Chicken Vs Beef Cholesterol Meat and Alzheimer's

• Journal List
• Am J Clin Nutr
• PMC8246598

Am J Clin Nutr. 2021 Jul; 114(1): 175–184.

Meat consumption and risk of incident dementia: accomplice study of 493,888 UK Biobank participants

Huifeng Zhang

Nutritional Epidemiology Group, School of Food Scientific discipline and Nutrition, University of Leeds, Leeds, UK

Darren C Greenwood

Leeds Institute for Information Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, United kingdom

Harvey A Risch

Department of Chronic Disease Epidemiology, Yale Schoolhouse of Public Health, New Haven CT, Us

David Bunce

School of Psychology, Kinesthesia of Medicine and Wellness, Academy of Leeds, Leeds, Britain

Laura J Hardie

Partition of Clinical and Population Sciences, Leeds Constitute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, Great britain

Janet Due east Cade

Nutritional Epidemiology Grouping, School of Food Science and Nutrition, University of Leeds, Leeds, UK

Received 2020 October 19; Accepted 2021 January 28.

Supplementary Materials

nqab028_Supplemental_File.

GUID: A9D0DA2B-E291-4593-B81C-36736F3881D4

Data Availability Argument

The data sets described in the manuscript are not publicly available considering the Great britain Biobank has proprietary rights of the data. External investigators tin request the data and approval of utilise on application to the UK Biobank (www.ukbiobank.ac.uk/).

Abstract

Background

Worldwide, the prevalence of dementia is increasing and diet as a modifiable factor could play a role. Meat consumption has been cross-sectionally associated with dementia take chances, simply specific amounts and types related to risk of incident dementia remain poorly understood.

Objective

Nosotros aimed to investigate associations betwixt meat consumption and risk of incident dementia in the U.k. Biobank accomplice.

Methods

Meat consumption was estimated using a short dietary questionnaire at recruitment and repeated 24-h dietary assessments. Incident all-cause dementia comprising Alzheimer illness (AD) and vascular dementia (VD) was identified by electronic linkages to hospital and mortality records. HRs for each meat type in relation to each dementia upshot were estimated in Cox proportional adventure models. Interactions between meat consumption and the apolipoprotein East (APOE) ε4 allele were additionally explored.

Results

Among 493,888 participants included, 2896 incident cases of all-crusade dementia, 1006 cases of AD, and 490 cases of VD were identified, with mean ± SD follow-up of eight ± i.one y. Each additional 25 g/24-hour interval intake of candy meat was associated with increased risks of incident all-crusade dementia (HR: i.44; 95% CI: ane.24, 1.67; P-trend < 0.001) and Advertisement (HR: 1.52; 95% CI: 1.xviii, one.96; P-trend = 0.001). In contrast, a l-k/d increase in unprocessed red meat intake was associated with reduced risks of all-cause dementia (HR: 0.81; 95% CI: 0.69, 0.95; P-trend = 0.011) and AD (HR: 0.70; 95% CI: 0.53, 0.92; P-trend = 0.009). The linear trend was not significant for unprocessed poultry and total meat. Regarding incident VD, there were no statistically significant linear trends identified, although for processed meat, higher consumption categories were associated with increased risks. The APOE ε4 allele increased dementia risk by 3 to 6 times but did not modify the associations with nutrition significantly.

Conclusion

These findings highlight processed-meat consumption as a potential take a chance factor for incident dementia, independent of the APOE ε4 allele.

Keywords: dementia, Alzheimer disease, vascular dementia, meat consumption, candy meat, United kingdom of great britain and northern ireland Biobank

Run across respective editorial on folio 7 and article on page 154.

Introduction

Dementia is a major public health business organization with around 50 million cases globally and an incidence of nearly ten million new cases per annum (1, 2). It comprises Alzheimer disease (Advertising), which contributes to 50–70% of dementia cases, vascular dementia (VD), which contributes to ∼25%, and other forms of dementia (2, iii). Dementia development and progression are associated with both genetic and environmental factors, including nutrition and lifestyle (4, 5). Lifestyle-related and dietary factors associated with dementia are potentially modifiable and thus correspond targets for master prevention (half dozen).

Meat consumption has gained increasing involvement in relation to health, since high consumption of processed meat and probably ruddy meat were found to exist consistently associated with an increased adventure of colorectal cancer (7). In recent decades meat consumption has doubled or fifty-fifty tripled globally, especially in developing countries (8). This dietary transition has been associated with increasing AD prevalence in Nihon, Republic of peru, Cuba and other low- and middle-income countries in both ecological and cross-sectional studies (9, 10). A written report of cognitively healthy individuals in Sweden showed that depression consumption of meat and meat products was associated with improve cognitive operation in clinical dementia screening tests and greater total brain book later a 5-y follow-up period (11). Our previous review on meat consumption and cognitive disorders including dementia showed that most meat-related studies were embedded in complex dietary patterns with considerable heterogeneity, and the bear witness of associations between adventure of dementia and specific types or amounts of meat consumption was express (12).

A consequent association has been established between railroad vehicle of the apolipoprotein E (APOE) ε4 allele and elevated take a chance of dementia or AD (xiii). Previous stratified analyses by APOE ε4 status showed that unfavourable lifestyle factors (eastward.yard., less healthy dietary pattern, less physical activity, smoking, and social isolation) were associated with college risk of dementia in APOE ε4 noncarriers just not in carriers (14). The discrepancy between carriers and noncarriers indicates that APOE genotype may alter associations between lifestyle factors and dementia risks, and might be explained past a potential masking of weak associations from lifestyle factors by the strongly associated APOE ε4 allele. Notwithstanding, at nowadays whether APOE ε4 allele carriage interacts with lifestyle factors, such as nutrition, influencing risk of dementia remains unclear.

In the present study we examined the hypothesis that loftier consumption of meat increases the incidence of dementia in the general population, which may be more pronounced amidst APOE ε4 noncarriers.

Methods

Study design

The U.k. Biobank is a largescale population-based cohort study of half a million participants aged 40–69 y recruited from across the United Kingdom between 2006 and 2010 (fifteen). The Biobank recruited participants using National Health Service patient registers and conducted the baseline assessments across 22 assessment centers in England, Scotland, and Wales which included a touchscreen questionnaire, verbal interview, physical measures, and biosample drove. At recruitment, participants electronically signed consent forms and completed various touchscreen questionnaires and measurements. All available resource are listed on the United kingdom Biobank website (http://www.ukbiobank.ac.uk/resource/). Upstanding approval was granted for the UK Biobank by the North West–Haydock Research Ethics Committee (REC reference: 16/NW/0274). The UK Biobank dataset for this project included 502,493 participants.

Meat consumption measures

At the recruitment cess-eye visit, each participant was asked to complete a brief touchscreen FFQ with 47 dietary items covering main foods, food groups, and drinking habits (16). The meat-related questionnaire items (fish not included) examined in the electric current study were the following: candy meat (such as bacon, ham, sausages, meat pies, kebabs, burgers, chicken nuggets), unprocessed poultry, unprocessed beefiness, unprocessed lamb/mutton, and unprocessed pork. Consumption of unprocessed beef, lamb, and pork were summed to provide the "unprocessed reddish meat" type, and all meat items listed above were combined into "total meat." Frequencies of consumption consisted of 6 categories and were assigned values for frequency per week (never eaten = 0, eaten <one time/wk = 0.5, one time/wk = ane, 2–four times/wk = three, 5–half dozen times/wk = five.five, and ≥1 time daily = 7). Nosotros categorized intake frequencies for each meat type into v groups as follows: candy meat (0, 0.ane–0.9, once, 2.0–4.ix, and ≥ 5.0 times/wk), unprocessed poultry (0, 0.1–0.9, in one case, two.0–4.9, and ≥ v.0 times/wk), unprocessed red meat (0, 0.ane–1.0, i.ane–1.9, ii.0–2.9, and ≥ three.0 times/wk), and total meat (0, 0.i–3.0, 3.1–four.9, v.0–6.9, and ≥ vii.0 times/wk). These categories were determined based on information distribution to provide similar-sized groups (additional details in Supplemental Methods 1).

Every bit an enhancement to the baseline touchscreen brief FFQ, the Oxford WebQ dietary questionnaire (17), which assesses a more detailed dietary intake over the previous 24 h was added to the assessment centers from April 2009 to September 2010. After that the WebQ questionnaire was administered online in one case every 3–4 mo and repeated for a total of 4 rounds over a 16-mo catamenia from Feb 2011 to June 2012 for 24-h dietary assessments. The Oxford WebQ asked participants to select the number of portions for each detail they consumed over the previous 24-h period with instructions specifying i standard portion size such as 1 sausage, one rasher of bacon, or 1 serving of beef. The daily intakes in grams were calculated past multiplying reported numbers of portions by standard portion sizes (16). Similar foods were then combined together into distinct meat types to match the baseline touchscreen questionnaire. A subgroup of participants (n  = 126,844) who completed at to the lowest degree two 24-h dietary assessments were included in this study (18) (run across comparisons between participants without or with ane+, two+, and 3+ completions of the Oxford WebQ in Supplemental Tabular array ane); values from multiple assessments were averaged for each participant with 2+ completions. We so calculated the hateful intakes from the 24-h dietary assessments inside each category of meat types from the touchscreen brief FFQ. The corresponding mean daily intakes in each category were used in combination with frequency from the touchscreen questionnaire equally continuous variables to examine the effect sizes per specific increment of meat intakes (25 thousand/d for candy meat and unprocessed poultry; l g/d for unprocessed red meat and total meat). These increments correspond to usual average portion sizes for regular eaters of these products, especially in men in the United kingdom Biobank (nineteen), and are consequent with other study presentations of results (20). The hateful daily intakes in each meat category were also used to examination the P-trend beyond 5 categories of each meat type, equally well as to correct for the potential regression dilution bias in the touchscreen brief FFQ reported in previous studies (16, 21) (more details seen in Supplemental Methods 1).

Ascertainment of dementia

Prevalent and incident dementia cases inside the UK Biobank were ascertained through data linkage to hospital inpatient admissions and death registries. Cocky-reported dementia cases at recruitment were additionally classified equally prevalent cases. The electronic linkage to hospital inpatient data and decease registry records includes main or secondary events across healthcare systems in England, Scotland, and Wales. Date of diagnosis was fix as the primeval appointment of dementia codes recorded regardless of source used. According to the International Classification of Diseases (ICD), AD was defined as code 331.0 in edition 9 and codes F00 and G30 in edition x; VD was defined every bit codes 290.4 in edition 9 and codes F01 and I67.3 in edition 10; all-cause dementia was defined every bit all of the above codes plus ICD-9 codes 290, 291.2, 294.ane, 331.0–331.2, and 331.v, and ICD-10 codes A81.0, F02, F05.1, F10.6, G31.0, G31.ane, and G31.viii. The updating engagement of linkages to hospital inpatient admission and death registries was 31 March 2017 in England, 31 October 2016 in Scotland, and 29 Feb 2016 in Wales in this study. Participant survival time in person-y was calculated from the date of dietary cess until date of dementia diagnosis, engagement of loss to follow-upwards, appointment of death, or updating engagement of linkages.

APOE genotyping

Genotypes of near one-one-half one thousand thousand participants in the Britain Biobank were assayed using ii very like genotyping arrays manufactured by Affymetrix: the BiLEVE Axiom array for ∼fifty,000 participants and the UK Biobank Axiom array for the remaining ∼450,000 participants; genotyping quality command was performed by UK Biobank centrally (22). Information from UK Biobank participants with unusually high heterozygosity and missingness (>5%) and disagreement betwixt reported sex and genetic sexual activity were excluded in genotype-related analyses (23). In addition, we used genetic kinship to other participants (Biobank field ID 22,021) as a covariate to limit misreckoning from population relatedness (24). The APOE haplotypes (ε2/ε3/ε4) were directly genotyped and determined by ii genetic variants, rs429358 and rs7412. Participants with ane or 2 ε4 alleles were defined as APOE ε4 carriers and otherwise as APOE ε4 noncarriers. Subsequently quality control procedures, APOE genotypes were bachelor on 405,126 UK Biobank participants and were included in APOE genotype related analyses.

Statistical analysis

Participants with prevalent dementia, and those with incomplete data on meat-related variables were excluded earlier analyses. Given the possibility that underlying dementia may cause changes in dietary behaviors in advance of diagnosis, nosotros excluded incident dementia cases that occurred in the first-y menstruation from baseline dietary data collection to dementia diagnosis to limit the possibility of reverse causality (25). A more than stringent 3-y cutting-off was also applied as a sensitivity analysis (encounter the flowchart in Supplemental Figure 1).

Baseline sociodemographic, lifestyle, and principal dietary characteristics were summarized and stratified by dementia condition (incident dementia and no dementia). Amidst incident cases, all-crusade dementia, Ad, and VD were treated as separate outcomes. The associations between incident dementia and reported consumption of candy meat, unprocessed poultry, unprocessed red meat, and total meat were fitted in Cox proportional hazards regressions with the duration of follow-upward in years as the timescale and the second everyman category of meat intakes as the reference; HRs with 95% CIs were reported for all analyses.

3 models were applied in our analyses: unadjusted models, minimally adjusted models, and fully adapted models. The minimally adapted model was adjusted for age at baseline, gender, self-reported ethnicity (White, Asian, Black, mixed, other/unknown), socioeconomic condition (low, moderate, or high deprivation), educational level (with university/college degree or non), determined by a directed acyclic graph (26) (Supplemental Methods ii). The fully adjusted model was additionally adjusted for region (England, Wales, Scotland), BMI (in kg/mⁱⁱ; <25, 25–29.9, and ≥30), physical action level (low, moderate, and high), smoking status (never, past, and electric current), typical sleep duration (<seven, 7–8, >8 h/d), stroke history, family unit history of dementia, and dietary factors including full consumption of vegetables and fruits, full fish, tea and coffee, and booze. Processed meat, unprocessed poultry, and unprocessed red meat were also mutually adjusted for in the models. More than details on covariates tin can be seen in Supplemental Methods three. For covariates where participants answered "exercise not know" or "prefer not to answer," these responses were classified as missing. An "unknown" category was created to replace missing values for each covariate; the effect of replacement of missing values was assessed by a sensitivity analysis conducted in participants with consummate data on all covariates.

To investigate potential modifying effects of the APOE ε4 allele on take a chance of dementia from meat consumption, stratified analyses by APOE ε4 carrying status were conducted and additionally P-interaction between each meat blazon and APOE ε4 status was tested. As a sensitivity analysis, the main analyses were repeated amidst participants anile ≥lx y at baseline since individuals anile >60 y have a higher take a chance of incident dementia (27). Statistical analyses were conducted using Stata/IC, version 16.1 (Stata Corp LP).

Results

During a mean follow-upwardly of eight ± 1.1 y, excluding cases arising in the first year of follow-upward (n = 77), 2896 incident cases of all-cause dementia occurred, of which 1006 were AD and 490 were VD. Baseline characteristics stratified by dementia status are provided in Table 1 . Dementia cases were by and large older, more economically deprived, less educated, more than likely to smoke, less physically active, more likely to accept stroke history and family dementia history, and more probable to be APOE ε4 carriers. More men than women were diagnosed with dementia in the report population. Participant characteristics across v categories of reported consumption of processed meat, unprocessed poultry, unprocessed red meat, and full meat are shown in Supplemental Tables 2, iii, 4, and five respectively. Generally, compared with those in the everyman category, participants in higher categories of reported consumption of candy meat and total meat were more than likely to be men, less educated, smokers, and overweight or obese, and had lower intakes of vegetables and fruits and college intakes of energy, protein, and fat (including saturated fat).

TABLE 1

Baseline characteristics of participants stratified by dementia condition in the United kingdom of great britain and northern ireland Biobank cohort report¹

	All participants (n  =  493,888)	Incident dementia (north = 2896)	No dementia (n = 490,992)
Age at baseline, y	56.5 ± viii.1	63.7 ± five.5	56.5 ± viii.one
Duration of follow-upwards, y	eight.0 ± 1.one	5.9 ± 2.1	8.0 ± one.1
Gender
Men	224,691 (45.5%)	1625 (56.one%)	223,066 (45.4%)
Women	269,197 (54.5%)	1271 (43.nine%)	267,926 (54.half dozen%)
Ethnicity
White	466,835 (94.5%)	2757 (95.2%)	464,078 (94.5%)
Asian	ten,737 (2.2%)	44 (one.5%)	x,693 (two.2%)
Black	7454 (1.5%)	52 (ane.8%)	7402 (1.5%)
Mixed	2951 (0.half dozen%)	13 (0.4%)	2938 (0.6%)
Others/unknown	5911 (1.2%)	xxx (1.0%)	5881 (1.ii%)
Region
England	438,178 (88.7%)	2510 (86.7%)	435,668 (88.7%)
Wales	20,505 (four.ii%)	121 (4.ii%)	20,384 (4.2%)
Scotland	35,205 (seven.1%)	265 (9.2%)	34,940 (7.1%)
Townsend deprivation alphabetize
Low deprivation	164,443 (33.3%)	858 (29.6%)	163,585 (33.3%)
Moderate deprivation	164,409 (33.3%)	876 (thirty.2%)	163,533 (33.iii%)
High impecuniousness	164,426 (33.iii%)	1160 (twoscore.1%)	163,266 (33.3%)
Unknown	610 (0.ane%)	2 (0.1%)	608 (0.1%)
Educational level
Without higher/university degree	327,638 (66.3%)	2245 (77.5%)	325,393 (66.3%)
With higher/university degree	161,496 (32.7%)	582 (20.1%)	160,914 (32.8%)
Unknown	4754 (1.0%)	69 (2.4%)	4685 (1.0%)
Smoking status
Never	269,599 (54.6%)	1273 (44.0%)	268,326 (54.six%)
Past	170,941 (34.6%)	1233 (42.6%)	169,708 (34.6%)
Current	51,734 (10.5%)	371 (12.viii%)	51,363 (10.v%)
Unknown	1614 (0.3%)	xix (0.7%)	1595 (0.three%)
Physical activity level
Low	75,335 (15.3%)	478 (16.5%)	74,857 (15.2%)
Moderate	162,588 (32.9%)	882 (30.5%)	161,706 (32.9%)
High	160,784 (32.6%)	779 (26.nine%)	160,005 (32.vi%)
Unknown	95,181 (xix.3%)	757 (26.1%)	94,424 (19.ii%)
BMI, kg/m2
Normal/underweight (<25)	162,906 (33.0%)	893 (thirty.viii%)	162,013 (33.0%)
Overweight (25–29.ix)	208,812 (42.3%)	1184 (40.9%)	207,628 (42.iii%)
Obese (≥30)	119,702 (24.ii%)	775 (26.8%)	118,927 (24.ii%)
Unknown	2468 (0.5%)	44 (ane.5%)	2424 (0.5%)
Sleep duration
<7 h/d	120,987 (24.v%)	750 (25.ix%)	120,237 (24.5%)
7–eight h/d	332,852 (67.iv%)	1687 (58.3%)	331,165 (67.4%)
>8 h/d	37,564 (7.half dozen%)	415 (14.iii%)	37,149 (vii.6%)
Unknown	2485 (0.5%)	44 (1.v%)	2441 (0.5%)
With stroke history	7397 (i.5%)	177 (6.1%)	7220 (one.5%)
With family history of dementia	57,728 (eleven.7%)	558 (xix.3%)	57,170 (11.half-dozen%)
APOE ε4 carrying condition
Noncarriers	290,382 (58.8%)	1177 (40.6%)	289,205 (58.ix%)
Carriers	115,873 (23.five%)	1182 (40.8%)	114,691 (23.four%)
Missing	87,633 (17.7%)	537 (xviii.5%)	87,096 (17.vii%)
Total meat
Never	20,473 (4.1%)	94 (3.2%)	20,379 (4.2%)
≤3 times/wk	77,261 (15.six%)	459 (fifteen.8%)	76,802 (15.6%)
3–5 times/wk	90,065 (18.ii%)	509 (17.6%)	89,556 (18.2%)
≥five times/wk	162,570 (32.9%)	875 (thirty.2%)	161,695 (32.9%)
≥7 times/wk	143,519 (29.ane%)	959 (33.i%)	142,560 (29.0%)
Vegetables/fruits
<2 servings/d	28,960 (5.nine%)	194 (6.7%)	28,766 (5.ix%)
<4 servings/d	133,350 (27.0%)	638 (22.0%)	132,712 (27.0%)
4–six servings/d	190,853 (38.half-dozen%)	1032 (35.half-dozen%)	189,821 (38.7%)
>six servings/d	128,487 (26.0%)	893 (30.8%)	127,594 (26.0%)
Unknown	12,238 (two.five%)	139 (4.8%)	12,099 (2.5%)
Total fish
≤1 times/wk	126,980 (25.7%)	678 (23.4%)	126,302 (25.7%)
1–ii times/wk	107,219 (21.7%)	520 (18.0%)	106,699 (21.7%)
≥2 times/wk	150,200 (xxx.4%)	865 (29.nine%)	149,335 (30.4%)
≥4 times/wk	106,331 (21.5%)	791 (27.3%)	105,540 (21.v%)
Unknown	3158 (0.vi%)	42 (1.5%)	3116 (0.6%)
Alcohol
<ane time/wk	150,575 (30.5%)	1075 (37.1%)	149,500 (30.4%)
1–2 times/wk	127,529 (25.8%)	664 (22.ix%)	126,865 (25.8%)
3–four times/wk	114,501 (23.2%)	536 (xviii.5%)	113,965 (23.2%)
Daily or near daily	100,944 (xx.4%)	610 (21.one%)	100,334 (20.4%)
Unknown	339 (0.1%)	11 (0.4%)	328 (0.one%)
Tea/coffee
≤iii cups/d	108,836 (22.0%)	663 (22.9%)	108,173 (22.0%)
≤v cups/d	161,965 (32.8%)	918 (31.seven%)	161,047 (32.eight%)
≤7 cups/d	132,660 (26.9%)	698 (24.one%)	131,962 (26.9%)
>7 cups/d	88,987 (18.0%)	593 (20.v%)	88,394 (18.0%)
Unknown	1440 (0.3%)	24 (0.eight%)	1416 (0.3%)

The associations between each meat type and each dementia issue were analyzed in iii adjustment models. For the incident all-cause dementia ( Effigy ane ), there was a significant linear trend for each additional 25 g processed meat consumed per 24-hour interval (Hour: i.44; 95% CI: 1.24, 1.67; P-trend < 0.001). Unprocessed red meat appeared to be protective, with a HR of 0.81 for each boosted 50 g intake per day (95% CI: 0.69, 0.95; P-trend = 0.011) in the fully adjusted model. The linear-trend was not statistically meaning for unprocessed poultry in relation to risk of all-cause dementia. For total meat, there was a borderline increased risk of incident all-cause dementia (HR: i.09; 95% CI: 1.00, ane.19; P-trend = 0.057).

HRs (95% CIs) for the associations between incident all-cause dementia and meat consumption in UK Biobank (n = 493,888). The black squares and horizontal lines correspond HRs and 95% CIs respectively in Cox proportional-hazards regressions. The distribution of ticks on the x centrality is exponential. Participants were categorized based on the data distribution of baseline meat intakes. Hateful daily intakes in each category were calculated from the multiple 24-h dietary assessments which were used to test the linear trend per increment. Minimally adjusted models adapted for age, gender, ethnicity, education, socioeconomic status. Fully adapted models additionally adjusted for region, smoking condition, physical activity, BMI, sleep duration, stroke history, and family history of dementia, and dietary covariates including vegetables and fruits, full fish, tea and coffee, booze drinking, processed meat, unprocessed poultry, and unprocessed red meat were likewise mutually adjusted for.

In terms of incident Ad ( Effigy ii ), a similar picture to all-crusade dementia was seen. Higher consumption of processed meat was associated with increased take chances of AD (Hr: 1.52 per additional 25 g/d; 95% CI: 1.xviii, 1.96; P-tendency = 0.001). College consumption of unprocessed cerise meat was associated with reduced risk of AD (60 minutes: 0.seventy per additional l g/d; 95% CI: 0.53, 0.92; P-trend = 0.009). Regarding the run a risk of incident VD ( Figure 3 ), at that place were no statistically significant linear trends identified, although for processed meat, the highest consumption categories were associated with increased risk. For all dementia outcomes, 0 times/wk consumption of each meat type appeared to be different from other higher frequencies (Figure ane,2, andthree); however, about HRs in this category were not significant in the fully adjusted models.

HRs (95% CIs) for the associations between incident Alzheimer disease and meat consumption in Britain Biobank (n = 493,888). The blackness squares and horizontal lines represent HRs and 95% CI, respectively, in Cox proportional-hazards regressions. The distribution of ticks on the 10 axis is exponential. Participants were categorized based on the data distribution of baseline meat intakes. Hateful daily intakes in each category is calculated from the multiple 24-h dietary assessments which were used to test the linear trend per increment. Minimally adapted models adapted for age, gender, ethnicity, instruction, and socioeconomic status. Fully adapted models additionally adjusted for region, smoking condition, concrete activity, BMI, slumber duration, stroke history, family unit history of dementia, and dietary covariates including vegetables and fruits, total fish, tea and coffee, booze drinking; processed meat, unprocessed poultry, and unprocessed ruby meat were also mutually adjusted for.

HRs (95% CIs) for the associations between incident vascular dementia and meat consumption in United kingdom of great britain and northern ireland Biobank (northward = 493,888). The blackness squares and horizontal lines correspond HRs and 95% CI respectively in Cox proportional-hazards regressions. The distribution of ticks on the 10 axis is exponential. Participants were categorized based on the data distribution of baseline meat intakes. Mean daily intakes in each category is calculated from the multiple 24-h dietary assessments which were used to exam the linear tendency per increment. Minimally adjusted models adapted for age, gender, ethnicity, education, socioeconomic status. Fully adapted models additionally adjusted for region, smoking status, physical activity, BMI, sleep duration, stroke history, and family unit history of dementia, and dietary covariates including vegetables and fruits, total fish, tea and coffee, booze drinking; candy meat, unprocessed poultry, and unprocessed red meat were too mutually adjusted for.

The stratified analyses by APOE ε4 conveying condition and P values for interaction between APOE ε4 carriage and meat consumption are shown in Table 2 and Supplemental Tabular array six. Compared with APOE ε4 noncarriers, carriers had increased risks of developing all-cause dementia by ∼3 times, AD past ∼six times, and VD by ∼5 times, independent of any blazon of meat consumption. However, there were no statistically significant interactions between APOE ε4 carriage and meat consumption in the fully adjusted models. Increased risks of incident all-cause dementia were observed per 25 grand/d increments of processed meat in both APOE ε4 carriers and noncarriers. Nevertheless, APOE ε4 carriers but not noncarriers had reduced risks of incident all-cause dementia and incident AD per 50 g/d increment of unprocessed red meat.

Table 2

Risks of all-cause dementia under different meat types among APOE Ɛ4 noncarriers (n  = 289,589) and carriers ( north  = 115,537) respectively ¹

	Unadjusted models (n  = 405,126)				Minimally adjusted models (due north  = 405,126)				Fully adapted models (n  = 405,126)
	Hr	LCI	UCI	P	HR	LCI	UCI	P	60 minutes	LCI	UCI	P
Risk of all-crusade dementia
APOE Ɛ4 carriers vs. noncarriers	3.31	2.38	4.61	<0.001	iii.59	2.48	5.19	<0.001	three.51	2.44	5.04	<0.001
Processed meat, 25 g/d
Stratified analysis
APOE Ɛ4 noncarriers	1.64	ane.33	2.02	<0.001	1.36	ane.09	1.70	0.007	1.46	1.15	1.84	0.002
APOE Ɛ4 carriers	one.eighteen	0.96	ane.45	0.112	1.09	0.88	1.36	0.436	1.47	1.16	1.85	0.001
P for interaction with APOE Ɛ4 allele				0.027				0.026				0.185
Unprocessed poultry, 25 g/d
Stratified assay
APOE Ɛ4 noncarriers	0.84	0.74	0.96	0.009	0.92	0.79	ane.07	0.261	0.93	0.79	1.09	0.379
APOE Ɛ4 carriers	0.82	0.73	0.93	0.002	0.89	0.77	1.03	0.111	0.94	0.81	1.09	0.435
P-interaction with APOE Ɛ4 allele				0.787				0.329				0.765
Unprocessed cerise meat, l g/d
Stratified analysis
APOE Ɛ4 noncarriers	1.31	one.04	one.66	0.023	0.94	0.75	1.19	0.633	0.93	0.72	1.21	0.594
APOE Ɛ4 carriers	0.89	0.72	1.xi	0.311	0.64	0.51	0.80	<0.001	0.64	0.50	0.82	<0.001
P-interaction with APOE Ɛ4 allele				0.020				0.019				0.095
Total meat, 50 g/d
Stratified analysis
APOE Ɛ4 noncarriers	i.22	ane.07	1.39	0.003	1.11	0.96	1.28	0.168	1.sixteen	1.00	1.34	0.044
APOE Ɛ4 carriers	1.05	0.93	i.17	0.462	0.95	0.83	1.09	0.469	1.02	0.89	1.17	0.816
P-interaction with APOE Ɛ4 allele				0.091				0.062				0.054

When nosotros additionally excluded dementia cases occurring within the first three-y follow-upwardly (n = 329) for more than rigorous controls of potential reverse causality, the HRs were of like magnitude (Supplemental Figure 2, 3, and 4, Supplemental Table seven). When nosotros conducted a sensitivity analysis in participants with consummate data on all covariates (due north = 381,809), the HRs were very like to the primary results (Supplemental Figure 5, 6, and vii, Supplemental Table eight). Exclusion of participants anile <lx y at baseline likewise did not significantly change these associations (Supplemental Figure 8, 9, and 10, Supplemental Tabular array 9).

Discussion

In this population-based, nationwide Great britain Biobank cohort written report our results showed that consumption of processed meat was associated with increased risks of incident all-crusade dementia and AD while unprocessed red meat was associated with lower risks. Related cohort studies remain few and inconsistent, and detailed knowledge of which type and corporeality of meat consumption would be the most influential is not articulate. The Iii-Metropolis (3C) accomplice written report took meat consumption of loftier frequency (≥four times/wk) as the reference and plant that low frequency (≤1 times/wk) was related to an increased take chances of incident dementia and AD over x y of follow-up (28), which is inconsistent with our findings; however, the methods of collapsing data and reference selection are dissimilar. In addition, excessive category combination may take adulterate the study power and specific meat types were not explored in that study. A accomplice study conducted in French citizens anile 68 and over showed that compared with daily meat consumers, weekly or less consumers had a higher incidence rate of all-cause dementia and Advertizement after seven y of follow-up; however, those associations were not significant probably because of minor sample sizes (170 incident dementia including 135 Advertisement among 1674 participants) (29). Longitudinal assay amidst 2622 elderly German participants suggested no pregnant association between risk of incident AD and consumption frequency of meat and sausage after iv y of follow-up (30); however, this study just investigated single meat items.

Our results also showed that presence of the APOE ε4 allele increased the hazard of incident dementia, especially AD; nevertheless, in that location were simply minor differences in associations between meat consumption and dementia run a risk among APOE ε4 noncarriers and carriers, and all P values for interaction were nonsignificant. Currently, testify on the interaction betwixt APOE genotype and dietary factors with dementia has by and large focused on dietary patterns and dietary fat intake; those studies found older individuals (aged ≥threescore y) who had a nutrition high in fatty fish or higher polyunsaturated fatty intake were associated with a decreased risk of all-cause dementia, especially among APOE ε4 noncarriers (31, 32). In contrast, studies conducted at midlife found that moderate to high intake of saturated fats in relation to an increased risk of dementia/AD was simply detected or more pronounced among APOE ε4 carriers (33, 34). A German cohort study of individuals aged 75 + constitute there was no difference in the clan of meat and sausage consumption with incident Advert risk between APOE ε4 noncarriers and carriers (30). In addition, a cohort study from eastern Finland showed that the APOE ε4 genotype did not alter associations of egg and cholesterol intakes with risk of incident dementia and Advertising over ∼22 y of follow-up (35). Inconsistency in these and our study results may reflect particular cohort characteristics; in particular our participants were younger (50–68 y) and this may have led to our insignificant interactions between APOE genotype and meat intake with dementia run a risk in this population. It is as well possible that APOE ε4 wagon is an contained process from dietary aspects in relation to dementia risk.

The underlying reasons for the inconsistent associations between different meat types in relation to dementia risk are non understood. High levels of protein in meat may potentially explain the link between unprocessed meat intake and a lower take chances of dementia; adequate protein intake has been linked to a reduced risk of balmy cognitive impairment and dementia in the elderly (36). High iron levels in unprocessed red meat may be protective, with iron deficiency being associated with decreased cognitive and attentional processes. Studies in animals take shown a negative impact of iron deficiency on myelination (37). On the other paw, as people historic period, atomic number 26 deposits in the brain may impair normal cerebral function. Abnormal iron metabolism triggers oxidative stress, a major correspondent to neurodegeneration (38). Processed meat contains nitrites and N-nitroso compounds, which may result in oxidative stress, lipid peroxidation, and activation of proinflammatory cytokines or other mechanisms potentially involved in the development of dementia (39). In add-on, as meat consumption increases, intake of saturated fatty acids increases, which has been associated with a college chance of dementia (40). Processed meat is often high in sodium, and rats fed a long-term high-table salt diet had a marked increase in systolic blood pressure linked to reduced regional cerebral blood catamenia, and potentially linked to cerebral deficit (41). These differences in nutritional composition may explain why consumption of processed meat was associated with a higher risk of dementia rather than unprocessed poultry and unprocessed cherry meat. These potentially beneficial and negative effects of different meat types on risk of dementia may exist simultaneously, leading to the inconsistent associations seen with meat in this study.

A major strength of the current study is that the prospective study with large sample sizes ensured sufficient statistical power. To our noesis, this is the first study to estimate specific meat types in relation to several dementia outcomes with additional exploration of interactions with the APOE ε4 allele. Other strengths include apply of multiple data linkages to maximize capture of incident dementia outcomes, and consideration of opposite causation in analyses. Nevertheless, our study has several limitations. Firstly, the baseline touchscreen cursory FFQ merely covered some commonly consumed foods and was not suitable to assess total energy or nutrient intakes; systematic bias from self-reported measures at recruitment and depression responses to the more detailed repeated 24-h dietary assessments with less than half participants may limit generalizability. Secondly, the Uk Biobank cohort study does not have a long follow-up (∼8 y). This will limit our ability to distinguish between reverse causation and causality for gamble factors for dementia, equally indicated in the Whitehall II accomplice study (42). Thirdly, use of linkages to electronic wellness records may be high in specificity but low in sensitivity; moreover, without linkage to principal intendance information in our study, milder cases of dementia may accept been missed (43). The percentage of Advertising out of all-cause dementia cases was low in our study (35%) compared with the report of the WHO (50–lxx%) (2); it is possible that some cases had non been clinically classified by type of dementia, which may attenuate associations between meat consumption and risk of Advertizing. In addition, taking dates of hospital admission and expiry registry as proxy of diagnosis dates of incident dementia could accept resulted in measurement errors; some incident cases might actually exist prevalent cases diagnosed prior to hospital admission. Therefore, electronic linkages to accurate primary-care information should be taken into consideration for dementia ascertainment in future research.

Our findings suggest that consumption of processed meat may increase take chances of incident dementia, and unprocessed red meat intake may be associated with lower risks, independent of APOE ε4 carriage. On the basis of the findings of this report, more specific public wellness guidance could be indicated differentiating between types of meat. However farther enquiry is recommended to confirm these results. Overall, the inquiry adds to the growing body of bear witness linking meat, especially processed meat consumption, to increased risk of a range of noncommunicable diseases.

Supplementary Material

nqab028_Supplemental_File

Acknowledgements

This study has been conducted using resources from Great britain Biobank under application number 48684. The authors give thanks Mary Mitchell as the PPI representative who has commented on our manuscript, Chunxiao Li (MRC Epidemiology Unit, University of Cambridge) for her advice on analyses of genetic data, and Timothy J Primal and Aurora Perez-Cornago (University of Oxford) for their help with the standard portion sizes in the Oxford WebQ.

The authors' responsibilities were equally follows—HZ: conceived the study; HG, DG, LH, JC: worked on the study design, data acquisition, and statistical analyses; HZ: wrote the first draft of the manuscript and had primary responsibility for terminal content; DG, HR, DB, LH, JC: provided critical comments on the scientific estimation of the results; all authors: made substantial contributions to revision of the manuscript; and all authors: read and approved the last manuscript.

Writer disclosure: J Cade is the director of University of Leeds company Dietary Assessment Ltd. Other authors declare no competing interests. All other authors report no conflicts of interest.

Notes

This work was supported by the China Scholarship Council and the University of Leeds to HZ (201806010423). The sponsors had no role in the pattern and conduct of the study; collection, management, analysis, and interpretation of the information; and preparation, review, or approval of this manuscript.

Supplemental Methods 1–three, Supplemental Tables i–9, and Supplemental Figures 1–10 are available from the "Supplementary data" link in the online posting of the commodity and from the same link in the online tabular array of contents at https://bookish.oup.com/ajcn/.

Abbreviations used: Advertising, Alzheimer disease; APOE, apolipoprotein East; ICD, International Nomenclature of Diseases; VD, vascular dementia.

Contributor Data

Huifeng Zhang, Nutritional Epidemiology Group, School of Nutrient Science and Diet, Academy of Leeds, Leeds, U.k..

Darren C Greenwood, Leeds Constitute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK.

Harvey A Risch, Department of Chronic Illness Epidemiology, Yale School of Public Health, New Haven CT, United states of america.

David Bunce, Schoolhouse of Psychology, Faculty of Medicine and Wellness, Academy of Leeds, Leeds, UK.

Laura J Hardie, Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.

Janet Due east Cade, Nutritional Epidemiology Grouping, School of Food Science and Nutrition, University of Leeds, Leeds, UK.

Data Availability

The data sets described in the manuscript are not publicly available because the United kingdom of great britain and northern ireland Biobank has proprietary rights of the data. External investigators can request the data and approval of use on application to the UK Biobank (www.ukbiobank.ac.uk/).

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