Red meat consumption and long-term cancer risk Alicja Wolk Professor of Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet
WCRF/AICR report 2007 Food, Nutrition, Physical Activity and the Prevention of Cancer Recommendations Animal foods Limited intake of red meat and avoid processed meat Personal recommendation People who eat red meat to consume less than 500g a week, very little if any to be processed Public health goal Population average consumption of red meat to be no more than 300g a week, very little if any of which to be processed World Cancer Research Fund 2007 8 May, 2012 2
Convincing increased risk Limited suggestive Increased risk Red meat and cancer scientific evidence Red meat Colorectum Esophagus Lung Pancreas Endometrium Processed meat Colorectum Esophagus Lung Stomach Prostate World Cancer Research Fund 8 May 2012 3
Criteria for grading evidence 1 Convincing Evidence strong enough to support a judgement of a convincing causal relationship, which justifies goals and recommendations designed to reduce the incidence of cancer 2 Probable Slightly weaker from above, but can generally justify recommendations 3 Limited- Evidence too limited to permit a probable or suggestive convincing causal judgement 4 Limited no conclusion 5 Substantialeffect unlikely 8 May 2012 4
Convincing increased risk Limited suggestive Increased risk Red meat and cancer -scientific evidence Red meat Colorectum Esophagus Lung Pancreas Endometrium Processed meat Colorectum Esophagus Lung Stomach Prostate World Cancer Research Fund 8 May 2012 5
8 May 2012 6
Increased risk of colorectal cancer in relation to red meat consumption Highest vs. Lowest category Larsson SC., Wolk A. Meat consumption and risk of colorectal cancer. Int. J. Cancer: 119, 2657-2664 (2006) 8 May 2012 7
Increased risk of colorectal cancer in relation to processed meat consumption Highest vs. Lowest category Larsson SC., Wolk A. Meat consumption and risk of colorectal cancer. Int. J. Cancer: 119, 2657-2664 (2006) 8 May 2012 8
Dose response relationships between red meat or processed meat consumption and colorectal cancer risk Larsson SC., Wolk A. Meat consumption and risk of colorectal cancer. Int. J. Cancer: 119, 2657-2664 (2006) 8 May 2012 9
8 May 2012 10
Red meat consumption and risk of cancers of the distal colon Swedish population Int. J. Cancer 2005; 113, 829-34
8 May 2012 12
Red meat consumption and risks of pancreatic cancer per 120 g per day increment 8 May 2012 13
Processed meat consumption and risk of pancreatic cancer per 50 g per day increment 8 May 2012 14
8 May 2012 15
Red meat and risk of stomach cancer Swedish population 8 May 2012 16
Processed meat and risk of stomach cancer Swedish population 8 May 2012 17
N-Nitrosodimethylamine intake and risk of stomach cancer Swedish population 8 May 2012 18
8 May 2012 19
Prostate cancer processed meat Highest vs. Lowest Category 8 May 2012 20
Potentially preventable proportion of Gastrointestinal Cancers in Swedish men Red meat, 4 serving/week Cancer Prevalence PAR* Colorectal 32% 9% Pancreatic 32% 9% Processed meat, 3 servings/week Gastric 59% 19% *PAR, population attributable risk 8 May 2012 21
Potentially preventable proportion of Gastrointestinal Cancers in Swedish women Red meat, 4 serving/week Cancer Prevalence PAR* Colorectal 25% 7% Pancreatic 25% 7% Processed meat, 3 servings/week Gastric 44% 15% *PAR, population attributable risk 8 May 2012 22
Stroke Red meat and stroke, Swedish women Total red meat, 86g vs. 36g/d Total stroke 1680 cases 1.12 (95% CI) 0.95-1.32 Cerebral infarction 1310 cases 1.22 (95% CI) 1.01-1.46 146 Processed meat, 49g vs. 16g/d Total stroke 1.18 (95% CI) 1.00-1.38 Cerebral infarction 1.24 (95% CI) 1.04-1.49 Larsson, Virtamo, Wolk. Stroke 2011;42:324-29 8 May 2012 23
Stroke Red meat and stroke, Swedish men Total red meat, 136g vs. 63g/d Total stroke 1.15 (95% CI) 1.00-1.33 Cerebral infarction 1.06 (95% CI) 0.90-1.25 125 Processed meat, 49g vs. 16g/d Total stroke 1.23 (95% CI) 1.07-1.40 Cerebral infarction 1.18 (95% CI) 1.01-1.38 Larsson, Virtamo, Wolk. Am J Clin Nutr 2011;94:417-21 8 May 2012 24
8 May 2012 25
Red meat intake and risk of all-cause mortality American population Men Wome n 8 May 2012 26
Red meat intake and mortality cancer, cardiovascular and all-cause mortality American population Cancer mortality Cardiovascular mortality All-cause mortality 8 May 2012 27
Summary There is convincing evidence, that red meat (unprocessed and processed) is associated with increased risk of colorectal cancer. There is an accumulating evidence regarding increased risk for other cancer sites. Red meat consumption has been shown to be associated with increased risk for cardiovscular diseases and diabetes as well as increased mortality. 8 May 2012 28
Thank you! Alicja Wolk Professor Institute of Environmental Medicine Karolinska Institutet