* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Meat as a Risk Factor for Type 2 Diabetes
Survey
Document related concepts
Food and drink prohibitions wikipedia , lookup
Low-carbohydrate diet wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Human nutrition wikipedia , lookup
Abdominal obesity wikipedia , lookup
Thrifty gene hypothesis wikipedia , lookup
Diet-induced obesity model wikipedia , lookup
Vegetarianism wikipedia , lookup
Transcript
Meat as a Risk Factor for Type 2 Diabetes Susan Levin, M.S., R.D., C.S.S.D. American Diabetes Association Risk factors for overweight adults • Physical inactivity • First-degree relative with diabetes • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) • Women who delivered a baby weighing > 9 lb or were diagnosed with GDM • Hypertension (blood pressure ≥ 140/90 mmHg or on therapy for HTN) • HDL cholesterol level < 35 mg/dL (0.90 mmol/L) and/or a TG level > 250 mg/dL (2.82 mmol/L) • Women with polycystic ovarian syndrome • A1C ≥ 5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans) • History of CVD • Meat eater? American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37:S14–S80. Measuring Meat Consumption • Categorical – meat vs. no meat • Gradations – Scalar – Dietary patterns Categorical Variable Seventh-day Adventists (SDA) • Avoid alcohol, tobacco, caffeine • Half vegetarian, half omnivores • Three studies Adventist Mortality Study • ~25,000 – 40% increased risk for meat-eating women – 80% increased risk for meat-eating men Snowdon DA, et al. Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health. 1985;75:507–512. Adventist Health Study • ~34,000 – 93% increased risk for meat-eating women – 97% increased risk for meat-eating men Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr. 1999;70:S532–S538. Adventist Health Study-2 • ~61,000 – 2x the risk for meat-eaters Tonstad S, et al. Type of vegetarian diet, body weight and prevalence of type 2 diabetes. Diabetes Care. 2009;32:791–796. Gradations • Scalar • Dietary Patterns Meta-analysis • ~440,000 participants – 100 grams of red meat (3.5 oz) 19% increased risk – 50 grams processed meat 51% increased risk Pan A, et al. Red meat consumption and risk of type 2 diabetes: 3 Cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011;94:1088–1096. Nurses’ Health Study I • ~70,000 – Western dietary pattern • 49% increased risk of developing diabetes during 14 years follow-up, compared with lowest quintile • Isolating products showed 26% increase risk for each serving of red meat added and 38% for each serving of processed meat – Prudent dietary pattern Fung TT, et al. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 2004;164:2235– 2240. Nurses’ Health Study II • ~91,000 • Processed meat ≥5 x/week 91% increased risk • Adjusting for other products in pattern did not change this finding • Red meat ≥5 x/week 59% increased risk Schulze MB, et al. Processed meat intake and incidence of type 2 diabetes in younger and middle-aged women. Diabetologia. 2003;46:1465–1473. EPIC-InterAct Study • ~ 16,000 • Animal protein • People who ate the most 22 percent more likely to develop diabetes • Each additional 10 grams of protein, the risk for DM went up by 6 percent. Van Nielen M, et al. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-INTERACT case-cohort study. Diabetes Care. 2014;37:1854-1862. Conclusion While a Western dietary pattern is associated with diabetes risk, meat consumption increases diabetes risk independently of dietary pattern. What About Fish? • ~195,000 – Nurses’ Health Study I and II, Health Professionals Follow-up Study – Fish ≥5 x/week 22% increased risk for developing DM during 14-18 year followup, compared with fish < 1/month • ~20,000 – EPIC and Multiethnic Cohort Study – Fish consumption higher in those with DM Kaushik M, et al. Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus. Am J Clin Nutr. 2009;90:613–620. Nöthings U, et al. Food intake of individuals with and without diabetes across different countries and ethnic groups. Eur J Clin Nutr. 2011;65:635–641. Mechanisms of Action Body weight Visceral fat Inflammation Diabetes Intracellular lipid Nitrates Iron Body Weight • Observational studies show meat eaters are heavier • High-fat diet • Low-fiber diet • Possible association between animal protein and weight – Insulin resistance aggravated by certain amino acids and fat? – SFA in meat increase insulin response which reduces fat oxidation? Berkow S, et al. Vegetarian diets and weight status. Nutr Rev. 2006;64:175–188. Barnard ND, et al. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med. 2005;118:991–997. Bujnowski D, et al. Longitudinal association between animal and vegetable protein intake and obesity among men in the United States: The Chicago Western Electric Study. J Am Diet Assoc. 2011;111:1150–1155. Visceral Fat • Eliminating fat may reduce visceral fat and improve insulin sensitivity, compared with conventional diabetes diet. • ↑ visceral fat ↑ insulin resistance Kahleova H, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med. 2011;28:549-559. Hamdy O, et al. Metabolic obesity: The paradox between visceral and subcutaneous fat. Curr Diabetes Rev. 2006;2:367–373. Intracellular Lipid • IMCL aggravates insulin resistance • Heart of the problem and solution • Avoiding animal products ↓ IMCL Sparks LM, et al. A High-fat diet coordinately downregulates genes required for mitochondrial oxidative phosphorylation in skeletal muscle. Diabetes. 2005;54:1926–1933. Iron • Pro-oxidation damages tissues • Associated with insulin resistance • Reductions associated with increased sensitivity Rajpathak SN, et al. The role of iron in type 2 diabetes in humans. Biochim Biophys.Acta. 2009;1790:671–681. Hua NW, et al. Low iron status and enhanced insulin sensitivity in lacto-ovo-vegetarians. Br J Nutr. 2001;86:515–519. Nitrates Preservatives may explain increased risk often seen with processed meat products specifically. Pereira EC, et al. Biomarkers of oxidative stress and endothelial dysfunction in glucose intolerance and diabetes mellitus. Clin Biochem. 2008;41:1454–1460. Inflammation • Meat-based diets positively associated with biomarkers of inflammation • Plant-based inversely associated with biomarkers of inflammation Barbaresko J, et al. Dietary pattern analysis and biomarkers of low-grade inflammation: A systematic literature review. Nutr Rev. 2013;71:511–527. Ley SH, et al. Associations between red meat intake and biomarkers of inflammation and glucose metabolism in women. Am J Clin Nutr. 2010:99:352–360. Common Nutrition Questions • • • • Protein B12 Iron Omega-3 Protein Of the approximately 20 different amino acids used by the body, nine (essential amino acids) cannot be synthesized by the body and must be obtained from the diet. Protein • It is easy to meet protein needs without meat. • Amino acids that are low in some plants are high in others – usually reflected in traditional meals such as beans and rice. – Grains are low in lysine while beans are high in lysine. • Complementary proteins do not need to be consumed at the same meal. Young et al. Plant proteins in relation to human protein and amino acid nutrition. Am J Clin Nutr. 1004;59:1203S-1212S. Protein Sources • • • • • • • • Legumes = 15 grams/cup Tofu = 20 grams/cup Brown rice = 5 grams/cup White rice = 4.25 grams/cup White-flour spaghetti = 8.1 grams/cup Quinoa = 8.4 grams/cup Soymilk = 7.1 grams/cup Broccoli = 2.6 grams/cup Source: USDA National Nutrient Database for Standard Reference. Nutrient Data Laboratory Web site, http://www.nal.usda.gov/fnic/foodcomp/search/. Vitamin B12 (Cobalamin) Produced by microorganisms – plants and animals can not synthesize B12. Vitamin B12 • Needs are small – 2.4 micrograms per day. • Ability to absorb B12 decreases with age because of a decrease in intrinsic factor in the gut. Anyone over the age of 50 should supplement with B12. • Reliable sources include supplemented foods and supplements. • Only supplement someone following a plant-based diet needs to take. Iron • Iron is only lost through bleeding, although very small amounts are excreted through feces, sweat, and exfoliation. • Men and post-menopausal women should never take an iron supplement. Iron • Vegetarians tend to consume more iron than their meateating counterparts. • Non-heme regulation vs. heme • Non-heme iron is sensitive to enhancers and blockers – Blockers: phytates, calcium, polyphenolics – Enhancers: vitamin C and other organic acids, soaking • Although vegetarian adults have lower iron stores than nonvegetarians, anemia does not afflict vegans any more than meat eaters. In addition, there may be some benefits to having low iron stores. Craig WJ, Mangels AR. Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009;109:1266-1282. Iron Sources Grains – Bran flakes (1 cup) – Oatmeal (packet) – Brown rice (1/2 cup cooked) 10.5 mg 8.2 mg 0.4 mg Vegetables (1/2 cup cooked) – Spinach – Swiss chard – Pumpkin – Kombu (8 g dry or < 2 TBS) – Nori (8 g dry or < 2 TBS) 3.2 mg 2.0 mg 1.7 mg 22.1 mg 3.7 mg Source: USDA National Nutrient Database for Standard Reference. Nutrient Data Laboratory Web site, http://www.nal.usda.gov/fnic/foodcomp/search/. Iron Sources Fruits – Prunes (1/4 cup) Apricots, dried (1/4 cup) 1.2 mg 0.9 mg Legumes (1/2 cup cooked) – Black-eyed peas Garbanzo beans Lentils 2.2 mg 2.4 mg 3.3 mg Soyfoods Soybeans (1/2 cup cooked) Tofu, firm (1/2 cup) 4.4 mg 6.6 mg Other Blackstrap molasses (1 Tblesp) Pumpkin seeds (2 Tblesp) 3.6 mg 2.5 mg Omega-3 • There are two essential fatty acids: omega-6 and omega-3. • ALA, an 18-carbon omega-3 fatty acid, is converted to eicosapentaenoic acid (EPA) which, in turn, can be elongated to docosahexaenoic acid (DHA). Omega-3 • Americans consume tremendous amounts of omega-6s compared to omega-3s. • Lop-sided ratio makes it difficult for omega-3s to impart their anti-inflammatory effects. • The AI for omega-3 for men is 1.6 g/d (14 calories) and for women is 1.1 g/d (10 calories). • Aim for a 4:1 ratio. • Happens naturally with a low-fat, plant-based diet. In Summary Vegetarian diets are often associated with a number of health advantages, including lower blood cholesterol levels, lower risk of heart disease, , lower blood pressure levels, and lower risk of hypertension and type 2 diabetes. - The Academy of Nutrition and Dietetics Craig WJ, et al. Position of the American Dietetic Association: vegetarian diets. 2009;109:1266-1282. Thank You [email protected]