Risk of diabetes, cardiovascular disease and colorectal cancer

Impact of protein sources

Authorized nutritionist, M.Sc, MBAReijo Laatikainen

www.pronutritionist.net www.pronutritionistblog.com

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11 April 2023Page 3

Diet high in animal protein & fat - health risk in prospective cohorts

Sjögren et al. 2010(adequate reporters)

Lagiou et al. 2007

Trichopoulou et al. 2007

Halton et al. 2009

Fung et al. 2011

Koning et al. 2011

Similä et al, 2012

Mortality NS 11 % per 5 index points

22 % per 5 index points

N/A 12 % (lowest vs highest)

N/A N/A

CHD mortality

NS 37 % per 5 index points

9 % per 5 index points

N/A NS N/A N/A

Any cardiac event

50 % per SD

N/A N/A N/A N/A N/A N/A

T2D 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

T2D CHD Strokes Colorectal cancer

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.19

1

1.11

1.28

1.511.42

1.13 1.09

1 serving Red meat (Fresh)

1 serving Processed meat

Red meat. Prospective cohorts / meta-analyses

4

RR

*) 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.Curr Atheroscler 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

100

g

100

g

120

g

100

g

50 g

30 g

* *** ***

50 g

50 g

Effects are independent of fat

content

SFA per se is not risk factor for CHD (prospective cohorts)

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Siri-Tarino PW et al. Am J Clin Nutr (January 13, 2010). doi:10.3945/ajcn.

SFA from dairy SFA from meat0

0.20.40.60.8

11.21.41.6

0.62

1.48

RR for CVD (per each 5 % increase as of energy)

Is saturated fat from meat different ?

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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 cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis .Am J Clin Nutr. 2012 Aug;96(2):397-404.

”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.”

T2D CHD Strokes Colorectal cancer

0.75

0.8

0.85

0.9

0.95

1

1.05

0.86

1

0.87

0.91

Dairy. Prospective cohorts / meta-analyses

7

RR

* ****

***

Hig

h vs

low

200

ml

200

ml

200

ml

*) Tong et al. Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J Clin Nutr. 2011 Sep;65(9):1027-31**) Soedamah-Muthu et al, Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies, J Clin Nutr. 2011 Jan;93(1):158-71***) Aune et al, Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, ,Ann Oncol. 2012 Jan;23(1):37-45

Red and processed meat in randomized controlled trials

Data is sparse but quite coherently against high intake of red & processed meat

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• 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

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Randomized trials /mortality and morbidity?

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 version

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

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1. de Mello et al, Long-term effect of a chicken-based diet versus enalapril on albuminuria in type 2 diabetic patients with microalbuminuria. Ren Nutr. 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 Clin Nutr. 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):645-51

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

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Krauss R et al, Separate effects of reduced carbohydrate intake and weight loss on atherogenic.Am J Clin Nutr. 2006 May;83(5):1025-31

Mangravite et al. Changes in atherogenic dyslipidemia 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 Clin Nutr. 2012 Sep 5. doi: 10.1038/ejcn.2012.118

Red meat or oily fish?

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N=25, 8 week cross-over, womenred bars= red meat, black bars = fish

HDL –cholesterol was higher in fish group. No other significant differences between groups,

Navas-Carretero An oily fish diet increases insulin sensitivity compared to a red meat diet in young iron-deficient women. S Br J Nutr. 2009 Aug;102(4):546-53

Red meat, soy beans and low grade inflammation

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N=42, 8 week cross-over, women w metabolic syndrome

Azadbakht L et al, Soy Consumption, Markers of Inflammation, and Endothelial FunctionA cross-over study in postmenopausal women with the metabolic syndrome. Diabetes Care 30:967–973, 2007

• Following markers of inflammation were reduced on soy bean diet– E-selectin– IL-18– Nitric Oxide– TNF-α– CRP

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 age

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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)

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Wellcome aboard!

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http://www.pronutritionist.net

Reijo Laatikainen, Authorized Nutritionist, Registered dietitian, MBA

Food images bought and licensed from BigStockPhoto

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