Association of lunch meat consumption with nutrient intake, diet quality and health risk factors in U.S. children and adults: NHANES 2007–2010

This is the first report to investigate lunch meat consumption in the U.S. population and explore its relationships with nutrient intake, diet quality and physiological markers of health. In the present study, we combined NHANES 2007–2008 and NHANES 2009–2010 data and the combined data set provided a sample size of over 15 thousand adults and children. Lunch meats, also known as deli meat or cold cuts, are precooked or cured meat that are sliced and used to make a convenient sandwich filling or salad topping. The NHANES 2007–2010 data showed that almost one-fifth of the population (18 % children age 2–18 and 19 % adults age 19 years and older) consumed lunch meat on the day of the recall.

Both adults and children consumers of lunch meat consumed significantly more calories as well as protein compared to their respective non-consumers. Additionally, they consumed more energy adjusted calcium, potassium and thiamine compared to non-consumers. Calcium and potassium are termed as “nutrients of concern” by the Dietary Guidelines for Americans, 2010 [1]. Current intake of calcium is estimated to be below the Estimated Average Requirement for over 40 % of the population and only about 3 % population is currently consuming more than the Adequate Intake for potassium [10]. Adequate calcium status is important for optimal bone health and potassium helps lower the blood pressure. Dietary Guidelines for Americans, 2010 has recommended increasing intake of calcium and potassium [1]. Meat (especially lean meat) is considered as one of the most nutrient dense food [6]. Lunch meat consumers also had higher intakes of sodium compared to non-consumers. Excessive sodium intake has been related to high prevalence of high blood pressure [1]. Sodium intake estimated in this study was higher than the recommended 2,300 mg for both adult and children, irrespective of their being consumers or non-consumers. Potassium lowers blood pressure by blunting the adverse effects of sodium on blood pressure. However, it should be noted there were no significant differences in blood pressure between consumers and non-consumers for both adults and children.

The HEI 2010 scores of lunch meat consumers were not significantly different from those of non-consumers for both adults and children. The HEI is a measure of diet quality that indicates compliance/adherence of the diets to the recommendations of Dietary Guidelines for Americans, 2010. HEI is commonly used to evaluate diets including subpopulations [22] and food environments [23], to assess changes in the diet quality over time [24] and the efficacy of dietary interventions, and to validate other nutrition research tools and indexes [25]. It has also been used in recent research to understand relationships between nutrients/foods/dietary patterns and health-related outcomes [26‐29]. Lunch meat consumers had similar HEI 2010 scores as non-consumers and the differences in HEI 2010 scores remained non-significant even when the data was further analyzed by age (young children, adolescent, adults and older adults) and gender groups (males and females) indicating that the diet quality of lunch meat consumers were similar to non-consumers for every age/gender group. These results suggest that lunch meats do not necessarily decrease average diet quality of adults and children. HEI 2010 has 12 components (9 for adequacy and 3 for moderation) each of which relate to the key recommendations of the Dietary Guidelines for Americans, 2010. Although the total HEI scores were not different for lunch meat consumers compared to non-consumers, there were some differences in the subcomponent scores which may provide insight into incorporating lunch meats into diets to help align with Dietary Guidelines Recommendations. For example, lower sodium lunch meat options may be considered and it appears that the use of cheese and whole grains are more common in lunch meat consumers thus improving HEI subcomponent scores for dairy and whole grains, respectively.

In the current study, lunch meat intake was not associated with any physiological measurements including BMI, blood pressure, blood lipids or blood sugar. The recently released Scientific Report of the Dietary Guidelines Advisory Committee 2015 indicated that dietary patterns consisting of lower consumption of red and processed meat were associated with positive health outcomes [10]. In an abstract the International Agency for Research on Cancer experts indicated that 34,000 to 50,000 cancer deaths per year worldwide may be attributable to diets high in processed meat and red meat respectively while air pollution, alcohol intake and tobacco smoking are responsible for 200,000, 600,000 and 1 million deaths per year worldwide respectively [30, 31]. The expert report concluded that each 50 g portion of processed meat eaten daily may increase the risk of colorectal cancer by 18 %, [30, 31]. It is impossible to accurately discern the contribution of one single food consumed with causation of cancer because it is impossible to separate an individual food from the confounding interactions of other potential carcinogenic “hazards” experienced over the course of a lifetime. Intake of processed meat was found to be associated with a higher risk of coronary heart disease (CHD) and type-2 diabetes [32]. In a meta-analysis, consumption of processed meats was associated with higher incidence of CHD and diabetes mellitus [33]. High intake of processed meat was also implicated with increased risk of early death, in particular due to cardiovascular diseases and cancer, in a recently published European epidemiological study [34]. However, most observational studies reported only a small increase in relative risk [6]. Industry efforts for the past 10 years have focused on simplification of ingredient lists. This “clean labeling” effort has resulted in significant changes regarding processing techniques applied to product development of luncheon meats. In the present study, we did not find any significant differences in physiological measures or in the odds ratio of all studied health related conditions between lunch meat consumers and non-consumers (in fact, lunch meat consumers had better average physiological measures for lipids and overweight/obesity risk in our findings.) Whether the lack of significant effect on physiological parameters is a result of using NHANES, an observational study; effect of presence of other dietary components such as fruits and vegetables, whole grain etc. in the diet of consumers; or whether lunch meats have evolved since the previously mentioned studies were published will have to await further research.

A limitation of this study is that cross-sectional studies cannot be used to determine cause and effect. Additionally, 24-h dietary recalls rely on participants’ memory to self-report dietary intakes; and therefore data are subject to misreporting. Also the data used in this study was based on single 24-h dietary recall. Strengths of this study included the use of large nationally representative sample achieved through combining several sets of NHANES data releases and adjusting for numerous covariates, but even with these covariates some residual confounding may still exist.

Future research might consider comparing lunch meat consumers, with consumers of other meats and/or non-consumers of meat. Additionally, when further data are available it might also be meritorious to conduct analyses comparing particular types of lunch meats (e.g., whole cut versus sectioned/formed, versus processed meat). Other work might examine further other items consumed with lunch meats and whether more healthy items could be identified.