1. The Effects of Red Meat Consumption and Risk of Cancer
Holly Dinh
Clinical II – Houston San Jacinto Methodist
Spring 2015
March 26, 2015
School of Health Professions

2. Meat Classification Red Meat Beef Pork Veal Lamb Processed Meat
Sausage
Bacon
Hot dogs
Bologna
Salami
Lunch meat

3. Cancers Associated w/Red Meat Consumption
Colon Rectal Esophageal Gastric

4. Compounds N-nitroso compounds (NOCs) Associated w/processed meats
Heterocyclic amines (HCAs)
Polycyclic aromatic hydrocarbons (PAHs)
HCAs & PAH are formed when meat are cooked at high temperatures

5. Meat Consumption and Risk of Colorectal Cancer
Egeberg R, Olsen A, Christensen J, Halkjaer J, Jakobsen MU, Overvad K, Tjonneland A, et al. Associations between Red Meat and Risks for Colon and Rectal Cancer Depend on the Type of Red Meat Consumed. The Journal of Nutrition. 2013; 143:

6. Purpose of the Study
To evaluate associations between intake of red meat and its subtypes, processed meat, fish and poultry and risk for cancer:
Colon
Cecum, appendix, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, rectosigmoid junction
Rectal
Tumors of the rectum
Danish Diet, Cancer and Health Cohort Study

7. Subjects of the Study Danish Diet, Cancer and Health Cohort Study
: 160,725 Danish men and women invited to participate
Total of 53,988 agreed to participate
25,832 Men
28,156 Women

8. Inclusion Criteria Age: 50-64 years
Living in greater Copenhagen and Aarhus areas
Born in Denmark
Not registered w/cancer diagnosis in the Danish Cancer Registry

9. Exclusion Criteria If subjects had a previous cancer diagnosis
Lifestyle questionnaire not filled out
Missing information on the variables

10. Methods Completed 2 questionnaires on diet and lifestyle
Diet: 192- item FFQ; calculated w/ FoodCalc
Provided biological samples
Anthropometric measurements

11. FFQ 192-item FFQ 63 covered intake of meat items and meat dishes
Exposure variables
Intake in grams per day of red meat, processed meat, fish and poultry
Red Meat: fresh and minced beef, veal, pork, lamb, and offal
Processed meat: salting, smoking, or curing

12. Lifestyle Questionnaire
Detailed questions on:
Social factors
Health status
Reproductive factors
Lifestyle habits
Information was provided on:
Years of schooling
Use of hormone replacement therapy
Sports activity
Smoking status
ETOH consumption
NSAIDs use

13. Statistical Analyses Analyses were done between:
Red meat & its subtypes
Processed meat and its subtypes
Fish
Poultry
Colon/rectal cancer rates
Cox proportional hazards models

14. Results Median follow-up of subjects: Gender differentiations
644 colon CA
345 rectal CA
Gender differentiations
Lifestyle factors

15. Table 2

16. Results
No significant associations between intake of red meat and risk for colon/rectal cancer
Red meat sub-types = positive associations with risk of colon/rectal cancer
Lamb – increase risk of colon cancer
Substituting fish instead of poultry – decrease risk of colon cancer
Pork – increase risk of rectal cancer
Beef – decrease risk of rectal cancer

17. Meat Consumption and Risk of Esophageal and Gastric Cancer in a Large Prospective Study
Cross AJ, Freedman ND, Ren J, Ward MH, Hollenbeck AR, Schatzkin A, Sinha R, Abnet CC, et al. Meat Consumption and Risk of Esophageal and Gastric Cancer in a Large Prospective Study. The American Journal of Gastroenterology. 2011; 106:

18. Purpose of the Study
To assess whether consumption of red and processed meats could increase risk of gastric/esophageal cancer in a large cohort study.
Gastric
Adenocarcinoma
Cardia or non-cardia cancers
Esophageal
Squamous cell carcinoma (ESCC)
Adenocarcinoma (EADC)

19. Subjects of the Study
Total for Baseline Analytic Cohort questionnaire = 494,979 people
295,305 Men
199,674 Women
Risk Factor Questionnaire = 303,156 people
176,842 Men
126,314 Women

20. Recruitment NIH – AARP Diet & Healthy study recruited: Men and women
Aged years
CA, FL, LA, NJ, NC, PA
Atlanta, GA/ Detroit, MI

21. Exclusion Criteria
Questionnaires who were filled in by someone else on the subject’s behalf
Had prevalent cancer diagnosis according to the cancer registry or self-report
Subjects w/extreme daily total energy intake

22. Methods Baseline Questionnaire (1995-96)
Self-administered demographic & lifestyle questionnaires
124-item FFQ
Risk Factor Questionnaire
Mailed out 6 months later
F/U for analyses occurred
Identified cancer cases through state cancer registries

23. Baseline/Risk Factor Questionnaire
124-item FFQ:
Usual frequency of consumption and portion size info of foods and drinks over previous 12 mo.
Risk Factor (6 months later)
Cancer free participants were mailed this
Detailed info on meat intake and cooking preferences

24. Assessment From the questionnaires, these variables were assessed:
Method meats were cooked
Varying degrees of doneness
Total iron = dietary Fe + supplementary Fe
Heme iron levels
Nitrate and nitrite intake
Estimated HCAs, PCAs, mutagenic activity

25. Statistical Analyses
Hazard ratios (HRs) and 95% confidence intervals (CIs)
Cox proportional hazards regression
Models constructed as addition models – where the model summed to total meat
Dietary variables

26. Results Median F/U time of 10 years: Data from baseline questionnaire:
215 esophageal squamous cell carcinomas
630 esophageal adenocarcinomas
454 gastric cardia cancers
501 gastric non-cardia cancers
Data from risk factor questionnaire:
128 esophageal squamous cell carcinomas
377 esophageal adenocarcinomas
255 gastric cardia cancers
277 gastric non-cardia cancers

27. Table 2

28. Results
Red meat intake was positively associated w/esophageal squamous cell carcinoma
No associations w/risk of esophageal/gastric cancer
White meat nor processed meat
Increase of DiMeIQx, MeIQx, PhIp, heme Fe = increase risk of esophageal adenocarcinomas

29. Discussion/Summary Not all red meat is associated with cancer
Depends on the sub-types
Beef, pork, veal, lamb
Type of cancer risk varies
Increase consumption of:
HCA’s = increase risk for EADC
Beef = increase risk for ESCC
Pork = increase risk for rectal CA
Lamb = increase risk for colon CA

30. References
Why you should reduce your red meat consumption. Seattle Organic Restaurants Web site. meat/. Published Accessed March 31, Egeberg R, Olsen A, Christensen J, Halkjaer J, Jakobsen MU, Overvad K, Tjonneland A, et al. Associations between Red Meat and Risks for Colon and Rectal Cancer Depend on the Type of Red Meat Consumed. The Journal of Nutrition. 2013; 143: Cross AJ, Freedman ND, Ren J, Ward MH, Hollenbeck AR, Schatzkin A, Sinha R, Abnet CC, et al. Meat Consumption and Risk of Esophageal and Gastric Cancer in a Large Prospective Study. The American Journal of Gastroenterology. 2011; 106: