ArticleLiterature Review

Red Meat and Processed Meat Consumption and All-Cause Mortality: A Meta-Analysis

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Abstract

High consumption of red meat and processed meat has been associated with increased risk of several chronic diseases. We conducted a meta-analysis to summarize the evidence from prospective studies on red meat and processed meat consumption in relationship to all-cause mortality. Pertinent studies were identified by searching PubMed through May 2013 and by reviewing the reference lists of retrieved articles. Prospective studies that reported relative risks with 95% confidence intervals for the association of red meat or processed meat consumption with all-cause mortality were eligible. Study-specific results were combined by using a random-effects model. Nine prospective studies were included in the meta-analysis. The summary relative risks of all-cause mortality for the highest versus the lowest category of consumption were 1.10 (95% confidence interval (CI): 0.98, 1.22; n = 6 studies) for unprocessed red meat, 1.23 (95% CI: 1.17, 1.28; n = 6 studies) for processed meat, and 1.29 (95% CI: 1.24, 1.35; n = 5 studies) for total red meat. In a dose-response meta-analysis, consumption of processed meat and total red meat, but not unprocessed red meat, was statistically significantly positively associated with all-cause mortality in a nonlinear fashion. These results indicate that high consumption of red meat, especially processed meat, may increase all-cause mortality.

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... Several prospective studies have shown that high red meat consumption is associated with elevated risks of all-cause and CVD mortality [11][12][13]; however, inconsistent results have been reported [5,[14][15][16][17][18]. The potential reasons for the heterogeneity among studies include that unprocessed red meat and processed meat might have different types of meat items, which might produce different effects on mortality risk. ...
... For example, a meta-analysis showed that processed meat consumption was associated with higher risks of allcause and CVD mortality, while red meat consumption was not associated with all-cause mortality [14]. Furthermore, in another meta-analysis, the consumption of processed meat and total red meat, but not unprocessed red meat, was positively associated with all-cause mortality [15]. Generally, the association between processed meat and mortality risk was relatively consistent compared with unprocessed red meat [12][13][14][15]. ...
... Furthermore, in another meta-analysis, the consumption of processed meat and total red meat, but not unprocessed red meat, was positively associated with all-cause mortality [15]. Generally, the association between processed meat and mortality risk was relatively consistent compared with unprocessed red meat [12][13][14][15]. ...
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Purpose To investigate the prospective associations between red meat consumption and all-cause and cardiovascular diseases (CVD) mortality, and to assess the modification effects of lifestyle and genetic risk factors. Methods 180,642 individuals free of CVD or cancer were enrolled from 2006 to 2010 and followed up to 2018 in the UK Biobank. Information on demographics, lifestyles, and medical history was collected through a baseline touchscreen questionnaire. The information on diet was collected through a single touchscreen food-frequency questionnaire. A total of ten single-nucleotide polymorphisms were used to calculate the genetic risk score (GRS) of trimethylamine N-oxide (TMAO), a gut microbiota metabolite from red meat. Adjusted Cox proportional hazard regression models were used to assess the association of red meat consumption with mortality. Results We documented 3596 deaths [655 CVD deaths, 285 coronary heart disease (CHD) deaths, and 149 stroke deaths] during median 8.6 years of follow-up. Compared with the lowest red meat intake (< 1.5 times/week), the highest red meat intake (≥ 3.0 times/week) was associated with a 20%, 53%, and 101% elevated risk for CVD, CHD, and stroke mortality (P for trend = 0.04, 0.007, and 0.02, respectively), but not all-cause mortality. We found that the associations between red meat intake and mortality were not modified by dietary and lifestyle factors, as well as TMAO GRS. In addition, substitution analyses showed that a decrease in red meat consumption and an increase in the consumption of poultry or cereal was significantly associated with 9%–16% lower CVD or CHD mortality risk. Conclusion Our results indicated that red meat consumption was associated with higher risks of CVD, CHD, and stroke mortality, and the associations were not modified by lifestyle and genetic risk factors. Replacing red meat by poultry or cereal was related to lower risks of CVD and CHD mortality.
... Twenty-eight studies were further excluded because meta-analyses of RCT (n ¼ 1), narrative/systematic reviews without quantitative evaluation of the association between exposure and outcome (n ¼ 10), pooled analysis of prospective cohort studies (n ¼ 3) and investigating biomarkers (n ¼ 14). Thus, a total number of 23 studies on total meat (Boyd et al. 1993;Sandhu et al. 2001;Norat et al. 2002;Faramawi et al. 2007;Aune et al. 2009;Kolahdooz et al. 2010;Micha et al. 2010;Chan et al. 2011;Wallin et al. 2011;Wang and Jiang 2012;Chen et al. 2013;Salehi et al. 2013;Zhu et al. 2013;Abete et al. 2014;Larsson and Orsini 2014;Liu and Lin 2014;Luo et al. 2014;Zhu et al. 2014;Alexander et al. 2015;Fang et al. 2015;Ge et al. 2015;Wu et al. 2016), 52 studies on red meat (Boyd et al. 1993;Sandhu et al. 2001;Norat et al. 2002; None. None. ...
... Association with increased odds of inflammatory bowel disease. Paluszkiewicz et al. 2012;Wang and Jiang 2012;Aune et al. 2013;Chen et al. 2013;Choi et al. 2013;Huang et al. 2013;Qu et al. 2013;Salehi et al. 2013;Xu et al. 2013;Zhu et al. 2013;Abete et al. 2014;Fallahzadeh et al. 2014;Larsson and Orsini 2014;Li et al. 2014;Luo et al. 2014;Song et al. 2014;Xue et al. 2014;Zhu et al. 2014;Alexander et al. 2015;Bylsma and Alexander 2015;Fang et al. 2015;Guo et al. 2015;Saneei et al. 2015;Yang et al. 2015;Caini et al. 2016;Li et al. 2016;Solimini et al. 2016;Wang et al. 2016;Wu et al. 2016;Yang et al. 2016;Zhao et al. 2016;, and 47 studies on processed meat consumption (Sandhu et al. 2001;Norat et al. 2002;Huncharek et al. 2003;Faramawi et al. 2007;Alexander and Cushing 2009;Aune et al. 2009;Huxley et al. 2009;Alexander, Miller, et al. 2010; Characteristics of the studies on total meat consumption and health outcomes ...
... Two meta-analyses conducted on a limited number of prospective cohort studies (<3) and case-control studies also reported a potential association of high total meat intake and endometrial cancer (significant among case-control studies but not in the only prospective one) (Bandera et al. 2007), inflammatory bowel disease (Ge et al. 2015) and nasopharynx cancer . Most studies reported limited information on potential confounding factors: however, higher risk of colorectal cancer was significant only among European cohorts (Chan et al. 2011), while higher risk of all-cause mortality only among US ones (Larsson and Orsini 2014). Subgroup analyses by sex showed no significant association with risk of colorectal, colon and rectal cancers (Chan et al. 2011). ...
Article
Meat consumption has represented an important evolutionary step for humans. However, modern patterns of consumption, including excess intake, type of meat and cooking method have been the focus of attention as a potential cause of rise in non-communicable diseases. The aim of this study was to investigate the association between total, red and processed meat with health outcomes and to assess the level of evidence by performing a systematic search of meta-analyses of prospective cohort studies. Convincing evidence of the association between increased risk of (i) colorectal adenoma, lung cancer, CHD and stroke, (ii) colorectal adenoma, ovarian, prostate, renal and stomach cancers, CHD and stroke and (iii) colon and bladder cancer was found for excess intake of total, red and processed meat, respectively. Possible negative associations with other health outcomes have been reported. Excess meat consumption may be detrimental to health, with a major impact on cardiometabolic and cancer risk.
... Unprocessed red meat consumption has generally been associated with increased risks of total mortality and CVD (15). In contrast, a meta-analysis of 6 observational studies involving 1,330,352 individuals, with 137,376 deaths, indicated that unprocessed red meat was not associated with an increased risk of mortality (16). Similarly, in a meta-analysis of 17 prospective cohort studies conducted globally, higher unprocessed red meat consumption was not associated with total mortality (HR: 1.05; 95% CI: 0.93, 1.19; P = 0.43) (17). ...
... We found an adverse association between processed meat intake and health outcomes, consistent with meta-analyses of observational studies (17,21,22). A meta-analysis of 9 observational studies, including 1,330,352 individuals and 137,376 deaths, showed 23% higher mortality among higher processed meat consumers (16). The potential adverse impact of processed meat on health may not be entirely due to its saturated fat or cholesterol content as the amounts of these nutrients are similar in processed and unprocessed meats (23). ...
Article
Background Dietary guidelines recommend limiting red meat intake because it is a major source of medium- and long-chain SFAs and is presumed to increase the risk of cardiovascular disease (CVD). Evidence of an association between unprocessed red meat intake and CVD is inconsistent. Objective The study aimed to assess the association of unprocessed red meat, poultry, and processed meat intake with mortality and major CVD. Methods The Prospective Urban Rural Epidemiology (PURE) Study is a cohort of 134,297 individuals enrolled from 21 low-, middle-, and high-income countries. Food intake was recorded using country-specific validated FFQs. The primary outcomes were total mortality and major CVD. HRs were estimated using multivariable Cox frailty models with random intercepts. Results In the PURE study, during 9.5 y of follow-up, we recorded 7789 deaths and 6976 CVD events. Higher unprocessed red meat intake (≥250 g/wk vs. <50 g/wk) was not significantly associated with total mortality (HR: 0.93; 95% CI: 0.85, 1.02; P-trend = 0.14) or major CVD (HR: 1.01; 95% CI: 0.92, 1.11; P-trend = 0.72). Similarly, no association was observed between poultry intake and health outcomes. Higher intake of processed meat (≥150 g/wk vs. 0 g/wk) was associated with higher risk of total mortality (HR: 1.51; 95% CI: 1.08, 2.10; P-trend = 0.009) and major CVD (HR: 1.46; 95% CI: 1.08, 1.98; P-trend = 0.004). Conclusions In a large multinational prospective study, we did not find significant associations between unprocessed red meat and poultry intake and mortality or major CVD. Conversely, a higher intake of processed meat was associated with a higher risk of mortality and major CVD.
... Similar results were found for red meat in a large American cohort [4] but not in another American cohort [6], and not in European cohorts [6,28]. Three meta-analyses showed no associations between red meat intake and all-cause mortality risk [5,6,29], while one meta-analysis showed that each additional intake of 100 g red meat/day was positively associated with all-cause mortality [30]. ...
... In contrast to our results, in a European cohort including Denmark, intake of processed meat was positively associated with all-cause mortality [28], which was also the result of four meta-analyses [5,6,29,30]. ...
Article
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Meat intake has been linked to increased risk of colorectal cancer (CRC) and mortality. However, diet composition may affect the risks. We aimed to estimate associations between red and processed meat and poultry intake and risk of CRC and all-cause mortality and if they are modified by dietary quality using Cox regression analyses. Baseline dietary data were obtained from three survey rounds of the Danish National Survey on Diet and Physical Activity. Data on CRC and all-cause mortality were extracted from national registers. The cohort was followed from date of survey interview—or for CRC, from age 50 years, whichever came last, until 31 December 2017. Meat intake was analysed categorically and continuously, and stratified by dietary quality for 15–75-year-old Danes at baseline, n 6282 for CRC and n 9848 for mortality analyses. We found no significant association between red and processed meat intake and CRC risk. For poultry, increased CRC risk for high versus low intake (HR 1.62; 95%CI 1.13–2.31) was found, but not when examining risk change per 100 g increased intake. We showed no association between meat intake and all-cause mortality. The association between meat intake and CRC or mortality risk was not modified by dietary quality.
... Elucidating the association of meat intake with overall mortality will aid in assessing the differential impact of meat intake on health among Asians. Current reporting of summary estimates of the link between meat consumption and mortality has primarily been obtained from Western populations [10][11][12][13], where meat intake is considerably higher than that in Asian populations. Evidence from Japan is scarce: only a few studies have reported the association of meat intake on mortality [2,3,14,15] and the results are in any case disconcordant. ...
... Compared with subjects in the lowest quartile of total meat intake, men in the highest quartile had 18% higher risk of dying from all causes, although the associations were not doseresponsive. Our results agree with a 2014 meta-analysis of nine prospective cohort studies in the US, Europe and China, although total red meat intake in that review increased the risk of all-cause mortality by 29% in the highest intake category [10] compared with 18% in our study. This difference in the magnitude of risk increase is because the analyses in both studies were performed using relative consumption categories rather than absolute consumption amounts. ...
Article
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Purpose We examined the association between meat intake and mortality due to all-cause and major causes of death using a population-based cohort study in Japan. Methods 87,507 Japanese aged between 45 and 74 years old at 5-year follow-up study were followed for 14.0 years on average. Associations between meat intake and mortality risk were assessed using a Cox proportional hazards model. Results A heavy intake of total meat was associated with a higher risk of all-cause mortality relative to the lowest quartile intake in men (Q4: HR,1.18; 95%CIs, 1.06–1.31). A higher intake of total meat was associated with a lower risk of stroke mortality in women (Q2: HR, 0.70; 95%CIs, 0.51–0.94, Q3: HR, 0.68; 95%CIs, 0.50–0.95, Q4: HR, 0.66; 95%CIs, 0.44–0.99). A heavy intake of red meat was also associated with all-cause mortality (Q4: HR, 1.13; 95%CIs, 1.02–1.26) and heart disease mortality (Q4: HR, 1.51; 95%CIs, 1.11–2.06) in men but not in women. Heavy intake of chicken was inversely associated with cancer mortality in men. Conclusions Heavy intakes of total and red meat were associated with an increase in all-cause and heart disease mortality in men, while total meat intake was associated with a lower risk of stroke mortality in women.
... Meat also contains polycyclic aromatic hydrocarbons and heterocyclic aromatic amines, two groups of compounds recognized as carcinogenic [39]. Indeed, consumption of red meat has been associated with an increased risk of diverse types of cancers, including breast, endometrial, colorectal, colon, rectal, lung, and hepatocellular, while highly processed meat consumption has been linked to a higher risk of developing breast, colorectal, and lung cancers [34], as well as increased mortality [35,[40][41][42]. In addition, proteins from animal sources increase the dietary acid load, triggering acid-base balance towards acidosis, which has been associated with insulin resistance, impaired glucose homeostasis, and with a higher risk of urolithiasis [43,44]. ...
... Because the consumption of meat, in particular red and processed meat, has been associated with increased mortality and other harmful health outcomes [34,35,[40][41][42], it is challenging to elucidate if the eventual benefit of vegetarian diets stems from the conspicuous consumption of plant foods, the absence of meat consumption, or the replacement of meat by other types of food. Regardless, vegetarian diets continue to be reported as associated with health benefits. ...
Article
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A number of factors contribute to the complex process of aging, which finally define whether someone will or not develop age-associated chronic diseases in late life. These determinants comprise genetic susceptibility as well as various behavioral, environmental, and dietary factors, all of which have been shown to influence specific pathways regulating the aging process and the extension of life, which makes longevity a multidimensional phenomenon. Although a “miraculous elixir” or a “nutrition pill” are not plausible, researchers agree on the notion that nutritional factors have major impact on the risk of age-associated chronic non-communicable diseases and mortality. In recent years nutrition research in relation to health outcomes has considerably changed from focusing exclusively on single nutrients to considering combinations of foods rather than nutrients in isolation. Although research on specific nutrients is scientifically valid providing crucial evidence on the mechanisms by which nutrition impacts health, the recent switch targeting the multifaceted synergistic interplay among nutrients, other dietary constituents, and whole foods, has promoted emerging interest on the actions of total dietary patterns. This narrative review aims to describe some specific dietary patterns with evidence of associations with reduction in the incidence of chronic diseases allowing older adults to live a long-lasting and healthier life, and confirming the powerful impact nutrition can exert on healthy aging.
... However, when type of meat consumed is analyzed disjointedly, different associations have been observed. In fact, while several reviews and meta-analyses have convincingly shown a positive association between red and processed meat consumption and risk of all-cause mortality [7,[12][13][14][15], incidence of CVD, diabetes and some types of cancers [16][17][18][19][20][21], the association of white meat with mortality and morbidity for NCD is not clearly established [11,15,22,23]. There is evidence that the substitution of one daily serving of red meat with white meat, mainly poultry, is associated with a 19% reduction of cardiovascular risk [24], but this finding was not confirmed by other studies [11,15,22]. ...
... Diet is one of the major modifiable factors that affect disease risk, thus it is of the greatest importance to identify dietary habits that decrease the risk of disease and death. The relationship of red and processed meat consumption with increased risk of all-cause death and incidence of CVD has been consistently demonstrated [5,10,[12][13][14][15]17,31,[37][38][39]41,42,46]; however, it remains unclear whether the adverse health effects associated with red and processed meat consumption are also shared by white meat [11,15,22,23]. We conducted a comprehensive meta-analysis of cohort studies exploring the relationship between withe meat consumption, total mortality and incident CV events (fatal or nonfatal). ...
Article
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The association of meat consumption with mortality and morbidity for non-communicable diseases has been extensively studied. However, the relation of white meat consumption with health outcomes remains controversial. The present meta-analysis was conducted to comprehensively analyze the available evidence on the consistency and strength of the association between the consumption of white meat, death from any cause and incidence of fatal and non-fatal cardiovascular (CV) events. PubMed, Web of Science, Scopus and Embase databases were searched for articles published up to April 30, 2020. We included prospective cohort studies reporting relative risks and pertinent 95% confidence intervals (CI) for all-cause mortality and/or CV events (fatal or non-fatal). A total of 22 studies were included in the meta-analysis. Eleven studies (14 data sets) reported data on all-cause mortality, 10 studies (15 datasets) on cardiovascular disease (CVD) mortality and 10 studies (11 datasets) on non-fatal CV events. When comparing the highest versus the lowest consumption of white meat, the pooled OR and pertinent 95% CI were 0.94 (0.90, 0.97, p < 0.001) for all-cause mortality, 0.95 (0.89, 1.01, p = 0.13) for CV mortality, and 0.99 (0.95, 1.02, p = 0.48) for non-fatal CV events. In conclusion, the study shows for the first time a robust and inverse association between white meat consumption and all-cause mortality and a neutral association with CV mortality and morbidity. This highlights the importance of differentiating the meat types for what concerns their health effects and suggests that white meat might be a healthier alternative to read and processed meat consumption.
... This transition is well demonstrated by evidence from LMICs (59), and, with increasing prosperity, population growth, and aging, it is expected that the NCD burden will continue to increase in the absence of strong preventive actions (26). This dietary pattern has direct implications for NCDs, promoting obesity, cardiovascular disease, diabetes, and some cancers (5,15,80,106,107). It also has environmental impacts that, in turn, may loop back to exert indirect impacts on human health. ...
... However, these surveillance studies have limited input in instituting proper food controls. Intake of meat entails consumption of both the unprocessed and processed products, subjected to various traditional or modern processing techniques (Larsson and Orsini 2014); with a variation in the intensity of risks posed due to processing and final product. The susceptibility of this delicacy to contaminants and the denouement of intake of these hazards necessitate the instituting of evidence-based controls to decipher and lower the risks posed. ...
Article
Prevalent risks in meat value-chains of sub-Saharan African (SSA) countries are increasingly attributed to microbial rather than chemical hazards. Resource constraints and lack of capacity has limited the utilization of risk assessment tools in the instituting of food controls to mitigate the risks. The review sought to bring to light the focus of risk assessment studies in SSA while generating evidence of feasible options to further the contribution of this component in risk mitigation. The informal street vending sector emerges as a priority in the meat value chain with a vendor population that are unwilling to abandon it. Campylobacter and Staphylococcus aureus are prevalent risks that have bedeviled this sector. However, limited risk assessment studies with capacity to inform proper food controls for the sector have been done. Evidence in place indicate that the incorporation of qualitative aspects in quantitative approaches serve as less-costly and effective ways of generating risk estimates. Limitations of capacity and gaps in epidemiological data are also circumvented. Considering that the street-vending sector is robust and its dynamics of operation are not fully in the picture of policy actors; incorporation of a participatory approach that combines qualitative and quantitative aspects of risk assessment is highly recommended.
... Epidemiologic studies have linked Western dietary patterns that are high in the consumption of animal products, processed foods, refined sugars, and fats with escalating rates of chronic diseases. Red and processed meat consumption, in particular, has been associated with increased risks of heart disease and type 2 diabetes (Micha et al., 2012), stroke (Kaluza et al., 2012), certain cancers (particularly colorectal) (IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2018), and allcause mortality (Pan et al., 2012;Larsson and Orsini, 2014;Zheng et al., 2019). A nascent body of exploratory literature suggests that the consumption of certain compounds in animal foods (e.g., Lcarnitine, found primarily in red meat) may promote the growth of intestinal microbiota that produce metabolites associated with an increased risk for cardiovascular disease and inflammatory bowel disease (Koeth et al., 2013(Koeth et al., , 2019. ...
Article
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Over the past decade, there has been growing interest in the development and production of plant-based and cell-based alternatives to farmed meat. Although promoted for their capacity to avoid or reduce the environmental, animal welfare, and, in some cases, public health problems associated with farmed meat production and consumption, little research has critically evaluated the broader potential public health and food systems implications associated with meat alternatives. This review explores key public health, environmental, animal welfare, economic, and policy implications related to the production and consumption of plant-based meat substitutes and cell-based meats, and how they compare to those associated with farmed meat production. Based on the limited evidence to date, it is unknown whether replacing farmed meats with plant-based substitutes would offer comparable nutritional or chronic disease reduction benefits as replacing meats with whole legumes. Production of plant-based substitutes, however, may involve smaller environmental impacts compared to the production of farmed meats, though the relative impacts differ significantly depending on the type of products under comparison. Research to date suggests that many of the purported environmental and health benefits of cell-based meat are largely speculative. Demand for both plant-based substitutes and cell-based meats may significantly reduce dependence on livestock to be raised and slaughtered for meat production, although cell-based meats will require further technological developments to completely remove animal-based inputs. The broader socioeconomic and political implications of replacing farmed meat with meat alternatives merit further research. An additional factor to consider is that much of the existing research on plant-based substitutes and cell-based meats has been funded or commissioned by companies developing these products, or by other organizations promoting these products. This review has revealed a number of research gaps that merit further exploration, ideally with independently funded peer-reviewed studies, to further inform the conversation around the development and commercialization of plant-based substitutes and cell-based meats.
... Epidemiological evidence suggests that the Mediterranean diet, characterised by an abundance of fruits, vegetables, fish, legumes, olive oil and wholegrains, is an optimal diet for promoting longevity and preventing chronic ageing-related disease (1) . Conversely, eating a more traditional or processed diet has been linked to poorer health outcomes and an increased risk of mortality (2)(3)(4) . Assessing the relationship between diet and risk of mortality is of scientific interest because it can shed light on the possible health benefits gained by adhering to certain dietary patterns and therefore has the potential to translate into public health recommendations for reducing the risk of premature death. ...
Article
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Objective: To prospectively evaluate the association of three dietary patterns: the MIND (Mediterranean-DASH diet intervention for Neurodegenerative Delay) diet; a Mediterranean-type diet and a traditional diet, with all-cause mortality over a 12-year period in an older sample. Design: A longitudinal birth cohort study. We ascertained dietary patterns using FFQ data at baseline (2004-2007) and mortality using linkage data. Cox regression was used to estimate mortality hazard ratios (HR) with adjustment for confounders. Setting: The Lothian Birth Cohort 1936 (LBC1936) study in Edinburgh, Scotland. Participants: Dietary patterns were ascertained in 882 participants, mean age 69·5 (±0·8) years, at baseline. During the 12-year follow-up (to October 2019), 206 deaths occurred. Results: In the basic-adjusted model, all three dietary patterns were significantly associated with mortality, the MIND diet and Mediterranean-type diet with a lower risk and the traditional diet with a higher risk. In fully adjusted models, MIND diet score was inversely related to all-cause mortality (HR 0·88; 95 % CI 0·79, 0·97) such that the risk of death was reduced by 12 % per unit increase in MIND diet score. Participants in the top compared with the bottom third of MIND diet score had a 37 % lower risk of death (HR 0·63; 95 % CI 0·41, 0·96). No significant associations with the Mediterranean-type or traditional dietary patterns were observed in the final multivariate model. Conclusions: Our findings suggest that closer adherence to the MIND diet is associated with a significantly lower risk of all-cause mortality, over 12 years of follow-up, and may constitute a valid public health recommendation for prolonged survival.
... There is strong evidence linking red and processed meat intake with increased risk of diabetes, cardiovascular disease, cancer mortality, and total mortality. 43,44 Furthermore, it is well known that food production places an enormous demand on natural resources and is a major source of greenhouse gas emissions, with meat and dairy accounting for almost half of all food-related emissions. 45,46 Thus, considering the emphasis placed by MDPAG in a healthy eating pattern that supports environmentally sustainable food systems, reducing red meat consumption is advisable, particularly for adults. ...
Article
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Objective. To estimate energy contribution (EC) of food groups in 2016, to compare consumption against Mexican Dietary Guidelines, and to examine changes in EC from 2012 to 2016. Materials and methods. We analyzed 24-hour dietary recalls from the 2012 and 2016 National Health and Nutrition Surveys (Ensanut). Foods and beverages were clas­sified into eight food groups: cereals, legumes, dairy, meats, fruit and vegetables, fats and oils, sugar-sweetened beverages, and high in saturated fat and added sugar (HSFAS) products. Results. Cereals had the highest EC (30.1%), followed by meats (15.9%), HSFAS products (15.5%), and SSBs (10.5%). Fruits and vegetables, and legumes had the lowest contribu­tion with 6.4 and 3.8%, respectively. SSBs, meats, and HSFAS products were 250, 59 and 55% above the recommended intake, respectively. Conclusions. This analysis confirms the need to generate a food environment conducive to a healthier diet.
... Associations with adverse health effects in humans are also present when looking at food groups. For instance, although a high intake of meat in general is associated with an increased risk for several health outcomes [15][16][17][18][19], processed meat shows a much stronger association [20][21][22][23]. Intake of whole grains is associated with a reduced risk of several non-communicable diseases, as opposed to refined grains [24,25] . ...
Preprint
The dietary pattern that characterizes the Western diet is strongly associated with obesity and related metabolic diseases, but biological mechanisms supporting these associations remain largely unknown. We argue that the Western diet promotes inflammation that arises from both structural and behavioral changes in the resident microbiome. The environment created in the gut by ultra-processed foods, a hallmark of the Western diet, is an evolutionarily unique selection ground for microbes that can promote diverse forms of inflammatory disease. Recognizing the importance of the microbiome in the development of diet-related disease has implications for future research, public dietary advice as well as food production practices. Research into food patterns suggests that whole foods are a common denominator of diets associated with a low level of diet-related disease. Hence, by studying how ultra-processing changes the properties of whole foods and how these foods affect the gut microbiome, more useful dietary guidelines can be made. Innovations in food production should be focusing on enabling health in the super-organism of man and microbe, and stronger regulation of potentially hazardous components of food products is warranted.
... in general is associated with increased risk of several health outcomes [15][16][17][18][19], processed meat shows much stronger associations [20][21][22][23]. Intake of whole grains is associated with reduced risk of several non-communicable diseases, as opposed to refined grains [24,25]. ...
Preprint
The dietary pattern that characterizes the Western diet is strongly associated with obesity and related metabolic diseases, but biological mechanisms supporting these associations remain largely unknown. We argue that the Western diet is promoting inflammation that arises from both structural and behavioral changes in the resident microbiome. The environment created in the gut by ultra-processed foods, a hallmark of the Western diet, is an evolutionarily unique selection ground for microbes that can promote diverse forms of inflammatory disease. Recognizing the importance of the microbiome in the development of diet-related disease has implications for future research, public dietary advice as well as food production practices. Research into food patterns suggest that whole foods is a common denominator of diets associated with a low level of diet-related disease. Hence, by studying how ultra-processing changes properties of whole foods and how these foods affect the gut microbiome, more useful dietary guidelines can be made. Innovations in food production should be focusing on enabling health in the super-organism of man and microbe, and stronger regulation of potentially hazardous components of food products is warranted.
... The health implications of red meat consumption are of great public interest (5)(6)(7)(8). Based on evidence predominantly from white populations (9)(10)(11)(12)(13)(14)(15)(16)(17), the WHO stated that red meat in general is "probably carcinogenic" to humans and processed red meat is "carcinogenic" (18). The 2015 committee for US dietary guidelines recommended that Americans cut down on red meat and processed red meat consumption (19), but some argue that lean beef can be part of a healthy diet (20). ...
Article
Background: Red meat is a rich source of nutrients but is typically high in saturated fats. Carcinogenic chemicals can be formed during cooking and processing. Little is known about the relation of red meat consumption to mortality in African Americans (AAs), a group with excess mortality and high consumption of red meat relative to whites. Objective: Our objective was to assess the association between red meat consumption and mortality in AA women. Methods: The Black Women's Health Study (BWHS) is a prospective cohort study of AA women across the USA who completed health questionnaires at enrollment in 1995 (median age 38 y, median BMI 27.9 kg/m2) and every 2 y thereafter. The analyses included 56,314 women who completed a validated FFQ and were free of cardiovascular disease and cancer at baseline in 1995. Exposures were total red meat, processed red meat, and unprocessed red meat consumption. Outcomes were all-cause and cause-specific mortality. Cox proportional hazards models with control for age, socioeconomic status, lifestyle factors, medical history, and dietary factors were used to estimate HRs with 95% CIs. Results: During 22 y of follow-up through to 2017, we identified 5054 deaths, which included 1354 cardiovascular deaths and 1801 cancer deaths. The HR for all-cause mortality was 1.47 (95% CI: 1.33, 1.62) for the highest quintile of total red meat consumption relative to the lowest. Each 1 serving/d increase in red meat consumption was associated with a 7% (95% CI: 5%, 9%) increased risk of all-cause mortality. Red meat consumption was also associated with increased cardiovascular mortality, but not with cancer mortality. Results were similar for the consumption of processed and unprocessed red meat. Conclusions: Red meat consumption is associated with increased all-cause and cardiovascular mortality among AA women.
... Large, prospective US and European cohort studies and meta-analyses of epidemiological studies reported that long-term consumption of red meat, particularly processed meat, can lead to an increased risk of overall mortality, cardiovascular disease, colorectal cancer, and type 2 diabetes in both men and women [6]. The World Cancer Research Fund recommends not to eat more than 500 g (cooked weight) of red meat per week and to avoid processed meats to reduce cancer risk [7]. A meta-analysis study showed that consumption of unprocessed red meat (100 g/day) and processed meat (50 g/day) increased the risk of colorectal cancer by 17 percent and 18 percent, respectively [8]. ...
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A diet containing cholesterol is an essential component of biological function; however, cholesterol oxidation products (COPs) remain a major public health concern. This study investigated the effects of cooking methods (boiling and frying) on the production levels of COPs in processed foods. Samples, as represented by minced beef, chicken sausages, and fish fillets, were subjected to different cooking methods followed by COP extraction using a saponification method. Then, six common COPs, 5α-cholest, α-epoxy, β-epoxy, 25-HC, triol, and 7-keto, were quantified by triple quadrupole gas chromatography–mass spectrometry (GS-MS/MS). A significantly high number of COPs were detected in minced meat, of which 7-keto and triol were detected as major oxidation products, followed by chicken sausages and fish fillets (p ≤ 0.05). Compared to boiling, frying generated significantly more COPs, specifically triol (0.001–0.004 mg/kg) and 7-keto (0.001–0.200 mg/kg), in all samples. Interestingly, cholesterol level was found to be slightly (but not significantly) decreased in heat-treated samples due to oxidation during cooking, producing a higher number of COPs. Notably, the fish fillets were found to produce the fewest COPs due to the presence of a low amount of cholesterol and unsaturated fatty acids. In conclusion, adapting boiling as a way of cooking and choosing the right type of meat could serve to reduce COPs in processed foods.
... The reason for this may be common knowledge that white meat is healthier than red meat. Many studies have reported that red meat consumption is associated with an increased risk of cardiovascular disease (Cross 2012, Larsson and Orsini 2013, McAfee et al 2010, Babio et al 2012. In contrast, Micha et al (2010) indicated that consumption of processed meats, but not red meats, is associated with higher incidence of CVD. ...
... Although protein from meat, poultry, fish, dairy and eggs have optimal amino acid composition and high digestibility, the majority of large-scale animal protein production practices raise environmental concerns [2,3]. Moreover, dietary patterns characterised by frequent consumption of meat-the leading source of protein in the Western world [4]-have been associated with increased risk of cardiovascular disease, metabolic syndrome, some forms of cancers and premature mortality [5][6][7][8][9][10][11][12][13][14][15][16]. Consumer interest in plant-based eating has also been steadily increasing globally. ...
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The potential beneficial effects of plant-based diets on human health have been extensively studied. However, the evidence regarding the health effects of extracted plant-based proteins as functional ingredients, other than soya, is scarce. The aim of this review was to compile evidence on the effects of extracted protein from a wide range of traditional and novel plant sources on glycemic responses, appetite, body weight, metabolic, cardiovascular and muscle health. A comprehensive search of PubMed, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL) was conducted through 23 and 27 March 2020 for randomized controlled trials that featured any of the following 18 plant protein sources: alfalfa, duckweed, buckwheat, chickpea, fava bean, hemp, lentil, lupin, mushroom, oat, pea, potato, pumpkin, quinoa, rapeseed, rice, sacha inchi, sunflower. Only interventions that investigated concentrated, isolated or hydrolysed forms of dietary protein were included. Searched health outcome measures were: change in blood glucose, insulin, satiety hormones concentration, subjective assessment of appetite/satiety, change in blood lipids concentration, blood pressure, body weight and muscle health parameters. Acute and sub-chronic studies were considered for inclusion. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach we identified 1190 records. Twenty-six studies met the inclusion criteria. Plant protein sources used in interventions were most often pea (n = 16), followed by lupin (n = 4), fava bean (n = 2), rice (n = 2), oat (n = 2), hemp (n = 2) and lentil (n = 1). Satiety and postprandial glycemic response were the most frequently reported health outcomes (n = 18), followed by blood lipids (n = 6), muscle health (n = 5), body weight (n = 5) and blood pressure (n = 4). No studies on the remaining plant proteins in the extracted form were identified through the search. Most studies confirmed the health-promoting effect of identified extracted plant protein sources across glycemic, appetite, cardiovascular and muscular outcomes when compared to baseline or non-protein control. However, the current evidence is still not sufficient to formulate explicit dietary recommendations. In general, the effects of plant protein were comparable (but not superior) to protein originating from animals. This is still a promising finding, suggesting that the desired health effects can be achieved with more sustainable, plant alternatives. More methodologically homogenous research is needed to formulate and validate evidence-based health claims for plant protein ingredients. The relevance of these findings are discussed for the food sector with supporting market trends.
... The consumption of animal protein, specifically red and processed meat, is associated with higher all-cause, cardiovascular and cancer-related mortality compared to plant protein. [30][31][32][33][34][35][36][37][38][39][40][41] In a large US cohort, red and processed meats were associated with nine causes of death, with the strongest correlation being for mortality from chronic liver disease. 34 High animal protein intake is also associated with NAFLD in overweight Caucasians independent of sociodemographic, lifestyle and metabolic traits. ...
Article
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Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and affects approximately one third of adults in the United States. The disease is becoming a global epidemic as a result of the rising rates of obesity and metabolic disease. Emerging data suggest weight loss of ≥10% overall body weight is beneficial in resolving steatosis and reversing fibrosis. Prospective trials comparing various diets are limited by lack of sufficient power as well as pre- and post-treatment histopathology, and therefore no specific diet is recommended at this time. In this narrative review we examine the pathophysiology behind specific macronutrient components that can either promote or reverse NAFLD to help inform more specific dietary recommendations. Overall, the data supports reducing saturated fat, refined carbohydrates, and red and processed meats in the diet, and increasing the consumption of plant-based foods. Diets that incorporate these recommendations include plant-based diets such as the Dietary Approaches to Stop Hypertension, Mediterranean, vegetarian, and vegan diets.
... and animal-welfare reasons(Espinosa, 2019, e.g.). Reducing meat consumption can sharply reduce greenhouse gas emissions(Tilman & Clark, 2014;Aleksandrowicz et al., 2016;Springmann et al., 2016) and deforestation(Erb et al., 2016), and can improve health and reduce health-care costs(Berners-Lee et al., 2012;Hu et al., 2000;Song et al., 2004;Schulze et al., 2005;Aune et al., 2009;Sinha et al., 2009;Elwood et al., 2010;Pan et al., 2011Pan et al., , 2012Micha et al., 2012;Larsson & Orsini, 2013;Orlich et al., 2013). ...
Article
We develop a method to assess population knowledge about any given topic. We define, and rationalize, types of beliefs that form the ‘knowledge spectrum’. Using a sample of over 7000 UK residents, we estimate these beliefs with respect to three topics: an animal-based diet, alcohol consumption and immigration. We construct an information-campaign effectiveness index (ICEI) that predicts the success of an information campaign. Information resistance is greatest for animal-based diets, and the ICEI is highest for immigration. We test the predictive power of our ICEI by simulating information campaigns, which produces supportive evidence. Our method can be used by any government or company that wants to explore the success of an information campaign.
... Additionally, five studies included red and processed meat as a detrimental component in their index as opposed to one all-encompassing component for meat [20,[32][33][34]36]. In general adult populations, red and processed meat consumption increases the risk of CVD and all-cause mortality [66,67], particularly in comparison to white-meat (e.g., poultry) [60,66]. Although comparatively research during pregnancy is limited, research has shown the higher pre-pregnancy consumption of a Western dietary pattern, explained largely by red and processed meat products, was associated with increased risk of GDM in comparison to a more prudent dietary pattern, featuring high intakes of vegetables and fruit as well as poultry and fish [68]. ...
Article
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Currently, many a priori indexes are being used to assess maternal adherence to the Mediterranean diet (MD) during pregnancy but each with different components, cut-off points, and scoring systems. This narrative review aimed to identify all observational studies utilizing a priori indexes to assess maternal adherence to the MD during pregnancy. A systematic search was conducted in Pubmed until 1 July 2020. Among the 27 studies included, eight different a priori indexes were identified. Studies included a range of 5 to 13 dietary components in their indexes. Only three dietary components—vegetables, fruits, and fish—were common among all indexes. Dairy and alcohol were the only two components modified for pregnancy. All but one study either excluded alcohol from their index or reversed its scoring to contribute to decreased adherence to the MD. Approximately half of the studies established cut-off points based on the distribution of the study population; the others utilized fixed criteria. This review emphasizes the incongruent definitions of the MD impairing effective comparison among studies relating to maternal or offspring health outcomes. Future research should carefully consider the heterogeneous definitions of the MD in a priori indexes and the relevance of incorporating pregnancy-specific nutritional requirements.
... Their conclusions were based upon a systematic review, including a meta-analysis, carried out in-line with the PROSPERO protocol (Zeraatkar et al., 2017). Their general recommendation that adults can continue their current meat consumption, however, conflicts with almost all other similar studies to date (Chan et al., 2011;Larsson and Orsini, 2014;Wang et al., 2016). The results also sparked a heated debate among the scientific community, 1 with criticism of the interpretation and exclusion of environmental impacts. 2 An editorial in the same journal later advocated that ethical concerns about animal welfare and environment impacts related to beef would provide better arguments for reduced meat consumption, rather than health concerns (Carroll and Doherty, 2019). ...
Article
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Systematic reviews, sometimes including meta-analyses, are often presented as an approach for identifying healthy and sustainable diets. Here we explore to which extent systematic review protocols have been adopted by studies comparing environmental impacts of foods based on Life Cycle Assessment (LCA) results, and to which extent they comply with the PRISMA protocol for transparent reporting. Out of 224 studies screened, seven explicitly define themselves as systematic reviews, and/or claim to carry out meta-analyses. Of these, only one acknowledges a review protocol, while none complies with all the PRISMA criteria. Neither do we believe that reviews of LCA results can comply with all the criteria or carry out meta-analyses, due to underreporting on standard deviations and artificial sample sizes in LCAs. Nonetheless, reviews of food commodities and diets based on LCA results would benefit from better aligning with criteria in systematic review protocols.
... Often referred to as the "stealth intervention" approach, Robinson's (2010) theory of process motivation posits that health-beneficial interventions may be more effective by focusing on other rewarding aspects of a behavior-such as enjoyment or participation in a social movement-rather than health outcomes [38]. In the current study, students who took the Foodprint seminar were likely motivated to reduce their environmental footprint, which supported the reported adoption of health-beneficial dietary changes, such as increased vegetable intake and decreased red meat intake [39][40][41][42][43]. Intervention students also reported decreasing sugar-sweetened beverage intake and increasing intention to limit processed/fast food, both of which may protect against weight gain and chronic disease [44][45][46][47]. ...
Article
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Background: Dietary patterns affect both human health and environmental sustainability. Prior research found a ten-unit course on food systems and environmental sustainability shifted dietary intake and reduced dietary carbon footprint among college students. This research evaluated the impact of a similar, more scalable one-unit Foodprint seminar taught at multiple universities. Methods: We used a quasi-experimental pre-post nonequivalent comparison group design (n = 176). As part of the Menus of Change University Research Collaborative, research was conducted at three university campuses in California over four academic terms. All campuses used the same curriculum, which incorporates academic readings, group discussions, and skills-based exercises to evaluate the environmental footprint of different foods. The comparison group comprised students taking unrelated one-unit courses at the same universities. A questionnaire was administered at the beginning and end of each term. Results: Students who took the Foodprint seminar significantly improved their reported vegetable intake by 4.7 weekly servings relative to the comparison group. They also reported significantly decreasing intake of ruminant meat and sugar-sweetened beverages. As a result of dietary shifts, Foodprint seminar students were estimated to have significantly decreased their dietary carbon footprint by 14%. Conclusions: A scalable, one-unit Foodprint seminar may simultaneously promote environmental sustainability and human health.
... Americans are, however, encouraged to limit consumption of red meat and in particular processed meat [1], largely based on concerns of chronic disease risk observed in epidemiological studies [5][6][7][8]. Some evidence suggests that adverse effects of meat intake may be attributed to processed meat rather than total meat [9,10], and evidence indicates that effects vary based on the comparator diet [11]. ...
Article
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Background Dietary patterns developed by the USDA provide modest levels of protein (14–18% energy) within the Acceptable Macronutrient Distribution Range (AMDR) of 10–35% for adults, though diets providing a higher percentage of energy may be beneficial for some individuals. The purpose of this study was to determine if it is feasible to modify the Healthy U.S.-Style Eating Pattern (“HEP”) to provide a higher percentage of energy from protein. Methods Using the framework implemented by the USDA in developing the HEP, energy from protein was set at 20%, 25%, and 30%. Amounts of protein foods were proportionally increased while amounts of other foods were adjusted iteratively within specified parameters. The models also disaggregated total meat/poultry into fresh and processed forms to develop patterns maintaining current proportions, current levels, reduced, or no processed meat/poultry. Nutrient intakes were compared with nutrient goals for representative U.S. populations with 2,000 kcal needs (females 19–30 years, males 51–70 years), with 90% of the Recommended Dietary Allowance or Adequate Intake regarded as sufficient. Results Dietary patterns with 20% energy from protein were constructed with minor deviations from the current 2,000 kcal HEP. Dietary patterns with 25% energy from protein were constructed for all levels of processed meat/poultry excluding the current proportion model, though relative to the current HEP the constructed patterns reflect substantial reductions in amounts of refined grains and starchy vegetables, and substantial increases in protein foods consumed as beans and peas, seafood, and soy products. It was not possible to develop a pattern with 30% energy from protein without reducing the percentage of energy from carbohydrate below the AMDR or non-compliance with other modeling constraints. Stepwise reductions in processed meat/poultry reduced sodium intake. Conclusions It is feasible to develop dietary patterns in a 2,000 kcal diet while mirroring the HEP that meet recommended intakes of nutrients with 20% or 25% energy from protein, though the pattern with 25% energy from protein may be more idealistic than realistic. Reduced levels of processed meat/poultry may translate to lower sodium intake.
... In addition, a positive association was detected between an increased sheep/goat and chicken meat intake and functionality in activities of daily living, suggesting that a surplus of animal proteins may have indirectly improved motor performance by preserving muscle mass [54]. Although meat consumption has been linked to increased all-cause mortality [55], this is restricted to red and processed meat, while the consumption of poultry meat, as in the case of LBZ, can provide several health benefits [56]. The consumption of dairy products, similar before and after the NT, did not affect health indicators. ...
Article
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Health and longevity in humans are influenced by numerous factors, including lifestyle and nutrition. However, the direct relationship between lifetime eating habits and functional capacity of the elderly is poorly understood. This study investigated the dietary changes across nutrition transition (NT) in the early 1960s, in a population located in the Sardinia island known for its longevity, dubbed as “Longevity Blue Zone” (LBZ), as well as the relationship between the dietary patterns and a panel of health indicators. A total of 150 oldest-old participants (89 women and 61 men, age range 90–101 years) living in the LBZ were recruited. Participants were interviewed using validated questionnaires to assess the consumption frequency of common food items, as well as the correlation with self-rated health, comorbidity, affective and cognitive level, physical mobility, disability and anthropometric parameters. Differences between subgroups were evaluated using the Mann-Whitney U test for independent samples or the Wilcoxon signed-rank test for paired samples. Correlation analysis was performed by calculating the Spearman correlation coefficient, separately in males and females. Compared to the pre-NT epoch, the consumption of meat, olive oil and fresh fruit slightly increased, while the consumption of lard, legumes and vegetables decreased. A significant association was found between increased olive oil intake across NT and self-rated health (ρ = 0.519), mobility (ρ = 0.502), improved vision (ρ = −0.227) and hearing (ρ = −0.314); increased chicken meat intake and performance in activities of daily living (basic activities of daily living: ρ = 0.351; instrumental activities of daily living: ρ = 0.333). Instead, vegetable consumption showed low correlation with health indicators. A mild increase in meat intake, mostly pastured poultry, is associated with better physical performance in the Sardinian LBZ elders, suggesting that a supply of protein may have been crucial to maintaining adequate functional capacity.
... RM provides all types of essential amino acids, essential fatty acids, micronutrients like iron and zinc, and various vitamins. However, RM consumption is also positively associated with multiple health outcomes, including cardiovascular diseases [3], cancers [4,5], diabetes [3,6], and all-cause mortality [7][8][9]. Nutritional metabolomics is rapidly evolving to integrate nutrition with complex metabolomics data [10]. As it becomes possible to examine concerns about the association between RM consumption and human metabolites, finding and validating biomarkers of RM intake are important to nutritional epidemiology to complement dietary recalls for measuring RM intake and understanding the mechanisms leading to various health outcomes. ...
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Red meat (RM) consumption is correlated with multiple health outcomes. This study aims to identify potential biomarkers of RM consumption in the Chinese population and evaluate their predictive ability. We selected 500 adults who participated in the 2015 China Health and Nutrition Survey and examined their overall metabolome differences by RM consumption by using elastic-net regression, then evaluate the predictivity of a combination of filtered metabolites; 1108 metabolites were detected. In the long-term RM consumption analysis 12,13-DiHOME, androstenediol (3α, 17α) monosulfate 2, and gamma-Glutamyl-2-aminobutyrate were positively associated, 2-naphthol sulfate and S-methylcysteine were negatively associated with long-term high RM consumption, the combination of metabolites prediction model evaluated by area under the receiver operating characteristic curve (AUC) was 70.4% (95% CI: 59.9–80.9%). In the short-term RM consumption analysis, asparagine, 4-hydroxyproline, and 3-hydroxyisobutyrate were positively associated, behenoyl sphingomyelin (d18:1/22:0) was negatively associated with short-term high RM consumption. Combination prediction model AUC was 75.6% (95% CI: 65.5–85.6%). We identified 10 and 11 serum metabolites that differed according to LT and ST RM consumption which mainly involved branch-chained amino acids, arginine and proline, urea cycle and polyunsaturated fatty acid metabolism. These metabolites may become a mediator of some chronic diseases among high RM consumers and provide new evidence for RM biomarkers.
... It significantly increased the carbohydrate intake (from fruits and vegetables, legumes, and starchy foods, which are rich in complex carbohydrates) and decreased the total fat intake, due to a reduction in the consumption of red and processed meat, both of which are rich in saturated fat. Several studies have shown that high red and processed meat consumption can increase the risk of colorectal cancer, heart disease, diabetes, and other chronic diseases [61,62]. Thus, an optimally healthy diet would moderate the consumption of red and processed meats [63]. ...
Article
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Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (−5.7% (95% CI: −10.4 to −1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: −1.0 to 5.8)), total fats (−5.9% (95% CI: −8.9 to −3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (−17.5 g/day (95% CI: −34.0 to −1.1)), and processed meat (−6.6 g/day (95% CI: −13.1 to −0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.
... The diets of Africans are largely plant-based, which have been associated with a lower prevalence of CVD [205]. A study conducted in the US reported a clear correlation between meat consumption and CVD [206]. Another significant study showed that a vegetarian diet reduces the risk of CVD by 32%, as vegetables have anti anti-inflammatory and antioxidant effects due to the prevalence of carotenoids, flavonoids, and other polyphenols [207]. ...
Article
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Abnormal lipid metabolism leads to the development of hyperlipidemia, a common cause of multiple chronic disorders, including cardiovascular disease (CVD), obesity, diabetes, and cerebrovascular disease. Low-density lipoprotein cholesterol (LDL-C) currently remains the primary target for treatment of hyperlipidemia. Despite the advancement of treatment and prevention of hyperlipidemia, medications used to manage hyperlipidemia are limited to allopathic drugs, which present certain limitations and adverse effects. Increasing evidence indicates that utilization of phytochemicals and plant-based whole foods is an alternative and promising strategy to prevent hyperlipidemia and CVD. The current review focuses on phytochemicals and their pharmacological mode of actions for the regulation of LDL-C and prevention of CVD. The important molecular mechanisms illustrated in detail in this review include elevation of reverse cholesterol transport, inhibition of intestinal cholesterol absorption, acceleration of cholesterol excretion in the liver, and reduction of cholesterol synthesis. Moreover, the beneficial effects of plant-based whole foods, such as fresh fruits, vegetables, dried nuts, flax seeds, whole grains, peas, beans, vegan diets, and dietary fibers in LDL-C reduction and cardiovascular health are summarized. This review concludes that phytochemicals and plant-based whole foods can reduce LDL-C levels and lower the risk for CVD.
... Often referred to as the "stealth intervention" approach, Robinson's (2010) theory of process motivation posits that health-beneficial interventions may be more effective by focusing on other rewarding aspects of a behavior-such as enjoyment or participation in a social movement-rather than health outcomes [38]. In the current study, students who took the Foodprint seminar were likely motivated to reduce their environmental footprint, which supported the reported adoption of health-beneficial dietary changes, such as increased vegetable intake and decreased red meat intake [39][40][41][42][43]. Intervention students also reported decreasing sugar-sweetened beverage intake and increasing intention to limit processed/fast food, both of which may protect against weight gain and chronic disease [44][45][46][47]. ...
Conference Paper
Objectives During the COVID-19 pandemic, the Centers for Disease Control and Prevention has recommended limiting in-person grocery store visits by using online delivery and pick-up. We sought to understand how the pandemic has impacted grocery shopping patterns among adolescents and young adults, including the shopping mediums (i.e., in-person, pick-up, or delivery) and types of goods purchased. Methods This research is part of MyVoice, a national text message survey of US adolescents and young adults between 14 and 24 years old. In November 2020, this cohort was asked these open-ended questions: 1) During the pandemic, how have you or your family been getting groceries (in-person, pick-up, delivery)? Why? 2) If you or your family have shopped for groceries online during the pandemic, was it pick-up or delivery? How did it go? 3) During the pandemic, have you or your family changed the types of food you are buying? Tell us about it. Responses were assessed using thematic analysis. Quantitative data were summarized using descriptive statistics. Results Among 889 responses (RR = 77.6%), 47% were female, 56% were White, 13% were Hispanic, and median age was 18 (interquartile range 17, 21). Since the pandemic began, 86% of respondents reported at least use of in-person grocery shopping. Meanwhile, 46% indicated they had used a form of online grocery shopping; 26% reported use of delivery and 27% reported use of pick-up. Over half of participants using online shopping had a positive experience. Half of respondents changed their grocery purchase choices since the pandemic began, among whom 33% reported healthier purchases, 27% bought more snack foods, 24% bought in bulk and/or more non-perishable foods, and 10% bought more foods to cook at home. Conclusions Among young people, online grocery shopping is widely utilized with generally positive perceptions, although in-person shopping remains most prevalent. While many young people reported healthier purchases, there was a tendency toward more snack and non-perishable foods. Further investigation is needed to understand reasons behind changes in purchasing habits of adolescents and young adults and the impact of these changes on diet quality during the pandemic. Funding Sources Michigan Institute for Clinical & Health Research, University of Michigan MCubed program, University of Michigan Department of Family Medicine
... While the association between protein intake, frailty, and death may provide a mechanism for the association found in the present study, it is important to note that we have not been able to explore this relationship by protein type. This is a limitation as previous studies have identified a negative association between different animal-based sources of protein with mortality (23) . Conversely, there is a growing body of evidence investigating the health and environmental benefits of consuming plant-based protein. ...
Article
This study aimed to investigate the association between individual, and combinations of, macronutrients with premature death, cardiovascular disease (CVD) and dementia. Sex differences were investigated. Data were utilised from a prospective cohort of 120,963 individuals (57% female) within the UK Biobank, who completed ≥two 24-hour diet recalls. The associations of macronutrients, as percentages of total energy intake, with outcomes were investigated. Combinations of macronutrients were defined using k-means cluster analysis, with clusters explored in association with outcomes. There was a higher risk of death with high carbohydrate intake (Hazard ratios (HRs), 95% confidence intervals (95% CI) upper v lowest third 1.13 (1.03, 1.23)), yet a lower risk with higher intakes of protein (upper v lowest third 0.82 (0.76, 0.89)). There was a lower risk of CVD with moderate intakes (middle v lowest third) of energy and protein (sub distribution HRs (SHR), 0.87 (0.79, 0.97) and (0.87 (0.79, 0.96)) respectively). There was a lower risk of dementia with moderate energy intake (SHR 0.71 (0.52, 0.96)). Sex differences were identified. The dietary cluster characterised by low carbohydrate, low fat and high protein was associated with a lower risk of death (HR 0.84 (0.76, 0.93)) compared to the reference cluster, and a lower risk of CVD for men (SHR 0.83 (0.71, 0.97)). Given that associations were evident, both as single macronutrients and for combinations with other macronutrients for death, and for CVD in men, we suggest that the biggest benefit from diet-related policy and interventions will be when combinations of macronutrients are targeted.
... Reducing red meat consumption in countries with high levels of consumption was identified by the 2019 EAT-Lancet commission as a strategy that would benefit both the environment and human health [1]. Recent meta-analyses show the associations between red meat (beef, lamb, pork, and other mammalian meat) and colorectal cancer [2][3][4], type II diabetes [5], stroke [6], coronary heart disease [6], heart failure [6], obesity [7], and allcause mortality [8,9]. Because of these relationships, organizations including the American Cancer Society recommend limiting red meat consumption in favor of poultry, fish, or plant-based proteins [10,11]. ...
Article
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Reducing red meat consumption in high-consuming countries is critical for mitigating climate change and preventing chronic disease. This study tested the effectiveness of messages conveying the worsening or reduction of environmental harms at discouraging red meat consumption. 1078 U.S. adults viewed seven messages in an online survey highlighting the reduction or worsening of environmental harms associated with eating red meat (between-subjects factor) and rated the messages on how much they discouraged them from wanting to buy beef. Each message highlighted a different environmental harm: deforestation, climate change, water shortages, biodiversity loss, carbon footprint, greenhouse gas emissions, or environment (within-subjects factor). No statistically significant difference was found between the reduction and worsening of environmental harms conditions for most topics, though the worsening of harms frame slightly outperformed the reduction of harms frame for the ‘environment’ topic. ‘Environment’ was also the message topic that elicited the strongest response from participants overall. Latino participants, those with more than a high school degree, and those who consume beef once a week or less rated messages as more effective than non-Latino participants, those who completed high school or less, and those who consumed beef more than once a week. Future research should explore the effect of messages on behavioral outcomes.
... For studies with an open-ended intake range, we assumed that the category width was the same as the adjacent category. If studies reported intakes by frequency, we assumed the following serving sizes: unprocessed red meat and poultry 85 g (Schwingshackl et al. 2017;Richman et al. 2011), processed meat 30 g (Larsson and Orsini 2014). We rescaled all intakes for the trend analysis to 50 g/day for each meat type. ...
Article
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There is uncertainty regarding the association between unprocessed red and processed meat consumption and the risk of ischemic heart disease (IHD), and little is known regarding the association with poultry intake. The aim of this systematic review and meta-analysis was to quantitatively assess the associations of unprocessed red, processed meat, and poultry intake and risk of IHD in published prospective studies. We systematically searched CAB Abstract, MEDLINE, EMBASE, Web of Science, bioRxiv and medRxiv, and reference lists of selected studies and previous systematic reviews up to June 4, 2021. All prospective cohort studies that assessed associations between 1(+) meat types and IHD risk (incidence and/or death) were selected. The meta-analysis was conducted using fixed-effects models. Thirteen published articles were included (ntotal = 1,427,989; ncases = 32,630). Higher consumption of unprocessed red meat was associated with a 9% (relative risk (RR) per 50 g/day higher intake, 1.09; 95% confidence intervals (CI), 1.07 to 1.16; nstudies = 12) and processed meat intake with an 18% higher risk of IHD (1.18; 95% CI, 1.12 to 1.25; nstudies = 10). There was no association with poultry intake (nstudies = 10). This study provides substantial evidence that unprocessed red and processed meat, though not poultry, might be risk factors for IHD.
... p = 0.043). Red/processed meat consumption had been associated with incident cardiovascular diseases and all-cause mortality in the general population [39][40][41], but the association was not significant in the aforementioned meta-analysis [29]. Intake of processed meat (other than red meat) had also been associated with risk of heart failure [42]. ...
Article
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We investigated the associations of adherence to the Mediterranean diet with all-cause and cardiovascular mortality in patients with heart failure. We analyzed the National Health and Nutrition Examination Survey (NHANES) participants from 1999 to 2010, with their vital status confirmed through to the end of 2011. The alternate Mediterranean Diet Index (aMED) was used to assess study participants’ adherence to the Mediterranean diet according to information on dietary questionnaires. We conducted weighted Cox proportional hazards regression models to determine the associations of adherence to the Mediterranean diet (aMED ≥ median vs. <median) with all-cause and cardiovascular mortality in participants with a history of heart failure. A total of 832 participants were analyzed, and the median aMED was 3. After a median follow-up of 4.7 years, 319 participants had died. aMED ≥ 3 (vs. <3) was not associated with a lower risk of all-cause (adjusted HR 0.797, 95% CI 0.599–1.059, p = 0.116) and cardiovascular (adjusted HR 0.911, 95% CI 0.539–1.538, p = 0.724) mortality. The findings were consistent across several subgroup populations. Among the components of aMED, a lower intake of red/processed meat was associated with a higher risk of mortality (adjusted HR 1.406, 95% CI 1.011–1.955, p = 0.043). We concluded that adherence to the Mediterranean diet was not associated with a lower risk of all-cause and cardiovascular mortality in participants with a history of heart failure. The higher risk of mortality associated with a lower intake of red/processed meat deserves further investigation.
... but subgroup analyses had been made by age groups and depression subtype [27]. Nowadays, the negative impact of processed meat on disease occurrence is well established [28][29][30], including coronary heart disease [30], the major cause of death in the older age group. Based on the analysis of the average nutrient and preservative contents of red and processed meats [31], components in meats other than fats may be especially remarkable for health effects [30]. ...
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... On one side, meat is an important micronutrient-rich food and a significant dietary source of high-quality protein. On the other, high consumption of meat has been widely blamed for the prevalence of chronic diseases, with specific concern over the category of red meat and processed meat [65]. For example, colorectal cancer, one of the leading diagnosed malignancies in different countries over the world, has been linked with the consumption of red and processed meat [66]. ...
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Nowadays people are living longer, and there has been a substantial growth in the global elderly population in the past decades. While life expectancy is increasing, there are growing concerns towards the heavy financial and social burdens related to chronic diseases among the elderly. These have been critical health care issues, and healthy ageing is considered a top priority in public health. Diet and eating habits are crucial factors contributing to healthy ageing. These important aspects have attracted much attention in health research, particularly in consideration of the causes and management of chronic conditions which affect most elder adults in the world. Recently, a growing number of investigations have reported significant findings on the association of reduction in the risks of chronic non-communicable diseases with plant-based diets. Meanwhile, there have been worldwide initiatives and programmes implemented for reduction of salt intake. A green diet, which emphasises the consumption of a diet rich in plant foods with minimal portions of red or processed meat and reduced salt intake, is advocated with due consideration to the importance of sustainable environment and healthy ageing. This paper highlights a brief review of the recent advance of knowledge in diet and health, its effects on the elderly and the significance of a green diet on healthy ageing. Implications for a green diet and recommendations for future research are also discussed.
... For example, there is a large body of evidence supporting the links between increased red meat consumption and morbidity and mortality, 20 including an increased risk of type 2 diabetes, 21 cardiovascular disease, 22 certain types of cancer, 23 and mortality. 24 According to our counterfactual attributable fraction models, up to 63% of deaths and 39% of incident cancers could be prevented in a 20-year risk period by fully adopting the EAT-Lancet reference diet (ie, perfect adherence), compared to not adopting the diet. A reduction in mortality from adhering to the EAT-Lancet reference diet is supported by findings from the EAT-Lancet Commission report, where results from one analysis estimated that, by adopting their reference diet, about 11·1 million deaths per year could be avoided worldwide by 2030 and premature mortality reduced by 19%. ...
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... The European Prospective Investigation into Cancer and Nutrition (EPIC) study and two large prospective Swedish cohorts reported a higher risk of CVD mortality associated with red and processed meat intake (Rohrmann et al. 2013;Bellavia et al. 2016). Meta-analyses have reported comparable results (O'Sullivan et al. 2013;Abete et al. 2014;Larsson and Orsini 2014;Wang et al. 2016). In the U.S., three large cohort studies found associations between red and processed meat consumption with CVD mortality among both men and women (Sinha et al. 2009;Pan et al. 2012;Etemadi et al. 2017). ...
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Sustainable diets are proposed as a means to improve public health and food security and to reduce the impact of the food system on the environment. Guidance around sustainable diets includes a reduction of animal products in order to move towards a more plant-based diet, meaning that plant-originated foods are a predominant, but not the sole component of a diet. The main principles of a sustainable diet (as provided by the Food and Agriculture Organization of the United Nations/World Health Organization) are to consume a variety of unprocessed or minimally processed foods, mainly as wholegrains, pulses, fruits and vegetables, with moderate amounts of eggs, dairy, poultry and fish and modest amounts of ruminant meat, which are consistent with the current UK healthy eating recommendations (e.g. Eatwell Guide). The aim of this review was twofold: (i) to discuss public health challenges associated with consumers' knowledge regarding protein sustainability, healthier protein sources and protein requirements, and (ii) to review potential approaches to facilitate the shift towards a more sustainable diet. Consumers would benefit from receiving clear guidance around how much protein is needed to meet their daily requirements. The public health message directed to a consumer could highlight that desired health outcomes, such as muscle protein synthesis and weight control, can be achieved with both sources of protein (i.e. animal and plant-based), and that what is more important is the nature of the 'protein package'. Health promotion and education around the benefits of plant-based protein could be one of the strategies encouraging the wider population to consider a shift towards a predominantly plant-based diet.
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Decreasing the consumption of meat and dairy has been identified as an effective strategy for protecting the health of humans and the planet. More specifically, transitioning to diets that are lower in animal-source foods and higher in fruits, vegetables, legumes, and whole grains offers a promising opportunity to better align consumer behaviors with contemporary nutritional and ecological goals. However, given the limited understanding of how these changes in dietary behaviors can be best promoted, there is a need to explore the merits of community-based approaches to meat reduction and their capacity to advance more sustainable practices of eating at the individual, household, and community levels. To address this gap in the literature, we surveyed more than 100 American households participating in a communitywide, 12-week-long Meatless Monday challenge and tracked the changes in their knowledge, attitudes, beliefs, and food choices over a nine-month period. The case study provided herein highlights a number of key findings from our evaluation. Most notably, our results demonstrate the value of community-based efforts in initiating and maintaining dietary behavior change and provide preliminary insights into the unique roles of multilevel interventions and diverse stakeholder engagement in promoting healthier, more sustainable diets.
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Para afrontar el reto de alimentar a una población creciente que cambia su estilo de vida y su dieta y, al mismo tiempo, tratar de conservar los recursos naturales y proteger la biodiversidad, se proponen tres estrategias principales para lograr tales objetivos: 1) cambiar la forma de producir los alimentos en el campo (aumentando la eficiencia), 2) reducir las pérdidas y desperdicios a lo largo de la cadena agroalimentaria, y 3) promover la adopción de dietas saludables y sostenibles. Las dos primeras estrategias fueron contempladas en nuestro país y forman parte de la agenda académica, gubernamental y productiva, pero la tercera ha sido muy poco explorada. A través de un análisis de la bibliografía destacamos la importancia de incluir a las dietas saludables como herramienta para contribuir simultáneamente a la sustentabilidad del sistema agroalimentario y al mejoramiento de la salud pública, y resaltamos los desafíos que esto implicaría para el abastecimiento del mercado interno. Para ello, primero presentamos información de los impactos ambientales de los sistemas agroalimentarios y las dos primeras estrategias nombradas, utilizadas tradicionalmente para abordarlos. Segundo, exponemos los motivos por los cuales la búsqueda de la eficiencia no debería ser el único camino a seguir debido a las consecuencias esperadas del cada vez mejor conocido ‘Efecto Rebote’ (o Paradoja de Jevons). Tercero, analizamos las evidencias a favor de una correlación positiva entre los beneficios para la salud de varios grupos de alimentos (en general, de origen vegetal) y el impacto relativamente bajo que tiene su producción sobre el ambiente. Finalmente, hacemos un breve análisis físico (no económico) sobre la capacidad que tendría el sistema agroalimentario nacional para proveer de alimentos saludables en cantidad suficiente y sus consecuencias para el ambiente y el sector productivo.
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Background & aims The association between dietary fat and mortality remains inconsistent, and recent results for the association between dietary saturated fat and chronic disease are controversial. To quantitatively assess this association, we conducted a meta-analysis of prospective cohort studies. Methods The PubMed and Web of Science were searched up to February 2020. A random effects model was used. Results Nineteen studies including 1,013,273participants and 195,515deaths were identified. Significant inverse associations between all-cause mortality and a 5% energy increment in intakes of total (RR=0.99; 95% CI:0.98-1.00), monounsaturated (RR=0.98; 95% CI:0.97-0.99), and polyunsaturated fat (RR=0.93; 95% CI:0.89-0.97) were found. A 5% increase in energy from polyunsaturated fat was associated with 5% (RR=0.95; 95% CI:0.91-0.98) and 4% (RR=0.96; 95% CI:0.94-0.99) lower mortality from CVD and cancer, respectively. A 1% energy increment in dietary trans-fat was associated with 6% higher risk of mortality from all-causes (RR=1.06; 95% CI:1.01-1.10) and CVD (RR=1.06; 95% CI:1.02-1.11). We found a non-linear association between dietary saturated fat and all-cause mortality showing a significant increased risk up to 11% of energy from saturated fat intake. The risk of cancer mortality increased by 4% for every 5% increase in energy from saturated fat (RR=1.04; 95% CI:1.02-1.06). Conclusions Diets high in saturated fat were associated with higher mortality from all-causes, CVD, and cancer, whereas diets high in polyunsaturated fat were associated with lower mortality from all-causes, CVD, and cancer. Diets high in trans-fat were associated with higher mortality from all-causes and CVD. Diets high in monounsaturated fat were associated with lower all-cause mortality.
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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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Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and 'other causes of death'. The consumption of poultry was not related to all-cause mortality. The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer.
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BACKGROUND/OBJECTIVES: There is growing evidence that meat consumption is associated with total and cause-specific mortality. Our objective was to evaluate the association of meat intake and the healthy eating index (HEI) with total mortality, cancer and cardiovascular disease (CVD) mortality. SUBJECTS/METHODS: Analyses are based on 17, 611 participants from Third National Health and Nutrition Examination Survey (NHANES III) (1986-2010). Meat intake was assessed using a food frequency questionnaire administrated at baseline. Adherence to the HEI was analyzed with a single 24-h dietary recall. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality according to five categories of meat consumption and three categories of the HEI score. RESULTS: During the follow-up period, 3683 deaths occurred, of which 1554 were due to CVD and 794 due to cancer. After multivariable adjustment, neither red and processed meat, nor white meat consumption were consistently associated with all-cause or cause-specific mortality. In men, white meat consumption tended to be inversely associated with total mortality (P for trend=0.02), but there was no such association among women. Significantly decreased mortality was observed in the top compared with the bottom third of the HEI score (HR=0.70, 95% CI 0.52-0.96). This association was only observed in men, but not in women. CONCLUSIONS: Meat consumption was not associated with mortality. A healthy diet according to HEI, however, was associated with a decreased total mortality in men, but not in women.
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Most previous studies of meat intake and total or cause-specific mortality were conducted in North America, whereas studies in other areas have been limited and reported inconsistent results. This study investigated the association of red meat or poultry intake with risk of total and cause-specific mortality, including cancer and cardiovascular disease (CVD), in two large population-based prospective cohort studies of 134,290 Chinese adult women and men in Shanghai. Meat intakes were assessed through validated food frequency questionnaires administered in person at baseline. Vital status and dates and causes of deaths were ascertained through annual linkage to the Shanghai Vital Statistics Registry and Shanghai Cancer Registry databases and home visits every 2-3 years. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death associated with quintiles of meat intake. During 803,265 person-years of follow up for women and 334,281 person-years of follow up for men, a total of 4,210 deaths in women and 2,733 deaths in men accrued. The median intakes of red meat were 43 g/day among women and 54 g/day among men, and pork constituted at least 95% of total meat intake for both women and men. Red meat intake was associated with increased total mortality among men, but not among women; the HR (95% CI) comparing the highest with the lowest quintiles were 1.18 (1.02-1.35) and 0.92 (0.82-1.03), respectively. This sex difference was statistically significant ( = 0.01). Red meat intake was associated with increased risk of ischemic heart disease mortality (HR = 1.41, 95% CI = 1.05-1.89) and with decreased risk of hemorrhagic stroke mortality (HR = 0.62, 95% CI = 0.45-0.87). There were suggestive inverse associations of poultry intake with risk of total and all-CVD mortality among men, but not among women. Further investigations are needed to elucidate the sex-specific associations between red meat intake and mortality.
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The consumption of fruit and vegetables is associated with a reduced rate of coronary heart disease (CHD) in observational cohorts. The purpose of this study was to assess the strength of this association in a meta-analysis. Cohort studies were selected if they reported relative risks (RRs) and 95% CI for coronary heart disease or mortality and if they presented a quantitative assessment of fruit and vegetable intake. The pooled RRs were calculated for each additional portion of fruit and/or vegetables consumed per day, and the linearity of the associations were examined. Nine studies were eligible for inclusion in the meta-analysis that consisted of 91,379 men, 129,701 women, and 5,007 CHD events. The risk of CHD was decreased by 4% [RR (95% CI): 0.96 (0.93-0.99), P = 0.0027] for each additional portion per day of fruit and vegetable intake and by 7% [0.93 (0.89-0.96), P < 0.0001] for fruit intake. The association between vegetable intake and CHD risk was heterogeneous (P = 0.0043), more marked for cardiovascular mortality [0.74 (0.75-0.84), P < 0.0001] than for fatal and nonfatal myocardial infarction [0.95 (0.92-0.99), P = 0.0058]. Visual inspection of the funnel plot suggested a publication bias, although not statistically significant. Therefore, the reported RRs are probably overestimated. This meta-analysis of cohort studies shows that fruit and vegetable consumption is inversely associated with the risk of CHD. The causal mechanism of this association, however, remains to be demonstrated.
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Purpose of review: This review will discuss some relevant and novel studies on the relationship between sodium intake and cardiovascular structure and function, focusing on blood pressure independent effects of salt on the heart, arteries, and kidneys. Recent findings: Several new reports clearly demonstrate the role of high dietary salt in mediating cardiovascular and renal morbidity and mortality including stroke, myocardial infarction, arterial stiffening, heart failure, and renal insufficiency. A number of recent studies also indicate that in addition to increased sodium intake, simultaneous decrease in potassium intake may aggravate adverse cardiovascular and renal manifestations. Summary: It is now generally accepted that there is a direct positive correlation between dietary salt and arterial pressure. Thus, the beneficial effects of dietary salt reduction are, at least in part, due to a decrease in arterial pressure. Furthermore, the beneficial, pressure-independent effects of sodium restriction on the heart, blood vessels, and kidneys are being increasingly recognized, but not generally appreciated.
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This paper presents a command, glst, for trend estimation across different exposure levels for either single or multiple summarized case-control, incidence-rate, and cumulative incidence data. This approach is based on constructing an approximate covariance estimate for the log relative risks and estimating a corrected linear trend using generalized least squares. For trend analysis of multiple studies, glst can estimate fixed- and random-effects metaregression models. Copyright 2006 by StataCorp LP.
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Background: Fruit and vegetables is a heterogeneous food group with different content of dietary fiber, vitamins, minerals, carotenoids, and bioactive phytochemicals. Our objective was to examine the relation between specific consumption of fruit and vegetable subgroups and stroke risk in a cohort of Swedish women and men. Methods and results: We prospectively followed 74,961 participants (34,670 women and 40,291 men) who had completed a food frequency questionnaire in the autumn of 1997 and were free from stroke, coronary heart disease, and cancer at baseline. Diagnoses of stroke in the cohort during follow-up were ascertained from the Swedish Hospital Discharge Registry. A total of 4089 stroke cases, including 3159 cerebral infarctions, 435 intracerebral hemorrhages, 148 subarachnoid hemorrhages, and 347 unspecified strokes, were ascertained during 10.2 years of follow-up. The multivariable relative risk (RR) of total stroke for the highest vs. lowest category of total fruit and vegetable consumption was 0.87 (95% confidence interval [CI] 0.78-0.97; P for trend = 0.01). The association was confined to individuals without hypertension (corresponding RR, 0.81; 95% CI, 0.71-0.93; P for trend = 0.01). Among individual fruits and vegetable subgroups, inverse associations with total stroke were observed for apples/pears (RR, 0.89; 95% CI, 0.80-0.98; P for trend = 0.02) and green leafy vegetables (RR, 0.92; 95% CI, 0.81-1.04; P for trend = 0.03). Conclusion: This study shows an inverse association of fruit and vegetable consumption with stroke risk. Particularly consumption of apples and pears and green leafy vegetables was inversely associated with stroke.
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Background/objectives: Epidemiological evidence is suggestive, but inconclusive, for an association between consumption of red and processed meat and risk of stroke. We aimed to assess this association by conducting a meta-analysis of prospective cohort studies. Subjects/methods: We performed a literature search on PubMed database through June 2012 to identify prospective cohort studies of red and processed meat intake in relation to risk of stroke. Reference lists of the retrieved articles were also reviewed. Both fixed-effects and random-effects model were assumed to compute the summary risk estimates. Results: Five large independent prospective cohort studies were identified. These studies contained a total of 2 39 251 subjects and 9593 stroke events. Comparing the highest category of consumption with lowest category, the pooled relative risks (RRs) of total stroke were 1.15 (95% confidence interval (CI), 1.05-1.25) for total meat (red and processed meat combined) (n=4), 1.09 (95% CI, 1.01-1.18) for red meat (n=5) and 1.14 (95% CI, 1.05-1.25) for processed meat (n=5); the corresponding RRs of ischemic stroke (highest vs lowest quintile) were 1.15 (95% CI, 1.04-1.28), 1.13(95% CI, 1.01-1.25) and 1.19 (95% CI, 1.08-1.31). Consumption of red and/or processed meat was not associated with hemorrhagic stroke. In the dose-response analysis, the risk of stroke increased significantly by 10% and 13% for each 100 g per day increment in total and red meat consumption, respectively, and by 11% for each 50 g per day increment in processed meat consumption. Conclusion: Findings from this meta-analysis indicate that consumption of red and/or processed meat increase risk of stroke, in particular, ischemic stroke.
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Prospective studies of red meat consumption and risk of stroke have provided inconsistent results. We performed a meta-analysis to summarize the evidence regarding the effects of red meat (fresh, processed, and total) consumption on stroke risk. Studies were identified by searching the PubMed database through May 26, 2012, and by reviewing the reference lists of retrieved articles. Prospective studies that reported relative risks (RR) with 95% confidence intervals (CI) for the association between red meat consumption and risk of stroke were eligible. Results were combined using a random-effects model. Five articles including results from 6 prospective studies with 10 630 cases of stroke and 329 495 participants were included in the meta-analysis. For each serving per day increase in fresh red meat, processed meat, and total red meat consumption, the RR (95% CI) of total stroke were 1.11 (1.03-1.20), 1.13 (1.03-1.24), and 1.11 (1.06-1.16), respectively, without heterogeneity among studies (P>0.16). Among 4 articles with results for stroke subtypes, the risk of ischemic stroke was positively associated with consumption of fresh red meat (RR, 1.13; 95% CI, 1.00-1.27), processed meat (RR, 1.15; 95% CI, 1.06-1.24), and total red meat (RR, 1.12; 95% CI, 1.05-1.19); no statistically significant associations were observed for hemorrhagic stroke. Results from this meta-analysis indicate that consumption of fresh red meat and processed red meat as well as total red meat is associated with increased risk of total stroke and ischemic stroke, but not hemorrhagic stroke.
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This review will discuss some relevant and novel studies on the relationship between sodium intake and cardiovascular structure and function, focusing on blood pressure independent effects of salt on the heart, arteries, and kidneys. Several new reports clearly demonstrate the role of high dietary salt in mediating cardiovascular and renal morbidity and mortality including stroke, myocardial infarction, arterial stiffening, heart failure, and renal insufficiency. A number of recent studies also indicate that in addition to increased sodium intake, simultaneous decrease in potassium intake may aggravate adverse cardiovascular and renal manifestations. It is now generally accepted that there is a direct positive correlation between dietary salt and arterial pressure. Thus, the beneficial effects of dietary salt reduction are, at least in part, due to a decrease in arterial pressure. Furthermore, the beneficial, pressure-independent effects of sodium restriction on the heart, blood vessels, and kidneys are being increasingly recognized, but not generally appreciated.
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Multivariate meta-analysis is increasingly used in medical statistics. In the univariate setting, the non-iterative method proposed by DerSimonian and Laird is a simple and now standard way of performing random effects meta-analyses. We propose a natural and easily implemented multivariate extension of this procedure which is accessible to applied researchers and provides a much less computationally intensive alternative to existing methods. In a simulation study, the proposed procedure performs similarly in almost all ways to the more established iterative restricted maximum likelihood approach. The method is applied to some real data sets and an extension to multivariate meta-regression is described.
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High intakes of red or processed meat may increase the risk of mortality. Our objective was to determine the relations of red, white, and processed meat intakes to risk for total and cause-specific mortality. The study population included the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study cohort of half a million people aged 50 to 71 years at baseline. Meat intake was estimated from a food frequency questionnaire administered at baseline. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) within quintiles of meat intake. The covariates included in the models were age, education, marital status, family history of cancer (yes/no) (cancer mortality only), race, body mass index, 31-level smoking history, physical activity, energy intake, alcohol intake, vitamin supplement use, fruit consumption, vegetable consumption, and menopausal hormone therapy among women. Main outcome measures included total mortality and deaths due to cancer, cardiovascular disease, injuries and sudden deaths, and all other causes. There were 47 976 male deaths and 23 276 female deaths during 10 years of follow-up. Men and women in the highest vs lowest quintile of red (HR, 1.31 [95% CI, 1.27-1.35], and HR, 1.36 [95% CI, 1.30-1.43], respectively) and processed meat (HR, 1.16 [95% CI, 1.12-1.20], and HR, 1.25 [95% CI, 1.20-1.31], respectively) intakes had elevated risks for overall mortality. Regarding cause-specific mortality, men and women had elevated risks for cancer mortality for red (HR, 1.22 [95% CI, 1.16-1.29], and HR, 1.20 [95% CI, 1.12-1.30], respectively) and processed meat (HR, 1.12 [95% CI, 1.06-1.19], and HR, 1.11 [95% CI 1.04-1.19], respectively) intakes. Furthermore, cardiovascular disease risk was elevated for men and women in the highest quintile of red (HR, 1.27 [95% CI, 1.20-1.35], and HR, 1.50 [95% CI, 1.37-1.65], respectively) and processed meat (HR, 1.09 [95% CI, 1.03-1.15], and HR, 1.38 [95% CI, 1.26-1.51], respectively) intakes. When comparing the highest with the lowest quintile of white meat intake, there was an inverse association for total mortality and cancer mortality, as well as all other deaths for both men and women. Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality.
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Meta-analysis often requires pooling of correlated estimates to compute regression slopes (trends) across different exposure or treatment levels. The authors propose two methods that account for the correlations but require only the summary estimates and marginal data from the studies. These methods provide more efficient estimates of regression slope, more accurate variance estimates, and more valid heterogeneity tests than those previously available. One method also allows estimation of nonlinear trend components, such as quadratic effects. The authors illustrate these methods in a meta-analysis of alcohol use and breast cancer.
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This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
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To determine whether responses to simple dietary questions are associated with specific causes of death. Self-reported frequency intakes of various classes of foods and data on confounding factors were collected at the baseline survey. Death notifications up to 31 December 1997 were ascertained from the Office for National Statistics. Relative risk (RR) of death and 95% confidence intervals (CI) associated with baseline dietary factors were calculated by Cox regression. Prospective follow-up study based on five UK general practices. Data were used from 11,090 men and women aged 35-64 years (81% of the eligible patient population) who responded to a postal questionnaire in 1989. After 9 years of follow-up, 598 deaths were recorded, 514 of these among the 10,522 subjects with no previous history of angina. All-cause mortality was positively associated with age, smoking and low social class, as expected. Among the dietary variables, all-cause mortality was significantly reduced in participants who reported relatively high consumption of vegetables, puddings, cakes, biscuits and sweets, fresh or frozen red meat (but not processed meat), among those who reported using polyunsaturated spreads and among moderate alcohol drinkers. These associations were broadly similar for deaths from ischaemic heart disease (IHD), cancer and all other causes combined, and were not greatly attenuated by adjusting for potential confounding factors including social class. Responses to simple questions about nutrition were associated with mortality. These findings must be interpreted with caution since residual confounding by dietary and lifestyle factors may underlie the associations.
Article
The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity.
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Diets containing substantial amounts of red or preserved meats may increase the risk of various cancers, including colorectal cancer. This association may be due to a combination of factors such as the content of fat, protein, iron, and/or meat preparation (e.g., cooking or preserving methods). Red meat may be associated with colorectal cancer by contributing to N-nitroso compound (NOC) exposure. Humans can be exposed to NOCs by exogenous routes (from processed meats in particular) and by endogenous routes. Endogenous exposure to NOCs is dose-dependently related to the amount of red meat in the diet. Laboratory results have shown that meats cooked at high temperatures contain other potential mutagens in the form of heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs). To investigate the role of these compounds, we have created separate databases for HCAs and PAHs, which we have used in conjunction with a validated meat-cooking food frequency questionnaire. The role of meat type, cooking methods, doneness levels, and meat-cooking mutagens has been examined in both case-control studies and prospective cohort studies, with mixed results. Here, we review the current epidemiologic knowledge of meat-related mutagens, and evaluate the types of studies that may be required in the future to clarify the association between meat consumption and colorectal cancer.
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Some weight loss diets promote protein intake; however, the association of protein with disease is unclear. In 1986, 29,017 postmenopausal Iowa women without cancer, coronary heart disease (CHD), or diabetes were followed prospectively for 15 years for cancer incidence and mortality from CHD, cancer, and all causes. Mailed questionnaires assessed dietary, lifestyle, and medical information. Nutrient density models estimated risk ratios from a simulated substitution of total and type of dietary protein for carbohydrate and of vegetable for animal protein. The authors identified 4,843 new cancers, 739 CHD deaths, 1,676 cancer deaths, and 3,978 total deaths. Among women in the highest intake quintile, CHD mortality decreased by 30% from an isoenergetic substitution of vegetable protein for carbohydrate (95% confidence interval (CI): 0.49, 0.99) and of vegetable for animal protein (95% CI: 0.51, 0.98), following multivariable adjustment. Although no association was observed with any outcome when animal protein was substituted for carbohydrate, CHD mortality was associated with red meats (risk ratio = 1.44, 95% CI: 1.06, 1.94) and dairy products (risk ratio = 1.41, 95% CI: 1.07, 1.86) when substituted for servings per 1,000 kcal (4.2 MJ) of carbohydrate foods. Long-term adherence to high-protein diets, without discrimination toward protein source, may have potentially adverse health consequences.