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Anxiety is a potential effect modifier of the association between red and processed meat consumption and cancer risk: findings from the NutriNet-Santé cohort

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Abstract

Purpose

Red and processed meats are recognized by the International Agency for Research on Cancer as probably carcinogenic and carcinogenic to humans, respectively. Heme iron has been proposed as a central factor responsible for this effect. Furthermore, anxiety affects the intestinal barrier function by increasing intestinal permeability. The objective of this work was to assess how anxiety modifies the association between red and processed meat consumption and cancer risk in the NutriNet-Santé prospective cohort (2009–2019).

Methods

Using multi-adjusted Cox models in a sample of 101,269 subjects, we studied the associations between the consumption of red and processed meat, the amount of heme iron coming from these meats and overall, colorectal, prostate, and breast cancer risks, overall and separately among participants with and without anxiety.

Results

An increase in red and processed meat consumption was associated with an increased risk of developing colorectal cancer in the total population (HR for an increase of 50 g/day = 1.18 (1.01–1.37), p = 0.03). After stratification on anxiety, the HR 50 g/day was 1.42 (1.03–1.94, p = 0.03) in anxious participants and 1.12 (0.94–1.33, p = 0.20) in other participants. Similar trends were observed for overall cancer risk. Analyses conducted with heme iron also provided similar results.

Conclusions

Our results strengthen the existing body of evidence supporting that red and processed meat consumption and heme iron intake are associated with an increased risk of overall and more specifically colorectal cancer, and suggest that anxiety modifies these associations, with an increased risk in anxious participants.

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Acknowledgments

The authors warmly thank all the volunteers of the NutriNet-Santé cohort. We also thank Younes Esseddik (IT manager), Thi Hong Van Duong, Régis Gatibelza, and Jagatjit Mohinder (computer scientists), Fabien Szabo de Edelenyi, PhD (data management supervisor), Julien Allègre, Nathalie Arnault, Laurent Bourhis (data-managers/biostatisticians), Fatoumata Diallo, MD, Roland Andrianasolo, MD and Sandrine Kamdem, MD (physicians), and Nathalie Druesne-Pecollo (operational coordinator) for their technical contribution to the NutriNet-Santé study. The authors also thank the scientific support of the French Network for Nutrition And Cancer Research (NACRe network).

Funding

This research was supported by the regular financial support of INRAE. The NutriNet-Santé study was supported by the following public institutions: Ministère de la Santé, Santé Publique France, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut national de recherche pour l’agriculture, l’alimentation et l’environnement (INRAE), Conservatoire National des Arts et Métiers (CNAM) and Sorbonne Paris Nord University. MB was supported by a doctoral grant from the École d'ingénieurs de Purpan and the region Occitanie. CD was supported by a grant from the French National Cancer Institute (INCa). EC was supported by a Doctoral Funding from Université Paris 13—Galilée Doctoral School. MD was supported by a Post-doctoral grant from the Fondation pour la Recherche Médicale. The funders had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.

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Author notes

  1. Fabrice Pierre and Mathilde Touvier contributed equally to this work.

Authors and Affiliations

  1. Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France

    Marie Beslay, Edwin Fouché, Nathalie Naud, Valerie Bacquié, Françoise Guéraud, Vassilia Theodorou & Fabrice Pierre

  2. Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), Sorbonne Paris Nord University, UFR SMBH - 74, rue Marcel Cachin 93017, Bobigny, France

    Bernard Srour, Mélanie Deschasaux, Valentina A. Andreeva, Sandrine Péneau, Eloi Chazelas, Charlotte Debras, Serge Hercberg, Paule Latino-Martel & Mathilde Touvier

  3. Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France

    Serge Hercberg

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  1. Marie Beslay
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Contributions

SH, FP, VT, MB and MT designed and conducted the study. BS, MD, FP, MT and VT developed the methodology. SH, MT, VAA, SP, PLM, EF, NN, VB, EC and CD acquired the data. MB analyzed the data and wrote the paper. FP and MT had primary responsibility for the final content; and all authors: were involved in interpreting the results and editing the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Bernard Srour.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The NutriNet‐Santé study, registered at ClinicalTrials.gov as NCT03335644, is conducted according to the Declaration of Helsinki guidelines and was approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm n°0000388FWA00005831) and the “Commission Nationale de l'Informatique et des Libertés” (CNIL n°908450/n°909216). Electronic informed consent is obtained from each participant.

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Beslay, M., Srour, B., Deschasaux, M. et al. Anxiety is a potential effect modifier of the association between red and processed meat consumption and cancer risk: findings from the NutriNet-Santé cohort. Eur J Nutr 60, 1887–1896 (2021). https://doi.org/10.1007/s00394-020-02381-3

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