Dena Zeraatkar, MSc; Mi Ah Han, MD, PhD; Gordon H. Guyatt, MD, MSc; Robin W.M. Vernooij, PhD; Regina El Dib, PhD; Kevin Cheung, MD, MSc; Kirolos Milio, BSc; Max Zworth, BASc; Jessica J. Bartoszko, HBSc; Claudia Valli, MSc; Montserrat Rabassa, PhD; Yung Lee, BHSc; Joanna Zajac, PhD; Anna Prokop-Dorner, PhD; Calvin Lo, BHSc; Malgorzata M. Bala, PhD; Pablo Alonso-Coello, MD, PhD; Steven E. Hanna, PhD; Bradley C. Johnston, PhD
Acknowledgment: The authors thank Thomasin Adams-Webber (Hospital for Sick Children) for her help in designing the search strategy.
Disclosures: Dr. El Dib received a São Paulo Research Foundation (FAPESP) (2018/11205-6) scholarship and funding from the National Council for Scientific and Technological Development (CNPq) (CNPq 310953/2015-4) and the Faculty of Medicine, Dalhousie University. Dr. Johnston received a grant from Texas A&M AgriLife Research to fund investigator-driven research related to saturated and polyunsaturated fats within the 36-month reporting period required by the International Committee of Medical Journal Editors, as well as funding received from the International Life Science Institute (North America) that ended before the 36-month reporting period. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0655.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
>Reproducible Research Statement: Study protocol: Registered with PROSPERO (CRD42017074074). Statistical code and data set: Available from Ms. Zeraatkar (e-mail, email@example.com). For sample code, see Supplement 2.
Corresponding Author: Bradley C. Johnston, PhD, Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Room 404, 5790 University Avenue, Halifax, Nova Scotia B3J 0E4, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Zeraatkar, Drs. Guyatt and Hanna, and Ms. Bartoszko: Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
Dr. Han: Department of Preventive Medicine, College of Medicine, Chosun University, 309 Philmun-daero, Dong-gu, Gwangju 61452, Korea.
Dr. Vernooij: Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, the Netherlands.
Dr. El Dib: Institute of Science and Technology, São José dos Campos, Avenida Engenheiro Francisco José Longo, 777, Jardim São Dimas, São José dos Campos, 12245-000, Spain.
Dr. Cheung: 114 Loganberry Crescent, Toronto, Ontario M2H 3H1, Canada.
Mr. Milio: 592 Regal Place, Waterloo, Ontario N2V 2G3, Canada.
Mr. Zworth: 28 York Downs Drive, Toronto, Ontario M3H 1J1, Canada.
Ms. Valli and Drs. Rabassa and Alonso-Coello: Iberoamerican Cochrane Centre, (IIB Sant Pau-CIBERESP), Carrer de Sant Antoni Maria Claret, 167, Barcelona, 08025, Spain.
Mr. Lee: 30 White Lodge Crescent, Richmond Hill, Ontario L4C 9A1, Canada.
Drs. Zajac, Prokop-Dorner, and Bala: Jagiellonian University Medical College, Department of Hygiene and Dietetics, Kopernika 7 Street, 31-034 Krakow, Poland.
Mr. Lo: 556 Amarone Court, Mississauga, Ontario L5W 0A7, Canada.
Dr. Johnston: Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Room 404, 5790 University Avenue, Halifax, Nova Scotia B3J 0E4, Canada.
Author Contributions: Conception and design: D. Zeraatkar, G.H. Guyatt, M.M. Bala, P. Alonso-Coello, S.E. Hanna, B.C. Johnston.
Analysis and interpretation of the data: D. Zeraatkar, M.A. Han, R.W.M. Vernooij, K. Milio, M. Rabassa, A. Prokop-Dorner, M.M. Bala, P. Alonso-Coello, S.E. Hanna, B.C. Johnston.
Drafting of the article: D. Zeraatkar, M.A. Han, S.E. Hanna, B.C. Johnston.
Critical revision for important intellectual content: D. Zeraatkar, G.H. Guyatt, R.W.M. Vernooij, M. Rabassa, Y. Lee, A. Prokop-Dorner, C. Lo, M.M. Bala, P. Alonso-Coello, S.E. Hanna, B.C. Johnston.
Final approval of the article: D. Zeraatkar, M.A. Han, G.H. Guyatt, R.W.M. Vernooij, R. El Dib, K. Cheung, K. Milio, M. Zworth, J.J. Bartoszko, C. Valli, M. Rabassa, Y. Lee, J. Zajac, A. Prokop-Dorner, C. Lo, M.M. Bala, P. Alonso-Coello, S.E. Hanna, B.C. Johnston.
Statistical expertise: D. Zeraatkar, S.E. Hanna, B.C. Johnston.
Administrative, technical, or logistic support: D. Zeraatkar, R. El Dib, Y. Lee, S.E. Hanna, B.C. Johnston.
Collection and assembly of data: D. Zeraatkar, M.A. Han, R.W.M. Vernooij, R. El Dib, K. Cheung, K. Milio, M. Zworth, J.J. Bartoszko, C. Valli, M. Rabassa, Y. Lee, J. Zajac, C. Lo, B.C. Johnston.
This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear.
To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults.
EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles.
Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest.
Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments.
Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes.
Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement.
The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty.
None. (PROSPERO: CRD42017074074)
Zeraatkar D, Han MA, Guyatt GH, et al. Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med. 2019;171:703–710. [Epub ahead of print 1 October 2019]. doi: https://doi.org/10.7326/M19-0655
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Published: Ann Intern Med. 2019;171(10):703-710.
Published at www.annals.org on 1 October 2019
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Neurology.
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