Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Food and health

Meat consumption and diet quality and mortality in NHANES III

Abstract

Background/Objectives:

There is growing evidence that meat consumption is associated with total and cause-specific mortality. Our objective was to evaluate the association of meat intake and the healthy eating index (HEI) with total mortality, cancer and cardiovascular disease (CVD) mortality.

Subjects/Methods:

Analyses are based on 17 611 participants from Third National Health and Nutrition Examination Survey (NHANES III) (1986–2010). Meat intake was assessed using a food frequency questionnaire administrated at baseline. Adherence to the HEI was analyzed with a single 24-h dietary recall. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality according to five categories of meat consumption and three categories of the HEI score.

Results:

During the follow-up period, 3683 deaths occurred, of which 1554 were due to CVD and 794 due to cancer. After multivariable adjustment, neither red and processed meat, nor white meat consumption were consistently associated with all-cause or cause-specific mortality. In men, white meat consumption tended to be inversely associated with total mortality (P for trend=0.02), but there was no such association among women. Significantly decreased mortality was observed in the top compared with the bottom third of the HEI score (HR=0.70, 95% CI 0.52–0.96). This association was only observed in men, but not in women.

Conclusions:

Meat consumption was not associated with mortality. A healthy diet according to HEI, however, was associated with a decreased total mortality in men, but not in women.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. WHO. Diet, Nutrition, and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series 916, Geneva. WHO: Geneva. Geneva, 2003.

  2. FAO. Livestock and Fish Primary Equivalent. FAO 2012, (updated 29.6.2012; cited 2012 10.10); Available from http://faostat.fao.org/site/610/default.aspx#ancor.

  3. Bruinsma J . World Agriculture: Towards 2015/2030: An FAO Perspective. Earthscan: London, 2003.

    Google Scholar 

  4. National Cholesterol Education Program (US). Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report. The Program: Washington, DC, 2002.

  5. World Cancer Research Fund International. Policy and Action for Cancer Prevention: Food, Nutrition, and Physical Activity; a Global Perspective. American Institute for Cancer Research: Washington, DC, 2009.

  6. Fraser GE . Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 1999; 70: 532s–538ss.

    Article  CAS  Google Scholar 

  7. Kontogianni MD, Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C . Relationship between meat intake and the development of acute coronary syndromes: the CARDIO2000 case-control study. Eur J Clin Nutr 2008; 62: 171–177.

    Article  CAS  Google Scholar 

  8. Micha R, Wallace SK, Mozaffarian D . Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus a systematic review and meta-analysis. Circulation 2010; 121: 2271–2283.

    Article  Google Scholar 

  9. Cross AJ, Leitzmann MF, Gail MH, Hollenbeck AR, Schatzkin A, Sinha R . A prospective study of red and processed meat intake in relation to cancer risk. PLoS Med 2007; 4: 1973–1984.

    Article  Google Scholar 

  10. Zheng W, Lee SA . Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr Cancer 2009; 61: 437–446.

    Article  CAS  Google Scholar 

  11. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A . Meat intake and mortality a prospective study of over half a million people. Arch Intern Med 2009; 169: 562–571.

    Article  CAS  Google Scholar 

  12. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ et al. Red meat consumption and mortality results from 2 prospective cohort studies. Arch Intern Med 2012; 172: 555–563.

    Article  Google Scholar 

  13. Kennedy ET, Ohls J, Carlson S, Fleming K . The healthy eating index—design and applications. J Am Diet Assoc 1995; 95: 1103–1108.

    Article  CAS  Google Scholar 

  14. McCullough ML, Feskanich D, Rimm EB, Giovannucci EL, Ascherio A, Variyam JN et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 2000; 72: 1223–1231.

    Article  CAS  Google Scholar 

  15. McCullough ML, Feskanich D, Stampfer MJ, Rosner BA, Hu FB, Hunter DJ et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr 2000; 72: 1214–1222.

    Article  CAS  Google Scholar 

  16. Guo XG, Crockett P . Healthy eating index and metabolic syndrome—Results from the NHANES 1999-2002. FASEB J 2006; 20: A577–A577.

    Article  Google Scholar 

  17. Tande DL, Magel R, Strand BN . Healthy Eating Index and abdominal obesity. Public Health Nutr 2010; 13: 208–214.

    Article  Google Scholar 

  18. Rathod AD, Bharadwaj AS, Badheka AO, Kizilbash M, Afonso L . Healthy eating index and mortality in a nationally representative elderly cohort. Arch Intern Med 2012; 172: 275–277.

    Article  Google Scholar 

  19. United States. National Center for Health Statistics. Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988–94. US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention: Hyattsville, MD, Washington, DC, 1994.

  20. US Department Health and Human Services. Third National Health and Nutrition Examination Survey, 1988–1994, NHANES III Healthy Eating Index Data File (Series 11, No. 6A) Prevention CfDCa (eds)., US Department Health and Human Services: Hyattsville, MD, Washington, DC, 1999.

  21. Bowman S, Lino M, Gerrior S, Basiotis P The Healthy Eating Index: 1994-96, US Department of Agriculture, Center for Nutrition and Policy and Promotion; CNPP-5, 1998.

  22. US Departments of Agriculture and Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. USDA/USDHHS: Washington, DC, 1990.

  23. Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

    Article  Google Scholar 

  24. National Center for Health Statistics. Office of Analysis and Epidemiology, The Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality File, Mortality follow-up through 2006: Matching Methodology May 2009. Hyattsville, Maryland.

  25. Thompson FE, Byers T . Dietary assessment resource manual. J Nutr 1994; 124 (11 Suppl), 2245S–2317SS.

    CAS  PubMed  Google Scholar 

  26. Nagao M, Iso H, Yamagishi K, Date C, Tamakoshi A, Grp JS . Meat consumption in relation to mortality from cardiovascular disease among Japanese men and women. Eur J Clin Nutr 2012; 66: 687–693.

    Article  CAS  Google Scholar 

  27. Zell JA, Ziogas A, Bernstein L, Clarke CA, Deapen D, Largent JA et al. Meat consumption, nonsteroidal anti-inflammatory drug use, and mortality among colorectal cancer patients in the California Teachers Study. Cancer Prev Res 2010; 3: 865–875.

    Article  CAS  Google Scholar 

  28. Pham TM, Fujino Y, Kikuchi S, Tamakoshi A, Matsuda S, Yoshimura T . Dietary patterns and risk of stomach cancer mortality: the Japan collaborative cohort study. Ann Epidemiol 2010; 20: 356–363.

    Article  Google Scholar 

  29. Waijers PM, Feskens EJ, Ocké MC . A critical review of predefined diet quality scores. Br J Nutr 2007; 97: 219–231.

    Article  CAS  Google Scholar 

  30. Akbaraly TN, Ferrie JE, Berr C, Brunner EJ, Head J, Marmot MG et al. Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort. Am J Clin Nutr 2011; 94: 247–253.

    Article  CAS  Google Scholar 

  31. Huffman FG, Zarini GG, Mcnamara E, Nagarajan A . The Healthy Eating Index and the Alternate Healthy Eating Index as predictors of 10-year CHD risk in Cuban Americans with and without type 2 diabetes. Public Health Nutr 2011; 14: 2006–2014.

    Article  Google Scholar 

  32. Fung TT, Hu FB, McCullough ML, Newby PK, Willett WC, Holmes MD . Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr 2006; 136: 466–472.

    Article  CAS  Google Scholar 

  33. Arvaniti F, Panagiotakos DB . Healthy indexes in public health practice and research: a review. Crit Rev Food Sci 2008; 48: 317–327.

    Article  Google Scholar 

  34. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 2002; 76: 1261–1271.

    Article  CAS  Google Scholar 

  35. McCullough ML, Willett WC . Evaluating adherence to recommended diets in adults: The alternate healthy eating index. Public Health Nutr 2006; 9: 152–157.

    Article  Google Scholar 

  36. Leitzmann C . ‘Healthy Eating Index’ and ‘Optimal Diet Membership’ nutritional evaluation. Ernahrungs Umschau 2012; 59: 380–385.

    Google Scholar 

  37. Hann CS, Rock CL, King ID, Drewnowski A . Validation of the Healthy Eating Index with use of plasma biomarkers in a clinical sample of women. Am J Clin Nutr 2001; 74: 479–486.

    Article  CAS  Google Scholar 

  38. Weinstein SJ, Vogt TM, Gerrior SA . Healthy Eating Index scores are associated with blood nutrient concentrations in the third national health and nutrition examination survey. J Am Diet Assoc 2004; 104: 576–584.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Rohrmann.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kappeler, R., Eichholzer, M. & Rohrmann, S. Meat consumption and diet quality and mortality in NHANES III. Eur J Clin Nutr 67, 598–606 (2013). https://doi.org/10.1038/ejcn.2013.59

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.59

Keywords

This article is cited by

Search

Quick links