Impact of red meat, processed meat and fibre intake on risk of late-onset chronic inflammatory diseases: prospective cohort study on lifestyle factors using the Danish 'Diet, Cancer and Health' cohort (PROCID-DCH): protocol

Nathalie Fogh Rasmussen, Katrine Hass Rubin, Maria Stougaard, Anne Tjønneland, Egon Stenager, Merete Lund Hetland, Bente Glintborg, Anette Bygum, Vibeke Andersen, Nathalie Fogh Rasmussen, Katrine Hass Rubin, Maria Stougaard, Anne Tjønneland, Egon Stenager, Merete Lund Hetland, Bente Glintborg, Anette Bygum, Vibeke Andersen

Abstract

Introduction: Chronic inflammatory diseases (CIDs) (Crohn's disease, ulcerative colitis, psoriasis, psoriatic arthritis, rheumatoid arthritis and multiple sclerosis) are diseases of the immune system that have some shared genetic and environmental predisposing factors, but still few studies have investigated the effects of lifestyle on disease risk of several CIDs. The primary aim of this prospective cohort study is to investigate the impact of fibre, red meat and processed meat on risk of late-onset CID, with the perspective that results of this study can contribute in supporting future diet recommendations for effective personalised prevention.

Methods and analysis: The study will use data from 57 053 persons from the prospective Danish cohort study 'Diet, Cancer and Health' together with National Health Registry data. The follow-up period is from December 1993 to December 2018. Questionnaire data on diet and lifestyle were collected at entry to the Diet, Cancer and Health study. The outcome CID is defined as having a diagnosis of one of the CIDs registered in the National Patient Registry or, for multiple sclerosis, in the Danish Multiple Sclerosis Registry during follow-up and being treated with a drug used for the specific disease. The major outcome of the analyses will be to detect variability in risk of late onset of any CID and, if power allows, disease risk of late onset of each CID diagnosis between persons with different fibre and red meat, and processed meat intake. The outcome will be adjusted for age, sex, body mass index, physical activity, energy, alcohol, fermented dairy products, education, smoking status, hormone replacement therapy and comorbidity.

Ethics and dissemination: The study is approved by the Danish Data Protection Agency (2012-58-0018). The core study is an open register-based cohort study. The study does not need approval from the Ethics committee or Institutional Review Board by Danish law. Study findings will be disseminated through peer-reviewed journals, patient associations and presentations at international conferences.

Trial registration number: NCT03456206; Post-results.

Keywords: chronic inflammatory diseases; diet; disease risk; fibre; lifestyle; red meat.

Conflict of interest statement

Competing interests: BG declares to have received research funding from Abbvie, Biogen, Pfizer. MLH declares to have received research funding from BMS, MSD, Pfizer, Biogen, Samsung, CellTrion, Lilly and Novartis. AB has participated in the development of educational material for Biogen. All other authors declare no conflict of interest.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Hypothesis for effects of diet in relation to the development of chronic inflammatory diseases (CIDs). Diet (meat, fibre, animal fat, n-3 and n-6 polyunsaturated fatty acids, vitamins A and D, carotenoids, smoking, gluten102) may affect the immune system either directly or indirectly via, for example, the activity and composition of the gut microbiome. The effect of low intake of fibre/high intake of red and processed meat is shown at left: in short, low intake of fibre (which could otherwise serve as a nutrient for the microbes) may lead to the microbial metabolism of mucus and to decrease of the intestinal mucus layer. A high intake of red and processed meat may render the mucus layer penetrable to, for example, bacteria by reducing the disulphide bonds in the mucus network. Thus, microbes may reach the epithelium and activate the immune system. There is some support for such a mechanism in CIDs, including findings of; high amounts of sulphate-reducing bacteria in patients with inflammatory bowel disease (IBD); association of high-fibre intake with low risk of IBD among 170 776 participants from the prospective Nurses’ Health Study I; and association of high intake of red meat and total protein and risk of developing inflammatory polyarthritis in the population-based prospective cohort of 25 630 participants from the European Prospective Investigation of Cancer in Norfolk. IEC, intestinal epithelial cell; MAMPs, microbe-associated molecular patterns; NFkB, nuclear factor kappa-light-chain-enhancer of activated B cells; TLRs, toll-like receptors; TNF, tumor necrosis factor. Figure from Christensen et al (copyright 2018 by Vibeke Andersen).

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Source: PubMed

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