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

Iqbal R 1 , Dehghan M 2 , Mente A 2 , Rangarajan S 2 , Wielgosz A 3 , Avezum A 4 Show all authors , Seron P 5 , AlHabib KF 6 , Lopez-Jaramillo P 7 , Swaminathan S 8 , Mohammadifard N 9 , Zatońska K 10 , Bo H 11 , Varma RP 12 , Rahman O 13 , Yusufali A 14 , Lu Y 11 , Ismail N 15 , Rosengren A 16 , Imeryuz N 17 , Yeates K 18 , Chifamba J 19 , Dans A 20 , Kumar R 21 , Xiaoyun L 11 , Tsolekile L 22 , Khatib R 23 , Diaz R 24 , Teo K 2 , Yusuf S 2

Affiliations 

  • 1 Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  • 2 McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
  • 3 Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 4 International Research Centre, Hospital Alemao Oswaldo Cruz, University of Santo Amaro (UNISA), Sao Paulo, SP Brazil
  • 5 Faculty of Medicine, University of La Frontera, Temuco, Chile
  • 6 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 7 Masira Research Institute, Medical School, University of Santander, Bucaramanga, Colombia
  • 8 Division of Nutrition, St John's Research Institute, Koramangala, Bangalore, India
  • 9 Isfahan University of Medical Sciences, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan, Iran
  • 10 Department of Medicine, Wroclaw Medical University, Wroclaw, Poland
  • 11 Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
  • 12 Health Action by People, Thiruvananthapuram and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  • 13 University of Liberal Arts, Dhaka, Bangladesh
  • 14 Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  • 15 Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 16 University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
  • 17 Department of Internal Medicine and Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
  • 18 Queen's University, Department of Medicine, Canada and Pamoja Tunaweza Research Center, Moshi, Tanzania
  • 19 University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  • 20 Department of Medicine, University of the Philippines, Manila, Philippines
  • 21 Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 22 School of Public Health, University of the Western Cape, Bellville, South Africa
  • 23 Birzeit University, Institute for Community and Public Health, Birzeit, Palestine
  • 24 Clinical Studies Latin America, Rosario, Santa Fe, Argentina
Am J Clin Nutr, 2021 09 01;114(3):1049-1058.
PMID: 33787869 DOI: 10.1093/ajcn/nqaa448

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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