Prospective investigation of poultry and fish intake in relation to cancer risk

Abstract

Dietary guidelines advise consumers to limit intake of red meat and choose lean protein sources, such as poultry and fish. Poultry consumption has been steadily increasing in the United States, but the effect on cancer risk remains unclear. In a large U.S. cohort, we prospectively investigated poultry and fish intake and cancer risk across a range of malignancies in men and women. Diet was assessed at baseline (1995-1996) with a food frequency questionnaire in 492,186 participants of the NIH-AARP Diet and Health Study. Over a mean follow-up of 9 years, we identified 74,418 incident cancer cases. In multivariable Cox proportional hazards regression models, we estimated the substitution and addition effects of white meat (poultry and fish) intake in relation to cancer risk. In substitution models with total meat intake held constant, a 10-g (per 1,000 kcal) increase in white meat intake offset by an equal decrease in red meat intake was associated with a statistically significant reduced (3%-20%) risk of cancers of the esophagus, liver, colon, rectum, anus, lung, and pleura. In addition models with red meat intake held constant, poultry intake remained inversely associated with esophageal squamous cell carcinoma, liver cancer, and lung cancer, but we observed mixed findings for fish intake. As the dietary recommendations intend, the inverse association observed between white meat intake and cancer risk may be largely due to the substitution of red meat. Simply increasing fish or poultry intake, without reducing red meat intake, may be less beneficial for cancer prevention.

Figure 1. Multivariate Hazard Ratiosa and 95% Confidence Intervals for substitution effect of a 10 gram increase in total white meat intake and cancer risk, NIH-AARP Diet and Health Study (n = 492,186)

^a Substitution (for red meat) model: adjusted for total meat intake (10g/1000 kcal), age, sex, education, marital status, family history of cancer, race, body mass index, smoking status, frequency of vigorous physical activity, menopausal hormone therapy in women, and intake of alcohol, fruit, vegetables, and total energy ^* Post-menopausal cases only

Figure 2. Multivariate Hazard Ratiosa and 95% Confidence Intervals for addition effect of a 10 gram increase in poultry intake and cancer risk, NIH-AARP Diet and Health Study (n = 492,186)

^a Addition model: adjusted for red meat intake and fish intake, age, sex, education, marital status, family history of cancer, race, body mass index, smoking status, frequency of vigorous physical activity, menopausal hormone therapy in women, and intake of alcohol, fruit, vegetables, and total energy ^* Significant interaction with sex ^** Post-menopausal cases only