title: Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis.
abstract: BACKGROUND
  Meat consumption is inconsistently associated with development of coronary heart disease (CHD), stroke, and diabetes mellitus, limiting quantitative recommendations for consumption levels. Effects of meat intake on these different outcomes, as well as of red versus processed meat, may also vary.
  
  
  RESULTS
  We performed a systematic review and meta-analysis of evidence for relationships of red (unprocessed), processed, and total meat consumption with incident CHD, stroke, and diabetes mellitus. We searched for any cohort study, case-control study, or randomized trial that assessed these exposures and outcomes in generally healthy adults. Of 1598 identified abstracts, 20 studies met inclusion criteria, including 17 prospective cohorts and 3 case-control studies. All data were abstracted independently in duplicate. Random-effects generalized least squares models for trend estimation were used to derive pooled dose-response estimates. The 20 studies included 1 218 380 individuals and 23 889 CHD, 2280 stroke, and 10 797 diabetes mellitus cases. Red meat intake was not associated with CHD (n=4 studies; relative risk per 100-g serving per day=1.00; 95% confidence interval, 0.81 to 1.23; P for heterogeneity=0.36) or diabetes mellitus (n=5; relative risk=1.16; 95% confidence interval, 0.92 to 1.46; P=0.25). Conversely, processed meat intake was associated with 42% higher risk of CHD (n=5; relative risk per 50-g serving per day=1.42; 95% confidence interval, 1.07 to 1.89; P=0.04) and 19% higher risk of diabetes mellitus (n=7; relative risk=1.19; 95% confidence interval, 1.11 to 1.27; P<0.001). Associations were intermediate for total meat intake. Consumption of red and processed meat were not associated with stroke, but only 3 studies evaluated these relationships.
  
  
  CONCLUSIONS
  Consumption of processed meats, but not red meats, is associated with higher incidence of CHD and diabetes mellitus. These results highlight the need for better understanding of potential mechanisms of effects and for particular focus on processed meats for dietary and policy recommendations.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. rmicha@hsph.harvard.edu
authors.forename: Renata
authors.initials: R
authors.lastname: Micha
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wallace
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004032:Diet / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008460:Meat / Q000009:adverse effects*; D008461:Meat Products / Q000009:adverse effects*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*