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

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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.
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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.
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MEAT INTAKE AND MORTALITY IN ASIA 1041
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Background: Consumption of unprocessed red meat in randomized trials has no adverse effects on cardiovascular risk factors and body weight, but its physiological effects during weight loss maintenance are not known. Objectives: We sought to investigate the effects of healthy diets that include small or large amounts of red meat on the maintenance of lost weight after successful weight loss, and secondarily on body composition (DXA), resting energy expenditure (REE; indirect calorimetry), and cardiometabolic risk factors. Methods: In this 5-mo parallel randomized intervention trial, 108 adults with BMI 28-40 kg/m2 (45 males/63 females) underwent an 8-wk rapid weight loss period, and those who lost ≥8% body weight (n = 80) continued to ad libitum weight maintenance diets for 12 wk: a moderate-protein diet with 25 g beef/d (B25, n = 45) or a high-protein diet with 150 g beef/d (B150, n = 35). Results: In per protocol analysis (n = 69), mean body weight (-1.2 kg; 95% CI: -2.1, -0.3 kg), mean fat mass (-2.7 kg; 95% CI: -3.4, -2.0 kg), and mean body fat content (-2.6%; 95% CI: -3.1, -2.1%) decreased during the maintenance phase, whereas mean lean mass (1.5 kg; 95% CI: 1.0, 2.0 kg) and mean REE (51 kcal/d; 95% CI: 15, 86 kcal/d) increased, with no differences between groups (all P > 0.05). Results were similar in intention-to-treat analysis with multiple imputation for dropouts (20 from B150 compared with 19 from B25, P = 0.929). Changes in cardiometabolic risk factors were not different between groups, the general pattern being a decrease during weight loss and a return to baseline during weight maintenance (and despite the additional mild reduction in weight and fat mass). Conclusions: Healthy diets consumed ad libitum that contain a little or a lot of unprocessed beef have similar effects on body weight, energy metabolism, and cardiovascular risk factors during the first 3 mo after clinically significant rapid weight loss.
... Of note, we did not observe any association of red meat with overweight/obesity, no matter whether it was in the overall study population or each dietary pattern. A meta-analysis of prospective studies suggested a positive association between red meat with overweight/obesity and weight gain, but three of the four studies used to generate estimates were from western countries, which had a much higher red meat intake than Asian countries, and the remaining one in Chinese population suggested no association of lean red meat with overweight/obesity [81,86]. These findings, together with the present findings, indicated attention should be paid to the selection of meat types and reduction in processed meat intake, especially for those with the typical southern diet. ...
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Regional dietetic cultures were indicated in China, but how dietary patterns geographically varied across China is unknown. Few studies systematically investigated the association of dietary patterns with overweight/obesity and hypertension and the potential mechanism with a national sample. This study included 34,040 adults aged 45 years and older from China Nutrition and Health Surveillance (2015–2017), who had complete outcome data, reliable intakes of calorie and cooking oils, unchanged diet habits, and without diagnosed cancer or cardiovascular disease. Outcomes were overweight/obesity and hypertension. By using the Gaussian finite mixture models, four dietary patterns were identified—common rice-based dietary pattern (CRB), prudent diversified dietary pattern (PD), northern wheat-based dietary pattern (NWB), and southern rice-based dietary pattern (SRB). Geographic variations in dietary patterns were depicted by age–sex standardized proportions of each pattern across 31 provinces in China. We assessed the association of these dietary patterns with outcomes and calculated the proportion mediated (PM) by overweight/obesity in the association of the dietary patterns with hypertension. Evident geographic disparities in dietary patterns across 31 provinces were observed. With CRB as reference group and covariates adjusted, the NWB had higher odds of being overweight/obese (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.36–1.52, p < 0.001) and hypertension (OR = 1.07, 95%CI: 1.01–1.14, p < 0.001, PM = 43.2%), while the SRB and the PD had lower odds of being overweight/obese (ORs = 0.84 and 0.92, 95%CIs: 0.79–0.89 and 0.85–0.99, p < 0.001 for both) and hypertension (ORs = 0.93 and 0.87, 95%CIs: 0.87–0.98 and 0.80–0.94, p = 0.038 for SRB and p < 0.001 for PD, PMs = 27.8% and 9.9%). The highest risk of overweight/obesity in the NWB presented in relatively higher carbohydrate intake (about 60% of energy) and relatively low fat intake (about 20% of energy). The different trends in the association of protein intake with overweight/obesity among dietary patterns were related to differences in animal food sources. In conclusion, the geographic distribution disparities of dietary patterns illustrate the existence of external environment factors and underscore the need for geographic-targeted dietary actions. Optimization of the overall dietary pattern is the key to the management of overweight/obesity and hypertension in China, with the emphasis on reducing low-quality carbohydrate intake, particularly for people with the typical northern diet, and selection of animal foods, particularly for people with the typical southern diet.
... It is necessary to be aware of changes in IHD risk, as significant increases in meat and fat intake could increase the risk of IHD. In a meta-analysis of prospective cohort studies conducted in Asian countries, including Japan, higher red meat consumption reduced the risk of CVD mortality in men [125]. In the past, meat consumption was low in Asian countries, so the increased intake might improve the nutritional balance and reduce the risk. ...
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This systematic review and meta-analysis elucidate the effects of the Japanese-style diet and characteristic Japanese foods on the mortality risk of cardiovascular disease (CVD), cerebrovascular disease (stroke), and heart disease (HD). This review article followed the PRISMA guidelines. A systematic search in PubMed, The Cochrane Library, JDreamIII, and ICHUSHI Web identified prospective cohort studies on Japanese people published till July 2020. The meta-analysis used a random-effects model, and heterogeneity and publication bias were evaluated with I2 statistic and Egger’s test, respectively. Based on inclusion criteria, we extracted 58 articles, including 9 on the Japanese-style diet (n = 469,190) and 49 (n = 2,668,238) on characteristic Japanese foods. With higher adherence to the Japanese-style diet, the pooled risk ratios (RRs) for CVD, stroke, heart disease/ischemic heart disease combined (HD/IHD) mortality were 0.83 (95% CI, 0.77–0.89, I2 = 58%, Egger’s test: p = 0.625, n = 9 studies), 0.80 (95% CI, 0.69–0.93, I2 = 66%, Egger’s test: p = 0.602, n = 6 studies), and 0.81 (95% CI, 0.75–0.88, I2 = 0%, Egger’s test: p = 0.544, n = 6 studies), respectively. Increased consumption of vegetables, fruits, fish, green tea, and milk and dairy products decreased the RR for CVD, stroke, or HD mortality. Increased salt consumption elevated the RR for CVD and stroke mortality. Increased consumption of dietary fiber and plant-derived protein decreased the RR for CVD, stroke, and HD/IHD mortality. The Japanese-style diet and characteristic Japanese foods may reduce CVD mortality. Most studies conducted diet surveys between 1980 and the 1990s. This meta-analysis used articles that evaluated the same cohort study by a different method. A new large-scale cohort study matching the current Japanese dietary habits is needed to confirm these findings.
... Notably, the percentage of energy from carbohydrate (especially high-quality carbohydrate) in our study was higher than that reported in the US (total carbohydrate, 57.1% versus 50.5%; high-quality carbohydrate, 10.6% versus 8.6%, respectively), whereas the percentage of energy from animal protein and saturated fat intake was much lower than the US (animal protein, 7.4% versus 10.4%; saturated fat, 4.9% versus 11.9%, respectively) [3]. Moreover, compared with the US, total per capita consumption of meat in Asians was much lower (49.4 kg/year versus 122.8 kg/year), whereas the percentage of energy from fish/sea food consumption was higher (43.5% versus 26.0%) [27]. Some recent studies showed that fish/seafood consumption was associated with a lower risk of all-cause and CVD mortality in Asians, but not in the US populations [28,29]. ...
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The long-term effects of a low-carbohydrate diet (LCD) on mortality, accounting for the quality and source of the carbohydrate, are unclear. Hence, we examined the associations of LCDs with all-cause and cause-specific mortality in a prospective cohort study. A total of 20,206 participants (13.8% diabetes) aged 50+ years were included. Overall, vegetable-based and meat-based LCD scores were calculated based on the percentage of energy as total and subtypes of carbohydrates, fat, and protein. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During 294,848 person-years of follow-up, 4624 deaths occurred, including 3661 and 963 deaths in participants without and with diabetes, respectively. In all participants, overall LCD score was not associated with all-cause and cause-specific mortality, after multivariable adjustment. However, for the highest versus the lowest quartiles of vegetable-based LCD, the adjusted HRs (95%CIs) of all-cause and CVD mortality were 1.16 (1.05–1.27) and 1.39 (1.19–1.62), respectively. The corresponding values for highest versus lowest quartiles of meat-based LCD for all-cause and CVD mortality were 0.89 (0.81–0.97) and 0.81 (0.70–0.93), respectively. Similar associations were found in participants without diabetes. In patients with diabetes, the adjusted HR (95%CI) of CVD mortality for the highest versus the lowest quartiles of vegetable-based LCD was 1.54 (1.11–2.14). Although there were no significant associations with overall LCD score, we found that the vegetable-based LCD score was positively, whereas the meat-based LCD score was negatively, associated with all-cause and CVD mortality in older Asian people.
... Moreover, compared with the US, total per capita consumption of meat in Asians was much lower (49.4kg/year versus 122.8kg/year), whereas the percentage of energy from sh/sea food consumption was higher (43.5% versus 26.0%) [25]. Some recent studies showed that sh/sea food consumption was associated with lower risk of all-cause and CVD mortality in Asians, but not in the US populations [26,27]. ...
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Background: Studies on long-term effects of low-carbohydrate diet (LCD) on mortality accounting for quality and sources of carbohydrate are unclear. Hence, we examined the associations of LCDs with all-cause and cause-specific mortality in a population-based cohort study. Methods: Prospective study using data from Guangzhou Biobank Cohort Study (GBCS). 20,206 participants (13.8% diabetes) aged 50+ years were recruited from 2003-2006 and followed up until 19 April 2021.Overall, vegetable-based, and meat-based LCD scores were calculated based on the percentage of energy as total and subtypes of carbohydrate, fat and protein. The main outcomes were all-cause, cancer and CVD mortality. Cox regression were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During 294,848 person-years of follow-up, 4,624 deaths occurred, including 3,661 and 963 deaths in participants without and with diabetes, respectively. In all participants, overall LCD score was not associated with all-cause and cause-specific mortality after multivariable adjustment. However, the adjusted HRs (95%CIs) of all-cause and CVD mortality for the highest, versus the lowest, quartiles of vegetable-based were 1.16 (1.05-1.27 Ptrend<0.001) and 1.39 (1.19-1.62 Ptrend<0.001), respectively. Meanwhile, we found that the adjusted HRs (95%CIs) of all-cause and CVD mortality for highest, versus lowest, quartile of meat-based LCD were 0.89 (0.81-0.97 Ptrend=0.007) and 0.81 (0.70-0.93 Ptrend=0.02), respectively. Similar associations were found in participants after excluding those with diabetes. In diabetic patients, there was no association between vegetable-based LCD or meat-based LCD scores and mortality. However, we found a positive association between the highest quartile of vegetable-based LCD score and CVD mortality comparing with the lowest quartile (HR 1.54, 95% CI, 1.11-2.14 Ptrend=0.003). Conclusions: Vegetable-based LCD score was positively and meat-based LCD score was negatively associated with all-cause and CVD mortality. Inconsistencies in the literature on the health effect of LCD may reflect the importance of the geographical context and age-related nutrient composition of the diet.
... The majority of these studies have been conducted in the Western populations with marked differences in socioeconomic status, and food preparation with moderate to high levels of red meat intake, particularly pork (Alshahrani et al. 2019). This leaves the question unanswered whether different quantities and types of meat consumption in Asian populations, with dissimilar confounding factors, might correlate with altered risk for CVD and its mortality (Lee et al. 2013). Similar to other Asian countries, particularly in the Middle East, the existing evidence in the Iranian population does not provide a clear overall association of red and/or processed meat consumption with CVD risk and mortality, therefore, this study was designed to investigate these associations in a large cohort study. ...
Article
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.
... Our findings indicate that animal fat intake is positively associated, whereas vegetable fat intake is negatively associated, with early AMD. In the USA, the main source of animal fat is red meat, and animal fat is rich in SFA [36,37]. High consumption of olive oil and nuts reportedly has a protective effect against AMD [38,39]. ...
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Lifestyle factors may be associated with the development of age-related macular degeneration (AMD), in addition to demographic and genetic factors. The purpose of this cross-sectional study is to elucidate the association between nutrient intake and AMD in the Japanese-American population living in Los Angeles. We conducted a medical survey of Japanese immigrants and their descendants living in Los Angeles, including interviews on dietary habits, fundus photography, and physical examinations. Participants were classified into early AMD and control groups on the basis of fundus photographic findings. Consequently, among the 555 participants, 111 (20.0%) were diagnosed with early AMD. There were no late-stage AMD participants. Multivariate logistic regression analysis showed that the intake of animal fat and saturated fatty acids (SFA) was positively associated with early AMD (p for trend = 0.01 for animal fat, p for trend = 0.02 for SFA), and the intake of vegetable fat, total carbohydrate, simple carbohydrate, sugar, and fructose was inversely associated with early AMD (p for trend = 0.04 for vegetable fat, p for trend = 0.046 for carbohydrate, p for trend = 0.03 for simple carbohydrate, p for trend = 0.046 for sugar, p for trend = 0.02). Our findings suggest that excessive animal fat and SFA intake increases the risk for early AMD in Japanese-Americans whose lifestyles have been westernized.
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Shifts in protein production methods are an emerging challenge toward realizing a sustainable society. This paper aims to examine preferences among Japanese consumers regarding attributes of beef mince and its substitutes, to develop consumer segments based on these preferences, and to explore the segment with higher acceptance of replacement from conventional products. This paper also aims to explain intersegment differences from consumer heterogeneity in human values, scientific literacy, and sociodemographic viewpoints for a deeper understanding of consumer behavior in each segment. The results of an online choice experiment involving 4421 consumers in Japan, using food labels on mince showed that Japanese-origin organic beef was associated with the highest utility among the five production methods mentioned. Five consumer segments were identified with latent class analysis: novelty accepters, generous customers, attribute-economy balancers, price–conscious, and conservatives, which vary in preference in choice behavior, sociodemographic, human values, and scientific literacy.
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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.
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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.
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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.
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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.
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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.
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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.