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Original Investigation
February 3, 2020

Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality

Author Affiliations
  • 1Division of Nutritional Sciences, Cornell University, Ithaca, New York
  • 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Intern Med. Published online February 3, 2020. doi:10.1001/jamainternmed.2019.6969
Key Points

Question  Is consuming processed meat, unprocessed red meat, poultry, or fish associated with incident cardiovascular disease and all-cause mortality?

Findings  In this cohort study of 29 682 US adults pooled from 6 prospective cohort studies, intake of processed meat, unprocessed red meat, or poultry was significantly associated with incident cardiovascular disease, but fish intake was not. Intake of processed meat or unprocessed red meat was significantly associated with all-cause mortality, but intake of poultry or fish was not.

Meaning  The findings of this study appear to have critical public health implications given that dietary behaviors are modifiable and most people consume these 4 food types on a daily or weekly basis.

Abstract

Importance  Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, or fish consumption with CVD and all-cause mortality are still uncertain.

Objective  To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality.

Design, Setting, and Participants  This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019.

Exposures  Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables.

Main Outcomes and Measures  Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations.

Results  Among the 29 682 participants (mean [SD] age at baseline, 53.7 [15.7] years; 13 168 [44.4%] men; and 9101 [30.7%] self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 [95% CI, 1.04-1.11]; adjusted ARD, 1.74% [95% CI, 0.85%-2.63%]), unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.06]; adjusted ARD, 0.62% [95% CI, 0.07%-1.16%]), or poultry (adjusted HR, 1.04 [95% CI, 1.01-1.06]; adjusted ARD, 1.03% [95% CI, 0.36%-1.70%]) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 [95% CI, 0.98-1.02]; adjusted ARD, 0.12% [95% CI, −0.40% to 0.65%]). Intake of processed meat (adjusted HR, 1.03 [95% CI, 1.02-1.05]; adjusted ARD, 0.90% [95% CI, 0.43%-1.38%]) or unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.05]; adjusted ARD, 0.76% [95% CI, 0.19%-1.33%]) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 [95% CI, 0.97-1.02]; adjusted ARD, −0.28% [95% CI, −1.00% to 0.44%]) or fish (adjusted HR, 0.99 [95% CI, 0.97-1.01]; adjusted ARD, −0.34% [95% CI, −0.88% to 0.20%]) was not significantly associated with all-cause mortality.

Conclusions and Relevance  These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.

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    1 Comment for this article
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    Relation of this study to the people of Pakistan
    Moiz Khan, MBBS | Shalamar Medical College, University of Health Sciences Lahore
    I’ve read the article and pretty much agree with the conclusion given here. The intake of read meat has been associated with CVD for quite a long time now and i think we’ve all seen some examples of this in our lives. I am a student of medicine and being a citizen of Pakistan I’ve seen most of the people here eating lots and lots of meat since we’re very fond of this stuff(including myself among the people) and most of our traditional dishes are meat based from our rice to our gravies, most of it is basically meat and hence the increased risk of CVDs here in our region. This is a good study based on good statistical analysis which basically explains why that is so and i hope more of such activities take place and people from our region too realise how important it is to keep a check on the amount of meat intake and keep a good balance and maintain a healthy diet.
    CONFLICT OF INTEREST: None Reported
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