Red meat consumption, obesity, and the risk of nonalcoholic fatty liver disease among women: Evidence from mediation analysis

Mi Na Kim; Chun-Han Lo; Kathleen E Corey; Xiao Luo; Lu Long; Xuehong Zhang; Andrew T Chan; Tracey G Simon

doi:10.1016/j.clnu.2021.12.014

Red meat consumption, obesity, and the risk of nonalcoholic fatty liver disease among women: Evidence from mediation analysis

Clin Nutr. 2022 Feb;41(2):356-364. doi: 10.1016/j.clnu.2021.12.014. Epub 2021 Dec 15.

Authors

Mi Na Kim¹, Chun-Han Lo², Kathleen E Corey³, Xiao Luo⁴, Lu Long⁵, Xuehong Zhang⁶, Andrew T Chan⁷, Tracey G Simon⁸

Affiliations

¹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
² Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning, PR China.
⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, PR China.
⁶ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: achan@mgh.harvard.edu.
⁸ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: tgsimon@mgh.harvard.edu.

Abstract

Background: Previous studies have suggested consumption of red meat may be associated with an increased risk of developing nonalcoholic fatty liver disease (NAFLD). However, large-scale, prospective data regarding red meat consumption in relation to the incidence of NAFLD are lacking, nor is it known whether any association is mediated by obesity.

Objective: We aimed to evaluate the relationship between red meat consumption and the subsequent risk of developing NAFLD.

Design: This prospective cohort study included 77,795 women in the Nurses' Health Study II cohort without NAFLD at baseline (in 1995), who provided detailed, validated information regarding diet, including consumption of red meat, every 4 years, followed through 2015. Lifestyle factors, clinical comorbidities and body mass index (BMI), were updated biennially. Cox proportional hazard models were used to estimate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Over 1,444,637 person years of follow-up, we documented 3130 cases of incident NAFLD. Compared to women who consumed ≤1 serving/week of red meat, the multivariable-adjusted HRs of incident NAFLD were 1.20 (95% CI: 0.97, 1.50) for 2-4 servings/week; 1.31 (95% CI: 1.06, 1.61) for 5-6 servings/week; 1.41 (95% CI: 1.13, 1.75) for 1 serving/day; and 1.52 (95% CI: 1.23, 1.89) for ≥2 servings/day. However, after further adjustment for BMI, all associations for red meat, including unprocessed and processed red meat, were attenuated and not statistically significant (all P-trend>0.05). BMI was estimated to mediate 66.1% (95% CI: 41.8%, 84.2%; P < 0.0001) of the association between red meat consumption and NAFLD risk.

Conclusions: Red meat consumption, including both unprocessed and processed red meat, was associated with significantly increased risk of developing NAFLD. This association was mediated largely by obesity.

Keywords: Epidemiology; NAFLD; Obesity; Red meat; Women.

Publication types

Evaluation Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Body Mass Index
Diet / adverse effects
Diet Surveys
Feeding Behavior
Female
Humans
Incidence
Life Style
Mediation Analysis
Middle Aged
Non-alcoholic Fatty Liver Disease / epidemiology*
Non-alcoholic Fatty Liver Disease / etiology*
Obesity / complications*
Proportional Hazards Models
Prospective Studies
Red Meat / adverse effects*
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding