A Prospective Cohort Study of Substitutions of Poultry, Red Meat or Lean Fish with Fatty Fish and the Risk of Incident Peripheral Arterial Disease in Men

Abstract

Introduction - The evidence regarding potential associations between intake of fish, poultry, red meat and the risk of peripheral arterial disease (PAD) is limited. Analysis and interpretation of dietary data are difficult. First, most foods are eaten together with foods characteristic for the dish and secondly, increased consumption of one food type is typically accompanied by a lower intake of other food types. To account for this we used the substitution approach in which we compare individuals with different food patterns corresponding to replacing one food item with another. The aims of this study were to examine associations for substitutions of poultry, red meat and lean fish with fatty fish and the risk of PAD. We hypothesised that a higher intake of fatty fish and a concomitant lower intake of other meat products was associated with a lower risk of PAD. Methods - We conducted a prospective cohort study based on data from the Diet, Cancer and Health cohort initiated in 1993 to 1997. At baseline, middle-aged men filled in a lifestyle questionnaire and a validated 192-item semi-quantitative food frequency questionnaire about their usual diet the year before. During follow-up, we identified participants with validated diagnoses of peripheral arterial disease with ankle-brachial index below 90% or toe-brachial index below 70%. Data were analysed using multivariable Cox regression models. Substitutions of 150 g/week of either poultry, processed red meat, unprocessed red meat or lean fish with 150 g/week of fatty fish were explored. Results - After relevant exclusions and follow-up for a median of 13.6 years, 546 eligible PAD cases were identified in the cohort of 25,725 men. In multivariable analyses including adjustment for established lifestyle risk factors for PAD, the HR of replacing poultry with fatty fish was 0.93 (95% CI 0.77-1.11), while the HRs of incident PAD after replacing either unprocessed or processed red meat with fatty fish were 0.88 (95% CI 0.76-1.03) and 0.85 (95% CI 0.73-1.00), respectively. When substituting lean fish with fatty fish the HR of PAD was 0.89 (95% CI 0.72-1.11). The associations were all in the same direction, however not statistically significant.Table 1Substitution between 150 g per week of different meat and the risk of peripheral arterial diseaseSubstitution between food groups per 150 g/weekHR∗95% CIHR∗∗95% CIFatty fish instead of poultry1.00(0.83-1.21)0.93(0.77-1.11)Fatty fish instead of unprocessed red meat0.85(0.73-0.99)0.88(0.76-1.03)Fatty fish instead of processed red meat0.76(0.65-0.89)0.85(0.73-1.00)Fatty fish instead of lean fish0.85(0.69-1.06)0.89(0.72-1.11)*Model 1A: Crude analysis adjusted for age and energy intake.**Model 1B: As model 1A with additional adjustment for traditional risk factors including educational level, BMI, waist circumference, physical activity, alcohol intake and smoking. Open table in a new tab *Model 1A: Crude analysis adjusted for age and energy intake. **Model 1B: As model 1A with additional adjustment for traditional risk factors including educational level, BMI, waist circumference, physical activity, alcohol intake and smoking. Conclusion - This study suggested that substituting meat products and lean fish with fatty fish might be associated with a lower risk of incident PAD, however not statistically significant.