Replacing red meat and processed red meat for white meat, fish, legumes or eggs is associated with lower risk of incidence of metabolic syndrome

doi:10.1016/j.clnu.2016.03.017

Clinical Nutrition

Volume 35, Issue 6, December 2016, Pages 1442-1449

https://doi.org/10.1016/j.clnu.2016.03.017 Get rights and content

Summary

Background & aims

Few studies have assessed the association between consumption of red meat (RM) and processed red meats (PRM) and the incidence of metabolic syndrome (MetS) and results have been inconsistent. We investigated associations between total consumption of meat and its subtypes and incident MetS and estimated the effect of substituting RM or PRM for alternative protein-rich foods.

Methods

We analyzed 1868 participants (55–80 years-old) recruited into the PREDIMED study who had no MetS at baseline and were followed for a median of 3.2 years. MetS was defined using updated harmonized criteria. Anthropometric variables, dietary habits, and blood biochemistry were determined at baseline and yearly thereafter. Multivariable-adjusted hazard ratios (HRs) of MetS were estimated for the two upper tertiles (versus the lowest one) of mean consumption of meat and its subtypes during the follow-up as exposure.

Results

Comparing the highest vs the lowest tertile of consumption, we observed an increased risk of MetS incidence, with HRs of 1.23 (95% confidence interval [CI]: 1.03–1.45) and 1.46 (CI: 1.22–1.74) for total meat and pooled RM and PRM, respectively. Compared with participants in the lowest tertile, those in the highest tertile of poultry and rabbit consumption had a lower risk of MetS incidence. The risk of MetS was lower when one-serving/day of RM or PRM was replaced by legumes, poultry and rabbit, fish or eggs.

Conclusion

RM and PRM consumption was associated with higher risk of MetS. Replacing RM or PRM with other protein-rich foods related to a lower risk of MetS and should, therefore, be encouraged.

This trial was registered at controlled-trials.com as ISRCTN35739639.

Introduction

Metabolic syndrome (MetS) is a cluster of metabolic disorders associated with abdominal obesity that is associated with an increased risk of cardiovascular disease (CVD) and diabetes [1]. It has been suggested that adherence to the Mediterranean diet (MedDiet) and a healthy lifestyle are cornerstones in the prevention and treatment of MetS [2]. On the other hand, a Western dietary pattern, characterized by a high consumption of red meat, processed meat, butter and margarine and refined grain has been associated with an increased prevalence and incidence [3] of MetS.

Some studies have reported a positive association between meat consumption – mainly red meat and processed meat – and hypertension [4], abdominal obesity [5], and type 2 diabetes [6], [7], all of which are MetS components. Cross-sectional [8], [9], [10], [11], [12] and prospective studies [3], [9], [13] have examined the association between red meat consumption and MetS, with controversial results. To our knowledge only three prospective studies have analyzed the association between red meat consumption and MetS [3], [9], [13]. In the Atherosclerosis Risk in Communities study, a direct association was observed between meat consumption (hamburger, hot dogs, processed meats, bacon, meat sandwiches or mixed dishes, meat as a main dish) and MetS incidence in middle-aged women and men [3]. Along the same lines, in a study limited to one of the centers of the PREDIMED trial we found an increased risk of MetS development in those individuals in the highest baseline quartile of red meat and processed red meat consumption compared to those in the first quartile after one year of follow-up [9]. Finally, in a cohort of Japanese ancestry a 4.7-fold increased risk of developing MetS was observed in those individuals in the top tertile of red meat consumption compared to those in the lower tertile, although the relationship was lost after adjustment for saturated fatty acid intake [13]. As far as we know, only two previous studies related exposure to poultry consumption with MetS prevalence [12] or incidence [13] and reported no associations.

In the present analysis we provide the results obtained in the full cohort of the PREDIMED study, a nutritional intervention trial for the primary prevention of cardiovascular disease [14] for the associations between total meat and specific types of meat consumption (especially red meat and processed red meat) and the incidence of MetS during the total study follow-up. We also estimated the effects on MetS incidence of replacing red meat and processed red meat with alternative protein-rich foods.

Section snippets

Study design and participants

This study is a secondary analysis of a previously published randomized clinical trial, the PREDIMED (PREvención con DIetaMEDiterránea, www.predimed.es) study. Briefly, PREDIMED is a randomized, multicentre, parallel-group field trial that was conducted in Spain between October 2003 and December 2010 to assess the effectiveness of the MedDiet on the primary prevention of CVD. The protocol and design have been described elsewhere [14]. The trial was registered at //www.controlledtrials.com/ISRCTN35739639

Results

A total of 1868 individuals free of MetS at baseline and without extreme total energy values in FFQ were included in the final longitudinal analyses after 226 individuals had been excluded because data on some of the MetS components during follow-up were missing. The mean daily consumption of total meat was 124 g, for which RM&PRM were the major contributors (55%).

After a median follow-up of 3.2 years (interquartile range 1.9–5.8), 980 participants without MetS at baseline (53.8% women)

Discussion

To the best of our knowledge, this is the first epidemiologic study that has evaluated the association between total meat and different subtypes of meat and the risk of MetS development in older individuals at high cardiovascular risk. The results showed that a high consumption of total meat (around more than one serving/day), especially RM&PRM, was associated with increased risk of MetS after adjusting for several potential confounders. In contrast, poultry and rabbit consumption was

Funding sources

This study was funded, in part, by the official funding agency for biomedical research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140, to Ramon Estruch, RTIC RD06/0045 to Miguel Ángel Martínez-González and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN); and by grants from Fondo de Investigación Sanitaria-Fondo Europeo de

Conflict of interest

The authors disclose no conflict of interest related with the article.

Authors' responsibilities

M.A.M.-G., D.C, R.E, E.R, L.S-M, J.L, E.G.-G., M.F., and J.S.-S. designed the PREDIMED study; N.B.-T., N.B., M.A.M.-G., D.C., R.E., E.R., M.F., L.S.-M., I.S., R.M.L.-R., J.L., E.G.-G., M.F., E.T., J.V.-S., R.P. and J.S.-S. conducted the research; N.B.-T. and N.B. analyzed data; N.B.-T., N.B., and J.S.-S. wrote the manuscript; M.A.M.-G., D.C., R.E., E.R., L.S.-M., M.F., J.L., J.S.-S. were the coordinators of subject recruitment and follow-up at the outpatient clinics; N.B.-T., N.B. and J.S.-S.

Acknowledgments

The authors thank all the participants for their collaboration, all the PREDIMED personnel for their assistance and all the personnel of affiliated primary care centers for making the study possible. CIBEROBN is an initiative of ISCIII, Spain.

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Citation Excerpt :
To our knowledge, no previous study has assessed the association between dietary patterns and barriers to healthy eating, so these results cannot be compared to the literature. More research is needed regarding a potential association between barriers to healthy eating and dietary patterns, given the increasing epidemiological evidence indicating that the overall quality of dietary patterns is more important in chronic disease risk than single food groups [2,6,13]; furthermore, increasing evidence also reveals that suboptimal consumption of healthy foods appears to be more detrimental for chronic disease risk than the high consumption of unhealthier foods [29–31]. Our findings indicate that interventions aimed at increasing adherence to the dietary guidelines need to be sensitive to the way the population perceives how difficult it is to achieve and maintain a healthy diet.
People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear.
To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines.
Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression.
Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85–0.98) and taste (0.85; 0.79–0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06–1.21) and limited options in restaurants (1.33; 1.23–1.45) and in supermarkets (1.18; 1.03–1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66–0.78), while price (1.20; 1.11–1.30), gluttony (1.17; 1.04–1.31), social group opposition (1.48; 1.18–1.85) and limited options in restaurants (1.56; 1.42–1.72) and in supermarkets (1.25; 1.07–1.47) were associated with higher adherence. Daily habits (0.82; 0.75–0.90), time (0.86; 0.78–0.94), lack of willpower (0.78; 0.70–0.87), and gluttony (0.86; 0.76–0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01–1.19), and limited options in restaurants (1.26; 1.14–1.39) and supermarkets (1.40; 1.20–1.63) were associated with higher adherence. Daily habits (0.89; 0.82–0.97), taste (0.66; 0.61–0.72), lack of willpower (0.84; 0.76–0.92) and gluttony (0.66; 0.58–0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78–0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09–1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85–0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03–1.22).
In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence.

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Original articleReplacing red meat and processed red meat for white meat, fish, legumes or eggs is associated with lower risk of incidence of metabolic syndrome

Summary

Background & aims

Methods

Results

Conclusion

Introduction

Section snippets

Study design and participants

Results

Discussion

Funding sources

Conflict of interest

Authors' responsibilities

Acknowledgments

Am J Clin Nutr

Nutr Metab Cardiovasc Dis

J Nutr

J Nutr

Clin Nutr

J Nutr

Clin Biochem

Am J Clin Nutr

Nutr Res

Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International

Circulation

Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial

CMAJ

Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study

Circulation

Meat intake and the risk of hypertension in middle-aged and older women

J Hypertens

Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies

Obes Rev

Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies

Diabetologia

High consumptions of grain, fish, dairy products and combinations of these are associated with a low prevalence of metabolic syndrome

J Epidemiol Community Health

Original article
Replacing red meat and processed red meat for white meat, fish, legumes or eggs is associated with lower risk of incidence of metabolic syndrome