背景:大量食用加工肉和未加工红肉与多种慢性疾病的风险增加有关,尽管未加工红肉的关系存在很大的不确定性。我们开发了一个微观模拟模型来评估加工肉类和未加工红肉消费的减少如何影响2型糖尿病的发病率。心血管疾病,结直肠癌,美国成年人的死亡率。
方法:我们使用了美国国家健康和营养调查的两个版本的数据,一项在2015-16年度进行,另一项在2017-18年度进行,以创建模拟美国人口.起始队列仅限于18岁或以上未怀孕且有2天饮食回忆数据的受访者。首先,我们使用以前开发的风险模型来估计个体的基线疾病风险.对于2型糖尿病,我们使用了逻辑回归模型,对于心血管疾病和结直肠癌,我们使用了Cox比例风险模型。然后,我们将基线风险乘以与个体加工肉类和未加工红肉消费相关的相对风险。预防2型糖尿病的发生,心血管疾病,结直肠癌,和死亡率是通过基线和干预方案的发病率之间的差异来计算的.所有阶段重复十次迭代,以对应于10年的时间跨度。情况是减少5%,10%,30%,50%,75%,100%以克计算的加工肉,未经加工的红肉,或者两者兼而有之。每个场景重复50次进行不确定性分析。
结果:模拟人群中的个体受访者总数为8665,代表242021876名美国成年人。8665人中有4493人(51·9%)为女性,4172人(48·1%)为男性;平均年龄为49·54岁(SD18·38)。在基线,加工肉的加权平均日消费量为29·1克,减少30%,每天8·7克,未加工的红肉为46·7克,减少30%,每天14·0克。Weestimatedthata30%reductioninprocessedmeatadvantagealonecouldleadto352900(95%的不确定性区间345500-359900)surrowaccessionsoftype2diabetes,92500(85600-99900)减少心血管疾病的发生,53300(51400-55000)减少结直肠癌的发生,在10年期间,全因死亡人数减少了16700人(15300-17700人)。仅在未加工的红肉摄入量中减少30%可能会导致732600(725700-740400)减少2型糖尿病的发生,291500(283900-298800)减少心血管疾病的发生,32200(31500-32700)减少结直肠癌的发生,在10年期间,全因死亡人数减少了46100人(45300-47200)。加工肉类和未加工红肉摄入量减少30%可导致1073400(1060100-1084700)减少2型糖尿病的发生,382400(372100-391000)减少心血管疾病的发生,84400(82100-86200)减少结直肠癌的发生,在10年期间,全因死亡人数减少了62200人(60600-64400)。
结论:减少加工肉类消费可以减轻美国某些慢性疾病的负担。然而,需要更多的研究来增加减少未加工红肉消费的估计效果的确定性。
背景:惠康信托基金。
BACKGROUND: High consumption of processed meat and unprocessed red meat is associated with increased risk of multiple chronic diseases, although there is substantial uncertainty regarding the relationship for unprocessed red meat. We developed a microsimulation model to estimate how reductions in processed meat and unprocessed red meat consumption could affect rates of type 2 diabetes, cardiovascular disease, colorectal cancer, and mortality in the US adult population.
METHODS: We used data from two versions of the US National Health and Nutrition Examination Survey, one conducted during 2015-16 and one conducted during 2017-18, to create a simulated US population. The starting cohort was restricted to respondents aged 18 years or older who were not pregnant and had 2 days of dietary-recall data. First, we used previously developed risk models to estimate the baseline disease risk of an individual. For type 2 diabetes we used a logistic-regression model and for cardiovascular disease and colorectal cancer we used Cox proportional-hazard models. We then multiplied baseline risk by relative risk associated with individual processed meat and unprocessed red meat consumption. Prevented occurrences of type 2 diabetes, cardiovascular disease, colorectal cancer, and mortality were computed by taking the difference between the incidence in the baseline and intervention scenarios. All stages were repeated for ten iterations to correspond to a 10-year time span. Scenarios were reductions of 5%, 10%, 30%, 50%, 75%, and 100% in grams consumed of processed meat, unprocessed red meat, or both. Each scenario was repeated 50 times for uncertainty analysis.
RESULTS: The total number of individual respondents included in the simulated population was 8665, representing 242 021 876 US adults. 4493 (51·9%) of 8665 individuals were female and 4172 (48·1%) were male; mean age was 49·54 years (SD 18·38). At baseline, weighted mean daily consumption of processed meat was 29·1 g, with a 30% reduction being 8·7 g per day, and of unprocessed red meat was 46·7 g, with a 30% reduction being 14·0 g per day. We estimated that a 30% reduction in processed meat intake alone could lead to 352 900 (95% uncertainty interval 345 500-359 900) fewer occurrences of type 2 diabetes, 92 500 (85 600-99 900) fewer occurrences of cardiovascular disease, 53 300 (51 400-55 000) fewer occurrences of colorectal cancer, and 16 700 (15 300-17 700) fewer all-cause deaths during the 10-year period. A 30% reduction in unprocessed red meat intake alone could lead to 732 600 (725 700-740 400) fewer occurrences of type 2 diabetes, 291 500 (283 900-298 800) fewer occurrences of cardiovascular disease, 32 200 (31 500-32 700) fewer occurrences of colorectal cancer, and 46 100 (45 300-47 200) fewer all-cause deaths during the 10-year period. A 30% reduction in both processed meat and unprocessed red meat intake could lead to 1 073 400 (1 060 100-1 084 700) fewer occurrences of type 2 diabetes, 382 400 (372 100-391 000) fewer occurrences of cardiovascular disease, 84 400 (82 100-86 200) fewer occurrences of colorectal cancer, and 62 200 (60 600-64 400) fewer all-cause deaths during the 10-year period.
CONCLUSIONS: Reductions in processed meat consumption could reduce the burden of some chronic diseases in the USA. However, more research is needed to increase certainty in the estimated effects of reducing unprocessed red meat consumption.
BACKGROUND: The Wellcome Trust.