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Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study.
Am J Clin Nutr. 2021 09 01; 114(3):1049-1058.AJ

Abstract

BACKGROUND

Dietary guidelines recommend limiting red meat intake because it is a major source of medium- and long-chain SFAs and is presumed to increase the risk of cardiovascular disease (CVD). Evidence of an association between unprocessed red meat intake and CVD is inconsistent.

OBJECTIVE

The study aimed to assess the association of unprocessed red meat, poultry, and processed meat intake with mortality and major CVD.

METHODS

The Prospective Urban Rural Epidemiology (PURE) Study is a cohort of 134,297 individuals enrolled from 21 low-, middle-, and high-income countries. Food intake was recorded using country-specific validated FFQs. The primary outcomes were total mortality and major CVD. HRs were estimated using multivariable Cox frailty models with random intercepts.

RESULTS

In the PURE study, during 9.5 y of follow-up, we recorded 7789 deaths and 6976 CVD events. Higher unprocessed red meat intake (≥250 g/wk vs. <50 g/wk) was not significantly associated with total mortality (HR: 0.93; 95% CI: 0.85, 1.02; P-trend = 0.14) or major CVD (HR: 1.01; 95% CI: 0.92, 1.11; P-trend = 0.72). Similarly, no association was observed between poultry intake and health outcomes. Higher intake of processed meat (≥150 g/wk vs. 0 g/wk) was associated with higher risk of total mortality (HR: 1.51; 95% CI: 1.08, 2.10; P-trend = 0.009) and major CVD (HR: 1.46; 95% CI: 1.08, 1.98; P-trend = 0.004).

CONCLUSIONS

In a large multinational prospective study, we did not find significant associations between unprocessed red meat and poultry intake and mortality or major CVD. Conversely, a higher intake of processed meat was associated with a higher risk of mortality and major CVD.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Iqbal R
Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
Dehghan M
McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.
Mente A
McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.
Rangarajan S
McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.
Wielgosz A
Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Avezum A
International Research Centre, Hospital Alemao Oswaldo Cruz, University of Santo Amaro (UNISA), Sao Paulo, SP Brazil.
Seron P
Faculty of Medicine, University of La Frontera, Temuco, Chile.
AlHabib KF
Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Lopez-Jaramillo P
Masira Research Institute, Medical School, University of Santander, Bucaramanga, Colombia.
Swaminathan S
Division of Nutrition, St John's Research Institute, Koramangala, Bangalore, India.
Mohammadifard N
Isfahan University of Medical Sciences, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan, Iran.
Zatońska K
Department of Medicine, Wroclaw Medical University, Wroclaw, Poland.
Bo H
Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Varma RP
Health Action by People, Thiruvananthapuram and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Rahman O
University of Liberal Arts, Dhaka, Bangladesh.
Yusufali A
Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
Lu Y
Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Ismail N
Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Rosengren A
University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
Imeryuz N
Department of Internal Medicine and Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
Yeates K
Queen's University, Department of Medicine, Canada and Pamoja Tunaweza Research Center, Moshi, Tanzania.
Chifamba J
University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Dans A
Department of Medicine, University of the Philippines, Manila, Philippines.
Kumar R
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Xiaoyun L
Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Tsolekile L
School of Public Health, University of the Western Cape, Bellville, South Africa.
Khatib R
Birzeit University, Institute for Community and Public Health, Birzeit, Palestine. Advocate Research Institute, Advocate Health Care, Chicago, IL, USA.
Diaz R
Clinical Studies Latin America, Rosario, Santa Fe, Argentina.
Teo K
McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.
Yusuf S
McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.

MeSH

AdultCardiovascular DiseasesCohort StudiesDietFeeding BehaviorFemaleFood HandlingGlobal HealthHumansMaleMeatMiddle AgedProspective StudiesRisk FactorsRural Population

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33787869

Citation

Iqbal, Romaina, et al. "Associations of Unprocessed and Processed Meat Intake With Mortality and Cardiovascular Disease in 21 Countries [Prospective Urban Rural Epidemiology (PURE) Study]: a Prospective Cohort Study." The American Journal of Clinical Nutrition, vol. 114, no. 3, 2021, pp. 1049-1058.
Iqbal R, Dehghan M, Mente A, et al. Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study. Am J Clin Nutr. 2021;114(3):1049-1058.
Iqbal, R., Dehghan, M., Mente, A., Rangarajan, S., Wielgosz, A., Avezum, A., Seron, P., AlHabib, K. F., Lopez-Jaramillo, P., Swaminathan, S., Mohammadifard, N., Zatońska, K., Bo, H., Varma, R. P., Rahman, O., Yusufali, A., Lu, Y., Ismail, N., Rosengren, A., ... Yusuf, S. (2021). Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study. The American Journal of Clinical Nutrition, 114(3), 1049-1058. https://doi.org/10.1093/ajcn/nqaa448
Iqbal R, et al. Associations of Unprocessed and Processed Meat Intake With Mortality and Cardiovascular Disease in 21 Countries [Prospective Urban Rural Epidemiology (PURE) Study]: a Prospective Cohort Study. Am J Clin Nutr. 2021 09 1;114(3):1049-1058. PubMed PMID: 33787869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study. AU - Iqbal,Romaina, AU - Dehghan,Mahshid, AU - Mente,Andrew, AU - Rangarajan,Sumathy, AU - Wielgosz,Andreas, AU - Avezum,Alvaro, AU - Seron,Pamela, AU - AlHabib,Khalid F, AU - Lopez-Jaramillo,Patricio, AU - Swaminathan,Sumathi, AU - Mohammadifard,Noushin, AU - Zatońska,Katarzyna, AU - Bo,Hu, AU - Varma,Ravi Prasad, AU - Rahman,Omar, AU - Yusufali,AfzalHussein, AU - Lu,Yin, AU - Ismail,Noorhassim, AU - Rosengren,Annika, AU - Imeryuz,Neşe, AU - Yeates,Karen, AU - Chifamba,Jephat, AU - Dans,Antonio, AU - Kumar,Rajesh, AU - Xiaoyun,Liu, AU - Tsolekile,Lungi, AU - Khatib,Rasha, AU - Diaz,Rafael, AU - Teo,Koon, AU - Yusuf,Salim, PY - 2020/08/06/received PY - 2020/12/29/accepted PY - 2021/4/1/pubmed PY - 2021/10/2/medline PY - 2021/3/31/entrez KW - cardiovascular disease KW - cohort study KW - mortality KW - poultry KW - processed meat intake KW - unprocessed red meat SP - 1049 EP - 1058 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 114 IS - 3 N2 - BACKGROUND: Dietary guidelines recommend limiting red meat intake because it is a major source of medium- and long-chain SFAs and is presumed to increase the risk of cardiovascular disease (CVD). Evidence of an association between unprocessed red meat intake and CVD is inconsistent. OBJECTIVE: The study aimed to assess the association of unprocessed red meat, poultry, and processed meat intake with mortality and major CVD. METHODS: The Prospective Urban Rural Epidemiology (PURE) Study is a cohort of 134,297 individuals enrolled from 21 low-, middle-, and high-income countries. Food intake was recorded using country-specific validated FFQs. The primary outcomes were total mortality and major CVD. HRs were estimated using multivariable Cox frailty models with random intercepts. RESULTS: In the PURE study, during 9.5 y of follow-up, we recorded 7789 deaths and 6976 CVD events. Higher unprocessed red meat intake (≥250 g/wk vs. <50 g/wk) was not significantly associated with total mortality (HR: 0.93; 95% CI: 0.85, 1.02; P-trend = 0.14) or major CVD (HR: 1.01; 95% CI: 0.92, 1.11; P-trend = 0.72). Similarly, no association was observed between poultry intake and health outcomes. Higher intake of processed meat (≥150 g/wk vs. 0 g/wk) was associated with higher risk of total mortality (HR: 1.51; 95% CI: 1.08, 2.10; P-trend = 0.009) and major CVD (HR: 1.46; 95% CI: 1.08, 1.98; P-trend = 0.004). CONCLUSIONS: In a large multinational prospective study, we did not find significant associations between unprocessed red meat and poultry intake and mortality or major CVD. Conversely, a higher intake of processed meat was associated with a higher risk of mortality and major CVD. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/33787869/Associations_of_unprocessed_and_processed_meat_intake_with_mortality_and_cardiovascular_disease_in_21_countries_[Prospective_Urban_Rural_Epidemiology__PURE__Study]:_a_prospective_cohort_study_ DB - PRIME DP - Unbound Medicine ER -