We thank Mozaffarian for his thoughtful comments about our article.1 We agree with Mozaffarian that residual confounding may be an issue, and we acknowledge this in the article as follows: “The problem of residual confounding may still exist and could explain the relatively small associations found throughout this study despite the care taken to adjust for known confounders.”1(p569) To decrease the possibility of residual confounding, Mozaffarian suggests that we could use the “all other deaths” category as a negative control; this assumes that meat consumption is not associated with mortality in this category of deaths, which may not be a valid assumption. As pointed out in our article, the “all other deaths” category is heterogeneous, including such causes as diabetes mellitus, Alzheimer disease, stomach and duodenal ulcers, chronic liver disease, cirrhosis, nephritis, nephrotic syndrome, and nephrosis, a number of which may be associated with meat intake. For example, diabetes and insulin resistance have been linked to increased red and processed meat consumption.2 In addition, red meat consumption has been implicated in the etiology of hepatocellular carcinoma, for which chronic liver disease is often a precursor.3 Red meat has also been positively associated with lung cancer, which is linked to chronic pulmonary disease.3,4
Sinha R, Graubard BI, Cross AJ, Leitzmann MF, Schatzkin A. Higher Red Meat Intake May Be a Marker of Risk, Not a Risk Factor Itself—Reply. Arch Intern Med. 2009;169(16):1539. doi:10.1001/archinternmed.2009.279
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: