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Circulation. 2019 Apr 22. doi: 10.1161/CIRCULATIONAHA.118.038813. [Epub ahead of print]

Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort.

Author information

1
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
2
Nuffield Department of Population Health, University of Oxford, Oxford, UK; National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand.
3
MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
4
Department of Odontology, Umeå University, Umeå, Sweden.
5
German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
6
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
7
Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, University of Helsinki, Helsinki, Finland.
8
Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
9
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
10
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of OncologyIDIBELL, Barcelona, Spain.
11
Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden.
12
Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, San Sebastian, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
13
Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany.
14
Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
15
CESP, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, Paris, France; Gustave Roussy, Villejuif, F-94805, Paris, France; Department of Endocrinology, Rennes University Hospital (CHU), Rennes,France; Rennes 1 University, Rennes, France.
16
CESP, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, Paris, France; Gustave Roussy, Villejuif, F-94805, Paris, France.
17
School of Public Health, Imperial College, London, UK.
18
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
19
International Agency for Research on Cancer, World Health Organization, Lyon, France.
20
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
21
Clinical Gerontology, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
22
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
23
Hellenic Health Foundation,Athens, Greece; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
24
Italian Institute for Genomic Medicine (IIGM), Turin, Italy;Department of Medical Sciences, University of Turin, Turin, Italy.
25
Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain.
26
WHO 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, Athens, Greece.
27
Arctic Research Centre at Umeå University, Umeå, Sweden.
28
Danish Cancer Society Research Center, Copenhagen, Denmark.
29
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy.
30
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
31
Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs., Universidad de Granada, Granada, Spain.
32
Public Health Directorate of Asturias, Oviedo, Spain.
33
Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
34
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
35
Hellenic Health Foundation, Athens, Greece; WHO 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, Athens, Greece.
36
Cancer Registry and Histopathology Unit, "Civic - M.p.Arezzo" Hospital, ASP Ragusa, Ragusa, Italy.
37
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.

Abstract

BACKGROUND:

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

METHODS:

A prospective study of 409,885 men and women in nine European countries. Diet was assessed using validated questionnaires, calibrated using 24-hour recalls. Lipids and blood pressure were measured in a subsample. During 12.6 years mean 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.

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 excluding 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 first 4 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:

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-HDL cholesterol, and for red and processed meat with systolic blood pressure, which could mediate such effects.

KEYWORDS:

dairy products; eggs; fish; meat

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