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Pearl Toh
09 Sep 2017

High intake of red meat and poultry was associated with an increased risk of developing type 2 diabetes (T2D) among middle-aged and elderly Chinese people, and substituting the meat with fish or shellfish could reduce the risk of T2D, according to the Singapore Chinese Health Study.

Compared with participants with the lowest quartile of red meat intake (mean, 24.5 g/day), those with the highest intake quartile (mean, 33.9 g/day) had a 23 percent increased risk of T2D after adjusting for age, sex, and education levels (adjusted hazard ratio [HR], 1.23; p<0.001). [Am J Epidemiol 2017;doi:10.1093/aje/kwx156]

Similarly, the highest poultry intake quartile (mean, 17.8 g/day) was also associated with a greater T2D risk compared with lowest intake quartile (mean, 22.2 g/day; HR, 1.15; p=0.004).  

In contrast, consumption of fish/shellfish was not significantly associated with an increased risk of T2D (HR, 1.07; p=0.12). When one daily serving of red meat was replaced with fish/shellfish, the risk of developing T2D associated with red meat intake was significantly lowered by 26 percent (95 percent confidence interval, 9–40).    

“We don’t need to remove meat from the diet entirely. Singaporeans just need to reduce the daily intake, especially for red meat, and choose chicken breast and fish/shellfish, or plant-based protein food and dairy products, to reduce the risk of diabetes,” said study principal investigator Professor Koh Woon-Puay of Duke-NUS Medical School in Singapore. “At the end of the day, we want to provide the public with information to make evidence-based choices in picking the healthier food to reduce disease risk.”

Also, the highest intake quartile of haem iron, but not nonhaem iron, was significantly associated with an increased risk of T2D compared with the lowest intake quartile after additional adjustment for lifestyle and dietary factors (HR, 1.14; p=0.03).     

After adjusting for haem iron levels, only red meat consumption remained significantly associated with an increased risk of T2D (HR, 1.13; p=0.02) while the association with poultry intake was attenuated.

“The association with poultry seemed to be mediated via its haem iron content, whereas the association with red meat was only partially explained by its haem iron content … and other chemicals in red meat may also account for the higher risk,” said Koh and co-authors, who revealed that 43.3 percent (p=0.026) of the total effect of red meat on T2D risk was mediated through haem intake in a mediation analysis.   

The population-based cohort study included 45,411 Chinese participants (mean age 55.2 years, 57.3 percent women) in Singapore whose diet was assessed using a 165-item food frequency questionnaire at study entry. The participants reported on physician-diagnosed T2D during two follow-up interviews over a mean follow-up duration of 10.9 years.

“The findings affirm Health Promotion Board [HPB]’s recommendation to consume red meat in moderation, and that a healthy and balanced diet should contain sufficient and varied protein sources, including healthier alternatives to red meat such as fish, tofu and legumes,” said Dr Annie Ling, Director of Policy, Research and Surveillance Division at HPB, Singapore.

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