The median (interquartile range [IQR]) intake in servings per week was 1.5 (0.5-3.8) for processed meat, 3.0 (1.5-5.0) for unprocessed red meat, 2.0 (1.0-3.0) for poultry, and 1.6 (0.9-3.4) for fish. Compared with participants with lower total intake of these 4 food types, participants with higher total intake (1) were younger and more likely to be male, non-Hispanic black, and current smokers and to have diabetes, higher body mass index, higher non-high-density lipoprotein cholesterol levels, higher energy intake, and higher alcohol intake; (2) had lower high-density lipoprotein cholesterol levels, had lower diet quality, and were less likely to use lipid-lowering drugs and hormone therapy; and (3) had higher incidence of CVD and all-cause mortality. [In other words, these persons were also the most likely to be mortally unhealthy in many other ways.]
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This study has several limitations. First, measurement error was unavoidable for self-reported diet and other data. Measurement error may result in an overestimation or underestimation of an association. Second, more detailed diet data were unavailable on food preparation methods (eg, fried vs nonfried). Third, only 1 dietary measurement was used, but participants’ dietary behaviors may have changed over time. Robust results were seen when follow-up was truncated at different times, except for the association of fish intake with all-cause mortality. Fourth, a comprehensive set of confounders was considered, but residual confounding was still likely. Fifth, the data pertained to only US adults; thus, caution should be taken when generalizing the findings to other countries and to children. Sixth, this study could not establish causality.
