Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease.
Key, Timothy J
Appleby, Paul N
Lund Würtz, Anne Mette
Boer, Jolanda MA
Cross, Amanda J
La Vecchia, Carlo
Quirós, J Ramón
van der Schouw, Yvonne T
Verschuren, WM Monique
Lippincott Williams & Wilkins Ltd.
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Key, T. J., Appleby, P. N., Bradbury, K. E., Sweeting, M., Wood, A., Johansson, I., Kühn, T., et al. (2019). Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease.. Circulation, 139 (25), 2835-2845. https://doi.org/10.1161/circulationaha.118.038813
Background: There is uncertainty about the relevance of intake of animal foods to the etiology of ischemic heart disease (IHD). We examined the relationships of meat, fish, dairy products and eggs with risk for IHD in the pan-European EPIC cohort. Methods: A prospective study of 409,885 men and women in nine European countries. Dietary intakes were assessed using validated questionnaires, calibrated using 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean 12.6 years follow up, 7198 participants had a myocardial infarction or died from IHD. The relationships of animal foods with risk were examined using Cox regression with adjustment for other animal foods and relevant covariates. Additional analyses excluded the initial 4 years of follow-up (to allow for possible reverse causation), and modelled substitutions of different animal foods for red and processed meat. Results: The hazard ratio (HR) for IHD was 1.19 (95% CI 1.06-1.33) for a 100 g/d increment in the intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR 1.25 [1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR 0.93 [0.89-0.98] per 100 g/d increment), cheese (HR 0.92 [0.86-0.98] per 30 g/d increment) and eggs (HR 0.93 [0.88-0.99] per 20 g/d increment); the associations with yogurt and eggs were attenuated and non-significant after excluding the initial four years of follow-up. Risk was not significantly associated with intakes of poultry, fish or milk. In analyses modelling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese or eggs was associated with approximately 20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-HDL cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-HDL cholesterol. Conclusions: The risk for IHD was moderately positively associated with consumption of red and processed meat, and modestly inversely associated with consumption of yogurt, cheese and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-HDL cholesterol, and for red and processed meat with systolic blood pressure, which could mediate such effects.
Humans, Myocardial Ischemia, Diet Surveys, Risk Assessment, Risk Factors, Prospective Studies, Cross-Sectional Studies, Risk Reduction Behavior, Nutritive Value, Blood Pressure, Time Factors, Dairy Products, Eggs, Meat, Seafood, Adult, Aged, Middle Aged, Europe, Female, Male, Cholesterol, HDL, Recommended Dietary Allowances, Protective Factors, Biomarkers, Diet, Healthy
Analyses supported by the UK Medical Research Council (MR/M012190/1), Cancer Research UK (C8221/A19170 and 570/A16491), and the Wellcome Trust (Our Planet Our Health, Livestock Environment and People 205212/Z/16/Z). EPIC-CVD has been supported by the European Union Framework 7 (HEALTH-F2-2012-279233), the European Research Council (268834), the UK Medical Research Council (G0800270 and MR/L003120/1), the British Heart Foundation (SP/09/002 and RG/08/014 and RG13/13/30194), and the UK National Institute of Health Research. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC), National Research Council (Italy) and MIUR "Dipartimenti di Eccellenza"(Project D15D18000410001) to the Department of Medical Sciences (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF); Health Research Fund (FIS), PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPICNorfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), UK Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford, MC_UU_12015/1 (CL, NJW), and MC_UU_12015/5 (NF), and NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215-20014) to the MRC Epidemiology Unit Cambridge. Kathryn Bradbury holds the Girdlers’ New Zealand Health Research Council Fellowship. Marinka Steur received Core MRC Unit support through the Nutritional Epidemiology Programme (MC_UU_12015/5) whilst at the MRC Epidemiology Unit, and received funding from the Alpro Foundation whilst at the Cardiovascular Epidemiology Unit. JD holds a BHF Professorship, NIHR Senior Investigator Award, and ERC Senior Investigator Award. The funders play no role in the design of the study; the collection, analysis, and interpretation of the data; or the decision to approve publication of the finished manuscript. The authors assume full responsibility for analyses and interpretation of these data.
European Commision (37197)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
British Heart Foundation (RG/13/13/30194)
MEDICAL RESEARCH COUNCIL (MR/N003284/1)
British Heart Foundation (RG/18/13/33946)
External DOI: https://doi.org/10.1161/circulationaha.118.038813
This record's URL: https://www.repository.cam.ac.uk/handle/1810/291213
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