Skip to main content Accessibility help

Red and processed meat consumption and mortality: dose–response meta-analysis of prospective cohort studies

  • Xia Wang (a1), Xinying Lin (a2), Ying Y Ouyang (a3), Jun Liu (a3), Gang Zhao (a4), An Pan (a5) and Frank B Hu (a6) (a7)...



To examine and quantify the potential dose–response relationship between red and processed meat consumption and risk of all-cause, cardiovascular and cancer mortality.


We searched MEDLINE, Embase, ISI Web of Knowledge, CINHAL, Scopus, the Cochrane library and reference lists of retrieved articles up to 30 November 2014 without language restrictions. We retrieved prospective cohort studies that reported risk estimates for all-cause, cardiovascular and cancer mortality by red and/or processed meat intake levels. The dose–response relationships were estimated using data from red and processed meat intake categories in each study. Random-effects models were used to calculate pooled relative risks and 95 % confidence intervals and to incorporate between-study variations.


Nine articles with seventeen prospective cohorts were eligible in this meta-analysis, including a total of 150 328 deaths. There was evidence of a non-linear association between processed meat consumption and risk of all-cause and cardiovascular mortality, but not for cancer mortality. For processed meat, the pooled relative risk with an increase of one serving per day was 1·15 (95 % CI 1·11, 1·19) for all-cause mortality (five studies; P<0·001 for linear trend), 1·15 (95 % CI 1·07, 1·24) for cardiovascular mortality (six studies; P<0·001) and 1·08 (95 % CI 1·06, 1·11) for cancer mortality (five studies; P<0·001). Similar associations were found with total meat intake. The association between unprocessed red meat consumption and mortality risk was found in the US populations, but not in European or Asian populations.


The present meta-analysis indicates that higher consumption of total red meat and processed meat is associated with an increased risk of total, cardiovascular and cancer mortality.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Red and processed meat consumption and mortality: dose–response meta-analysis of prospective cohort studies
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Red and processed meat consumption and mortality: dose–response meta-analysis of prospective cohort studies
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Red and processed meat consumption and mortality: dose–response meta-analysis of prospective cohort studies
      Available formats


Corresponding author

* Corresponding authors: Email;


Hide All
1. Speedy, AW (2003) Global production and consumption of animal source foods. J Nutr 133, 11 Suppl. 2, 4048S4053S.
2. Delgado, CL (2003) Rising consumption of meat and milk in developing countries has created a new food revolution. J Nutr 133, 11 Suppl. 2, 3907S3910S.
3. Daniel, CR, Cross, AJ, Koebnick, C et al. (2011) Trends in meat consumption in the USA. Public Health Nutr 14, 575583.
4. Walker, P, Rhubart-Berg, P, McKenzie, S et al. (2005) Public health implications of meat production and consumption. Public Health Nutr 8, 348356.
5. Sinha, R, Cross, AJ, Graubard, BI et al. (2009) Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med 169, 562571.
6. Pan, A, Sun, Q, Bernstein, AM et al. (2012) Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med 172, 555563.
7. Fraser, GE (1999) Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 70, 3 Suppl., 532S538S.
8. Sauvaget, C, Nagano, J, Allen, N et al. (2003) Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Int J Epidemiol 32, 536543.
9. Nagao, M, Iso, H, Yamagishi, K et al. (2012) Meat consumption in relation to mortality from cardiovascular disease among Japanese men and women. Eur J Clin Nutr 66, 687693.
10. Kappeler, R, Eichholzer, M & Rohrmann, S (2013) Meat consumption and diet quality and mortality in NHANES III. Eur J Clin Nutr 67, 598606.
11. Key, TJ, Appleby, PN, Spencer, EA et al. (2009) Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr 89, issue 5, 1613S1619S.
12. Abete, I, Romaguera, D, Vieira, AR et al. (2014) Association between total, processed, red and white meat consumption and all-cause, CVD and IHD mortality: a meta-analysis of cohort studies. Br J Nutr 112, 762775.
13. O’Sullivan, TA, Hafekost, K, Mitrou, F et al. (2013) Food sources of saturated fat and the association with mortality: a meta-analysis. Am J Public Health 103, e31e42.
14. Larsson, SC & Orsini, N (2014) Red meat and processed meat consumption and all-cause mortality: a meta-analysis. Am J Epidemiol 179, 282289.
15. Stroup, DF, Berlin, JA, Morton, SC et al. (2000) Meta-analysis of observational studies in epidemiology. JAMA 283, 20082012.
16. Carter, P, Gray, LJ, Troughton, J et al. (2010) Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 341, c4229.
17. Hedges, LV, Olkin, I & Statistiker, M (1985) Statistical Methods for Meta-Analysis. New York: Academic Press.
18. Higgins, J, Thompson, SG, Deeks, JJ et al. (2003) Measuring inconsistency in meta-analyses. BMJ 327, 557560.
19. Berlin, JA, Longnecker, MP & Greenland, S (1993) Meta-analysis of epidemiologic dose–response data. Epidemiology 4, 218228.
20. Greenland, S & Longnecker, MP (1992) Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol 135, 13011309.
21. Orsini, N, Bellocco, R & Greenland, S (2006) Generalized least squares for trend estimation of summarized dose–response data. Stata J 6, 4057.
22. Harre, FE, Lee, KL & Pollock, BG (1988) Regression models in clinical studies: determining relationships between predictors and response. J Natl Cancer Inst 80, 11981202.
23. Egger, M, Smith, GD, Schneider, M et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.
24. Begg, CB & Mazumdar, M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 10881101.
25. Cox, BD & Whichelow, MJ (1997) Frequent consumption of red meat is not risk factor for cancer. BMJ 315, 1018.
26. Qiu, D, Mei, J, Tanihata, T et al. (2003) A cohort study on cerebrovascular disease in middle-aged and elderly population in rural areas in Jiangxi Province, China. J Epidemiol 13, 149156.
27. Kinjo, Y, Beral, V, Akiba, S et al. (1999) Possible protective effect of milk, meat and fish for cerebrovascular disease mortality in Japan. J Epidemiol 9, 268274.
28. Kelemen, LE, Kushi, LH, Jacobs, DR et al. (2005) Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women. Am J Epidemiol 161, 239249.
29. Trichopoulou, A, Bamia, C & Trichopoulos, D (2009) Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 338, b2337.
30. Zell, JA, Ziogas, A, Bernstein, L et al. (2010) Meat consumption, nonsteroidal anti-inflammatory drug use, and mortality among colorectal cancer patients in the California Teachers Study. Cancer Prev Res 3, 865875.
31. Breslow, RA, Graubard, BI, Sinha, R et al. (2000) Diet and lung cancer mortality: a 1987 National Health Interview Survey cohort study. Cancer Causes Control 11, 419431.
32. Mann, JI, Appleby, PN, Key, TJ et al. (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 78, 450455.
33. Chang-Claude, J, Hermann, S, Eilber, U et al. (2005) Lifestyle determinants and mortality in German vegetarians and health-conscious persons: results of a 21-year follow-up. Cancer Epidemiol Biomarkers Prev 14, 963968.
34. Takata, Y, Shu, X-O, Gao, Y-T et al. (2013) Red meat and poultry intakes and risk of total and cause-specific mortality: results from cohort studies of Chinese adults in Shanghai. PLoS One 8, e56963.
35. Lee, JE, McLerran, DF, Rolland, B et al. (2013) Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies. Am J Clin Nutr 98, 10321041.
36. Rohrmann, S, Overvad, K, Bueno-de-Mesquita, HB et al. (2013) Meat consumption and mortality-results from the European Prospective Investigation into Cancer and Nutrition. BMC Med 11, 63.
37. Whiteman, D, Muir, J, Jones, L et al. (1999) Dietary questions as determinants of mortality: the OXCHECK experience. Public Health Nutr 2, 477487.
38. Jamrozik, K, Broadhurst, RJ, Forbes, S et al. (2000) Predictors of death and vascular events in the elderly: the Perth Community Stroke Study. Stroke 31, 863868.
39. Fortes, C, Forastiere, F, Farchi, S et al. (2000) Diet and overall survival in a cohort of very elderly people. Epidemiology 11, 440445.
40. Spring, B, King, AC, Pagoto, SL et al. (2015) Fostering multiple healthy lifestyle behaviors for primary prevention of cancer. Am Psychol 70, 7590.
41. Calder, PC & Yaqoob, P (2009) Omega-3 polyunsaturated fatty acids and human health outcomes. Biofactors 35, 266272.
42. Tapiero, H, Ba, GN, Couvreur, P et al. (2002) Polyunsaturated fatty acids (PUFA) and eicosanoids in human health and pathologies. Biomed Pharmacother 56, 215222.
43. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR.
44. Skog, K, Steineck, G, Augustsson, K et al. (1995) Effect of cooking temperature on the formation of heterocyclic amines in fried meat products and pan residues. Carcinogenesis 16, 861867.
45. Butler, L, Sinha, R, Millikan, R et al. (2003) Heterocyclic amines, meat intake, and association with colon cancer in a population-based study. Am J Epidemiol 157, 434445.
46. Bernstein, AM, Sun, Q, Hu, FB et al. (2010) Major dietary protein sources and risk of coronary heart disease in women. Circulation 122, 876883.
47. Micha, R, Wallace, SK & Mozaffarian, D (2010) Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation 121, 22712283.
48. Bibbins-Domingo, K, Chertow, GM, Coxson, PG et al. (2010) Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 362, 590599.
49. Cook, NR, Cutler, JA, Obarzanek, E et al. (2007) Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 334, 885888.
50. Kleinbongard, P, Dejam, A, Lauer, T et al. (2006) Plasma nitrite concentrations reflect the degree of endothelial dysfunction in humans. Free Radic Biol Med 40, 295302.
51. Hughes, R, Cross, A, Pollock, J et al. (2001) Dose-dependent effect of dietary meat on endogenous colonic N-nitrosation. Carcinogenesis 22, 199202.
52. Cross, AJ & Sinha, R (2004) Meat-related mutagens/carcinogens in the etiology of colorectal cancer. Environ Mol Mutagen 44, 4455.
53. Sen, NP, Seaman, SW, Burgess, C et al. (2000) Investigation on the possible formation of N-nitroso-N-methylurea by nitrosation of creatinine in model systems and in cured meats at gastric pH. J Agric Food Chem 48, 50885096.
54. Cross, AJ, Leitzmann, MF, Gail, MH et al. (2007) A prospective study of red and processed meat intake in relation to cancer risk. PLoS Med 4, e325.
55. Koeth, RA, Wang, Z, Levison, BS et al. (2013) Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 19, 576585.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Wang supplementary material
Figures S1-S5

 Word (183 KB)
183 KB

Red and processed meat consumption and mortality: dose–response meta-analysis of prospective cohort studies

  • Xia Wang (a1), Xinying Lin (a2), Ying Y Ouyang (a3), Jun Liu (a3), Gang Zhao (a4), An Pan (a5) and Frank B Hu (a6) (a7)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.