Table 3.
Hazard ratios of type 2 diabetes during 12 (NHS II) and 16 years (NHS and HPFS) of follow-up, according to initial 4-years changes in total red meat categoriesa
| Changes in frequency of red meat consumption (categories in serving/d)
|
P for trendb | |||||
|---|---|---|---|---|---|---|
| Moderate to large decrease (>0.50) | Small to moderate decrease (0.15–0.50) | No change /relatively stable (±0.14) | Small to moderate increase (0.15–0.50) | Moderate to large increase (>0.50) | ||
| HPFS | ||||||
| Cases/person-years | 410/88993 | 320/79063 | 326/98626 | 277/64893 | 274/50940 | |
| Multivariate model 1c | 0.91 (0.77–1.09) | 1.06 (0.90–1.24) | 1.00 | 1.24 (1.05–1.47) | 1.40 (1.17–1.66) | <0.001 |
| Multivariate model 2d | 0.94 (0.78–1.11) | 1.06 (0.90–1.25) | 1.00 | 1.22 (1.03–1.44) | 1.30 (1.09–1.55) | <0.001 |
|
| ||||||
| NHS | ||||||
| Cases/person-years | 894/168326 | 769/162814 | 840/191145 | 585/125816 | 455/73919 | |
| Multivariate model 1c | 0.82 (0.73–0.91) | 0.92 (0.83–1.01) | 1.00 | 1.03 (0.92–1.14) | 1.25 (1.11–1.41) | <0.001 |
| Multivariate model 2d | 0.86 (0.77–0.97) | 0.91 (0.83–1.01) | 1.00 | 0.98 (0.88–1.09) | 1.12 (1.00–1.27) | 0.002 |
|
| ||||||
| NHS II | ||||||
| Cases/person-years | 658/191832 | 579/220505 | 592/253202 | 397/127237 | 303/69634 | |
| Multivariate model 1c | 0.90 (0.79–1.03) | 0.95 (0.84–1.07) | 1.00 | 1.21 (1.06–1.38) | 1.34 (1.16–1.55) | <0.001 |
| Multivariate model 2d | 0.93 (0.82–1.07) | 0.97 (0.86–1.09) | 1.00 | 1.12 (0.99–1.28) | 1.16 (1.01–1.34) | 0.01 |
|
| ||||||
| Poolede | ||||||
| Multivariate model 1c | 0.86 (0.80–0.93) | 0.95 (0.89–1.02) | 1.00 | 1.13 (1.05–1.21) | 1.31 (1.21–1.42) | <0.001 |
| Multivariate model 2d | 0.90 (0.83–0.97) | 0.96 (0.89–1.03) | 1.00 | 1.07 (0.99–1.15) | 1.17 (1.08–1.27) | <0.001 |
Data are based on 20 years of follow-up (1986–2006) in the Health Professionals Follow-up Study (HPFS), 20 years of follow-up (1986–2006) in the Nurses’ Health Study (NHS), and 16 years of follow-up (1991–2007) in the Nurses’ Health Study II (NHS II). The exposure was change in red meat intake in the baseline 4-year period (1986 to 1990 in the HPFS and NHS, and 1991 to 1995 in the NHS II), and the outcome was the incidence of type 2 diabetes in the subsequent follow-up years (1990 to 2006 in the HPFS and NHS, and 1995 to 2007 in the NHS II).
P value for trend was derived from tests of linear trend across categories of changes in red meat consumption by treating the median value of the each category as a continuous variable.
Multivariate Model 1: adjusted for age, initial red meat intake (quintiles), race (white, non-white), marital status (with spouse, yes or not), family history of diabetes (yes or not), history of hypertension (yes or not), history of hypercholesterolemia (yes or not), and simultaneous changes in other lifestyle factors: smoking status (never to never, never to current, past to past, past to current, current to past, current to current, missing indicator), initial and change in alcohol intake (quintiles), initial and change in physical activity (quintiles), initial and change in total energy intake (quintiles), as well as initial and change in diet quality (Alternative Healthy Eating Index, quintiles). Among nurses, postmenopausal status and menopausal hormone use (NHS and NHS II) were also included.
Multivariate Model 2: model 1 plus initial BMI (<23, 23–24.9, 25–29.9, 30–34.9, ≥35 kg/m2) and weight change (quintiles) during the 4-year period.
The results across the three cohorts were pooled using fixed-effect meta-analysis.