Red meat consumption is linked to higher risk of death from most major causesBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2241 (Published 10 May 2017) Cite this as: BMJ 2017;357:j2241
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This is not the first time that the associations between red and white meat consumption and mortality risk in NIH-AARP have been analysed.
In the earlier paper by Sinha et al, similar associations were found. However, the associations between unprocessed red meat and accidental death in men, HR 1.26 (1.04-1.54), were as great as the associations for cancer mortality, HR 1.22 (1.16-1.29) or CVD mortality, HR 1.27 (1.20-1.35). There was a comparable protective association between white meat and accidental death which was non-significant after adjustment.
There has never been a biological mechanism proposed by which red meat could cause accidental death in men, and the cognitive effects of deficiencies of red meat nutrients such as vitamin B12 suggest that an unconfounded relationship should run in the opposite direction. Men's risk of accidental injury mortality in the US is 2-3x that of women, accidental death rates in NIH-AARP were low, and the association was not seen in women. However women's accidental deaths may be less due to risk-taking behaviour than the deaths of men (for example if women are more likely to be victims in vehicular accidents caused by men than by women).
The finding for accidental death gives us some idea of the effect of healthy-user bias in this population. Men who ignored health warnings about red meat and did not replace it with white meats or vegetable protein were more likely to ignore basic safety advice, or work in dangerous workplaces. Dangerous workplaces are also places where one can be exposed to carcinogens and pollutants which increase cardiovascular risk. People who ignore health warnings about red meat are also likely to ignore warnings about sugar-sweetened beverages, and highest intake of fructose from SSBs was also associated with cardiovascular mortality in NIH-AARP.
For some reason accidental death was dropped as an outcome of interest in the current study, concealing important information about the likely effect of health-user bias on the results, and the analysis did not include adjustment for fructose or other nutrients of interest.
Risk-taking behaviour and workplace safety are important considerations with regard to the two strongest associations in Etemadi et al, liver disease mortality (risk of both viral infection and hepatotoxicity from drug-taking) and respiratory mortality (pollutant exposure), causes of death which lack mechanisms sufficient to explain the strength of association with meats in this paper.
The conclusion that this paper, and others like it, say anything convincing about the effects of red meat or chicken per se at a population level is premature.
 Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality: a prospective study of over half a million people. Archives of internal medicine. 2009;169(6):562-571. doi:10.1001/archinternmed.2009.6.
 Tasevska N, Park Y, Jiao L, Hollenbeck A, Subar AF, Potischman N. Sugars and risk of mortality in the NIH-AARP Diet and Health Study. The American Journal of Clinical Nutrition. 2014;99(5):1077-1088. doi:10.3945/ajcn.113.069369.
Competing interests: No competing interests