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Meat consumption and risk of ischemic heart disease and stroke: results from the UK Biobank
- Keren Papier, Georgina Fensom, Anika Knuppel, Timothy Key, Aurora Perez-Cornago
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E454
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Introduction
Meat consumption may be associated with a higher risk of cardiovascular diseases, but the evidence remains inconclusive. We prospectively examined the association between meat (total meat, red and processed meat, red meat, processed meat and poultry) intake and risk of ischemic heart disease (IHD) and stroke, including ischemic and haemorrhagic subtypes, in a large British cohort.
Materials and methodsData were from UK Biobank participants who were free of IHD, stroke and cancer at recruitment (2006–2010), with available information on meat intake in the baseline touchscreen survey, and linked hospital admissions and death data for IHD, stroke, and stroke subtypes over follow-up (n = 441,700). We used multivariable Cox proportional hazards models to assess associations between meat consumption and risk of IHD, total stroke and ischemic and haemorrhagic stroke subtypes.
ResultsOver a mean of 8.1 years of follow-up, 13,590 incident cases of IHD, 5,441 cases of total stroke, 2,258, cases of ischaemic stroke, and 949 cases of haemorrhagic stroke occurred. The risk of IHD was positively associated with intakes of total meat (Hazard ratio (HR) = 1.18, 95% Confidence Interval (CI) 1.09, 1.27 per 100 g/day higher intake), red and processed meat (HR = 1.15, 95% CI 1.08, 1.24 per 70 g/day higher intake), red meat (HR = 1.15, 95%, CI 1.07–1.24 per 50 g/day higher intake), processed meat (HR = 1.11, 95% CI 1.05, 1.16 per 20 g/day higher intake), and poultry (HR = 1.07, 95% CI 1.01, 1.13 per 30 g/day higher intake). The risk of total stroke was positively associated with intakes of total meat (HR = 1.15, 95% CI 1.02–1.29 per 100 g/day higher intake) and red and processed meat (HR = 1.14, 95% CI 1.03–1.27 per 70 g/day higher intake). Meat intake was not associated with ischaemic or haemorrhagic stroke.
DiscussionThis large prospective study found that any meat consumption was associated with an increased risk of IHD and that red and processed meat consumption was associated with an increased risk of total stroke. Our findings for IHD and total stroke in relation to red and processed meat are in line with previous studies but our positive findings for poultry and IHD and null findings for red meat and ischaemic stroke are not, thus warranting further study.
Comparison of major protein-source foods and other food groups in meat-eaters and non-meat-eaters in the EPIC-Oxford cohort
- Keren Papier, Tammy Tong, Paul Appleby, Kathryn Bradbury, Georgina Fensom, Anika Knuppel, Aurora Perez-Cornago, Julie Schmidt, Ruth Travis, Timothy Key
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E334
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Introduction
Differences in health outcomes between meat-eaters and non-meat-eaters might relate to differences in dietary intakes between these diet groups. We assessed intakes of major protein-source foods and other food groups in six groups of meat-eaters and non-meat-eaters participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study.
Materials and methodsData were from 30, 239 participants who answered four questions regarding their consumption of meat, fish, dairy or eggs and completed a food frequency questionnaire (FFQ) in 2010. Participants were categorized as regular meat-eaters (> 50 grams of total/any meat per day: n = 12,997); low meat-eaters (< 50 grams of total/any meat per day: n = 4,650); poultry-eaters (poultry but no red meat: n = 591); fish-eaters (no meat but consumed fish: n = 4,528); vegetarians (no meat or fish: n = 6,672); and vegans (no animal products: n = 801). FFQ foods were categorised into 45 food groups. Analysis of variance was used to test for differences between age-adjusted mean intakes of each food group by diet group.
ResultsWe found that regular meat-eaters, vegetarians and vegans, respectively, consumed about a third, quarter and a fifth of their total energy intake from high protein-source foods. Compared with regular meat-eaters, low and non-meat-eaters consumed higher amounts of high-protein meat alternatives (soy, legumes, pulses, nuts, seeds) and other plant-based foods (whole grains, vegetables, fruits) and lower amounts of refined grains, fried foods, alcohol, and sugar-sweetened beverages.
DiscussionOverall, our results suggest that there were large differences in the amounts and types of protein-rich and other foods eaten by regular, low and non-meat-eaters. These findings provide insight into potential nutritional explanations for differences in health outcomes between diet groups.
Vegetarian diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study
- Tammy Y.N. Tong, Paul N. Appleby, Aurora Perez-Cornago, Timothy J. Key
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E73
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Introduction
It has been speculated that vegetarians or vegans may have higher risks of fractures than meat eaters, but there is limited evidence from prospective cohorts. We aimed to assess the risks of total and site-specific fractures in people of different diet groups, in a prospective cohort with a large proportion of non-meat eaters.
Materials and methodsIn EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up around 14 years later (≈2010). Participants were categorised into five diet groups (≈20,106 regular meat eaters: ≥ 50 g of meat per day, ≈9,274 low meat eaters: < 50 g of meat per day, ≈8,037 fish eaters, ≈15,499 vegetarians and ≈1,982 vegans, with minor variations in numbers for each outcome after pre-specified exclusions) at both time points. Using multivariable Cox regression adjusted for socio-demographic, lifestyle, and physiological confounders, we estimated the risks of total and site-specific fractures (arm, wrist, hip, leg, ankle, and other main sites i.e. clavicle, rib and vertebra) in the different diet groups, with outcomes identified through record linkage.
ResultsOver an average of 17.6 years of follow-up, we observed 3,941 cases of total fractures, 566 arm fractures, 889 wrist fractures, 945 hip fractures, 366 leg fractures, 520 ankle fractures, and 467 other main site fractures. Compared with meat eaters, vegetarians had marginally higher risks of total fractures (hazard ratios and 95% confidence intervals: 1.10; 1.00–1.20) and arm fractures (1.28; 1.01–1.63), while vegans had significantly higher risks of total fractures (1.44; 1.21–1.72) and leg fractures (2.06; 1.22–3.47), and marginally higher risks of arm fractures (1.60, 1.01–2.54). For hip fractures, the risks were higher in fish eaters (1.28; 1.03–1.59), vegetarians (1.27; 1.05–1.55) and vegans (2.35; 1.67–3.30, p-heterogeneity < 0.0001) than regular meat eaters. There were no significant differences in risks of wrist, ankle or other main site fractures by diet groups. Overall, the significant associations appeared stronger without adjustment for body mass index (e.g. 1.52; 1.27–1.81 in vegans for total fractures), and were slightly attenuated with additional adjustment for total protein (1.41; 1.17–1.69) or dietary calcium (1.32; 1.10–1.59).
DiscussionIn conclusion, non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. The higher risks might be partly explained by the lower body mass index in these diet groups, but differences in dietary intakes of protein and calcium are likely relevant as well. Given the observational design of this study, causality and potential mechanisms should be further investigated.
Meat intake and cancer risk: prospective analyses in UK Biobank
- Anika Knuppel, Keren Papier, Paul N. Appleby, Timothy J. Key, Aurora Perez-Cornago
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E115
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Introduction
Meat intake is thought to play a role in the risk of cancer. The Third Expert Report of the World Cancer Research Fund/American Institute for Cancer Research concluded that red meat was a probable cause and processed meat a convincing cause of colorectal cancer. However, evidence for associations between red and processed meat intake and other cancer sites is limited. Furthermore, few studies have investigated the association between poultry intake and cancer risk. Therefore, this study aimed to examine the associations between red, processed meat and poultry intake and incidence for 20 common cancer sites.
Material and methodsWe analysed data from 475,264 participants (54 % women) in UK Biobank. Participants were aged 37–73 years and cancer free at baseline. Cancer diagnosis and death due to cancer without prior diagnosis during follow-up were determined using data-linkage with cancer and death registries (with follow-up until 31 March 2016 for England and Wales and until 31 October 2015 for Scotland, respectively). Information on meat consumption was based on a touchscreen questionnaire completed at baseline covering type and frequency of meat intake. We used multivariable-adjusted Cox proportional hazards models to determine the association between baseline meat intake and cancer incidence. Analyses of lung cancer risk were restricted to never smokers. All analyses were adjusted for socio-demographic, lifestyle and women-specific factors.
ResultsOver a mean 6.9 (SD 1.3) years of follow-up, 28,431 participants were diagnosed with any type of cancer. Red meat intake was positively associated with risk for colorectal cancer (n cases = 3,164; Hazard ratio (HR) per 50 g/day higher intake 1.22, 95% Confidence Interval (CI) 1.05–1.41), breast cancer (n cases = 5,536; 1.12, 1.01–1.24) and prostate cancer (n cases = 5,807; 1.16, 1.03–1.30). Processed meat intake was positively associated with risk for colorectal cancer (n cases = 3,189; HR per 20 g/day higher intake 1.17, 95% CI 1.06–1.30). Poultry intake was positively associated with risk for cancers of the lymphatic and hematopoietic tissues (n cases = 2,431; HR per 30g/day increment in intake 1.16, 95%-CI 1.03, 1.32).
DiscussionIn summary, higher intakes of red and processed meat were associated with a higher risk of colorectal cancer. Red meat consumption was also positively associated with risk of breast and prostate cancer, but these associations are not supported by most previous prospective studies. The positive association of poultry intake with cancers of the lymphatic and hematopoietic tissues requires further investigation.
The associations of major foods and fibre with risk of ischaemic and haemorrhagic stroke: results from the prospective EPIC study.
- Tammy Y.N. Tong, Paul N. Appleby, Timothy J. Key, Aurora Perez-Cornago,
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E116
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Introduction
The evidence of associations between individual foods and dietary fibre with subtypes of stroke (ischaemic and haemorrhagic) is not conclusive. We aimed to investigate this in a large prospective cohort.
Materials and methodsWe analysed data on 418,329 men and women from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Consumption of various animal-sourced foods (red and processed meat, poultry, fish, dairy, egg), plant-sourced foods (fruit and vegetables, legumes, nuts and seeds) and dietary fibre was assessed using validated country-specific questionnaires, calibrated with 24-hour recalls. Using multivariable Cox regressions adjusted for energy intake and socio-demographic, lifestyle and physiological confounders, we estimated hazard ratios of fatal and non-fatal ischaemic, haemorrhagic and total (i.e. ischaemic, haemorrhagic and unspecified) stroke associated with calibrated increment differences in consumption of each food or dietary fibre.
ResultsOver an average of 12.7 years of follow-up, we observed 4281 cases of ischaemic stroke, 1430 cases of haemorrhagic stroke, and 7378 cases of total stroke. For ischaemic stroke, lower risks were observed with higher consumption of fruit and vegetables (hazard ratio (HR); 95% confidence interval (CI) for per 200g/d of calibrated intake, 0.87; 0.82–0.93) and dietary fibre (per 10g/d, HR 0.77; 95% CI 0.69–0.86) (p-trend < 0.001 for both); more modest inverse associations were also observed for milk (per 200g/d, HR 0.95; 95% CI 0.91–0.99, p-trend = 0.02), yogurt (per 100g/d, HR 0.91; 95% CI 0.85–0.97, p-trend = 0.004) and cheese (per 30g/d, HR 0.88; 95% CI 0.81–0.97, p-trend = 0.008), while a modest positive association was observed with higher red meat consumption (per 50g/d, HR 1.14; 95% CI 1.02–1.27, p-trend = 0.02). For haemorrhagic stroke, higher risk was associated with higher egg consumption (per 20g/d, HR 1.25; 95% CI 1.09–1.43, p-trend = 0.002). For total stroke, associations were consistent with those of both subtypes; we observed inverse associations for fruit and vegetables (HR 0.89, 95% CI 0.85–0.93), dietary fibre (HR 0.80, 95% CI 0.74–0.86), yogurt (HR 0.91, 95% CI 0.87–0.96), cheese (HR 0.88, 95% CI 0.82–0.94), and positive associations for red and processed meat (HR 1.18, 95% CI 1.05–1.33) and egg (HR 1.07, 95% CI 1.01–1.14).
DiscussionTo conclude, risk of ischaemic stroke was inversely associated with consumption of fruit and vegetables, dietary fibre and dairy foods, and positively associated with red meat, while risk of haemorrhagic stroke was positively associated with egg consumption. Causality of the associations cannot be determined in this observational study.
A prospective investigation of plant foods, dietary fibre and ischaemic heart disease in the EPIC cohort
- Aurora Perez-Cornago, Francesca L. Crowe, Paul N. Appleby, Timothy J Key
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- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E169
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Introduction
There is evidence that plant-based diets might be associated with a lower risk of IHD; however, previous studies have not reported on intake of subtypes of fruit and vegetables and sources of dietary fibre. This study aims to assess the associations of major plant foods, their subtypes and dietary fibre with risk of ischaemic heart disease (IHD) in the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD Consortium.
Material and methodsWe conducted a prospective analysis of 490,311 men and women in ten European countries without a history of myocardial infarction or stroke at recruitment. Dietary intake was assessed using validated questionnaires and calibrated with 24-hour recall data. Cox regression models, adjusted for IHD risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
ResultsDuring a mean of 12.6 years follow-up, we documented 8504 myocardial infarction cases or deaths from IHD. Participants consuming at least eight portions (80 grams each) of fruits and vegetables a day had a 10% lower risk of IHD (HR 0.90, 95% CI: 0.82–0.98) compared with those consuming fewer than three portions a day. The risk of IHD was 6% (95% CI 0.90–0.99; P-trend = 0.009) lower for a 200 g/day higher intake of fruit and vegetables combined, 3% (0.95–1.00; P-trend = 0.021) lower for a 100 g/ day higher fruit intake, and 8% (0.86–0.97; P-trend = 0.006) lower for a 50 g/ day higher intake of bananas. Moreover, risk of IHD was 9% (0.83–0.99; P-trend = 0.032) lower for a 10g/ day higher intake of nuts and seeds, and 10% (0.82–0.98; P-trend = 0.020) lower for a 10g/ day higher intake of total dietary fibre. No associations were observed between legumes, total vegetables and other subtypes of fruit and vegetables and IHD risk.
DiscussionThe results from this large prospective study suggest that higher intakes of fruit and vegetables combined, total fruit, bananas, nuts and seeds, and total fibre are associated with a lower risk of IHD. Given the observational design of this study, causality and potential mechanisms should be further investigated.
A prospective investigation of dietary prebiotic intake and colorectal cancer risk in the EPIC-Oxford cohort
- Carlota Castro-Espin, Brittany Graham, Paul N. Appleby, Antonio Agudo, Timothy J. Key, Aurora Perez-Cornago
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E612
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Introduction:
Prebiotics are a subtype of dietary fibre selectively fermented by beneficial bacterial in the colon. Preclinical evidence has suggested that prebiotics may be associated with a decreased risk of colorectal cancer. However, the association between dietary intake of prebiotics and colorectal cancer risk has not been investigated prospectively. This study aims to prospectively investigate the association between total prebiotic intake and colorectal cancer risk. Further characterisation of the association by prebiotic sub-type (fructans and galacto-oligosaccharides (GOSs)) and colorectal cancer sub-site (colon cancer and rectal cancer) were secondary objectives.
Material and methods:A total of 53,700 men and women living in England and Scotland who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, were included in the analysis and followed up for incident colorectal cancers. Validated semi-quantitative food frequency questionnaires administered at baseline were used to calculate daily fructan, GOS and total prebiotic intake. We used multivariable Cox proportional hazards models to assess associations between prebiotic intake and risk of colorectal cancer.
Results:A total of 574 incident cases of colorectal cancer were identified during a mean of 16.1 years of follow-up. Total prebiotic, fructan and GOS intake were not significantly associated with colorectal cancer risk. The hazard ratios for those in the highest fourths of total prebiotic, fructan and GOS intake compared to those in the lowest fourths were 0.87 (95% confidence intervals (CI) 0.66–1.14; P for trend = 0.3), 0.91 (95% CI 0.70–1.18; P for trend = 0.4), and 0.87 (95% CI 0.66–1.15; P for trend = 0.4) respectively. The associations remained nonsignificant when colorectal cancer sub-sites were investigated separately.
Discussion:The results from this observational study do not support an association between prebiotic intake and colorectal cancer risk. Given the biological plausibility of a role for prebiotics in reducing colorectal cancer risk and since the non-significant association between prebiotic intake and colorectal cancer risk observed in the current study may be due to the small number of cases and the healthy profile of the cohort, further epidemiological research is needed to characterise the association between dietary prebiotic intake and colorectal cancer incidence.
Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project
- Almudena Sanchez-Villegas, Itziar Zazpe, Susana Santiago, Aurora Perez-Cornago, Miguel A. Martinez-Gonzalez, Francisca Lahortiga-Ramos
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- British Journal of Nutrition / Volume 119 / Issue 2 / 28 January 2018
- Published online by Cambridge University Press:
- 22 December 2017, pp. 211-221
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- 28 January 2018
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The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results.
Relationship between adherence to Dietary Approaches to Stop Hypertension (DASH) diet indices and incidence of depression during up to 8 years of follow-up
- Aurora Perez-Cornago, Almudena Sanchez-Villegas, Maira Bes-Rastrollo, Alfredo Gea, Patricio Molero, Francisca Lahortiga-Ramos, Miguel Ángel Martinez-Gonzalez
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- Public Health Nutrition / Volume 20 / Issue 13 / September 2017
- Published online by Cambridge University Press:
- 23 June 2016, pp. 2383-2392
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Objective
Our aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression.
DesignIn a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed.
ResultsAfter a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped).
ConclusionsModerate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given.