Robin W.M. Vernooij, PhD; Dena Zeraatkar, MSc; Mi Ah Han, MD, PhD; Regina El Dib, PhD; Max Zworth, BA⪼ Kirolos Milio, BSc; Daegan Sit, MD; Yung Lee, BHSc; Huda Gomaa, MSc; Claudia Valli, MSc; Mateusz J. Swierz, MD; Yaping Chang, PhD; Steven E. Hanna, PhD; Paula M. Brauer, PhD, RD; John Sievenpiper, MD, PhD; Russell de Souza, RD, ScD; Pablo Alonso-Coello, MD, PhD; Malgorzata M. Bala, PhD; Gordon H. Guyatt, MD, MSc; 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 scholarship (2018/11205-6) and support from the National Council for Scientific and Technological Development (CNPq 310953/2015-4). Dr. Sievenpiper reports grants from the Canadian Institutes of Health Research, the Calorie Control Council, the Canada Foundation for Innovation, and the Ministry of Research and Innovation's Ontario Research Fund during the conduct of the study; grants from the Canadian Institutes of Health Research, the Nutrition Trialists Fund at the University of Toronto, the International Nut and Dried Fruit Council Foundation, the Tate & Lyle Nutritional Research Fund at the University of Toronto, the American Society for Nutrition, the Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto, and the National Dried Fruit Trade Association outside the submitted work; a PSI Graham Farquharson Knowledge Translation Fellowship, a Diabetes Canada Clinician Scientist award, a CIHR INMD/CNS New Investigator Partnership Prize, and a Banting & Best Diabetes Centre Sun Life Financial New Investigator Award outside the submitted work; personal fees from Perkins Coie, Tate & Lyle, Dairy Farmers of Canada, PepsiCo, FoodMinds, European Fruit Juice Association, International Sweeteners Association, Nestlé, the Canadian Society of Endocrinology and Metabolism, the GI Foundation, Pulse Canada, Mott's, the Canadian Nutrition Society, Abbott, BioFortis, the European Food Safety Authority, and the Physicians Committee for Responsible Medicine outside the submitted work; nonfinancial support from Tate & Lyle, PepsiCo, FoodMinds, the European Fruit Juice Association, the International Sweeteners Association, Nestlé, Mott's, the Canadian Nutrition Society, Abbott, BioFortis, the European Food Safety Authority, the Physicians Committee for Responsible Medicine, Kellogg Canada, the American Peanut Council, Barilla, Unilever, Unico Primo, Loblaw Companies, WhiteWave Foods, Quaker Oats, the California Walnut Commission, and the Almond Board of California outside the submitted work; membership in the International Carbohydrate Quality Consortium and the clinical practice guidelines expert committees of Diabetes Canada, the European Association for the Study of Diabetes (EASD), the Canadian Cardiovascular Society, and Obesity Canada; appointments as an executive board member of the Diabetes and Nutrition Study Group of the EASD, director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation, and an unpaid scientific advisor for the Food, Nutrition, and Safety Program and the Technical Committee on Carbohydrates of the International Life Science Institute North America; and a spousal relationship with an employee of Sobeys. Dr. de Souza reports personal fees and nonfinancial support from the World Health Organization; personal fees from the Canadian Institutes of Health Research/Health Canada and McMaster Children's Hospital; grants from the Canadian Foundation for Dietetic Research, Canadian Institutes for Health Research, Hamilton Health Sciences Corporation, and Hamilton Health Sciences Corporation/Population Health Research Institute outside of the submitted work. He also reports other support from the College of Family Physicians of Canada, Royal College (speaking at a recent conference), and he has served on the Board of Directors of the Helderleigh Foundation. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1583.
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: Available at www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=74074. Statistical code: Available from Ms. Zeraatkar (e-mail, firstname.lastname@example.org). Data set: Available from Dr. Vernooij (e-mail, email@example.com) or Dr. Johnston (e-mail, firstname.lastname@example.org).
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, email@example.com.
Current Author Addresses: Dr. Vernooij: Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511DT, the Netherlands.
Ms. Zeraatkar and Drs. Chang and Hanna: 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, School of Medicine, Chosun University, 309 Philmum-daero, Dong-gu, Gwangju 61452, Republic of Korea.
Dr. El Dib: Institute of Science and Technology, Universidade Estadual Paulista, Avenida Engenheiro Francisco José Longo, 777, Jardim São Dimas, São José dos Campos, São Paulo 12245-000, Brazil.
Mr. Zworth, Mr. Milio, Mr. Lee, and Dr. Guyatt: McMaster University, Health Sciences Center, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
Dr. Sit: Department of Medicine, University of British Columbia, 107-1165 West 13th Avenue, Vancouver, British Columbia V6H 1N4, Canada.
Ms. Gomaa: Department of Biostatistics, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue – El-Ibrahimia, Alexandria, Egypt.
Ms. Valli and Dr. Alonso-Coello: Iberoamerican Cochrane Centre, Carrer de Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
Dr. Swierz: Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7, 31-034, Krakow 30019, Poland.
Dr. Brauer: Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
Dr. Sievenpiper: St. Michael's Hospital, #6138-61 Queen Street East, Toronto, Ontario M5C 2T2, Canada.
Dr. de Souza: McMaster University, 1280 Main Street West, MDCL, Room 3210, Hamilton, Ontario L8S 4K1, Canada.
Dr. Bala: Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7, Krakow 30019, Poland.
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: R.W.M. Vernooij, D. Zeraatkar, Y. Chang, S.E. Hanna, P.M. Brauer, J. Sievenpiper, R. de Souza, G.H. Guyatt, B.C. Johnston.
Analysis and interpretation of the data: R.W.M. Vernooij, D. Zeraatkar, S.E. Hanna, G.H. Guyatt, B.C. Johnston.
Drafting of the article: R.W.M. Vernooij, D. Zeraatkar, B.C. Johnston.
Critical revision of the article for important intellectual content: R.W.M. Vernooij, D. Zeraatkar, M.A. Han, C. Valli, S.E. Hanna, P.M. Brauer, J. Sievenpiper, R. de Souza, P. Alonso-Coello, M.M. Bala, G.H. Guyatt, B.C. Johnston.
Final approval of the article: R.W.M. Vernooij, D. Zeraatkar, M.A. Han, R. El Dib, M. Zworth, K. Milio, D. Sit, Y. Lee, H. Gomaa, C. Valli, M.J. Swierz, Y. Chang, S.E. Hanna, P.M. Brauer, J. Sievenpiper, R. de Souza, P. Alonso-Coello, M.M. Bala, G.H. Guyatt, B.C. Johnston.
Statistical expertise: R.W.M. Vernooij, D. Zeraatkar, S.E. Hanna, G.H. Guyatt, B.C. Johnston.
Administrative, technical, or logistic support: R.W.M. Vernooij, D. Zeraatkar, R. El Dib, M. Zworth, K. Milio, D. Sit, Y. Lee, H. Gomaa, C. Valli, M.J. Swierz, Y. Chang, P. Alonso-Coello, M.M. Bala, B.C. Johnston.
Collection and assembly of data: R.W.M. Vernooij, D. Zeraatkar, M.A. Han, R. El Dib, M. Zworth, K. Milio, D. Sit, Y. Lee, H. Gomaa, M.J. Swierz, Y. Chang, B.C. Johnston.
Studying dietary patterns may provide insights into the potential effects of red and processed meat on health outcomes.
To evaluate the effect of dietary patterns, including different amounts of red or processed meat, on all-cause mortality, cardiometabolic outcomes, and cancer incidence and mortality.
Systematic search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global from inception to April 2019 with no restrictions on year or language.
Teams of 2 reviewers independently screened search results and included prospective cohort studies with 1000 or more participants that reported on the association between dietary patterns and health outcomes.
Two reviewers independently extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
Eligible studies that followed patients for 2 to 34 years revealed low- to very-low-certainty evidence that dietary patterns lower in red and processed meat intake result in very small or possibly small decreases in all-cause mortality, cancer mortality and incidence, cardiovascular mortality, nonfatal coronary heart disease, fatal and nonfatal myocardial infarction, and type 2 diabetes. For all-cause, cancer, and cardiovascular mortality and incidence of some types of cancer, the total sample included more than 400 000 patients; for other outcomes, total samples included 4000 to more than 300 000 patients.
Observational studies are prone to residual confounding, and these studies provide low- or very-low-certainty evidence according to the GRADE criteria.
Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes.
None. (PROSPERO: CRD42017074074)
Vernooij RW, Zeraatkar D, Han MA, et al. Patterns of Red and Processed Meat Consumption and Risk for Cardiometabolic and Cancer Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med. 2019;171:732–741. [Epub ahead of print 1 October 2019]. doi: https://doi.org/10.7326/M19-1583
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Published: Ann Intern Med. 2019;171(10):732-741.
Published at www.annals.org on 1 October 2019
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