Association of mushroom consumption with major chronic diseases and mortality
Open Access
- Author:
- Ba, Djibril
- Graduate Program:
- Epidemiology (PhD)
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- April 16, 2021
- Committee Members:
- Xiang Gao, Outside Unit & Field Member
Laila Al-Shaar, Major Field Member
Vernon Chinchilli, Major Field Member
Joshua Muscat, Dissertation Advisor
John Richie, Chair of Committee
Douglas Leslie, Program Head/Chair - Keywords:
- Mushrooms
Cancer
Mortality
Cardiometabolic Diseases
Depression
Epidemiology
NHANES - Abstract:
- The current burden of cardiovascular diseases, cancer, and mental health disorders, including depression, constitute a significant threat to public health globally. Cardiovascular diseases remained the leading cause of death globally and accounted for more than 800,000 deaths (1 of every 3 deaths) in the United States (US) in 2016. Globally, cancer is considered the second leading cause of death after cardiovascular diseases, with an estimated 9.6 million death in 2018. Mental illnesses, such as depression, are the third leading cause of hospitalization in the US among adults, and those living with an acute mental illness are more likely to die on average 25 years earlier than healthy individuals. Poor diet, such as low intake of fruit and vegetables, and high intake of sodium, saturated fat, and added sugars, is responsible for more deaths globally than any known traditional health risk factors such as smoking and high blood pressure. A previous study suggested that improvement of dietary intake could prevent 1 of every 5 deaths globally. Mushrooms, which are rich in several bioactive compounds including the crucial antioxidants ergothioneine and glutathione, are considered an important component of a healthy diet which have recently gained attention for their potential health benefits. However, whether mushrooms consumption is associated with lower risk of major chronic diseases, mental health illnesses, and premature mortality, remains uncertain. Another significant gap in the literature is whether substituting mushrooms for red/processed meat is associated with favorable health outcomes such as low mortality rate in the typical US eating pattern. The overall objective of this dissertation research is to provide empirical evidence about the associations of mushroom consumption with cancer, mortality, risk factors for cardiometabolic diseases, and depression. Mushroom intake was assessed from up to two days 24-hour dietary recall data using the US Department of Agriculture food (USDA) codes. Descriptive statistics and multivariable regression models, including Cox proportional hazards, linear, and logistic regression models, were used to perform the data analyses of this dissertation research project. For Aim 1, we conducted a systematic review and meta-analysis of observational studies to investigate the association between mushroom consumption and risk of cancer at any site. We found that higher mushroom consumption was associated with lower risk of total cancer (pooled RR for the highest vs. lowest consumption groups: 0.66; 95% CI: 0.55, 0.78; n=17). In particular, breast cancer appeared to be the most affected site as a significant association with mushroom intake was only observed for cancers at this site. For Aim 2, we conducted prospective cohort studies and a meta-analysis to examine the association between mushroom consumption and mortality among US adults using data from the National Health and Nutrition Examination Survey (NHANES III) (1988-1994) and continuous NHANES (2003-2014). We found that in the meta-analysis of hazards ratios (HR) from both cohorts, participants reporting mushroom intake had lower risk of all-cause mortality than those without mushroom intake (pooled adjusted HR=0.84; 95% CI: 0.74-0.95). Also, in the meta-analysis of cause-specific mortality, mushroom intake was only associated with a lower risk of mortality from diabetes (pooled adjusted HR=0.24; 95% CI: 0.07-0.81), but not from other specific causes of mortality. For Aim 3, we performed a cross-sectional study to evaluate the association between mushroom consumption and risk factors for cardiometabolic diseases among US adults. We found that mushroom consumption was not associated with a lower risk based on changes in risk factors. For Aim 4, we conducted a cross-sectional study to assess the association between mushroom consumption and depression among US adults using continuous NHANES (2003-2014) data. We found that compared with the lowest tertile of mushroom intake, participants in the middle tertile (median intake= 4.9 g/d, number of cases=16 ) had lower odds of depression (adjusted OR=0.31; 95% CI: 0.16, 0.60) while those in the highest tertile did not differ (median intake= 19.6 g/d, adjusted OR=0.91; 95% CI: 0.47, 1.78, number of cases=22 ) (P-trend= 0.42) after adjusting for confounding factors. In summary, findings from these studies suggest that regular mushroom consumption was associated with a low risk of cancer, mortality, and depression. Such findings may have significant public health and clinical implications in preventing chronic diseases, mental health disorders, and premature mortality.