Towards refining World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations for red and processed meat intake: insights from Alberta's Tomorrow Project cohort

Calcium-rich dairy matrix protects better than mineral calcium against colonic luminal haem-induced alterations in male rats

The haemoglobin content in meat is consistently associated with an increased risk of colorectal cancer, whereas calcium may play a role as a chemopreventive agent. Using rodent models, calcium salts have been shown to prevent the promotion of haem-induced and red meat-induced colorectal carcinogenesis by limiting the bioavailability of the gut luminal haem iron. Therefore, this study aimed to compare impacts of dietary calcium provided as calcium salts or dairy matrix on gut homoeostasis perturbations by high haeminic or non-haeminic iron intakes. A 3-week intervention study was conducted using Fischer 344 rats. Compared to the ferric citrate-enriched diet, the haemoglobin-enriched diet led to increased faecal, mucosal, and urinary lipoperoxidation-related biomarkers, resulting from higher gut luminal haem iron bioavailability. This redox imbalance was associated to a dysbiosis of faecal microbiota. The addition of calcium to haemoglobin-enriched diets limited haem iron bioavailability and counteracted redox imbalance, with improved preventive efficacy when calcium was provided in dairy matrix. Data integration revealed correlations between haem-induced lipoperoxidation products and bacterial communities belonging to Peptococcaceae, Eubacterium coprostanoligenes group, and Bifidobacteriaceae. This integrated approach provides evidence of the benefits of dairy matrix as a dietary calcium vehicle to counteract the deleterious side-effects of meat consumption.

Guidelines to restrict consumption of red meat to under 350 g/wk based on colorectal cancer risk are not consistent with health evidence

BACKGROUND

The Nordic Nutrition Recommendations of 2023 (NNR2023) incorporate sustainability, health, and nutrition in their food-based dietary guidelines (FBDGs). NNR2023 recommends a consumption of ≤350 g/wk of unprocessed red meat (RM) based on association with colorectal cancer (CRC). This recommendation is lower than other FBDGs such as the World Cancer Research Fund (WCRF) recommendation it is based on (350-500 g/wk).

OBJECTIVE

To evaluate the empirical evidence and models cited by the NNR2023 to support the RM guidance.

METHODS

We fitted least-assumption (LA) dose-response (DR) models to the studies included in two systematic reviews (SRs) selected by NNR2023 on the RM and CRC association. We compared them against six parametric models reported in the two SRs. We evaluated the statistical significance of modeled relative risks (RR) at different consumption levels.

RESULTS

Twenty-one studies (20,604,188 patient-years) were analyzed. We found no significant association (RR = 1.04, 0.99-1.09) between 350g/wk of RM and CRC using the LA models, in agreement with the least restrictive models reported by Lescinsky et al., 2022 (RR = 1.11[0.89-1.38]) and WCRF (RR= 1.01[0.96-1.07]). The association was significant at 350 g/wk only under restricting assumptions such as monotonicity RR=1.3[1.01-1.64], and linearity RR = 1.06 [1.00-1.12]. No significant empirical association is observed under 567 g/wk based on evidence used by NNR2023.

CONCLUSIONS

The sources cited by NNR2023 do not support a consumption restriction of ≤350 g/wk of RM due to CRC, and other studies omitted by NNR2023 do not support association between RM and CRC. We show that model assumptions rather than empirical evidence drive this recommendation. Model uncertainty should be explicitly incorporated in FBDGs.

Health effects associated with consumption of unprocessed red meat: a Burden of Proof study

Characterizing the potential health effects of exposure to risk factors such as red meat consumption is essential to inform health policy and practice. Previous meta-analyses evaluating the effects of red meat intake have generated mixed findings and do not formally assess evidence strength. Here, we conducted a systematic review and implemented a meta-regression-relaxing conventional log-linearity assumptions and incorporating between-study heterogeneity-to evaluate the relationships between unprocessed red meat consumption and six potential health outcomes. We found weak evidence of association between unprocessed red meat consumption and colorectal cancer, breast cancer, type 2 diabetes and ischemic heart disease. Moreover, we found no evidence of an association between unprocessed red meat and ischemic stroke or hemorrhagic stroke. We also found that while risk for the six outcomes in our analysis combined was minimized at 0 g unprocessed red meat intake per day, the 95% uncertainty interval that incorporated between-study heterogeneity was very wide: from 0-200 g d-1. While there is some evidence that eating unprocessed red meat is associated with increased risk of disease incidence and mortality, it is weak and insufficient to make stronger or more conclusive recommendations. More rigorous, well-powered research is needed to better understand and quantify the relationship between consumption of unprocessed red meat and chronic disease.