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

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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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Fig 1 Association between intake of different types of red meat, different types of white meat, and meat associated compounds and mortality in NIH-AARP Diet and Health Study, using substitution models. Point estimates are highest versus lowest fifth hazard ratios, and lines represent 95% CIs in adjusted models. Detailed results are shown in supplementary table A. Models were adjusted for sex, age at entry to study, marital status, ethnicity, education, fifths of composite deprivation index, perceived health at baseline, history of heart disease, stroke, diabetes, and cancer at baseline, smoking history, body mass index, vigorous physical activity, usual activity throughout day, alcohol consumption, fruit and vegetable intakes, total energy intake, and total meat intake (only in red and white meat models)
Fig 1 Association between intake of different types of red meat, different types of white meat, and meat associated compounds and mortality in NIH-AARP Diet and Health Study, using substitution models. Point estimates are highest versus lowest fifth hazard ratios, and lines represent 95% CIs in adjusted models. Detailed results are shown in supplementary table A. Models were adjusted for sex, age at entry to study, marital status, ethnicity, education, fifths of composite deprivation index, perceived health at baseline, history of heart disease, stroke, diabetes, and cancer at baseline, smoking history, body mass index, vigorous physical activity, usual activity throughout day, alcohol consumption, fruit and vegetable intakes, total energy intake, and total meat intake (only in red and white meat models)CC BY-NC · PubMed Central
Fig 2 Associations of total red meat and total white meat with all cause mortality in NIH-AARP Diet and Health Study, stratified by major risk factors. Point estimates are highest versus lowest fifth hazard ratios, and lines represent 95% CIs in adjusted models. *P for interaction<0.05; **P for interaction<0.001
Fig 2 Associations of total red meat and total white meat with all cause mortality in NIH-AARP Diet and Health Study, stratified by major risk factors. Point estimates are highest versus lowest fifth hazard ratios, and lines represent 95% CIs in adjusted models. *P for interaction<0.05; **P for interaction<0.001CC BY-NC · PubMed Central
Fig 3 Associations between meat associated compounds (heme iron, processed meat nitrate, processed meat nitrite) and all cause mortality in NIH-AARP Diet and Health Study, stratified by major risk factors. Point estimates are highest versus lowest fifth hazard ratios, and lines represent 95% CIs in adjusted models. *P for interaction<0.05; **P for interaction<0.001
Fig 3 Associations between meat associated compounds (heme iron, processed meat nitrate, processed meat nitrite) and all cause mortality in NIH-AARP Diet and Health Study, stratified by major risk factors. Point estimates are highest versus lowest fifth hazard ratios, and lines represent 95% CIs in adjusted models. *P for interaction<0.05; **P for interaction<0.001CC BY-NC · PubMed Central

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Metadata

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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