RESUMEN
PURPOSE: Red and processed meats are recognized by the International Agency for Research on Cancer as probably carcinogenic and carcinogenic to humans, respectively. Heme iron has been proposed as a central factor responsible for this effect. Furthermore, anxiety affects the intestinal barrier function by increasing intestinal permeability. The objective of this work was to assess how anxiety modifies the association between red and processed meat consumption and cancer risk in the NutriNet-Santé prospective cohort (2009-2019). METHODS: Using multi-adjusted Cox models in a sample of 101,269 subjects, we studied the associations between the consumption of red and processed meat, the amount of heme iron coming from these meats and overall, colorectal, prostate, and breast cancer risks, overall and separately among participants with and without anxiety. RESULTS: An increase in red and processed meat consumption was associated with an increased risk of developing colorectal cancer in the total population (HR for an increase of 50 g/day = 1.18 (1.01-1.37), p = 0.03). After stratification on anxiety, the HR 50 g/day was 1.42 (1.03-1.94, p = 0.03) in anxious participants and 1.12 (0.94-1.33, p = 0.20) in other participants. Similar trends were observed for overall cancer risk. Analyses conducted with heme iron also provided similar results. CONCLUSIONS: Our results strengthen the existing body of evidence supporting that red and processed meat consumption and heme iron intake are associated with an increased risk of overall and more specifically colorectal cancer, and suggest that anxiety modifies these associations, with an increased risk in anxious participants.
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Neoplasias de la Mama , Productos de la Carne , Carne Roja , Ansiedad/epidemiología , Ansiedad/etiología , Estudios de Cohortes , Dieta/efectos adversos , Femenino , Humanos , Masculino , Carne , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort. METHODS AND FINDINGS: A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (ß Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses. CONCLUSIONS: In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).
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Índice de Masa Corporal , Ingestión de Energía/fisiología , Comida Rápida/efectos adversos , Encuestas Nutricionales/tendencias , Valor Nutritivo/fisiología , Sobrepeso/epidemiología , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/epidemiología , Sobrepeso/diagnóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD. METHODS: A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12 months according to estimated glomerular filtration rate categories (eGFR < 30 including patients on dialysis, 30-60, 60-90, and ≥ 90 ml/min/1.73 m2) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4-5 CKD (eGFR < 30 ml/min/1.73 m2, n = 17), and matched controls with eGFR ≥ 90 ml/min/1.73 m2. RESULTS: In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30 ml/min/1.73 m2, the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: - 15% vs - 23% at 6 months (p < 0.01); - 17% vs - 27% at 12 months (p < 0.01). The percent excess weight loss at 1 year reached 47% in patients with stage 4-5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12 months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01). CONCLUSION: The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.
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Cirugía Bariátrica/métodos , Obesidad/complicaciones , Obesidad/cirugía , Insuficiencia Renal Crónica/etiología , Adulto , Índice de Masa Corporal , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Pronóstico , Insuficiencia Renal Crónica/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Pérdida de Peso/fisiologíaRESUMEN
OBJECTIVE: To assess the prospective associations between consumption of ultra-processed food and risk of cancer. DESIGN: Population based cohort study. SETTING AND PARTICIPANTS: 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants' usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification. MAIN OUTCOME MEASURES: Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors. RESULTS: Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis). CONCLUSIONS: In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations. STUDY REGISTRATION: Clinicaltrials.gov NCT03335644.