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Cited by 296Nutritional Studies and DietMeat and Animal Product QualityAgriculture Sustainability and Environmental Impact

Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study

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Etemadi, Arash, Sinha, Rashmi, Ward, Mary H, Graubard, Barry I, Inoue-Choi, Maki, Dawsey, Sanford M, Abnet, Christian C·2017·BMJ
DOI 10.1136/bmj.j1957PMC PMC5423547
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Abstract

Objective To determine the association of different types of meat intake and meat associated compounds with overall and cause specific mortality. Design Population based cohort study. Setting Baseline dietary data of the NIH-AARP Diet and Health Study (prospective cohort of the general population from six states and two metropolitan areas in the US) and 16 year follow-up data until 31 December 2011. Participants 536 969 AARP members aged 50-71 at baseline. Exposures Intake of total meat, processed and unprocessed red meat (beef, lamb, and pork) and white meat (poultry and fish), heme iron, and nitrate/nitrite from processed meat based on dietary questionnaire. Adjusted Cox proportional hazards regression models were used with the lowest fifth of calorie adjusted intakes as reference categories. Main outcome measure Mortality from any cause during follow-up. Results An increased risk of all cause mortality (hazard ratio for highest versus lowest fifth 1.26, 95% confidence interval 1.23 to 1.29) and death due to nine different causes associated with red meat intake was observed. Both processed and unprocessed red meat intakes were associated with all cause and cause specific mortality. Heme iron and processed meat nitrate/nitrite were independently associated with increased risk of all cause and cause specific mortality. Mediation models estimated that the increased mortality associated with processed red meat was influenced by nitrate intake (37.0-72.0%) and to a lesser degree by heme iron (20.9-24.1%). When the total meat intake was constant, the highest fifth of white meat intake was associated with a 25% reduction in risk of all cause mortality compared with the lowest intake level. Almost all causes of death showed an inverse association with white meat intake. Conclusions The results show increased risks of all cause mortality and death due to nine different causes associated with both processed and unprocessed red meat, accounted for, in part, by heme iron and nitrate/nitrite from processed meat. They also show reduced risks associated with substituting white meat, particularly unprocessed white meat.

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  • Several observational and cross-sectional studies have shown the harmful association between MASLD and high intake of red and processed meat.

    “Several observational and crosssectional studies have shown the harmful association between MASLD and high intake of red and processed meat. 302 -304”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [302]

    The Discussion (Possible mechanistic explanations; page unavailable) says meat intake has been associated with non-alcoholic fatty liver disease, supporting the general association. It does not specify high intake of both red and processed meat for that outcome. The Results (Meat consumption and mortality; page unavailable) concern chronic liver disease deaths, not MASLD incidence or prevalence, and this study is a cohort rather than a cross-sectional study. (LLM, conf=0.84)

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  • Both prospective cohorts used one dietary measurement at baseline.

    “Yet, both prospective cohorts used one dietary measurement at baseline.29 30”

    From Red meat intake and risk of coronary heart disease among US men: prospective cohort study (2020) · cites this paper as [30]

  • In another prospective US cohort study, the dietary intake of processed and unprocessed red meat was each associated with higher risk of mortality from heart disease.

    “In another prospective US cohort study, the dietary intake of processed and unprocessed red meat was each associated with higher risk of mortality from heart disease.30”

    From Red meat intake and risk of coronary heart disease among US men: prospective cohort study (2020) · cites this paper as [30]

  • Higher red and processed meat consumption has been consistently associated with increased premature death.

    “Higher red and processed meat consumption have been consistently associated with increased premature death”

    From Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality (2020) · cites this paper as [32]

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Authors
Etemadi, A., Sinha, R., Ward, M. H., Graubard, B. I., Inoue-Choi, M., Dawsey, S. M., & Abnet, C. C.
Affiliations
  • National Institutes of Health (US)
  • National Cancer Institute (US)
Corresponding author
Etemadi, Arash
ORCID
Venue
BMJ
Publisher
BMJ
Published
2017-05-09
Volume
357
Pages
j1957
ISSN
  • 1756-1833 (ISSN-L)
  • 0959-8138
DOI
10.1136/bmj.j1957
PMC
PMC5423547
OpenAlex
W2613130362
Cited by
296
References
62
Citations by year
2026: 15 · 2025: 20 · 2024: 31 · 2023: 29 · 2022: 44 · 2021: 41 · 2020: 38 · 2019: 38 · 2018: 27 · 2017: 13
FWCI
29.79
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Meat and Animal Product Quality
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
Keywords
meat consumption, red meat, processed meat, white meat, heme iron, nitrate, nitrite, all-cause mortality, cause-specific mortality, dietary risk factors, mediation analysis, NIH-AARP Diet and Health Study
MeSH terms
Aged, Diet, Diet Surveys, Feeding Behavior, Female, Follow-Up Studies, Heme, Humans, Iron, Male, Meat, Middle Aged, Mortality, Nitrates, Nitrites, Prospective Studies, Risk, United States, Proportional Hazards Models

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