Meats, Other Choices, and Risk of Cardiovascular Diseases and Diabetes

Transcription

1 Meats, Other Choices, and Risk of Cardiovascular Diseases and Diabetes Dariush Mozaffarian, MD DrPH Division of Cardiovascular Medicine, Brigham and Women's Hsopital and Harvard Medical School Departments of Epidemiology and Nutrition, Harvard School of Public Health 2011 World of Healthy Flavors, Culinary Institute of America January 19, 2011

2 Dietary Guidelines Recommendations: Consume red and processed meats in moderation Select low-fat, lean sources of meat Trim away visible fats Broil, roast, or boil rather than fry

3 Evidence Base for Guidelines? Current guidelines based on saturated fat and cholesterol contents, predicted effects on LDL cholesterol, and observed associations with some cancers. Unanswered Questions: Associations of meat intake with specific disease endpoints CHD, stroke, diabetes? Specific dose-responses? Different effects of unprocessed vs. processed meats?

4 Strength of Evidence Randomized Trials of Disease Outcomes Prospective Cohorts of Disease Outcomes Randomized Trials of Intermediate Risk Factors Retrospective Case-Control Studies of Disease Outcomes Animal Studies Ecologic Studies Prevalence Studies Harris, Mozaffarian, et al. J Nutrition 2009

5 Systematic Review & Meta-Analysis Quantify the dose-response relations of meat intake with specific cardiometabolicdisease endpoints. Separately evaluate: Unprocessed red vs. processed meats. Many prior studies included processed meats as "red meats." CHD vs. stroke vs. diabetes. Evaluate the constituents that may play a role. Micha et al, Circulation 2010

6 Twenty Studies Identified Globally ,218,380 individuals from 10countries on 4continents, with: 23,889 CHD cases 2,280 stroke cases 10,797 diabetes cases

7 Coronary Heart Disease: Risk per Daily Serving Per 100 g/day of red meats Study RR (95% CI) % Weight Whiteman (1999) 0.51 (0.22, 1.20) Ascherio (1994) Burke (2007) 1.03 (0.80, 1.33) 0.69 (0.39, 1.22) Martinez-Gonzalez (2002) 1.60 (0.94, 2.74) Overall (one-stage estimation) 1.00 (0.81, 1.23) Pooled RR=1.00 ( ) 56,311 participants and 769 CHD events Weights are from random effects analysis Study Whiteman (1999) Burke (2007) Liu (2003) Martinez-Gonzalez (2002) Sinha (2009) men * Sinha (2009) women * Per 50 g/day of processed meats RR (95% CI) 1.27 (0.36, 4.44) 11.4 (1.1, 115.3) 2.14 (1.25, 3.68) 1.06 (0.28, 3.98) 1.15 (1.08, 1.22) 1.42 (1.29, 1.56) % Weight Per 100 g/day of total meats Pooled RR=1.25 ( ) 635,558 participants and 22,562 CHD events Pooled RR=1.42 ( ) 614,062 participants and 21,308 CHD events Overall (one-stage estimation) 1.42 (1.07, 1.89) Weights are from random effects analysis *assessed total cardiovascular mortality (CHD plus stroke) only Micha et al, Circulation 2010

8 Diabetes Mellitus: Risk per Daily Serving Per 100 g/day of red meats Study RR (95% CI) % Weight Fung (2004) Schulze (2003) Kröger (unpublished data) van Dam (2002) Villegas (2006) Weights are from random effects analysis 1.20 (1.05, 1.38) 1.42 (1.05, 1.92) 1.49 (1.00, 2.22) 1.09 (0.94, 1.26) 0.87 (0.73, 1.04) Overall (one-stage estimation) 1.16 (0.92, 1.46) Pooled RR=1.16 ( ) 298,982 participants and 7,349 diabetes events Per 50 g/day of processed meats Study Fung (2004) Meyer (2001) Schulze (2003) Kröger (unpublished data) Song (2004) van Dam (2002) Villegas (2006) Weights are from random effects analysis RR (95% CI) 1.84 (1.42, 2.39) 1.21 (0.92, 1.59) 1.85 (1.41, 2.44) 1.08 (0.97, 1.21) 1.43 (1.06, 1.93) 1.47 (1.21, 1.78) 0.93 (0.80, 1.08) Overall (one-stage estimation) 1.19 (1.11, 1.27) % Weight Pooled RR=1.19 ( ) 372,279 participants and 10,782 diabetes events Micha et al, Circulation 2010

9 Stroke: Risk per Daily Serving Per 100 g/day of red meats Study RR (95% CI) % Weight Sauvaget (2003) Fung (2004) Weights are from random effects analysis 1.11 (0.89, 1.38) 1.23 (1.11, 1.37) Overall (one-stage estimation) 1.17 (0.40, 3.43) Pooled RR=1.17 ( ) 108,898 participants and 1,700 stroke events Per 50 g/day of processed meats Study RR (95% CI) % Weight Sauvaget (2003) Fung (2004) Weights are from random effects analysis (0.79, 1.59) 1.15 (0.91, 1.45) Overall (one-stage estimation) 1.14 (0.94, 1.39) Pooled RR=1.14 ( ) 108,898 participants and 1,434 stroke events Micha et al, Circulation 2010

10 Meats & Diabetes: New Evidence from the US NHS NHSII HPFS Pooled Cases 8,288 3,068 2,447 13,803 Total red meat ( ) ( ) ( ) ( ) Unprocessed (100 g) ( ) ( ) ( ) ( ) Processed (50 g) ( ) ( ) ( ) ( ) Multivariable-Adjusted Relative Risk of Diabetes per Daily Serving An Pan, 2011 (unpublished data)

11 Meats & Diabetes: New Findings from France 69,097 French women in the EPIC cohort. 1,398 cases of incident diabetes. Multivariable-Adjusted Relative Risks: Unprocessed Red Meat: Highest ( 5 servings/wk) vs. lowest (<1 serving/wk) categories, RR = 0.98 (95% CI: 0.85, 1.13). Processed Meat: Highest ( 5 servings/wk) vs. lowest (<1 serving/wk) categories, RR = 1.64 (95% CI: 1.34, 2.00). Per daily serving, RR=2.01 (95%CI: 1.82, 2.20). Unpublished, submitted to American Heart Association Spring Meeting Courtesy of EPIC-France Investigators.

12 Average Ingredients of Meats in the US Per 50g of meat Red meats Processed meats mean(se) mean(se) Energy (kcal) 123 (0.7) 138 (2.0) Total fat (% E) 50 (0.3) 58 (0.6) SFA (% E) 19 (0.1) 19 (0.3) MUFA (% E) 21 (0.1) 25 (0.3) PUFA (% E) 3 (0.0) 6 (0.1) Protein (% E) 46 (0.3) 35 (0.5) Sodium (mg)* (3.4) (7.6) Potassium (mg) (0.8) (1.9) Cholesterol (mg) 41.9 (0.2) 34.1 (0.3) Iron (mg) 1.1 (0.0) 0.6 (0.0) Nitrates (mg)* 3.3 (0.0) 4.6 (0.1) Nitrites (mg)* 0.5 (0.0) 0.8 (0.0) * Processed meats have higher preservative levels Nitrosamines (µg)* 0.1 (0.0) 0.3 (0.0) Micha et al. Circulation Based on NHANES and Griesenbeck 2009 Nutr J

13 Sodium Intake and Blood Pressure Systolic BP: 3.57 ( ) Diastolic BP: 1.66 ( ) Meta-analysis of 11 RCTS, including 2,200 participants Systolic BP: 7.11 ( ) Diastolic BP: 3.88 ( ) Meta-analysis of 16 RCTS, including 734 participants He FJ and MacGregor GA. Journal of Human Hypertension 2002

14 Sodium Intake and Heart Disease Processed meats: 500 to 1000 mg of sodium per serving ~ 1.6 mm Hg higher systolic BP in normotensives ~ 3.0 mm Hg higher systolic BP in hypertensives Per 5 mm Hg systolic BP : 18% higher risk of CHD (RR=1.18) 26% higher risk of stroke (RR=1.26) 50% higher risk of hypertensive heart disease (RR=1.50) He and MacGregor, J Human Hypertension 2002 Prospective Studies Collaboration, Lancet 2002

15 Other Preservatives, Cooking Methods Nitrates - in limited animal experiments: Promote atherosclerosis Reduce glucose tolerance Form carcinogenic by-products High temperature/commercial cooking: Production of heterocyclic amines Production of polycyclic aromatic hydrocarbons Could plausibly increase risk of: Coronary heart disease Diabetes Cancer

16 Saturated Fat Consumption and CVD Risk Pooled RR=1.07 ( ) Meta-analysis of 16 cohorts, including 214,182 participants and 8,644 CHD events Pooled RR=0.81 ( ) Meta-analysis of 8 cohorts, including 179,436 participants and 2,362 stroke events Pooled RR=1.00 ( ) Meta-analysis of 21 cohorts, including 347,747 participants and 11,006 CVD events Siri-Tarino et al, AJCN 2010

17 Saturated Fat Consumption and Diabetes Risk Study n, cases RR (95% CI) % Weight Meyer (2001), women 35988, (0.77, 1.18) Salmeron (2001), women 84204, (0.81, 1.20) van Dam (2002), men 42504, (0.78, 1.20) Harding (2004), men 9611, (0.67, 1.59) 6.87 Harding (2004), women 11861, (0.62, 1.73) 4.92 Overall estimate - Cohorts , (0.87, 1.10) Women's Health Initiative 45887, (0.97, 1.11) Relative Risk of Incident Diabetes for High vs. Low Category of SFA Intake Micha R, Mozaffarian D, Lipids 2010

18 Average Sources of Calories in US Diets Whole grain Other carbs Potatoes Sat fat Mono fat Refined grain Poly fat Added sugar Protein Trans fat

19 Top Foods in the US: Food Percent Energy 1. Soft drinks, sodas Cakes, sweet rolls, doughnuts, pastries Hamburgers, cheeseburgers, meatloaf Pizza Potato chips, corn chips, popcorn Rice Rolls, buns, English muffins, bagels Cheese, cheese spread Beer French fries, fried potatoes 2.2

20 Coronary Heart Disease: Meats vs. Other Foods Risk of CHD per daily serving, NHS , 3162 cases Bernstein et al., Circulation 2010

21 Conclusions Processed meats have stronger harmful relationships with CHD and diabetes than do unprocessed red meats, even at smaller serving sizes. Focus on fats may not explain this difference Preservatives may underlie such effects May guide industry strategies for reducing harm Policy priorities for reducing population risk There are healthier food choices than either unprocessed or processed red meats. Fish, beans, nuts, dairy.

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24 Percent of Americans Meeting Diet Guidelines Percent of Americans Meeting US Dietary Guidelines Adults Children Fruit + juices Vegetables + juices Whole Grains Fish, Shellfish Nuts, Seeds, Beans Sodium Sugar Beverages Based on NHANES ; Mozaffarian et al., in preparation

25 Acknowledgements Renata Micha, Sarah Wallace Funding Supported by the Bill & Melinda Gates Foundation/World Health Organization Global Burden of Diseases, Risk Factors, and Injuries Study; the National Heart, Lung, and Blood Foundation, NIH (R01 HL ); the Searle Scholars Program Frank Hu, Walter Willett, EPIC Investigators Other authors for clarifying/ providing missing data Alberto Ascherio Valerie Burke James Cerhan Linda Kelemen Aaron Folsom Teresa Fung Eric Grant Yoshihide Kinjo Paul Knekt Janine Kröger Carlo La Vecchia Laurie Lambert Miguel Martinez-Gonzalez Katie Meyer Jun Nagano Demosthenes Panagiotakos Catherine Sauvaget Matthias Schulze Duc Son Le Alessandra Tavani Rob van Dam Raquel Villegas Jyrki Virtanen Eberhard Windler