Abstract
Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and ‘other causes of death’. The consumption of poultry was not related to all-cause mortality. The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer.
Generated Summary
The European Prospective Investigation into Cancer and Nutrition (EPIC) study, a large prospective cohort study, examined the association between meat consumption and the risk of early death in a population of 448,568 men and women aged 35 to 69 years old at baseline, who were free from prevalent cancer, stroke, or myocardial infarction. The study, conducted across 10 European countries and involving extensive dietary questionnaires, assessed the consumption of red meat, processed meat, and poultry. The primary methodology involved the use of Cox proportional hazards regression to examine the relationship between meat consumption and all-cause and cause-specific mortality. This included a long-term follow-up from 1992 to 2009. The research aimed to assess whether meat consumption, specifically of red meat, processed meat, and poultry, was associated with an elevated risk of early death. This research also sought to evaluate the preventable fraction of deaths with adjustments for various lifestyle factors and dietary habits, in an effort to better understand the impact of meat consumption on mortality rates within a diverse European population.
Key Findings & Statistics
- Mortality Rates: Over the follow-up period, 26,344 deaths were observed.
- Red Meat Consumption and Mortality: High consumption of red meat was related to higher all-cause mortality, with a hazard ratio (HR) of 1.14 (95% CI 1.01 to 1.28) comparing the highest consumption (160+ g/day) to a lower consumption (10 to 19.9 g/day). After the adjustment of measurement error, the higher all-cause mortality was still statistically significant.
- Processed Meat Consumption and Mortality: Higher consumption of processed meat showed a stronger association with all-cause mortality. The HR for high (160+ g/day) versus low intake was 1.44 (95% CI 1.24 to 1.66) in the multivariate model. After correction for measurement error, the all-cause mortality remained significant (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d).
- Poultry Consumption and Mortality: The consumption of poultry was not related to all-cause mortality. Low consumption of poultry was associated with increased all-cause mortality compared with moderate consumption (Table 2), but there was no association of high poultry consumption compared with moderate consumption.
- Preventable Deaths: It was estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day.
- Cardiovascular Diseases: A high consumption of processed meat was associated with an increased risk of dying from cardiovascular diseases (HR = 1.72, 95% CI 1.29 to 2.30, for those consuming 160+ g/day).
- Cancer: High consumption of processed meat was associated with an increased risk of dying from cancer (HR = 1.11, 95% CI 1.03 to 1.21 per 50 g/day).
- Other Causes of Death: Processed meat was associated with mortality from other causes (HR = 1.22, 95% CI 1.11 to 1.34 per 50 g/day).
Other Important Findings
- Association Strength: The association between processed meat consumption and mortality was stronger than that for red meat.
- Meat Type and Mortality: High consumption of red meat was associated with increased all-cause mortality. Participants with an intake of 160+ g red meat/day had a HR = 1.37 (95% CI 1.23 to 1.54) compared with individuals with an intake of 10 to 19.9 g/day in the simple model.
- Gender Differences: There was no statistically significant effect modification by sex, with similarly increased all-cause mortality in both sexes, although the association was statistically significant only among men.
- Smoking and Meat Consumption Interaction: A statistically significant interaction was observed between smoking and processed meat consumption, with mortality being significantly increased among former and current smokers, but there was no association among never smokers.
- BMI and Meat Consumption Interaction: An interaction with body mass index was observed, such that the association between processed meat consumption and all-cause mortality was stronger in lean than in overweight and obese participants.
- Association with Vegetables: Participants with a lower fruit and vegetable intake had a higher overall mortality in the highest consumption category of processed meat (160+ g/day) as compared to subjects with a fruit and vegetable intake above the median intake.
- Cause-Specific Mortality: Very high consumption of red meat was associated with a non-significantly increased cancer mortality, but not with deaths due to cardiovascular diseases, respiratory diseases, diseases of the digestive tract, or any other cause of deaths (Table 5).
Limitations Noted in the Document
- Measurement Error: Measurement error may still have an effect on calibrated RRs to a certain extent because the error structure in the reference method is not entirely independent of that in the FFQ.
- Residual Confounding: The study could not exclude residual confounding, in particular due to incomplete adjustment for active and passive smoking.
- Cause of Death Coding: The study relied on mortality information from death certificates, and cause of death as coded on death certificates is not perfect.
- Heterogeneity: There was little heterogeneity in the association between meat consumption and overall mortality across the ten European countries that were studied.
- Sample Representativeness: The findings may not be generalizable to populations outside of the European context due to potential differences in dietary habits, lifestyle, and health outcomes.
Conclusion
The findings from the EPIC cohort strongly suggest that high processed meat consumption is linked to increased mortality, especially from cardiovascular diseases and cancer. The association between red meat consumption and mortality was less pronounced in the multivariate analysis. The study underscores the importance of dietary choices in public health. The observed association between processed meat consumption and mortality, alongside the lack of a similar association with poultry intake, highlights the significance of specific dietary components. The findings suggest that health promotion efforts should prioritize advice on reducing processed meat consumption. These outcomes have broad implications for public health recommendations and suggest the importance of considering the quality of food when making dietary choices. The results are in line with prior research, showing a connection between red and processed meat intake and mortality. However, the EPIC study highlights the importance of processed meats in terms of mortality. The results of this study support the need for more research into the mechanisms by which processed meats affect health and the need for dietary guidelines that provide specific advice on limiting processed meat consumption. The link between meat consumption and health outcomes provides further support for dietary guidelines that encourage reduced consumption of processed meats as a means of promoting public health. The study’s findings reinforce the complexity of diet-disease relationships and emphasize the need for continued research to understand the underlying mechanisms. By better understanding the links between diet and disease, public health initiatives can be developed to help people make informed choices that reduce their risk of disease and increase their lifespans.