protein sources and health

Effects of sources of animal protein on major chronic diseases.

Meta-analyses of prospective cohorts.

Registered dietitian, M.Sc, MBA Reijo Laatikainen

Aava Medical CenterDocrates Cancer Centerwww.pronutritionist.net

www.tervevatsa.fi

http://www.pronutritionist.net/

http://www.tervevatsa.fi/

Introduction• This slide deck bases on recent meta-analyses of prospective cohorts

which are considered at least as important as surrogate marker randomized studies.

• Small box depicts actual outcome (meta-regression). Red =risk is increased, blue=no statistically significant change in risk and green=risk is reduced

• Vertical line depicts confidence interval in each meta-analysis.

• Risk comparisons are formed by comparing the highest vs lowest category of consumption (ie. quintiles, tertiles, thirds or so). Exception: Red and processed meat (per 100g/50 g) and cardiovascular diseases.

Red meat is associated with increased of risk of diabetes, stroke and colorectal cancer

Kolorektaalisyöpä Rintasyöpä Eturauhassyöpä Tyypin 2 diabetes Aivohalvaus Sepelvaltimotauti0.70

0.80

0.90

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

1.80

1.90

2.00 Relative RIsk(Vertical line: 95% CI)

1.10

1.02 1.00

1.19

1.09 1.00

Colorectal cancer Breast cancer Prostate cancer Type 2 Diabetes Stroke Coronary Heart disease Stroke and CHD: Per 100 g/day, because comparison between lowest vs highest categories not given

Processed meat is associated with increased of diabetes, CHD, stroke and colorectal cancer

Kolorektaalisyöpä Rintasyöpä Eturauhassyöpä Tyypin 2 diabetes Aivohalvaus Sepelvaltimotauti0.70

0.80

0.90

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

1.80

1.90


Colorectal cancer Breast cancer Prostate cancer Type 2 Diabetes Stroke Coronary Heart disease


Stroke and CHD: Per 50 g/day, because comparison between lowest vs. highest categories not given

1.17

1.00 1.05

1.51

1.15

1.42

Fish is associated with decreased risk of cardiovascular diseases

Kolorektaalisyöpä

Rintasyö

pä

Eturau

hassyöpä

Tyypin 2 diabetes

Aivohalvaus

Sepelvaltimotauti

0.5

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4



0.93

1.03 1.01

1.15

0.87

0.79

Eggs are associated with increased risk of diabetes (for some peculiar reason)

Kolorektaalisyöpä

Rintasyö

pä

Eturau

hassyöpä

Tyypin 2 diabetes

Aivohalvaus

Sepelvaltimotauti

0.70.80.9

11.11.21.31.41.51.61.71.81.9

2 Relative RIsk(Vertical line: 95% CI)

No meta-analyses available


1.040.97

1.04 0.97

1.42

0.93 0.97

Dairy is associated with decreased risk of diabetes, CV diseases, breast and colorectal cancer but also with increased risk of prostate cancer

Kolorektaalisyöpä

Rintasyö

pä

Eturau

hassyöpä

Tyypin 2 diabetes

Aivohalvaus

Sepelvaltimotauti

0.70.80.9

11.11.21.31.41.51.61.71.81.9

2 Relative RIsk(Vertical line: 95% CI)


0.81 0.85

1.13

0.89 0.870.94

There are no meta-analyses of prospective cohorts available on white meat.

Kolorektaalisyöpä

Rintasyö

pä

Eturau

hassyöpä

Tyypin 2 diabetes

Aivohalvaus

Sepelvaltimotauti

0.5

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5

However, individual cohorts most of-ten so neutrality of poultry. Also, meta-analysis of colorectal adenomas demonstrated neutrality of poultry (Xu et al. 2014)


Sources 1/2Alexander DD, Morimoto LM, Mink PJ, Cushing CA. A review and meta-analysis of red and processed meat consumption and breast cancer. Nutr Res Rev. 2010;23(2):349-65.Alexander DD, Mink PJ, Cushing CA, Sceurman B.. A review and meta-analysis of prospective studies of red and processed meat intake and prostate cancer. Nutr J. 2010;9:50.Aune et al, Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, ,Ann Oncol. 2012;23(1):37-45.Chan DSM, Lau R, Aune D, et al. Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies. PLoS ONE. 2011;6(6):e20456Chen GC, Lv DB, Pang Z, Liu QF. Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2013 Jan;67(1):91-5. Dong J et al. Dairy consumption and risk of breast cancer: a meta-analysis of prospective cohort studies. Breast Cancer Res Treat. 2011;127(1):23-31Gao D, Ning N, Wang C, Wang Y, Li Q, Meng Z, Liu Y, Li Q.Dairy products consumption and risk of type 2 diabetes: systematic review and dose-response meta-analysis.PLoS One. 2013 Sep 27;8(9):e73965Leung Yinko SS, Stark KD, Thanassoulis G, Pilote L.Fish consumption and acute coronary syndrome: a meta-analysis. Am J Med. 2014 Sep;127(9):848-57.e2Micha R, Mozaffarian D. Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes - An Updated Review of the Evidence. Atheroscler Rep. 2012:14;515-52Qin LQ, Milk consumption is a risk factor for prostate cancer in Western countries: evidence from cohort studies. Asia Pac J Clin Nutr. 2007;16(3):467-76.

Sources 2/2Qin LQ, Xu JY, Han SF, Zhang ZL, Zhao YY, Szeto IM. Dairy consumption and risk of cardiovascular disease: an updated meta-analysis of prospective cohort studies. Asia Pac J Clin Nutr. 2015;24(1):90-100Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(1):146-59.Si R, Qu K, Jiang Z, Yang X, Gao P. Egg consumption and breast cancer risk: a meta-analysis. Breast Cancer. 2014 May;21(3):251-61 Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis. Am J Clin Nutr. 2010;92(5):1223-33.Xie B, He H. No association between egg intake and prostate cancer risk: a meta-analysis. Asian Pac J Cancer Prev. 2012;13(9):4677-81.Xun P, Qin B, Song Y. Fish consumption and risk of stroke and its subtypes: accumulative evidence from a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2012;66(11):1199-207.Wu S1, Feng B, Li K, Zhu X, Liang S, Liu X, Han S, Wang B, Wu K, Miao D, Liang J, Fan D.Fish consumption and colorectal cancer risk in humans: a systematic review and meta-analysis. Am J Med. 2012 Jun;125(6):551-9.e5.Zheng Ju-Sheng, Hu Xiao-Jie, Zhao Yi-Min, Yang Jing, Li Duo. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies BMJ 2013; 346 :f3706

Discussion 1/2

• Results are very well in line with recommendations of World Cancer Research Fund (WCRF/AIRC expert report 2007), and with most international dietary guidelines

• Results are rather well in line with results of randomized trials regarding Mediterranean Diet (Predimed, Lyon, Oslo Diet Heart)

• Results are very well in line with the analysis of systematic reviews and meta-analyses published between 1950-2013 (Fardet & Boirie 2013)

Discussion 2/2• These data are not the ”final word”. Prospective cohorts

cannot show causality and various confounders can affect results. However, no better data exists on the long term effects of protein sources on health.

• Magnitude of effects is relatively small

• These data do not tell much about extreme users. One is classified as a high user of eggs if consumption exceeds 7 eggs per week. This may dilute the actual effects.

• More randomized trials are needed to clarify the effects of different animal protein sources on health, but none of this data shows we should increase the intake of red or processed meat at the population level.

What might explain effects of red and processed meat?• Excessive intake of heme iron• Advanced glycation end products, AGE:s ↑• Polycyclic aromatic hydrocarbons, PAH:s ↑ • N-nitroso compounds (NOC) and N-nitrosation ↑• IGF-1↑• Amount of bifidobacteria ↓. Amount of various bad bacteria ↑ • Salt• Phosphates and other additives• Induction of TMAO production in the gut (from choline & carnitine)• Saturated fat• Arachidonic acid• Endotoxins (LPS) in minced and processed meat and increased LPS

production in gut • Neu5gc• Meat substitutes healthier choices of protein such as fish or plant protein

(less n-3 fatty acids, iodine, taurine & vitamin D)01.05.202319

Why dairy might be healthier than red and processed meat?• Fermented dairy has beneficial effects on gut bacteria• Natural ACE-inhibitors of fermented dairy products• Anti-inflammatory effects of whey protein• Vitamin K2 of cheese and fermented dairy• Production of TMAO in the gut decreases (studies on

cheese)• Production of butyrate increases in the gut (studies on

cheese)• Dairy substitutes unhealthier animal protein sources (less

heme iron, less NOCs, less PAH, less neu5gc, less arachidonic acid etc.)

01/05/202320

Wellcome aboard!

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Reijo Laatikainen, RD, MBA

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protein sources and health

Health & Medicine