Published on November 14, 2012
Risk of diabetes, cardiovascular disease and colorectal cancer Impact of protein sources Authorized nutritionist, M.Sc, MBA ReijoLaatikainen www.pronutritionist.net www.pronutritionistblog.comPage 1
Diet high in animal protein & fat - health risk in prospective cohorts Sjögren Lagiou et al. Trichopoul Halton et Fung et al. Koning et Similä et al, et al. 2007 ou et al. al. 2009 2011 al. 2011 2012 2010 2007 (adequate reporters)Mortality NS 11 % 22 % N/A 12 % N/A N/A per 5 index per 5 index (lowest vs points points highest)CHD NS 37 % 9% N/A NS N/A N/Amortality per 5 index per 5 index points pointsAny 50 % N/A N/A N/A N/A N/A N/Acardiac per SDeventT2D N/A N/A N/A N/A N/A 37 % 4 %↑/fat 2 E% 15 %/pro 2 E% Note! Read meat and processed meat are the biggest sources of animal protein & fat Page 3 14 November 2012
Red meat. Prospective cohorts / meta- analyses RR 1.6 1.51 1.42 1.4 Effects are 1.28 1.19 independent of fat 1.2 1.11 1.13 1.09 content 1 1 1 serving Red 0.8 meat (Fresh) 0.6 50 g 100 g 100 g 100 g 120 g 30 g 50 g 0.4 50 g 1 serving 0.2 Processed meat 0 * ** *** T2D CHD* Strokes Colorectal cancer*) Michas G, Mozaffarian D, Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes -An Updated Review of the Evidence.Micha R, D.CurrAtheroscler Rep. 2012 Sep 22. [Epub ahead of print]**) Kaluza J, Wolk A, Larsson SCRed meat consumption and risk of stroke: a meta-analysis of prospective studies. Stroke. 2012 Oct;43(10):2556-60.***) Larsson SC, Wolk A.Meat consumption and risk of colorectal cancer: a meta-analysis of prospective studies. Int J Cancer. 2006 Dec 1;119(11):2657-64 4
SFA per se is not risk factor for CHD(prospective cohorts) Siri-Tarino PW et al. Am J Clin Nutr (January 13, 2010). doi:10.3945/ajcn.5
Is saturated fat from meat different ? RR for CVD (per each 5 % increase as of energy) 1.6 1.48 1.4 1.2 1 0.8 0.62 0.6 0.4 0.2 0 SFA from dairy SFA from meat ”The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower CVD risk [HR (95% CI): 0.75 (0.63, 0.91)]. No associations were observed between plant or butter SF and CVD risk, but ranges of intakes were narrow.”de Oliveira Otto MC, Mozaffarian D, Kromhout D, Bertoni AG, Sibley CT, Jacobs DR Jr, Nettleton Dietary intake of saturated fat by food source and incident cardiovasculardisease: the Multi-Ethnic Study of Atherosclerosis .Am J Clin Nutr. 2012 Aug;96(2):397-404. www.pronutritionist.net
Dairy. Prospective cohorts / meta-analyses RR 1.05 1 1 0.95 0.91 0.9 0.87 0.86 0.85 200 ml Highvslow 200 ml 200 ml 0.8 0.75 T2D* CHD ** Strokes** Colorectal cancer *** *) Tong et al. Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J ClinNutr. 2011 Sep;65(9):1027-31 **) Soedamah-Muthu et al,Milk and dairyconsumption and incidence of cardiovasculardiseases and all- causemortality: dose-responsemeta-analysis of prospectivecohortstudies, J ClinNutr. 2011 Jan;93(1):158-71 ***) Aune et al, Dairyproducts and colorectalcancerrisk: a systematicreview and meta-analysis of cohortstudies, ,AnnOncol. 2012 Jan;23(1):37-457
Red and processed meat in randomized controlled trials Data is sparse but quite coherently against high intake of red & processed meat8 www.pronutritionist.net
Randomized trials /mortality andmorbidity?• 2 truly successful randomized trials in terms CHD mortality and morbidity – Oslo Diet Heart – Lyon Diet Heart• In both studies beef, pork and lamb were restricted Leren et al. The effect of plasma cholesterol lowering diet in male survivors of myocardial infarction. Acta Med Scand. 1966; Suppl 466; 1-9 Oslo Diet heart study, original thesis version9
White meat vs. red meat in RCTs? • In 3 different randomized trials replacing red meat by poultry reduced albuminuria in diabetic nephropathy • Generally what is good for kidney tends to be good for heart and brain 1. de Mello et al, Long-term effect of a chicken-based diet versus enalapril on albuminuria in type 2 diabetic patients with microalbuminuria. RenNutr. 2008 Sep;18(5):440-7 2. de Mello et all, Withdrawal of red meat from the usual diet reduces albuminuria and improves serum fatty acid profile in type 2 diabetes patients with macroalbuminuria. Am J ClinNutr. 2006 May;83(5):1032-8 3. Gross et al, Effect of a chicken-based diet on renal function and lipid profile in patients with type 2 diabetes: a randomized crossover trial. Diabetes Care. 2002 Apr;25(4):645-5110 www.pronutritionist.net
Red meat in low carb trials • LCD high in SFA based on high fresh beef intake – Small & Medium dense LDL ↑ – Total LDL ↑, apo B ↑ • “This was in contrast with our earlier studies where the same amount of saturated fat and very similar carbohydrate intake but a diet not loaded up with red meat, had no adverse effect even if it had lots of saturated fat in it.” – Krauss R, April 17, 2012, www.meandmydiabetes,com Krauss R et al, Separate effects of reduced carbohydrate intake and weight loss on atherogenic.Am J ClinNutr. 2006 May;83(5):1025-31 Mangravite et al. Changes in atherogenicdyslipidemia induced by carbohydrate restriction in men are dependent on dietary protein source. J Nutr. 2011 Dec;141(12):2180-5 Faghihnia et al, Effects of dietary saturated fat on LDL subclasses and apolipoprotein CIII in men. Eur J ClinNutr. 2012 Sep 5. doi: 10.1038/ejcn.2012.11811 www.pronutritionist.net
Red meat or oily fish? N=25, 8 week cross-over, women red bars= red meat, black bars = fish HDL –cholesterol was higher inNavas-Carretero An fish group. No other significant differences betweenoilyfishdietincreasesinsulinsensitivitycompared to a groups,redmeatdiet in youngiron-deficientwomen. S Br J Nutr.2009 Aug;102(4):546-53 12 www.pronutritionist.net
Red meat, soy beans and low gradeinflammation • Following markers of inflammation were reduced on soy bean diet – E-selectin – IL-18 – Nitric Oxide – TNF-α – CRP N=42, 8 week cross-over, women w metabolic syndrome Azadbakht L et al, SoyConsumption, Markers of Inflammation, and EndothelialFunction A cross-overstudy in postmenopausalwomenwith the metabolicsyndrome. Diabetes Care 30:967–973, 200713 www.pronutritionist.net
Opposing evidence? • I haven’t found any RCT or prospective cohort evidence that tied red and processed meat to better health outcomes in terms of T2D, CHD, strokes and cancer • Yes, red meat is a good source of heme iron and protein • Yes, humans have eaten red meat since stone age14 www.pronutritionist.net
Conclusions on red meat • Red and especially processed meat intake is strongly linked to T2D, CHD, strokes and colorectal cancer whereas dairy is not • Direct comparisons (RCTs) between red meat based diets and mixed protein diets are needed • Red meat is an example, how obsessing on one single nutrient (saturated fat)nutrient may make us (almost) blind to see other emerging evidence (like the risks of processed and red meat)Page 15
Wellcome aboard! http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist http://www.pronutritionist.net ReijoLaatikainen, Authorized Nutritionist, Registered dietitian, MBA Food images bought and licensed from BigStockPhotoPage 16
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