WHICH DIET FOR THE PREVENTION OF CARDIOVASCULAR DISEASE MEAT OR VEGETARISM

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1 WHICH DIET FOR THE PREVENTION OF CARDIOVASCULAR DISEASE MEAT OR VEGETARISM QUELLE ALIMENTATION POUR PRÉVENIR LES MALADIES CARDIOVASCULAIRES VIANDE OU VÉGÉTARISME Dr Jean-Michel LECERF Service de Nutrition - Institut Pasteur de Lille Service de Médecine Interne CHRU de Lille - 1 -

2 Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : Grant/Research Support: Company One Consulting Fees/Honoraria: Company Two Major Stock Shareholder/Equity: Company Three Royalty Income: Company Four Ownership/Founder: Company Five Intellectual Property Rights: Company Six Other Financial Benefit: Company Seven - 2 -

3 MEAT AND CARDIOVASCULAR RISK FACTORS RED MEAT CONSUMPTION BLOOD PRESSURE TYPE 2 DIABETES ++ [HR 1,14 à 1,19] WEIGHT AND WAIST CIRCUMFERENCE LDL CHOLESTEROL NOT FOR CHICKEN, POULTRY - 3 -

4 RED MEAT AND TYPE 2 DIABETES META-ANALYSIS 10 studies subjects Red meat«unprocessed» and «processed» AJCN 2011, 94,

5 MECHANISMS - DIRECT EFFECT IRON OXYDATIVE STRESS DESTRUCTION OF LANGHERANS ISLETS FAT??? - ROLE OF THE GLOBAL DIET LIFESTYLE HIGH RED MEAT CONSUMERS EAT MORE CALORIES LESS VEGETABLES AND FRUITS ARE MORE SEDENTARY - 5 -

6 MEAT CONSUMPTION AND CARDIOVASCULAR DISEASES EPIDEMIOLOGICAL STUDIES ECOLOGICAL STUDIES CASE CONTROL STUDIES COHORT STUDIES MOST OF THEM ASSOCIATION BETWEEN RED MEAT CONSUMPTION AND CORONARY HEART DISEASE MORBIDITY AND MORTALITY AND CEREBRO-VASCULAR EVENTS (+9%) BUT NOT ALL - 6 -

7 MEAT AND CEREBROVASCULAR EVENT META-ANALYIS 5 STUDIES - Total - «Red» - «Processed» EJCN 2013, 67,

8 MECHANISMS INCREASE OF CARDIOVASCULAR RISK FACTORS - WEIGHT? - LDL CHOLESTEROL - TYPE 2 DIABETES - HIGH BLOOD PRESSURE ROLE OF SATURATED FATTY ACIDS?? ROLE OF DIETARY CHOLESTEROL?? ROLE OF THE TRANSFORMATION OF CARNITINE INTO TRIMETHYLAMINE BY THE GUT MICROBIOTA AND INTO T.M.A.O. (ATHEROGENIC) BY THE LIVER ROLE OF THE LIFE STYLE - GLOBAL DIET - SEDENTARITY - 8 -

9 DIETARY CHOLESTEROL IS NOT ASSOCIATED TO AN HIGHER CV RISK SAUF CHEZ LES DIABETIQUES Am J Clin Nutr 2013, 98,

10 SATURATED FATTY ACIDS INTAKE ARE NOT ASSOCIATED TO AN HIGHER CVD RISK 21 studies Meta analysis subjects 5 23 years follow-up cas RR IC p CHD 1,07 0,94-1,19 0,22 Stroke 0,81 0,62-1,05 0,11 CVD 1,00 0,89-1,11 0,95 AJCN 2010, 91,

11 MEAT AND ATHEROSCLEROSIS INTERACTION CARNITINE/GUT MICROBIOTA L-CARNITINE (MAINLY IN RED MEAT) Suppression of microbiota (mice) MICROBIOTA (specific profil in human) TRIMETHYLAMINE-N-oxide (TMAO) Decrease the inverse transport of cholesterol (HDL) in mice ATHEROSCLEROSIS L-Carnitine predicts CVD only in human with high plasma TMAO levels Nature Medicine

12 VEGETARIANISM NO MEAT NO FISH MORE VEGETABLE FRUITS WHOLE GRAINS LEGUMES SOY FOODS NUTS (ALMONDS, NUTS) VEGANISM NO MEAT NO ANIMAL PRODUCTS NO DAIRY PRODUCTS NO EGGS MORE

13 THE EFFECTS OF VEGETARIANISM AND VEGANISM ON CV RISK FACTORS POSITIVE EFFECTS LESS CALORIES MORE FIBERS - GLUCAN OAT BARLEY - PECTIN MORE ANTI-OXIDANT - VITAMINE C AND E - POLYPHENOLS - CAROTENOIDS MORE POTASSIUM (VEGETARISM) LOW GLYCEMIC INDEX (LEGUMES FRUITS) WEIGHT LDL CHOLESTEROL OXIDIZED LDL BLOOD PRESSURE GLYCEMIA

14 WEIGHT IN MEAT EATERS AND VEGETARIANS ETUDE EPIC OXFORD subjects de years Meat eaters Fish eaters Vegetarians Vegans BMI mean Kg/m² H 24,41 23,30 23,37 22,49 F 23,52 22,66 22,71 21,98 linked to smoking physical activity education level protein intake fiber intake Int J Obes 2003, 27, not related to lipid intake

15 WEIGHT GAIN IN MEAT EATERS AND VEGETARIANS ETUDE EPIC OXFORD subjects 5 years follow-up Together Meat eaters Fish eaters Vegans WEIGHT GAIN (g) M / F Int J Obes 2006, 30,

16 NEGATIVE EFFECTS VEGETARIANISM LOW LC 3 PUFA FROM FISH THROMBOSIS RISK PRO INFLAMMATORY (UNSTABLE PLAQUES) ARYTHMIA VEGANISM NO DAIRY PRODUCTS TYPE 2 DIABETES RISK LOW VITAMINE B12 HOMOCYSTEINEMIA HYPERTRIGLYCERIDEMIC EFFECT OF A HIGH CARBOHYDRATES INTAKE

17 VEGETARIANISM AND CARDIO VASCULAR DISEASE LESS HYPERTENSION LESS CORONARY HEART DISEASE IN ALMOST ALL EPIDEMIOLOGICAL STUDIES MECHANISMS - GLOBAL DIET ON CV RISK FACTORS - NO RED MEAT - AND OFTEN NO TOBACCO (AND ALCOHOL) (ADVENTISTS)

18 A MITIGATE SOLUTION FLEXI OR SEMI VEGETARIANISM - LESS MEAT 3-4 TIMES / WEEK MAINLY LESS RED MEAT 1-2 TIMES / WEEK - MORE FISH 2 TIMES / WEEK - EGGS 2-3 TIMES / WEEK - MORE LEGUMES, SEEDS, VEGETABLES, FRUITS, NUTS - VEGETARIAN MENU 5-7 TIMES / WEEK = THE MEDITERRANEAN DIET!

19 CONCLUSION AN HIGH RED MEAT CONSUMPTION IS ASSOCIATED TO AN HIGHER CVD RISK THAT IS PROBABLY NOT DUE TO THE SATURATED FATTY ACID INTAKES VEGETARIANISM IS A DIET WHICH IS BENEFICIAL FOR CHD RISK VEGANISM IS NOT A WELL-BALANCED DIET A GOOD OPTION IS TO MAINTAIN A SMALL CONSUMPTION OF MEAT (MAINLY RED MEAT) AND TO ADOPT A MORE RICH PLANT-FOOD DIET