Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study.
Level 3 - non-randomized controlled study
Prospective cohort study with multivariable survival analysis
PubMed 33787869 · doi:10.1093/ajcn/nqaa448
What was done
The Prospective Urban Rural Epidemiology (PURE) study followed 134,297 individuals from 21 low-, middle-, and high-income countries over a median of 9.5 years. Dietary intake of unprocessed red meat, poultry, and processed meat was measured using country-specific validated food frequency questionnaires (FFQs). The primary outcomes were total mortality and major cardiovascular disease (CVD). Hazard ratios were estimated using multivariable Cox frailty models with random intercepts.
What was found
During 9.5 years of follow-up, 7,789 deaths and 6,976 major CVD events were documented. Higher unprocessed red meat intake (≥250 g/wk vs. <50 g/wk) showed no significant association with total mortality (HR: 0.93; 95% CI: 0.85, 1.02; P-trend = 0.14) or major CVD (HR: 1.01; 95% CI: 0.92, 1.11; P-trend = 0.72). Poultry intake also showed no significant association with these outcomes. In contrast, higher processed meat intake (≥150 g/wk vs. 0 g/wk) was significantly associated with higher risk of total mortality (HR: 1.51; 95% CI: 1.08, 2.10; P-trend = 0.009) and major CVD (HR: 1.46; 95% CI: 1.08, 1.98; P-trend = 0.004).
Why it matters
This study differentiates processed meat from unprocessed red meat across a diverse multinational cohort, showing adverse mortality and cardiovascular associations specifically for processed meat.
Limits
Dietary exposure was based on self-reported food frequency questionnaires, which carry inherent measurement error and recall bias. As an observational cohort study, residual confounding from socioeconomic status, lifestyle, or dietary patterns cannot be ruled out. The abstract does not report repeat dietary assessments over time.
Cited by
- supports The 2021 PURE study of 134,000 people across 21 countries found no correlation between unprocessed red meat intake and negative health outcomes, finding an association only with processed red meat.