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

Timothy J. Key*, Paul N. Appleby, Kathryn E. Bradbury, Michael Sweeting, Angela Wood, Ingegerd Johansson, Tilman Kühn, Marinka Steur, Elisabete Weiderpass, Maria Wennberg, Anne Mette Lund Würtz, Antonio Agudo, Jonas Andersson, Larraitz Arriola, Heiner Boeing, Jolanda M.A. Boer, Fabrice Bonnet, Marie Christine Boutron-Ruault, Amanda J. Cross, Ulrika EricsonGuy Fagherazzi, Pietro Ferrari, Marc Gunter, José María Huerta, Verena Katzke, Kay Tee Khaw, Vittorio Krogh, Carlo La Vecchia, Giuseppe Matullo, Conchi Moreno-Iribas, Androniki Naska, Lena Maria Nilsson, Anja Olsen, Kim Overvad, Domenico Palli, Salvatore Panico, Elena Molina-Portillo, J. Ramón Quirós, Guri Skeie, Ivonne Sluijs, Emily Sonestedt, Magdalena Stepien, Anne Tjønneland, Antonia Trichopoulou, Rosario Tumino, Ioanna Tzoulaki, Yvonne T. Van Der Schouw, W. M.Monique Verschuren, Emanuele Di Angelantonio, Claudia Langenberg, Nita Forouhi, Nick Wareham, Adam Butterworth, Elio Riboli, John Danesh

*Corresponding author for this work

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43 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2835-2845
Number of pages11
JournalCirculation
Volume139
Issue number25
DOIs
Publication statusPublished - 18 Jun 2019
Externally publishedYes

Bibliographical note

Funding Information:
Analyses were 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). The project (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, 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 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, and Institut National de la Santé et de la Recherche Médicale (IN-SERM) (France); German Cancer Aid, German Cancer Research Center, Federal Ministry of Education and Research, Deutsche Krebshilfe, Deutsches Krebsforsc-hungszentrum, and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Italian Association for Research on Cancer, National Research Council (Italy) and Ministero dell’Istruzione dell’Università e della Ricerca “Dipartimenti di Eccellenza” (Project D15D18000410001) to the Department of Medical Sciences (Italy); Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch Zorg Onderzoek Nederland, World Cancer Research Fund; Health Research Fund, PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, regional governments of Andalucía, Asturias, Basque Country, Murcia (No. 6236), and Navarra, Instituto de Salud Carlos III (ISCIII RETIC RD06/0020) (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; 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 (Drs Langenberg and Wareham), and MC_UU_12015/5 (Dr Forouhi), and National Institute for Health Research Biomedical Research Center Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215–20014) to the Medical Research Council Epidemiology Unit Cambridge. Dr Bradbury holds the Girdlers’ New Zealand Health Research Council Fellowship. Dr Steur received Core Medical Research Council Unit support through the Nutritional Epidemiology Program (MC_UU_12015/5) while at the Medical Research Council Epidemiology Unit and received funding from the Alpro Foundation while at the Cardiovascular Epidemiology Unit. John Danesh holds a British Heart Foundation Professorship, National Institute for Health Research Senior Investigator Award, and European Research Council Senior Investigator Award. The authors assume full responsibility for analyses and interpretation of these data.

Funding Information:
Analyses were 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). The project (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, 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 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 G?n?rale de l'Education Nationale, and Institut National de la Sant? et de la Recherche M?dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center, Federal Ministry of Education and Research, Deutsche Krebshilfe, Deutsches Krebsforschungszentrum, and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Italian Association for Research on Cancer, National Research Council (Italy) and Ministero dell'Istruzione dell'Universit? e della Ricerca "Dipartimenti di Eccellenza" (Project D15D18000410001) to the Department of Medical Sciences (Italy); Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch Zorg Onderzoek Nederland, World Cancer Research Fund; Health Research Fund, PI13/00061 to Granada, PI13/01162 to EPIC-Murcia, regional governments of Andaluc?a, Asturias, Basque Country, Murcia (No. 6236), and Navarra, Instituto de Salud Carlos III (ISCIII RETIC RD06/0020) (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Sk?ne and V?sterbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; 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 (Drs Langenberg and Wareham), and MC-UU-12015/5 (Dr Forouhi), and National Institute for Health Research Biomedical Research Center Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215-20014) to the Medical Research Council Epidemiology Unit Cambridge. Dr Bradbury holds the Girdlers' New Zealand Health Research Council Fellowship. Dr Steur received Core Medical Research Council Unit support through the Nutritional Epidemiology Program (MC-UU-12015/5) while at the Medical Research Council Epidemiology Unit and received funding from the Alpro Foundation while at the Cardiovascular Epidemiology Unit. John Danesh holds a British Heart Foundation Professorship, National Institute for Health Research Senior Investigator Award, and European Research Council Senior Investigator Award. The authors assume full responsibility for analyses and interpretation of these data.

Publisher Copyright:
© 2018 American Heart Association, Inc.

Keywords

  • dairy products
  • eggs
  • fish
  • heart diseases
  • meat

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