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      Systematic review of clinical studies related to pork intake and metabolic syndrome or its components

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          Abstract

          Globally, both the incidence of type 2 diabetes and the consumption of meat, in particular pork meat, have increased, concurrently. Processed meats have been associated with an increased risk for diabetes in observational studies. Therefore, it is important to understand the possible mechanisms of this association and the impact of meats from different species. The goal of this systematic review was to assess experimental human studies of the impact of pork intake compared with other protein sources on early markers for the development of diabetes, ie, insulin resistance, glucose intolerance, and the components of the metabolic syndrome. A systematic review was conducted searching PubMed and EMBASE and using the Cochrane and PRISMA guidelines. Eight studies were eligible and critically reviewed. Five studies were based on a single meal or single day exposure to pork, as compared with other sources of protein. The glucose-insulin response following the pork meals did not differ compared with beef, shrimp, or mixed sources of proteins. However, compared with eggs, ham (processed meat) led to a larger insulin response in nonobese subjects. Compared with whey, ham led to a smaller insulin response and a larger glucose response. These findings suggest possible mechanisms for the association between processed meat and the development of diabetes. Nonprocessed pork meats were not compared with eggs or whey. The three longer interventions (11 days to 6 months) did not show a significant impact of pork on the components of the metabolic syndrome, with the exception of a possible benefit on waist circumference and high-density lipoprotein cholesterol (one study each with significant limitations). Most of the findings are weak and there is a lack of solid evidence. The literature on the topic is limited and important research gaps are identified. Considering recent trends and projections for diabetes and pork intake, this is an important global public health question that requires more attention in order to provide improved evidence-based dietary recommendations.

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          Trends in meat consumption in the USA.

          To characterize the trends, distribution, potential determinants and public health implications of meat consumption within the USA. We examined temporal trends in meat consumption using food availability data from the FAO and US Department of Agriculture (USDA), and further evaluated the meat intake by type (red, white, processed) in the National Health and Nutrition Examination Surveys (NHANES) linked to the MyPyramid Equivalents Database (MPED). Overall meat consumption has continued to rise in the USA and the rest of the developed world. Despite a shift towards higher poultry consumption, red meat still represents the largest proportion of meat consumed in the USA (58 %). Twenty-two per cent of the meat consumed in the USA is processed. According to the NHANES 2003-2004, total meat intake averaged 128 g/d. The type and quantities of meat reported varied by education, race, age and gender. Given the plausible epidemiological evidence for red and processed meat intake in cancer and chronic disease risk, understanding the trends and determinants of meat consumption in the USA, where meat is consumed at more than three times the global average, should be particularly pertinent to researchers and other public health professionals aiming to reduce the global burden of chronic disease.
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            Rising consumption of meat and milk in developing countries has created a new food revolution.

            People in developing countries currently consume on average one-third the meat and one-quarter of the milk products per capita compared to the richer North, but this is changing rapidly. The amount of meat consumed in developing countries over the past has grown three times as much as it did in the developed countries. The Livestock Revolution is primarily driven by demand. Poor people everywhere are eating more animal products as their incomes rise above poverty level and as they become urbanized. By 2020, the share of developing countries in total world meat consumption will expand from 52% currently to 63%. By 2020, developing countries will consume 107 million metric tons (mmt) more meat and 177 mmt more milk than they did in 1996/1998, dwarfing developed-country increases of 19 mmt for meat and 32 mmt for milk. The projected increase in livestock production will require annual feed consumption of cereals to rise by nearly 300 mmt by 2020. Nonetheless, the inflation-adjusted prices of livestock and feed commodities are expected to fall marginally by 2020, compared to precipitous declines in the past 20 y. Structural change in the diets of billions of people is a primal force not easily reversed by governments. The incomes and nutrition of millions of rural poor in developing countries are improving. Yet in many cases these dietary changes also create serious environmental and health problems that require active policy involvement to prevent irreversible consequences.
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              Meat consumption, diabetes, and its complications.

              Several prospective studies have reported that risk of type 2 diabetes (T2DM) is elevated in meat consumers, especially when processed meats are consumed. Elevated risks of coronary heart disease (CHD) and stroke in meat consumers have also been reported. In this overview, the evidence regarding meat consumption and the risk of diabetes, both type 1 diabetes (T1DM) and T2DM and their macro- and microvascular complications, is reviewed. For T2DM, we performed a new meta-analysis including publications up to October 2012. For T1DM, only a few studies have reported increased risks for meat consumers or for high intake of saturated fatty acids and nitrates and nitrites. For T2DM, CHD, and stroke, the evidence is strongest. Per 100 g of total meat, the pooled relative risk (RR) for T2DM is 1.15 (95 % CI 1.07-1.24), for (unprocessed) red meat 1.13 (95 % CI 1.03-1.23), and for poultry 1.04 (95 % CI 0.99-1.33); per 50 g of processed meat, the pooled RR is 1.32 (95 % CI 1.19-1.48). Hence, the strongest association regarding T2DM is observed for processed (red) meat. A similar observation has been made for CHD. For stroke, however, a recent meta-analysis shows moderately elevated risks for meat consumers, for processed as well as for fresh meats. For the microvascular complications of diabetes, few prospective data were available, but suggestions for elevated risks can be derived from findings on hyperglycemia and hypertension. The results are discussed in the light of the typical nutrients and other compounds present in meat--that is, saturated and trans fatty acids, dietary cholesterol, protein and amino acids, heme-iron, sodium, nitrites and nitrosamines, and advanced glycation end products. In light of these findings, a diet moderate to low in red meat, unprocessed and lean, and prepared at moderate temperatures is probably the best choice from the public health point of view.
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                Author and article information

                Journal
                Diabetes Metab Syndr Obes
                Diabetes Metab Syndr Obes
                Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
                Dove Medical Press
                1178-7007
                2013
                25 September 2013
                : 6
                : 347-357
                Affiliations
                [1 ]Exponent Inc, Washington, DC, USA
                [2 ]Exponent Inc, Derby, United Kingdom
                [3 ]Translational Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
                Author notes
                Correspondence: Nicolas Stettler, Exponent Inc, 1150 Connecticut Avenue, NW, Suite 1100, Washington, DC 20036, USA, Tel +1 202 772 4900, Fax +1 202 772 4979, Email nstettler@ 123456exponent.com
                Article
                dmso-6-347
                10.2147/DMSO.S51440
                3792009
                24106428
                3a0d9ea2-b224-412b-bd2e-a191b97ecd28
                © 2013 Stettler et al. This work is published by Dove Medical Press Ltd, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed.

                History
                Categories
                Review

                Endocrinology & Diabetes
                blood glucose,high-density lipoprotein cholesterol,insulin resistance,meat,triglycerides,waist circumference

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