Table 1.
Characteristics of the Cohort Studies Included in the Quantitative Analysis of Total, Red, Processed, and White Meat Consumption and Risk of Stroke Incidence and Mortality
| Study | Country | Study Name | Follow‐Up Duration, y | Study Population (Baseline Age) | Type of Stroke and No. of Cases | Range of Meat Intake: Highest vs Lowest | Adjusted RR (95% CI) for Strokes | Adjustment | |
|---|---|---|---|---|---|---|---|---|---|
| Stroke incidence | |||||||||
| 1. | Larsson 201125 | Sweden | Swedish Mammography Cohort | 10.4 | 34 670 Women (49–83 y) | 1680 Total strokes, 1310 CIs, 154 ICHs, 79 SAHs 137 nonspecific |
Total red meat: ≥86.0 g/d vs <36.5 g/d Fresh red meat: ≥48.8 g/d vs <16.5 g/d Processed meat: ≥41.3 g/d vs 12.1 g/d |
TS: 1.12 (0.95–1.31) IS: 0.74 (0.45–1.12) TS: 1.07 (0.91–1.23) HS: 0.85 (0.54–1.34) TS: 1.18 (1.00–1.38) HS: 0.91 (0.60–1.39) |
Age, smoking, education, BMI, total physical activity, history of diabetes mellitus or hypertension, aspirin use, family history of MI, and intake of total energy, alcohol, coffee, fish, fruits, and vegetables |
| 2. | Larsson 201124 | Sweden | The Cohort of Swedish Men | 10.1 | 40 291 Men (45–79 y) | 2409 Total strokes, 1849 ISs, 350 HSs |
Total red meat: ≥136.2 g/d vs <62.5 g/d Fresh red meat: ≥83.1 g/d vs <33.5 g/d Processed meat: ≥57.1 g/d vs 20.1 g/d |
TS: 1.15 (1.00–1.33) HS: 1.57 (1.09–2.25) TS: 1.07 (0.93–1.24) HS: 1.27 (0.90–1.80) TS: 1.23 (1.07–1.40) HS: 1.39 (0.97–1.99) |
Age, smoking, education, BMI, total physical activity, history of diabetes mellitus or hypertension, aspirin use, family history of MI, and intake of total energy, alcohol, coffee, fish, fruits, and vegetables |
| 3. | Bernstein 201215 | United States | HFPS (Health Professionals Follow‐Up Study) | 22 | 43 150 Men (40–75 Years) | 1397 Total strokes, 829 ISs, 165 ICHs, 53 SAHs |
Total red meat: 2.29 servings/d vs 0.30 servings/d Fresh red meat: 1.11 servings/d vs 0.14 servings/d Processed red meat: 0.71 servings/d vs 0.03 servings/d White meat: 0.72 g/d vs 0.14 g/d |
TS: 1.28 (1.02–1.61) HS: 1.07 (0.55–2.08) IS: 1.31 (0.97–1.77) TS: 1.11 (0.88–1.39) HS: 0.70 (0.36–1.37) IS: 1.23 (0.91–1.67) TS: 1.27 (1.03–1.55) HS: 1.47 (0.80–2.72) IS: 1.31 (1.00–1.71) TS: 0.97 (0.81–1.17) HS: 0.66 (0.37–1.18) IS: 1.07 (0.84–1.37) |
Age, time period, BMI, smoking, physical exercise, parental history of early MI, menopausal status (including hormone replacement), multivitamin use, vitamin E supplement use, aspirin use, total energy, cereal fiber, alcohol, trans‐fat, fruit and vegetables, other protein sources, and history of MI, coronary artery bypass surgery, or percutaneous coronary intervention, angina, diabetes mellitus, hypertension, and hypercholesterolemia |
| 4. | Bernstein 201215 | United States | NHS (Nurses' Health Study) | 26 | 84 010 Women (30–55 y) | 2663 Total strokes, 1383 ISs, 235 ICHs, 240 SAHs |
Total red meat: 1.92 servings/d vs 0.44 servings/d Fresh red meat: 1.08 servings/d vs 0.28 servings/d Processed red meat: 0.64 servings/d vs 0.05 servings/d White meat: 0.54 g/d vs 0.14 g/d |
TS: 1.19 (1.00–1.41) HS: 1.30 (0.72–2.34) IS: 1.16 (0.92–1.48) TS: 1.19 (1.02–1.40) HS: 0.93 (0.54–1.60) IS: 1.30 (1.03–1.63) TS: 1.10 (0.95–1.27) HS: 0.94 (0.56–1.57) IS: 1.07 (0.87–1.31) TS: 0.82 (0.71–0.94) HS: 0.79 (0.51–1.24) IS: 0.78 (0.64–0.95) |
Age, time period, BMI, smoking, physical exercise, parental history of early MI, menopausal status (including hormone replacement), multivitamin use, vitamin E supplement use, aspirin use, total energy, cereal fiber, alcohol, trans‐fat, fruit and vegetables, other protein sources, and history of MI, coronary artery bypass surgery or percutaneous coronary intervention, angina, diabetes mellitus, hypertension, and hypercholesterolemia |
| 5. | Haring 201526 | United States | ARIC (Atherosclerosis Risk in Communities Study) | 22.7 | 11 601 Men and women (45–64 y) | 699 Total stroke |
Red and processed meats: 0.25 servings/d vs 1.90 servings/d Red meat: 0.14 servings/d vs 1.08 servings/d Processed meat: 0 servings/d vs 1.07 servings/d White meat 0.8 servings/d vs 0.07 servings/d |
Men TS: 1.62 (1.03–2.57) Women TS: 1.1 (0.75–1.89) Men and women: HS: 1.45 (0.66–3.17) IS: 1.35 (0.95–1.93) Men TS: 1.65 (1.06–2.56) Women TS: 1.22 (0.80–1.87) Men and women HS: 1.13 (.53–2.45) IS: 1.47 (1.06–2.05) Men TS: 1.20 (0.83–1.72) Women TS: 1.29 (0.85–1.97) Men and women HS 1.67 (0.80–3.51): IS: 1.20 (0.90–1.61) Men TS: 0.91 (0.61–1.36) Women TS: 0.79 (0.53–1.17) Men and women HS: 0.56 (0.26–1.20) IS: 0.94 (0.70–1.27) |
Age, sex, race, study center, total energy intake, smoking, cigarette years, education, systolic blood pressure, use of antihypertensive medication, high‐density lipoprotein cholesterol, total cholesterol, use of lipid‐lowering medication, BMI, waist to hip ratio, alcohol intake, sports‐related physical activity, leisure‐related physical activity, carbohydrate intake, fiber intake, fat intake, and magnesium intake |
| 6. | Amiano 201630 | Spain | EPIC (the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition) | 12 | 15 490 Men (29–69 y) | 373 Stroke, 302 ISs, 42 HS, 17 SAHs, 12 mixed or unspecified |
Unprocessed red meat: <24.3 g/d vs ≥86 g/d Processed meat: <21.5 g/d vs 72.6 g/d |
TS: 0.81 (0.54–1.21) IS: 0.80 (0.51–1.25) TS: 0.92 (0.64–1.32) IS: 0.86 (0.57–1.29) |
Age, center, total energy, BMI, waist circumference, smoking status, smoking before age 20, recreational physical activity, educational level, alcohol consumption, use of vitamin supplements (ATC code A11), use of antithrombotic or antihemorrhagic agents (ATC code B01/B02), use of cardiovascular drugs (ATC code C01–C10), use of salicylic acid or derivatives (ATC code N02BA), incident acute myocardial infarction cases, diabetes mellitus, self‐reported diseases (hypertension, hyperlidemia), percentage of energy from carbohydrates, protein and fats, and intake of vegetables, fruit, dairy products, and fish |
| 7. | Amiano 201630 | Spain | EPIC (the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition) | 12 | 25 530 Women (29–69 y) | 301 Stroke, 229 ISs, 37 HS, 25 SAHs, 10 mixed or unspecified |
Unprocessed red meat: 11.1 g/d vs ≥52.4 g/d Processed red meat: <12 g/d vs ≥46 g/d |
TS: 1.21 (0.79–1.85) IS: 1.24 (0.74–2.05) TS: 0.81 (0.51–1.27) IS: 0.82 (0.47–1.42) |
Age, center, total energy, BMI, waist circumference, smoking status, smoking before age 20, recreational physical activity, educational level, alcohol consumption, use of vitamin supplements (ATC code A11), use of antithrombotic or antihemorrhagic agents (ATC code B01/B02), use of cardiovascular drugs (ATC code C01–C10), use of salicylic acid or derivatives (ATC code N02BA), incident acute MI cases, diabetes mellitus, self‐reported diseases (hypertension, hyperlipidemia), menopausal status, hormone replacement therapy and oral contraceptives, percentage of energy from carbohydrates, protein, and fats, and intake of vegetables, fruit, dairy products, and fish |
| Stroke mortality | |||||||||
| 1. | Sauvaget 200331 | Japan | Life Spain Study | 16 | 37 130 Men and women (34–103 y) | 1462 Total stroke‐related deaths |
Red meat: never vs almost daily Processed meat: never vs almost daily |
TS: 1.01 (0.73–1.38) TS: 0.90 (0.61–1.33) |
Age, sex, city, radiation dose, BMI, smoking, alcohol, education, and history of diabetes mellitus or hypertension |
| 2. | Yaemsiri 201227 | United States | WHIO (Women's Health Initiative Observational Study) | 8 | 87 025 Women (50–79 y) | 1049 IS‐related deaths |
Total red meat: per 1 serving/d Red meat: per 1 serving/d |
IS: 0.94 (0.75–1.23) IS: 1.13 (0.95–1.34) |
Age, race, education, family income, years as a regular smoker, hormone replacement therapy use, total metabolic equivalent task h/wk, alcohol intake, history of coronary heart disease, history of atrial fibrillation, history of diabetes mellitus, aspirin use, use of antihypertensive medication, use of cholesterol‐lowering medication, BMI, systolic blood pressure, total energy intake, dietary vitamin E, fruits and vegetable intake, fiber intake |
| 3. | Nagano 201228 | Japan | JACC (the Japan Collaborative Cohort Study for Evaluation of Cancer Risk) | 18 | 20 466 men (40–79 y) | 1317 total stroke‐related death |
Total meat 77.6 g/d vs 10.4 g/d |
TS: 1.10 (0.84–1.43) | Age, BMI, ethanol intake, perceived mental stress, walking time, sports participation time, year of education, history of hypertension and diabetes mellitus, total energy, and energy‐adjusted food (rice, fish, soy, vegetables, and fruits) intakes |
| 4. | Nagano 201228 | Japan | JACC (the Japan Collaborative Cohort Study for Evaluation of Cancer Risk) | 18 | 31 217 Women (40–79 y) | 1368 Total stroke‐related death |
Total meat 59.9 g/d vs 7.5 g/d |
TS: 0.91 (0.70–1.19) | Age, BMI, ethanol intake, perceived mental stress, walking time, sports participation time, y of education, history of hypertension and diabetes mellitus, total energy and energy‐adjusted food (rice, fish, soy, vegetables, and fruits) intakes |
| 5. | Sharma 201329 | United States | The Multiethnic Cohort | 7.5 to | 78 844 Men (45–75 y) | 434 Total stroke‐related death | Total meat >7.3 servings/d vs 0 to 2.5 servings/d | TS: 0.87 (0.57–1.34) | Ethnicity, time in study, y of education, energy intake, smoking, BMI, physical activity, history of diabetes mellitus, and alcohol intake |
| 6. | Sharma 201329 | United States | The Multiethnic Cohort | 7.5 | 96 044 Women (45–75 y) | 426 total stroke‐related death | Total meat >7.3 servings/d vs 0 to 2.5 servings/d | TS: 1.06 (0.69–1.65) | Ethnicity, time on study, y of education, energy intake, smoking, BMI, physical activity, history of diabetes mellitus, and alcohol intake |
| 7. | Takata 201332 | China | SMHS (Shanghai Men's Health Study) | 5.5 | 61 483 Men (40–74 y) | 2733 Total stroke‐related deaths |
Red meat 126 g/d vs 21.4 g/d White meat 22.3 g/d vs 11.9 g/d |
HS: 0.71 (0.43–1.20) IS: 1.22 (0.69–2.15) HS: 0.89 (0.56–1.40) IS: 0.92 (0.54–1.57) |
Age, total caloric intake, income, occupation, education, comorbidity index, physical activity level, total vegetable intake, total fruit intake, fish intake, red meat or poultry intake where appropriate, smoking history, consumption of alcohol |
| 8. | Takata 201332 | China | SWHS (Shanghai Women's Health Study) | 11.2 | 74 941 Women (40–70 y) | 4210 Total stroke‐related deaths |
Red meat 103.4 g/d vs 16.5 g/d White meat: 19.9 g/d vs 11.9 g/d |
HS: 0.57 (0.37–0.87) IS: 0.84 (0.55–1.28) HS: 1.20 (0.79–1.80) IS: 1.04 (0.69–1.56) |
Age, total caloric intake, income, occupation, education, comorbidity index, physical activity level, total vegetable intake, total fruit intake, fish intake, red meat or poultry intake where appropriate, smoking history, consumption of alcohol |
ATC indicates anatomic therapeutic chemical; BMI, body mass index; CI, confidence intervals; HS, hemorrhagic stroke; ICH, intracerebral hemorrhage; IS, ischemic stroke; MI, myocardial infarction; RR, relative risk; SAH, subarachnoid hemorrhage; TS, total stroke.