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Cured Meat Consumption, Lung Function, and Chronic Obstructive Pulmonary Disease among United States Adults

American Journal of Respiratory and Critical Care Medicine, Apr 15, 2007 by Jiang, Rui, Paik, David C, Hankinson, John L, Barr, R Graham

Rationale: Cured meats are high in nitrites. Nitrites generate reactive nitrogen species that may cause nitrative and nitrosative damage to the lung resulting in emphysema.

Objective: To test the hypothesis that frequent consumption of cured meats is associated with lower lung function and increased odds of chronic obstructive pulmonary disease (COPD).

Methods: Cross-sectional study of 7,352 participants in the Third National Health and Nutrition Examination Survey, 45 years of age or more, who had adequate measures of cured meat, fish, fruit, and vegetable intake, and spirometry.

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Results: After adjustment for age, smoking, and multiple other potential confounders, frequency of cured meat consumption was inversely associated with FEV^sub 1^ and FEV^sub 1^/FVC but not FVC. The adjusted differences in FEV^sub 1^ between individuals who did not consume cured meats and those who consumed cured meats 1 to 2, 3 to 4, 5 to 13, and 14 or more times per month were -37.6, -11.5, -42.0, and -110 ml, respectively (p for trend

Conclusions: Frequent cured meat consumption was associated independently with an obstructive pattern of lung function and increased odds of COPD. Additional studies are required to determine if cured meat consumption is a causal risk factor for COPD.

Keywords: cured meats; nitrites; lung function; chronic obstructive pulmonary disease; emphysema

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the United States (1, 2). The death rate from COPD doubled between 1970 and 2002, in contrast to an overall decline in mortality in the United States (3). COPD prevalence and mortality continue to rise, such that COPD is projected to become the third leading cause of death worldwide by 2020 (4). Despite the magnitude of the problem, preventive strategies for COPD are limited to avoidance of cigarette smoking.

Nitrites generate reactive nitrogen species that may cause nitrative and nitrosative damage to the lung, producing structural changes resembling emphysema. In 1968, a rodent model of experimental emphysema was described in which rats exposed to 10 to 25 ppm of ambient nitrogen dioxide (NO^sub 2^, a nitrite gaseous precursor) developed emphysematous changes in their lungs (5-7). In 1972, Shuval and Gruener added 1,000 to 3,000 mg/L sodium nitrite to the drinking water of rats for a 2-year period (8). The authors intended to study the carcinogenic effects of long-term nitrite intake, which leads to production of nitrosamine and nitrosamide compounds, but instead observed dilated coronary arteries and pulmonary emphysema.

Cured meats, such as bacon, sausage, luncheon meats, and cured hams, are high in nitrites, which are added to meat products as a preservative, an antimicrobial agent, and a color fixative (9). Although these rodent studies suggest that inhalation of NO^sub 2^ and ingestion of sodium nitrite may contribute to emphysema, no human studies have examined the relationship between consumption of cured meats and COPD. We therefore tested the hypothesis that frequent consumption of cured meats would be associated with an obstructive pattern of spirometry and increased odds of COPD in a large, representative sample of U.S. adults. Some results in this article were presented in abstract form at the 2006 meeting of the European Respiratory Society (10).

METHODS

Study Population

The Third National Health and Nutrition Examination Survey (NHANES III) was a cross-sectional survey conducted from 1988 through 1994 by the National Center for Health Statistics. Approximately 33,994 noninstitutionalized U.S. civilians aged 2 months or older were selected via a stratified multistage probability sampling design. Detailed description of the methodology of NHANES III has been previously published (11, 12). For the present study, we restricted the sample to 9,787 participants aged 45 years or older because COPD is rare before that age and because the association of cured meat and COPD is less likely to be subject to misclassification with asthma. We excluded participants who were missing measures of cured meat consumption (n = 38), fish, fruit, or vegetable consumption (n = 80), or lung function (n = 2,143). One author (J.L.H.) supervised measurement of spirometry in NHANES III, reviewed all spirometry results, and excluded a further 174 participants who did not have acceptable spirometry curves.

Dietary Assessment

Frequency of food consumption was collected by food frequency questionnaire (13). Respondents were asked how often over the past month they had consumed selected food items, including meats, fish, fruits, and vegetables. Cured meat consumption was defined as the total consumption of bacon, sausage, and luncheon meats, which was ascertained as a single food item on the questionnaire. Ham was not included in cured meat consumption because it was only ascertained in combination with pork as a single food item on the questionnaire (pork is not a cured meat).

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Cured Meat Consumption, Lung Function, and Chronic Obstructive Pulmonary Disease among United States Adults

American Journal of Respiratory and Critical Care Medicine, Apr 15, 2007 by Jiang, Rui, Paik, David C, Hankinson, John L, Barr, R Graham

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