September 7, 2024Open Access
Consumption of different types of meat and the risk of chronic limb-threatening ischemia: the Singapore Chinese Health Study
Key Result
Higher intake of red meat was associated with a 24% increased risk of chronic limb-threatening ischemia compared to the lowest quartile of intake (HR 1.24).
Study Design
Type
Cohort (n=63,257)
Multicenter
No
Structured PICO
Does higher intake of red meat increase the risk of incident chronic limb-threatening ischemia in Chinese adults?
P
Population
63,257 Chinese adults aged 45-74 years in Singapore, followed for a mean of 18.8 years to assess the association between meat consumption and incident chronic limb-threatening ischemia.
E
Exposure
Higher intake of red meat (highest quartile, median 55.4 g/day), assessed via validated semi-quantitative food frequency questionnaire.
C
Comparator
Lower intake of red meat (lowest quartile, median 16.0 g/day).
O
Outcome
Incident chronic limb-threatening ischemia (CLTI) ascertained via linkage with nationwide hospital records for lower extremity amputation or angioplasty for peripheral arterial disease.hard clinical
Higher consumption of red meat is associated with an increased risk of chronic limb-threatening ischemia, suggesting that substituting red meat with poultry or fish may reduce severe peripheral arterial disease risk.
Main Result
Hazard Ratio: 1.24 (95% CI 1.03–1.49)
p-value: p=0.02
Limitations
- Dietary information was captured at a single time point about 20 years prior to analysis
- Observational study design cannot prove causality
- Use of self-reported data for covariates
- High consumption of pork in this population may limit generalizability to populations consuming more beef or lamb
- No biomarkers were collected to directly measure inflammatory markers of atherosclerosis
- Substitution results were derived from theoretical modeling rather than actual dietary interventions
Abstract
BACKGROUND: Although red meat consumption has been associated with risk of atherosclerotic coronary artery disease and stroke, no prospective study has examined this with the risk of chronic limb-threatening ischemia (CLTI). METHODS: In a prospective study of 63,257 Chinese in Singapore, who were aged 45-74 years old at recruitment, diet was assessed via a validated semi-quantitative food frequency questionnaire. Incident CLTI cases were ascertained via linkage with nationwide hospital records for lower extremity amputation or angioplasty for peripheral arterial disease. Multivariable Cox models were used to examine associations between quartiles of meat intake and CLTI risk. RESULTS: After a mean follow-up of 18.8 years, there were 1069 cases of CLTI. Higher intake of red meat intake was associated with increased risk of CLTI in a stepwise manner. Comparing extreme quartiles of red meat intake, the hazard ratio (HR) for the association with CLTI risk was 1.24 95% confidence interval (CI) = 1.03-1.49; P-trend = 0.02. In stratified analysis, red meat intake had a stronger association with CLTI risk among those without diabetes HR (95% CI) comparing extreme quartiles = 1.41 (1.10-1.80); P-trend = 0.03 than among those with diabetes at baseline HR (95% CI) comparing extreme quartiles = 1.04 (0.79-1.38); P-trend = 0.05 (P-interaction = 0.03). Otherwise, the associations were not different by sex, BMI, smoking status, hypertension, alcohol consumption, or history of cardiovascular diseases. Using a theoretical model in substitution analysis that substituted three servings per week of red meat with poultry or fish/shellfish, the relative risk of CLTI was reduced by 13-14%. CONCLUSIONS: Consumption of red meat was associated with higher CLTI risk in this Asian cohort. Substituting red meat with poultry or fish/shellfish may reduce this risk.