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Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease.
Circulation 2019; 139(25):2835-2845Circ

Abstract

BACKGROUND

There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition).

METHODS

In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates.

RESULTS

The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling 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 ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol.

CONCLUSIONS

Risk for IHD was positively associated with consumption of red and processed meat and 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-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.

Authors+Show Affiliations

Nuffield Department of Population Health, University of Oxford, United Kingdom (T.J.K., P.N.A., K.E.B.).Nuffield Department of Population Health, University of Oxford, United Kingdom (T.J.K., P.N.A., K.E.B.).Nuffield Department of Population Health, University of Oxford, United Kingdom (T.J.K., P.N.A., K.E.B.). National Institute for Health Innovation, School of Population Health, University of Auckland, New Zealand (K.E.B.).Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.).Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.).Department of Odontology, Umeå University, Sweden (I.J.).German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg (T.K., V. Katzke).Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.).Department of Community Medicine, Faculty of Health Sciences, Universitetet i Tromsø, Arctic University of Norway, Tromsø (E.W., G.S.). Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo (E.W.). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (E.W.). Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, University of Helsinki, Finland (E.W.).Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Sweden (M.W.).Section for Epidemiology, Department of Public Health, Aarhus University, Denmark (A.M.L.W., K.O.).Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-Institut d'Investigació Biomédica de Bellvitge, Barcelona, Spain (A.A.).Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Sweden (J.A.).Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, San Sebastian, Spain (L.A.). CIBER (Biomedical Research Networking Centres) de Epidemiología y Salud Pública, Madrid, Spain (L.A., J.M.H.).Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke (H.B.).Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B.).CESP, INSERM (Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale) U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, France (F.B., M.-C.B.-R., G.F.). Gustave Roussy, Villejuif Cedex, Paris, France (F.B., M.-C.B.-R., G.F.). Department of Endocrinology, Rennes University Hospital (CHU), France (F.B.). Rennes 1 University, France (F.B.).CESP, INSERM (Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale) U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, France (F.B., M.-C.B.-R., G.F.). Gustave Roussy, Villejuif Cedex, Paris, France (F.B., M.-C.B.-R., G.F.).School of Public Health, Imperial College, London, United Kingdom (A.J.C., E.R.).Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden (U.E., E.S.).CESP, INSERM (Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale) U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, France (F.B., M.-C.B.-R., G.F.). Gustave Roussy, Villejuif Cedex, Paris, France (F.B., M.-C.B.-R., G.F.).International Agency for Research on Cancer, World Health Organization, Lyon, France (P.F., M.G., M. Stepien).International Agency for Research on Cancer, World Health Organization, Lyon, France (P.F., M.G., M. Stepien).Department of Epidemiology, Murcia Regional Health Council, IMIB (Instituto Murciano de Investigación Biosanitaria)-Arrixaca, Spain (J.M.H.).German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg (T.K., V. Katzke).Clinical Gerontology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, United Kingdom (K.-T.K.).Epidemiology and Prevention Unit, Fondazione IRCCS (Institute for Research, Hospitalization and Health Care) Istituto Nazionale dei Tumori, Milan, Italy (V. Krogh).Hellenic Health Foundation, Athens, Greece (C.L.V., A. Trichopoulou). Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (C.L.V.).Italian Institute for Genomic Medicine, Turin (G.M.). Department of Medical Sciences, University of Turin, Italy (G.M.).Instituto de Salud Pública de Navarra, IdiSNA-Navarre Institute for Health Research, Pamplona, Spain (C.M.-I.).World Health Organization Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (A.N., A. Trichopoulou).Arctic Research Center at Umeå University, Sweden (L.M.N.).Danish Cancer Society Research Center, Copenhagen, Denmark (A.O., A.Tjønneland).Section for Epidemiology, Department of Public Health, Aarhus University, Denmark (A.M.L.W., K.O.).Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy (D.P.).Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy (S.P.).Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria, Universidad de Granada, Spain (E.M.-P.).Public Health Directorate of Asturias, Oviedo, Spain (J.R.Q.).Department of Community Medicine, Faculty of Health Sciences, Universitetet i Tromsø, Arctic University of Norway, Tromsø (E.W., G.S.).Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.S., Y.T.v.d.S., W.M.M.V.).Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden (U.E., E.S.).International Agency for Research on Cancer, World Health Organization, Lyon, France (P.F., M.G., M. Stepien).Danish Cancer Society Research Center, Copenhagen, Denmark (A.O., A.Tjønneland).Hellenic Health Foundation, Athens, Greece (C.L.V., A. Trichopoulou). World Health Organization Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (A.N., A. Trichopoulou).Cancer Registry and Histopathology Unit, "Civic-M.p.Arezzo" Hospital, ASP (Azienda Sanitaria Provinciale) Ragusa, Italy (R.T.).Department of Epidemiology and Biostatistics (I.T.), School of Public Health, Imperial College London, United Kingdom. Medical Research Council-Public Health England Centre for Environment (I.T.), School of Public Health, Imperial College London, United Kingdom. Department of Hygiene and Epidemiology, University of Ioannina Medical School, Greece (I.T.).Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.S., Y.T.v.d.S., W.M.M.V.).Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.S., Y.T.v.d.S., W.M.M.V.).Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.).Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.).Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.).Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (M. Steur, C.L., N.F., N.W.).Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.).School of Public Health, Imperial College, London, United Kingdom (A.J.C., E.R.).Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M. Sweeting, A.W., E.d.A., A.B., J.D.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31006335

Citation

Key, Timothy J., et al. "Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease." Circulation, vol. 139, no. 25, 2019, pp. 2835-2845.
Key TJ, Appleby PN, Bradbury KE, et al. Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease. Circulation. 2019;139(25):2835-2845.
Key, T. J., Appleby, P. N., Bradbury, K. E., Sweeting, M., Wood, A., Johansson, I., ... Danesh, J. (2019). Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease. Circulation, 139(25), pp. 2835-2845. doi:10.1161/CIRCULATIONAHA.118.038813.
Key TJ, et al. Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease. Circulation. 2019 Jun 18;139(25):2835-2845. PubMed PMID: 31006335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease. AU - Key,Timothy J, AU - Appleby,Paul N, AU - Bradbury,Kathryn E, AU - Sweeting,Michael, AU - Wood,Angela, AU - Johansson,Ingegerd, AU - Kühn,Tilman, AU - Steur,Marinka, AU - Weiderpass,Elisabete, AU - Wennberg,Maria, AU - Lund Würtz,Anne Mette, AU - Agudo,Antonio, AU - Andersson,Jonas, AU - Arriola,Larraitz, AU - Boeing,Heiner, AU - Boer,Jolanda M A, AU - Bonnet,Fabrice, AU - Boutron-Ruault,Marie-Christine, AU - Cross,Amanda J, AU - Ericson,Ulrika, AU - Fagherazzi,Guy, AU - Ferrari,Pietro, AU - Gunter,Marc, AU - Huerta,José María, AU - Katzke,Verena, AU - Khaw,Kay-Tee, AU - Krogh,Vittorio, AU - La Vecchia,Carlo, AU - Matullo,Giuseppe, AU - Moreno-Iribas,Conchi, AU - Naska,Androniki, AU - Nilsson,Lena Maria, AU - Olsen,Anja, AU - Overvad,Kim, AU - Palli,Domenico, AU - Panico,Salvatore, AU - Molina-Portillo,Elena, AU - Quirós,J Ramón, AU - Skeie,Guri, AU - Sluijs,Ivonne, AU - Sonestedt,Emily, AU - Stepien,Magdalena, AU - Tjønneland,Anne, AU - Trichopoulou,Antonia, AU - Tumino,Rosario, AU - Tzoulaki,Ioanna, AU - van der Schouw,Yvonne T, AU - Verschuren,W M Monique, AU - di Angelantonio,Emanuele, AU - Langenberg,Claudia, AU - Forouhi,Nita, AU - Wareham,Nick, AU - Butterworth,Adam, AU - Riboli,Elio, AU - Danesh,John, Y1 - 2019/04/22/ PY - 2019/4/23/pubmed PY - 2019/4/23/medline PY - 2019/4/23/entrez KW - dairy products KW - eggs KW - fish KW - heart diseases KW - meat SP - 2835 EP - 2845 JF - Circulation JO - Circulation VL - 139 IS - 25 N2 - BACKGROUND: There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition). METHODS: In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates. RESULTS: The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling 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 ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol. CONCLUSIONS: Risk for IHD was positively associated with consumption of red and processed meat and 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-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/31006335/Consumption_of_Meat_Fish_Dairy_Products_and_Eggs_and_Risk_of_Ischemic_Heart_Disease_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.118.038813?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -