Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study.
Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study.
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DOI：
10.1136/bmj.j1957
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发表时间：
2017-05-09
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影响因子：
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通讯作者：
Abnet CC
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文献类型：
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作者：
Etemadi A;Sinha R;Ward MH;Graubard BI;Inoue-Choi M;Dawsey SM;Abnet CC
目的确定不同类型肉类摄入量和肉类相关化合物与总死亡率和致死率的关系。设计以人群为基础的队列研究。建立NIH-AARP饮食与健康研究的基线饮食数据(来自美国六个州和两个大都市地区的普通人群的预期队列)和截至2011年12月31日的16年随访数据。参与者包括536名 969名美国退休人员协会成员，年龄在基线水平上50-71岁。根据膳食调查问卷，暴露于总肉类、加工和未加工的红肉(牛肉、羊肉和猪肉)和白肉(家禽和鱼)、血红素铁和加工肉类中的硝酸盐/亚硝酸盐的摄入量。使用调整后的COX比例风险回归模型，以卡路里调整后摄入量的最低五分之一作为参考类别。主要结果衡量的是随访期间任何原因造成的死亡率。结果：观察到全因死亡(最高与最低五分之一的危险比为1.26，95%可信区间为1.23至1.29)和因9种不同原因引起的死亡的风险增加。加工红肉和未加工红肉的摄入量都与所有原因和特定原因的死亡率有关。血红素铁和加工肉类硝酸盐/亚硝酸盐独立地与所有原因和原因特定死亡的风险增加有关。中介模型估计，与加工红肉相关的死亡率增加受到硝酸盐摄入量(37.0-72.0%)的影响，而血红素铁的影响较小(20.9%-24.1%)。当总肉类摄入量不变时，与最低摄入量相比，白肉摄入量最高的五分之一与所有原因死亡风险降低25%相关。几乎所有的死因都与白肉的摄入量呈负相关。结论：结果显示，所有原因死亡和死亡的风险增加，原因是与加工和未加工的红肉有关的9种不同原因，部分原因是加工肉类中的血红素铁和硝酸盐/亚硝酸盐。它们还表明，替代白肉，特别是未加工的白肉，风险会降低。
Objective To determine the association of different types of meat intake and meat associated compounds with overall and cause specific mortality. Design Population based cohort study. Setting Baseline dietary data of the NIH-AARP Diet and Health Study (prospective cohort of the general population from six states and two metropolitan areas in the US) and 16 year follow-up data until 31 December 2011. Participants 536 969 AARP members aged 50-71 at baseline. Exposures Intake of total meat, processed and unprocessed red meat (beef, lamb, and pork) and white meat (poultry and fish), heme iron, and nitrate/nitrite from processed meat based on dietary questionnaire. Adjusted Cox proportional hazards regression models were used with the lowest fifth of calorie adjusted intakes as reference categories. Main outcome measure Mortality from any cause during follow-up. Results An increased risk of all cause mortality (hazard ratio for highest versus lowest fifth 1.26, 95% confidence interval 1.23 to 1.29) and death due to nine different causes associated with red meat intake was observed. Both processed and unprocessed red meat intakes were associated with all cause and cause specific mortality. Heme iron and processed meat nitrate/nitrite were independently associated with increased risk of all cause and cause specific mortality. Mediation models estimated that the increased mortality associated with processed red meat was influenced by nitrate intake (37.0-72.0%) and to a lesser degree by heme iron (20.9-24.1%). When the total meat intake was constant, the highest fifth of white meat intake was associated with a 25% reduction in risk of all cause mortality compared with the lowest intake level. Almost all causes of death showed an inverse association with white meat intake. Conclusions The results show increased risks of all cause mortality and death due to nine different causes associated with both processed and unprocessed red meat, accounted for, in part, by heme iron and nitrate/nitrite from processed meat. They also show reduced risks associated with substituting white meat, particularly unprocessed white meat.