Etemadi Arash, Sinha Rashmi, Ward Mary H, Graubard Barry I, Inoue-Choi Maki, Dawsey Sanford M, Abnet Christian C
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20850, USA
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20850, USA.
BMJ. 2017 May 9;357:j1957. doi: 10.1136/bmj.j1957.
To determine the association of different types of meat intake and meat associated compounds with overall and cause specific mortality. Population based cohort study. 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. 536 969 AARP members aged 50-71 at baseline. 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. Mortality from any cause during follow-up. 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. 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.
确定不同类型肉类摄入量及与肉类相关的化合物与全因死亡率和特定病因死亡率之间的关联。基于人群的队列研究。美国国立卫生研究院-美国退休人员协会饮食与健康研究（来自美国六个州和两个大都市区的普通人群前瞻性队列）的基线饮食数据以及截至2011年12月31日的16年随访数据。基线时年龄在50 - 71岁的536969名美国退休人员协会会员。根据饮食问卷得出的总肉类、加工和未加工红肉（牛肉、羊肉和猪肉）以及白肉（家禽和鱼类）、血红素铁和加工肉类中的硝酸盐/亚硝酸盐的摄入量。使用调整后的Cox比例风险回归模型，将热量调整摄入量最低的五分之一作为参考类别。随访期间的任何原因导致的死亡率。观察到全因死亡率增加（最高五分之一与最低五分之一的风险比为1.26，95%置信区间为1.23至1.29）以及与红肉摄入量相关的九种不同病因导致的死亡。加工和未加工红肉的摄入量均与全因死亡率和特定病因死亡率相关。血红素铁和加工肉类中的硝酸盐/亚硝酸盐与全因死亡率和特定病因死亡率增加的风险独立相关。中介模型估计，与加工红肉相关的死亡率增加受硝酸盐摄入量影响（37.0 - 72.0%），受血红素铁影响程度较小（20.9 - 24.1%）。当总肉类摄入量恒定时，白肉摄入量最高的五分之一与最低摄入量水平相比，全因死亡率风险降低25%。几乎所有死因都与白肉摄入量呈负相关。结果表明，加工和未加工红肉与全因死亡率以及九种不同病因导致的死亡风险增加有关，部分原因是加工肉类中的血红素铁和硝酸盐/亚硝酸盐。研究结果还表明，用白肉替代，尤其是未加工白肉，可降低相关风险。
