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. 2017 May 9:357:j1957.
doi: 10.1136/bmj.j1957.

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

Arash Etemadi  1 , Rashmi Sinha  2 , Mary H Ward  2 , Barry I Graubard  2 , Maki Inoue-Choi  2 , Sanford M Dawsey  2 , Christian C Abnet  2
Affiliations

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

Arash Etemadi et al. BMJ. .

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work other than those described above; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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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)
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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
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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
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