.90 (0.78, 1.04) 1.02 (0.89, 1.18)
P-trend 0.25 0.27 0.80
Red meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.93 (0.87, 0.98) 0.92 (0.82, 1.04) 0.93 (0.82, 1.06)
Q3 0.88 (0.81, 0.95) 0.83 (0.74, 0.92) 0.86 (0.75, 0.99)
Q4 0.93 (0.86, 1.00) 0.85 (0.76, 0.94) 1.03 (0.85, 1.25)
P-trend 0.05 ,0.01 0.99
Poultry
T1 1.00 (ref) 1.00 (ref) 1.00 (ref)
T2 0.91 (0.85, 0.97) 0.91 (0.83, 1.01) 0.97 (0.85, 1.09)
T3 0.93 (0.86, 0.99) 0.88 (0.79, 0.97) 1.05 (0.92, 1.18)
P-trend 0.03 ,0.01 0.49
Fish
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.86 (0.75, 0.98) 0.97 (0.80, 1.17) 0.84 (0.75, 0.94)
Q3 0.89 (0.83, 0.96) 1.01 (0.81, 1.28)
y
0.79 (0.68, 0.91)
Q4 0.91 (0.85, 0.97) 1.00 (0.83, 1.20) 0.88 (0.77, 1.01)
P-trend 0.05 0.92 0.04
1
Values were adjusted for age, BMI, education, smoking habit, rural/urban residence, alcohol intake, fruit and
vegetable intake, and total energy intake. *P value for homogeneity across studies rejected at a , 0.05.
y
P value for
homogeneity across studies rejected at a , 0.01. CVD, cardiovascular disease; Q, quartile; ref, reference; T, tertile.
MEAT INTAKE AND MORTALITY IN ASIA 1037
FFQs. We examined whether there were similar associations be-
tween frequencies of meat intake and all-cause, cancer, and CVD
mortality. Similar to the results in the analysis of grams per day,
we found no statistically significant associations for total meat
intake with frequency of total meat consumption as the main
exposure (data not shown). Furthermore, when we used common
cutoffs rather than cohort-specific cutoffs to construct intake
quartiles, the results were similar for total meat intake (data not
shown). When we examined the associations for intakes of total
meat, red meat, poultry, and fish in individual cohort studies, we
found generally similar patterns with pooled results (see Sup-
plemental Table 2 under “Supplemental data” in the online is-
sue). Because socioeconomic status may have been linked to
meat availability during the study period, we investigated whether
associations varied by educational level (less than secondary,
secondary, and more than secondary graduate) (Table 4). We
found no statistically significant associations for all-cause mor-
tality with total meat intake in any education stratum. For red
meat intake, a lower risk of all-cause mortality was observed at
the second and third quartiles in women with less than secondary
school education. When we stratified BMI into 3 groups (BMI
,20, 20 to ,25, and $25), we found similar associations be-
tween total meat intake and all-cause mortality in both men and
women. A comparison of the highest with the lowest quartile
resulted in HRs (95% CIs) of 1.10 (0.94, 1.28) for men with
aBMI,20, 1.01 (0.88, 1.16) for men with a BMI of 20 to ,25,
and 1.01 (0.82, 1.24) for men with a BMI $25; the respective
values for women were 0.85 (0.70, 1.04) for women with a BMI
,20, 1.00 (0.84, 1.18) for women with a BMI of 20 to ,25, and
0.91 (0.77, 1.06) for women with a BMI $25. When we limited
our analysis to never-smokers, HRs for total meat intake in re-
lation to all-cause mortality in a comparison of the highest with
the lowest quartile were 1.12 (0.97, 1.29) in men and 0.94 (0.87,
1.02) in women. We also found that baseline period (before or
after 1995) did not modify any of the associations between total
meat, red meat, poultry, or sh/seafood and risk of all-cause
mortality (data not shown). When we excluded participants who
died within the first 3 y of follow-up, we found that the results of
total meat, red meat, poultry, or fish/seafood were similar for all-
cause, cancer, and CVD mortality (data not shown).
DISCUSSION
Even with the marked increase in industrialization and urban-
ization in Asian countries, food-availability data from FAO in-
dicated that meat consumption was still substantially higher in
the United States than in any Asian country. The main differences
between meat consumption in the United States and Asia were seen
for beef and poultry . Even though meat consumption has continued
to rise in China, Japan, and South Korea and ev en though the gap
between the United States and Asian countries has narrowed, meat
consumption in Asia has remained lower than that in the United
States into the 21st century. In contrast, fi sh and seafood con-
sumption in Japan and Korea is .2-fold that in the United States.
Our pooled analysis of 8 Asian prospective cohort studies did
not provide evidence of a higher risk of mortality for total meat
intake. For red meat and poultry, inverse associations were ob-
served for mortality in both men and women. We found that fish
intake was inversely associated with risk of mortality in women.
No variation in the associations between mortality and total meat
intake were observed by educational levels or study period.
Overall cancer and CVD mortality has increased in Asian
countries (24–26), and mortality rates from some cancers are
approaching those in Western countries (24, 27). Given the trend
of increasing meat consumption over time in Asia, a westernized
diet heavy in animal products has been invoked as a cause of this
increasing incidence and mortality from cancer and CVD (28).
However, Asian prospective cohort studies (29–33), most of
which were included in our pooled analysis, have not supported
the hypothesis that meat intake is involved in all-cause, cancer,
or CVD mortality, unlike the pattern seen in Europe and North
America (5, 6, 34, 35).
The absence of a positive association between meat intake and
mortality in Asia may be related to several factors. First, Asia has
been experiencing a dramatic change in many other chronic
disease risk factors, including physical activity, adiposity, and
access to medical care. At this stage, it is possible that meat
consumption may not be as large a contributor to risk of death as
socioeconomic status, a sedentary lifestyle (36, 37), or adiposity.
Furthermore, other risk factors such as obesity (12), hypertension
(38), and smoking (39) could largely explain the increasing risks
of cancer or CVD in Asia to date. Second, the null, and even
inverse, association between meat consumption and mortality
observed in our data warrants further study because the dietary
transition is still under way in many parts of Asia. Residual or
unmeasured confounding factors, such as socioeconomic status
related to meat availability, could be important because food
accessibility and availability is related to income levels in the
Asia-Pacific region (40); ie, even though we failed to detect
differences by education, a higher intake of meat at this point in
the epidemiologic transition may be a marker for other protective
factors, including a sufficient intake of energy and access to
medical care. Third, nondifferential measurement error in dietary
assessments could have led to bias toward the null, although all
the FFQs used in each study have been validated with modest
to good correlation with a reference method (13–18). Although
the absence of a positive association can be partly explained by
aforementioned reasons, we still cannot rule out the hypothesis
that total meat intake is not related to mortality in Asian pop-
ulations, given the findings we observed in this pooled analysis.
A reduced risk of all-cause and cancer mortality with higher
fish intakes in women could be explained as a result of delayed
progression of disease through inhibition of eicosanoid bio-
synthesis, which leads to a reduction in prostaglandin conversion
from arachidonic acid (41, 42). We found an inverse association
in women only, perhaps because social and cultural differences
between men and women determine health behaviors such as
alcohol intake and tobacco smoking in Asia; therefore, these risk
factors could play a role to a lesser extent in women than in men.
The strengths of our study include the size of the total ACC
cohort and a prospective study design with assessment of long-
term usual dietary intake. In the ACC study, we were able to
include unpublished individual data from some Asian studies,
which provides greater accuracy than meta-analyses. We had
extensive information on potential confounders. Furthermore, we
analyzed the data and adjusted for confounding factors in
a standardized, uniform way by using the original data from each
cohort, which is not allowed in a meta-analysis.
Our study had several limitations. Unmeasured or residual
confounding may still exist, although we adjusted for potential
confounding factors, including alcohol intake, fruit and vegetable
1038 LEE ET AL
intake, education, and smoking status. We did not analyze processed
meat intake because a limited number of processed meats were
included in the FFQs. We could not evaluate whether meat prep-
aration or cooking procedures were associated with risk of mortality
because most of the cohorts did not include such detailed in-
formation in their questionnaires. We were not able to examine
changes in meat intake or timing of meat intake in relation to
mortality because dietary information was not assessed at multiple
TABLE 4
HRs and 95% CIs for all-cause mortality by meat intake, stratified by educational level
1
Education
Low Middle High
Men
No. of deaths 5477 3102 1126
Total meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.98 (0.84, 1.14) 0.97 (0.86, 1.08) 0.97 (0.81, 1.16)
Q3 1.07 (0.93, 1.22) 0.83 (0.68, 1.00) 1.10 (0.88, 1.37)
Q4 1.05 (0.86, 1.30)* 1.07 (0.89, 1.28) 1.10 (0.86, 1.40)
P-trend 0.45 0.91 0.33
Red meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.95 (0.86, 1.04) 0.96 (0.87, 1.07) 1.06 (0.90, 1.26)
Q3 0.91 (0.80, 1.04) 0.83 (0.68, 1.03) 0.87 (0.72, 1.05)
Q4 0.97 (0.85, 1.11) 0.94 (0.78, 1.14)* 0.93 (0.69, 1.26)
P-trend 0.59 0.29 0.38
Poultry
T1 1.00 (ref) 1.00 (ref) 1.00 (ref)
T2 0.88 (0.79, 0.99) 0.89 (0.79, 1.00) 0.77 (0.63, 0.94)
T3 0.94 (0.84, 1.04) 0.97 (0.86, 1.10) 0.89 (0.74, 1.08)
P-trend 0.22 0.64 0.24
Fish
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.99 (0.87, 1.13) 0.98 (0.82, 1.17) 1.14 (0.86, 1.50)
Q3 1.02 (0.89, 1.16) 0.97 (0.82, 1.16) 1.14 (0.82, 1.60)*
Q4 1.11 (0.97, 1.28) 1.01 (0.81, 1.26) 1.21 (0.89, 1.64)
P-trend 0.19 0.95 0.17
Women
No. of deaths 4663 1928 985
Total meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.89 (0.80, 0.98) 0.84 (0.71, 1.00) 1.03 (0.84, 1.26)
Q3 0.97 (0.85, 1.11) 0.86 (0.71, 1.04) 1.11 (0.90, 1.38)
Q4 0.98 (0.88, 1.10) 0.88 (0.73, 1.06) 1.09 (0.88, 1.37)
P-trend 0.85 0.26 0.36
Red meat
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.89 (0.81, 0.97) 0.88 (0.76, 1.02) 1.13 (0.92, 1.37)
Q3 0.84 (0.76, 0.93) 0.87 (0.73, 1.03) 1.07 (0.87, 1.31)
Q4 0.95 (0.84, 1.07) 0.84 (0.69, 1.01) 1.11 (0.90, 1.38)
P-trend 0.29 0.09 0.44
Poultry
T1 1.00 (ref) 1.00 (ref) 1.00 (ref)
T2 0.92 (0.84, 1.01) 0.82 (0.70, 0.96) 0.97 (0.79, 1.21)
T3 0.94 (0.86, 1.04) 0.88 (0.73, 1.08) 1.06 (0.87, 1.30)
P-trend 0.26 0.22 0.55
Fish
Q1 1.00 (ref) 1.00 (ref) 1.00 (ref)
Q2 0.90 (0.82, 0.98) 0.81 (0.65, 1.01) 1.06 (0.87, 1.30)
Q3 0.89 (0.70, 1.12)* 0.84 (0.71, 1.00) 1.07 (0.88, 1.31)
Q4 0.98 (0.88, 1.08) 0.89 (0.70, 1.12) 0.96 (0.77, 1.19)
P-trend 0.68 0.35 0.98
1
Values were adjusted for age, BMI, smoking habit, rural/urban residence, alcohol intake, fruit and vegetable intake,
and total energy intake. Educational levels were categorized into: less than secondary; secondary; and more than secondary
school. Japan Public Health Center-Based Prospective Study 2 and Health Effects of Arsenic Longitudinal Study were
excluded from these analyses because educational level was not available. *P value for homogeneity across studies rejected
at a , 0.05. Q, quartile; ref, reference; T, tertile.
MEAT INTAKE AND MORTALITY IN ASIA 1039
times during the study period of each cohort. Heterogeneity in
intake was observed across studies; however, we found that
study-specific results in general did not show an increased risk of
mortality with higher total meat intake. We could not investigate
the role of meat intake with specific types of CVD and cancer
outcomes because we did not have the relevant information from
the different cohorts. However, our finding warrants subsequent
studies to explore the role of diet in the development of specific
CVD or cancer outcomes in this ACC study.
In conclusion, our pooled analysis of prospective cohort
studies showed that higher total and red meat consumption was
not associated with an increased risk of cancer or CVD mortality.
Fish and seafood intake was inversely associated with mortality
in women. Additional dietary studies among Asian populations
are needed to elucidate outstanding questions: 1) Is meat intake
associated with an increased risk of cancer and CVD mortality
beyond changes in lifestyle and environmental factors?; 2)Do
some, as yet undefined, characteristics of Asian populations
explain the association that we observed with meat intake?; and
3) Is the cumulative exposure to a high intake of meat crucial to
disease etiology?
The authors’ responsibilities were as follows—K-YY, PB, WZ, DK, JP,
and RS: conceived the study; JEL, DFM, and RS: designed the research; JEL
and RS: drafted the manuscript; DFM: analyzed the data; and all authors:
revised the manuscript and approved the final manuscript. None of the au-
thors declared a conflict of interest. The funders had no role in the study
design, data collection and analysis, decision to publish, or preparation of the
manuscript.
REFERENCES
1. Popkin BM. The nutrition transition and obesity in the developing
world. J Nutr 2001;131:871S–3S.
2. Gill T. Epidemiology and health impact of obesity: an Asia Pacific
perspective. Asia Pac J Clin Nutr 2006;15(suppl):3–14.
3. World Health Organization. The global burden of disease: 2004 update.
Geneva, Switzerland: World Health Organization, 2008.
4. Food and Agriculture Organization of the United Nations. The state of
food and agriculture. Rome, Italy: Food and Agriculture Organization
of the United Nations, 2009.
5. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ,
Willett WC, Hu FB. Red meat consumption and mortality: results from
2 prospective cohort studies. Arch Intern Med 2012;172:555–63.
6. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat
intake and mortality: a prospective study of over half a million people.
Arch Intern Med 2009;169:562–71.
7. Cross AJ, Sinha R. Meat-related mutagens/carcinogens in the etiology
of colorectal cancer. Environ Mol Mutagen 2004;44:44–55.
8. Sinha R, Knize MG, Salmon CP, Brown ED, Rhodes D, Felton JS,
Levander OA, Rothman N. Heterocyclic amine content of pork prod-
ucts cooked by different methods and to varying degrees of doneness.
Food Chem Toxicol 1998;36:289–97.
9. Hughes R, Cross AJ, Pollock JR, Bingham S. Dose-dependent effect of
dietary meat on endogenous colonic N-nitrosation. Carcinogenesis
2001;22:199–202.
10. Food and Agriculture Organization of the United Nations. FAO sta-
tistical databases (FAOSTAT). Food consumption data. Rome, Italy:
FAO, 2012.
11. Speedy AW. Global production and consumption of animal source
foods. J Nutr 2003;133:4048S–53S.
12. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, He
J, Gupta PC, Ramadas K, Tsugane S, et al. Association between body-
mass index and risk of death in more than 1 million Asians. N Engl J
Med 2011;364:719–29.
13. Shu XO, Yang G, Jin F, Liu D, Kushi L, Wen W, Gao YT, Zheng W.
Validity and reproducibility of the food frequency questionnaire used in
the Shanghai Women’s Health Study. Eur J Clin Nutr 2004;58:17–23.
14. Kim MK, Lee SS, Ahn YO. Reproducibility and validity of a self-
administered semiquantitative food frequency questionnaire. Korean
J Commun Nutr 1996;1:376–94.
15. Tsubono Y, Kobayashi M, Sasaki S, Tsugane S. Validity and re-
producibility of a self-administered food frequency questionnaire used
in the baseline survey of the JPHC Study Cohort I. J Epidemiol 2003;
13:S125–33.
16. Ogawa K, Tsubono Y, Nishino Y, Watanabe Y, Ohkubo T, Watanabe T,
Nakatsuka H, Takahashi N, Kawamura M, Tsuji I, et al. Validation of
a food-frequency questionnaire for cohort studies in rural Japan. Public
Health Nutr 2003;6:147–57.
17. Chen Y, Ahsan H, Parvez F, Howe GR. Validity of a food-frequency
questionnaire for a large prospective cohort study in Bangladesh. Br J
Nutr 2004;92:851–9.
18. Lee MS, Pan WH, Liu KL, Yu MS. Reproducibility and validity of
a Chinese food frequency questionnaire used in Taiwan. Asia Pac J
Clin Nutr 2006;15:161–9.
19. Yoo KY, Shin HR, Chang SH, Lee KS, Park SK, Kang D, Lee DH.
Korean Multi-center Cancer Cohort St udy including a Biological
Materials Bank (KMCC-I). Asi an Pac J Cancer Prev 2002; 3:
85–92.
20. Preston DL, Pierce DA, Shimizu Y, Cullings HM, Fujita S, Funamoto
S, Kodama K. Effect of recent changes in atomic bomb survivor do-
simetry on cancer mortality risk estimates. Radiat Res 2004;162:377–
89.
21. Chao A, Thun MJ, Connell CJ, McCullough ML, Jacobs EJ, Flanders
WD, Rodriguez C, Sinha R, Calle EE. Meat consumption and risk of
colorectal cancer. JAMA 2005;293:172–82.
22. Cross AJ, Leitzmann MF, Gail MH, Hollenbeck AR, Schatzkin A,
Sinha R. A prospective study of red and processed meat intake in re-
lation to cancer risk. PLoS Med 2007;4:e325.
23. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Willett WC,
Hu FB. Red meat consumption and risk of type 2 diabetes: 3 cohorts of
US adults and an updated meta-analysis. Am J Clin Nutr 2011;94:
1088–96.
24. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLO-
BOCAN 2008 v1.2, cancer incidence and mortality worldwide: IARC
CancerBase no. 10. Lyon, France: International Agency for Research
on Cancer, 2010.
25. Ramahi TM. Cardiovascular disease in the Asia Middle East region:
global trends and local implications. Asia Pac J Public Health 2010;22:
83S–9S.
26. Sasayama S. Heart disease in Asia. Circulation 2008;118:2669–71.
27. American Cancer Society. Global cancer facts & figures. 2nd ed. At-
lanta, GA: ACS, 2011.
28. Drewnowski A, Popkin BM. The nutrition transition: new trends in the
global diet. Nutr Rev 1997;55:31–43.
29. Kojima M, Wakai K, Tamakoshi K, Tokudome S, Toyoshima H, Wa-
tanabe Y, Hayakawa N, Suzuki K, Hashimoto S, Ito Y, et al. Diet and
colorectal cancer mortality: results from the Japan Collaborative Co-
hort Study. Nutr Cancer 2004;50:23–32.
30. Lee SA, Shu XO, Yang G, Li H, Gao YT, Zheng W. Animal origin
foods and colorectal cancer risk: a report from the Shanghai Women’s
Health Study. Nutr Cancer 2009;61:194–205.
31. Khan MM, Goto R, Kobayashi K, Suzumura S, Nagata Y, Sonoda T,
Sakauchi F, Washio M, Mori M. Dietary habits and cancer mortality
among middle aged and older Japanese living in hokkaido, Japan by
cancer site and sex. Asian Pac J Cancer Prev 2004;5:58–65.
32. Sato Y, Nakaya N, Kuriyama S, Nishino Y, Tsubono Y, Tsuji I. Meat
consumption and risk of colorectal cancer in Japan: the Miyagi Cohort
Study. Eur J Cancer Prev 2006;15:211–8.
33. Nagao M, Iso H, Yamagishi K, Date C, Tamakoshi A. Meat con-
sumption in relation to mortality from cardiovascular disease among
Japanese men and women. Eur J Clin Nutr 2012;66:687–93.
34. Kelemen LE, Kushi LH, Jacobs DR Jr, Cerhan JR. Associations of
dietary protein with disease and mortality in a prospective study of
postmenopausal women. Am J Epidemiol 2005;161:239–49.
35. Couto E, Boffetta P, Lagiou P, Ferrari P, Buckland G, Overvad K,
Dahm CC, Tjonneland A, Olsen A, Clavel-Chapelon F, et al. Medi-
terranean dietary pattern and cancer risk in the EPIC cohort. Br J
Cancer 2011;104:1493–9.
36. Pham NM, Mizoue T, Tanaka K, Tsuji I, Tamakoshi A, Matsuo K,
Ito H, Wakai K, Nagata C, Sasazuki S, et al. Physical activity and
colorectal cancer risk: an evaluation based on a systematic review of
1040 LEE ET AL
epidemiologic evidence among the Japanese population. Jpn J Clin
Oncol 2012;42:2–13.
37. Noda H, Iso H, Toyoshima H, Date C, Yamamoto A, Kikuchi S,
Koizumi A, Kondo T, Watanabe Y, Wada Y, et al. Walking and sports
participation and mortality from coronary heart disease and stroke. J
Am Coll Cardiol 2005;46:1761–7.
38. Murakami Y, Hozawa A, Okamura T, Ueshima H, Evidence for Car-
diovascular Prevention From Observational Cohorts in Japan Research
Group. Relation of blood pressure and all-cause mortality in 180,000
Japanese participants: pooled analysis of 13 cohort studies. Hyper-
tension 2008;51:1483–91.
39. Nakamura K, Huxley R, Ansary-Moghaddam A, Woodward M. The
hazards and benefits associated with smoking and smoking cessation
in Asia: a meta-analysis of prospective studies. Tob Control 2009;18:
345–53.
40. Yang RY, Hanson PM. Improved food availability for food security in
Asia-Pacific region. Asia Pac J Clin Nutr 2009;18:633–7.
41. Rose DP, Connolly JM. Omega-3 fatty acids as cancer chemo-
preventive agents. Pharmacol Ther 1999;83:217–44.
42. Tapiero H, Ba GN, Couvreur P, Tew KD. Polyunsaturated fatty acids
(PUFA) and eicosanoids in human health and pathologies. Biomed
Pharmacother 2002;56:215–22.
MEAT INTAKE AND MORTALITY IN ASIA 1041
... Takata et al. (47) found that there were suggestive inverse associations of poultry intake with risk of CVD mortality among men but not among women. Other studies (39,(44)(45)(46)48) did not show any associations (Table 2). A meta-analysis was performed including the six above-mentioned studies for this outcome indicating no significant associations between intake of white meat and risk of CVD mortality (RR: 0.95, 95%CI: 0.87-1.02, ...
... Nagao et al. (40) found similar associations between white meat intake and CHD mortality in men and women, whereas Bernstein et al. (41) found lower stroke incidence in relation to white meat only in women. On the other hand, results from Lee et al. (45) and Takata et al. (47) indicated that white meat was associated with lower CVD mortality in men but not in women. Regarding risk of T2D, the EPIC Interact study reported a higher risk related to white meat intake in women only (but not in men); however, the risk estimates related to white meat were similar in men and women according to the studies from Kurotani et al. (51) and Steinbrecher et al. (54). ...
Article
Full-text available
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.
... While most Western studies showed positive association between red meat intake and risk of colorectal cancer, Asian studies, on the other hand, yielded inconsistent results for the association between red meat and colorectal cancer. A metaanalysis on meat intake and cause-specific mortality generated a similar conclusion as our meta-analysis [25]. The paper followed eight Asian prospective cohort studies consisting of 112,310 men and 184,411 women. ...
... First of all, fish intake was believed to be a protective factor in developing cancer [28,29]. Fish and seafood consumption in East-Asian countries like Korea and Japan are much higher than Western countries, and the meat consumption of East-Asian countries is lower than the Western countries, indicating the dietary habits of East-Asians and Westerners are different, although the difference is being narrowed [25]. The mechanism of fish intake and the prevention of cancer could be explained by the inhibition of eicosanoid biosynthesis, and thus reducing the conversion of arachidonic acid to prostaglandin. ...
Article
Full-text available
Background and aims: Colorectal cancer has the third highest incidence and second highest mortality among all cancers worldwide. Although numerous studies investigating the associations between high red meat intake and risk of colorectal cancer have been published, the association between the intake of red meat and the risk of colorectal cancer in Asians remains unclear. We performed a systematic review and meta-analysis of cohort and case-control studies to estimate the association between red meat intake and colorectal cancer incidence rate between 2011-2021. Method: We searched PubMed database from 1 Jan 2011 to 21 July 2021. Prospective cohort studies and nested case-control studies that reported results on the association between red meat consumption and colorectal cancer were included in the meta-analysis. The outcome of interest was the association between the intake of red meat and the risk of colorectal cancer. We performed a meta-analysis to calculate the odds ratios (OR) with 95% confidence intervals (CI). Results: A total of 5 studies enrolling 48,158 participants were included. The results showed no significant association between red meat intake and colorectal cancer risks (OR=1.38; 95%CI: 0.98-1.93). The aspect of the corresponding funnel plot suggested the presence of significant publication bias. Egger's test confirmed the significant asymmetry of the funnel plot (t = 9.3024, p = 0.0026). Conclusions: Contrary to many other meta-analyses, our study showed that intake of red meat was not associated with increased risk of colorectal cancer in East-Asians from China, Japan and South Korea. However, due to the limited number of included papers and the lack of confounders adjustments, our results warrant cautious interpretations.
... Moreover, divergent results have been observed among studies conducted in different geographical regions. Several Asian studies have reported an inverse and linear association between fish consumption and all-cause mortality (6,8,26,27). This discrepancy could be explained by geographical variations of n-3 PUFA and POPs in fish (28,29). ...
Article
Full-text available
Western studies have shown a non-linear association between fish consumption and mortality, which might be explained by exposure to chemical contaminants. This study aims to explore the associations between fish consumption or omega-3 polyunsaturated fatty acids (n-3 PUFA) and mortality within the prospective E3N French cohort, and to investigate the role of dietary exposure to contaminants in these associations. In the E3N cohort composed of 72,585 women, we assessed fish consumption and n-3 PUFA intake through a food questionnaire sent in 1993. To estimate the dietary exposure to contaminants, we used the food contamination database of the second French total diet study. Cox proportional hazard models were used to estimate the association between fish, lean fish, fatty fish, and n-3 PUFA intake, with the risk of all-cause or cause-specific mortality. During the follow-up (1993–2014), 6,441 deaths were recorded. A U-shaped association was observed between fish consumption and all-cause mortality (P overall_association = 0.017). A similar association was observed with lean fish consumption, while the non-linear association between fatty fish consumption or n-3 PUFA intake and all-cause mortality did not reach statistical significance. A non-linear association was observed between fish consumption and lung cancer mortality (P overall_association = 0.005). A positive and linear association was observed between fatty fish consumption or n-3 PUFA intake and breast cancer mortality (HR [CI95%]: 1.07 [1.01–1.15] and 1.08 [1.01–1.15]). Our results remained unchanged when further adjusting on dietary exposure to contaminants. Our results showed a U-shaped association between fish consumption and all-cause mortality and suggest a notable role of lean fish consumption in this association, but no role of dietary exposure to contaminants. Further studies are needed to better clarify this U-shaped association and the different impacts of fatty and lean fish consumption on health.
... This variance could be attributed to several factors, including dietary habits, environmental influences, cultural differences, and genetic characteristics specific to each race. [30,31] These statistics suggest that trends in sarcopenia among Koreans are not significantly different from those in other countries. [32,33] Several critical constraints were encountered in this study. ...
Article
Full-text available
Background: As recognized by the World Health Organization in 2016 with its inclusion in the International Classification of Diseases, Tenth Revision as M62.84, and by South Korea in 2021 as M62.5, the diagnostic guidelines for sarcopenia vary globally. Despite its prevalence in older populations, data on sarcopenia in Koreans aged 60 and above is scarce, highlighting the need for research on its prevalence in this demographic.Methods: Utilizing the 2022 Korea National Health and Nutrition Examination Survey dataset, sarcopenia was assessed among 1,946 individuals aged 60 or older according to the Asian Working Group for Sarcopenia 2019 criteria, incorporating grip strength and bioelectrical impedance analysis measurements. Statistical analyses were performed to differentiate categorical and continuous variables using logistic regression and Student’s t-tests, respectively.Results: The prevalence of sarcopenia was found to increase with age, with the highest prevalence observed in the oldest age group (80 years and older). The overall prevalence of sarcopenia in our study population was 6.8%. Among men, the prevalence of sarcopenia was 5.5% in the 60 or older age group, 9.6% in the 70 or older age group, and 21.5% in the 80 or older age group. Among women, the prevalence of sarcopenia was 7.9%, 10.5%, and 25.9%, respectively.Conclusions: This study highlights the significant burden of sarcopenia in elderly Koreans, particularly among the oldest individuals. These findings call for targeted interventions to manage and prevent sarcopenia, along with further research on its risk factors, consequences, and effective mitigation strategies.
... Additionally, meat is an important source of bioactive nutrients, antioxidants and conjugated linoleic acids (Mann, 2018). A metaanalysis of Asian cohort studies showed a protective effect of poultry, red meat, and fish against all-cause mortality (Lee et al., 2013). Similarly, studies conducted in developing countries have shown a link between high meat intake and overall health improvements (Neumann et al., 2007;Mozumdar et al., 2009;Girard et al., 2012). ...
Article
Full-text available
Objective This study aims to disclose and compare meat consumer segments in Switzerland and Vietnam, which differ in terms of their socioeconomic and cultural settings (the former is a developed country, and the latter is an emerging one) to develop a set of segment-specific recommendations that might be applied to consumption in comparable contexts, that is, in other developed countries and other emerging economies. Methods Data were collected through two online surveys: one for Swiss residents from randomly selected households and one for Vietnamese urban residents recruited via snowball sampling. The final sample size was N = 643 for Switzerland and N = 616 for Vietnam. Hierarchical cluster analyses followed by K-means cluster analyses revealed five distinct clusters in both countries. Results Three clusters were common to both countries: meat lovers (21% in Switzerland and 19% in Vietnam), proactive consumers (22% in Switzerland and 14% in Vietnam) and suggestible consumers (19% in Switzerland and 25% in Vietnam). Two were specific to each country, namely traditional (19%) and basic (21%) consumers in Switzerland and confident (16%) and anxious (26%) consumers in Vietnam. Conclusion Relying on voluntary actions, nudging techniques, private initiatives and consumers’ sense of responsibility will certainly be useful but will nevertheless be insufficient to achieve a planetary health diet within the given timeframe (the 2030 Agenda for Sustainable Development). Governments will have no choice but to activate all levers within their sphere of influence – including regulatory measures – and oblige private sector actors to commit to the measures imposed on them. A binding international agenda with common objectives and measures is a judicious approach. Unlike most previous studies, which focused on meat consumption intensity and frequency or diet type to segment consumers, our approach, based on psychographic profiles, allows the identification of segments that share common drivers and barriers and thus the development of better-targeted measures to reduce meat consumption.
Article
Full-text available
Introduction Colorectal adenomas are recognized as precursors to colorectal cancer through the adenoma-carcinoma sequence. Identifying modifiable dietary factors that may inhibit cancer progression is critical, but epidemiologic studies in Asian populations are scarce. Methods This study explored the impact of fish and meat intake on colorectal adenoma risk among Koreans. The study enrolled asymptomatic adults who visited Seoul National University Hospital Healthcare System Gangnam Center for health check-ups from May to December 2011. All participants underwent screening colonoscopy and completed a validated food frequency questionnaire. The study included 536 adenoma patients, 135 high-risk adenoma patients and 1,122 adenoma-free controls. Using multivariate logistic regression, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) for fish and meat intake related to colorectal adenoma status, significant at p < 0.05. Results The intake of total fish, meat, red meat, chicken or processed meat showed no clear association with the prevalence of colorectal adenoma after adjusting for age, education, smoking status, alcohol intake, physical activity, body mass index, metabolic syndrome, colorectal cancer family history, total energy intake, and total fruit and vegetable intake. However, higher fish intake was associated with lower odds of high-risk colorectal adenoma, with a significant trend observed across quartiles (P for trend = 0.04). This trend was more pronounced among men than women (P for trend = 0.01). Conclusion In conclusion, we observed a significant inverse association between high fish intake and the prevalence of high-risk adenoma, but there were no clear associations between red and processed meat or chicken in the Korean population.
Article
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.
Article
Full-text available
What is already known about this topic? Red and processed meat consumption has been positively related to an increased risk of diabetes in Western populations. However, the results remain inconclusive within Asian populations. What is added by this report? This dose-response meta-analysis of prospective cohort studies conducted in East Asian populations reveals a positive relation between the consumption of processed meat and increased risk of diabetes. Furthermore, a U-shaped association was identified between the consumption of unprocessed red meat and the risk of diabetes. What are the implications for public health practice? This research presents substantive evidence advocating for the reduction of processed and unprocessed red meat consumption as a viable strategy for mitigating the risk of diabetes in East Asian populations.
Article
Full-text available
Background There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis. Methods We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach. Results In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality. Conclusions Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.
Article
Full-text available
Red meat consumption has been associated with an increased risk of chronic diseases. However, its relationship with mortality remains uncertain. We prospectively observed 37 698 men from the Health Professionals Follow-up Study (1986-2008) and 83 644 women from the Nurses' Health Study (1980-2008) who were free of cardiovascular disease (CVD) and cancer at baseline. Diet was assessed by validated food frequency questionnaires and updated every 4 years. We documented 23 926 deaths (including 5910 CVD and 9464 cancer deaths) during 2.96 million person-years of follow-up. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95% CI) of total mortality for a 1-serving-per-day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat. The corresponding HRs (95% CIs) were 1.18 (1.13-1.23) and 1.21 (1.13-1.31) for CVD mortality and 1.10 (1.06-1.14) and 1.16 (1.09-1.23) for cancer mortality. We estimated that substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat. Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.
Article
Full-text available
The relation between consumption of different types of red meats and risk of type 2 diabetes (T2D) remains uncertain. We evaluated the association between unprocessed and processed red meat consumption and incident T2D in US adults. We followed 37,083 men in the Health Professionals Follow-Up Study (1986-2006), 79,570 women in the Nurses' Health Study I (1980-2008), and 87,504 women in the Nurses' Health Study II (1991-2005). Diet was assessed by validated food-frequency questionnaires, and data were updated every 4 y. Incident T2D was confirmed by a validated supplementary questionnaire. During 4,033,322 person-years of follow-up, we documented 13,759 incident T2D cases. After adjustment for age, BMI, and other lifestyle and dietary risk factors, both unprocessed and processed red meat intakes were positively associated with T2D risk in each cohort (all P-trend <0.001). The pooled HRs (95% CIs) for a one serving/d increase in unprocessed, processed, and total red meat consumption were 1.12 (1.08, 1.16), 1.32 (1.25, 1.40), and 1.14 (1.10, 1.18), respectively. The results were confirmed by a meta-analysis (442,101 participants and 28,228 diabetes cases): the RRs (95% CIs) were 1.19 (1.04, 1.37) and 1.51 (1.25, 1.83) for 100 g unprocessed red meat/d and for 50 g processed red meat/d, respectively. We estimated that substitutions of one serving of nuts, low-fat dairy, and whole grains per day for one serving of red meat per day were associated with a 16-35% lower risk of T2D. Our results suggest that red meat consumption, particularly processed red meat, is associated with an increased risk of T2D.
Article
Full-text available
Although several studies have investigated the association of the Mediterranean diet with overall mortality or risk of specific cancers, data on overall cancer risk are sparse. We examined the association between adherence to Mediterranean dietary pattern and overall cancer risk using data from the European Prospective Investigation Into Cancer and nutrition, a multi-centre prospective cohort study including 142,605 men and 335,873. Adherence to Mediterranean diet was examined using a score (range: 0-9) considering the combined intake of fruits and nuts, vegetables, legumes, cereals, lipids, fish, dairy products, meat products, and alcohol. Association with cancer incidence was assessed through Cox regression modelling, controlling for potential confounders. In all, 9669 incident cancers in men and 21,062 in women were identified. A lower overall cancer risk was found among individuals with greater adherence to Mediterranean diet (hazard ratio=0.96, 95% CI 0.95-0.98) for a two-point increment of the Mediterranean diet score. The apparent inverse association was stronger for smoking-related cancers than for cancers not known to be related to tobacco (P (heterogeneity)=0.008). In all, 4.7% of cancers among men and 2.4% in women would be avoided in this population if study subjects had a greater adherence to Mediterranean dietary pattern. Greater adherence to a Mediterranean dietary pattern could reduce overall cancer risk.
Conference Paper
This article provides interpreted statistics and information on global livestock production and the consumption of animal source foods from the Food and Agriculture Organization of the United Nations statistical data base. Country data are collected through questionnaires sent annually to member countries, magnetic tapes, diskettes, computer transfers, websites of the countries, national/international publications, country visits made by the FAO statisticians and reports of FAO representatives in member countries. These data show that livestock production is growing rapidly, which is interpreted to be the result of the increasing demand for animal products. Although there is a great rise in global livestock production, the pattern of consumption is very uneven. The countries that consume the least amount of meat are in Africa and South Asia. The main determinant of per capita meat consumption appears to be wealth. Overall, there has been a rise in the production of livestock products and this is expected to continue in the future. This is particularly the case in developing countries. The greatest increase is in the production of poultry and pigs, as well as eggs and milk. However, this overall increase obscures the fact that the increased supply is restricted to certain countries and regions, and is not occurring in the poorer African countries. Consumption of ASF is declining in these countries, from an already low level, as population increases.
Article
Human male volunteers were studied in a metabolic facility whilst they were fed randomized controlled diets. In eight volunteers there was a significant increase in faecal apparent total N-nitroso compounds (ATNC) and nitrite excretion (P < 0.0001 and P = 0.046, respectively) when randomized doses of meat were increased from 0 to 60, 240 and 420 g/day over 10 day periods. Mean (± SE) faecal ATNC levels were 54 ± 7 μg/day when the diets contained no meat, 52 ± 11 μg/day when the diets contained 60 g meat/ day, 159 ± 33 μg/day with 240 g meat and 199 ± 36 μg/ day with 420 g meat. Higher concentrations of NOC were associated with longer times of transit in the gut (r = 0.55, P = 0.001) and low faecal weight (r = -0.51, P = 0.004). There was no significant decline in levels in individuals fed 420 g meat for 40 days. The exposures found on the higher meat diets were comparable with other sources of N-nitroso compounds (NOC), such as tobacco smoke. Many NOC are known large bowel initiators and promotors in colon cancer, inducing G→A transitions in codons 12 and 13 of K-ras. Endogenous NOC formation, combined with prolonged transit times in the gut, may explain the epidemiological associations between high meat/low fibre diets and colorectal cancer risk.
Article
Although high or low (no) meat consumption was associated with elevated or reduced mortality from cardiovascular disease, respectively, few studies have investigated the association between moderate meat consumption and cardiovascular disease. We aimed to evaluate the associations between moderate meat consumption and cardiovascular disease mortality. We conducted a prospective cohort study of 51,683 Japanese (20,466 men and 31,217 women) aged 40-79 years living in all of Japan (The Japan Collaborative Cohort Study; JACC Study). Consumptions of meat (beef, pork, poultry, liver and processed meat) were assessed via a food frequency questionnaire administrated at baseline survey. Hazard ratios (HRs) of mortality from cardiovascular disease were estimated from Cox proportional hazards regression models according to quintiles of meat consumption after adjustment for potential confounding variables. During 820,076 person-years of follow-up, we documented 2685 deaths due to total cardiovascular disease including 537 ischemic heart diseases and 1209 strokes. The multivariable HRs (95% confidence interval) for the highest versus lowest quintiles of meat consumption (77.6 versus 10.4 g/day) among men were 0.66 (0.45-0.97) for ischemic heart disease, 1.10 (0.84-1.43) for stroke and 1.00 (0.84-1.20) for total cardiovascular disease. The corresponding HRs (59.9 versus 7.5 g/day) among women were 1.22 (0.81-1.83), 0.91 (0.70-1.19) and 1.07 (0.90-1.28). The associations were similar when the consumptions of red meat, poultry, processed meat and liver were examined separately. Moderate meat consumption, up to ~100 g/day, was not associated with increased mortality from ischemic heart disease, stroke or total cardiovascular disease among either gender.
Article
Higher levels of physical activity have been consistently associated with a decreased risk of colon cancer, but not rectal cancer, in Western populations. The present study systematically evaluated epidemiologic evidence on the association between physical activity and colorectal cancer risk among the Japanese population. Original data were obtained from MEDLINE searched using PubMed or from searches of the Ichushi database, complemented by manual searches. The associations were evaluated based on the strength of evidence, the magnitude of association and biologic plausibility. Two cohort studies and six case-control studies were identified. A weak to strong protective association between physical activity and colon cancer risk was observed in both cohort studies, showing a graded relationship, and among the majority of case-control studies, with some showing a dose-response relationship. The association observed in cohort studies was more consistent and stronger in men than in women and for proximal colon cancer than for distal colon cancer. A protective association with rectal cancer was found only in case-control studies, but the evidence was less consistent and weaker than that observed for colon cancer. Physical activity probably decreases the risk of colorectal cancer among the Japanese population. More specifically, the evidence for the colon is probable, whereas that for the rectum is insufficient.
Article
Cardiovascular disease (CVD) is the leading cause of death worldwide and in most countries outside sub-Saharan Africa. The root causes of this modern epidemic are sedentary stressful urban lifestyles and high-calorie diets rich in saturated fats, salt, and simple sugars. Although the mortality from CVD has long peaked in most developed countries, its prevalence continues to rise because of improved survival and aging of the populations, placing tremendous strains on health care financing in some of these countries. In most Asian and Middle Eastern countries, outside East Asia, prevalence of CVD and its risk factors are high and still rising, while the rising mortality is among the highest in the world. As the predominantly young populations of these countries age, they face inadequate health care systems without assured financial coverage. Effective measures are therefore urgently needed to combat the epidemic of CVD. Comprehensive preventive measures are essential to curb the spread of this epidemic, while health care systems should be structured on the basis of locally derived data to provide adequate affordable care to the ever increasing pools of patients with CVD.