Red meat consumption and risk of stroke in Swedish men1–3
Susanna C Larsson, Jarmo Virtamo, and Alicja Wolk
ABSTRACT
Background: Red and processed meat consumption has been im-
plicated in several diseases. However, data on meat consumption in
relation to stroke incidence are sparse.
Objective: Our objective was to examine the associations of red
meat and processed meat consumption with stroke incidence in
men.
Design: We prospectively followed 40,291 men aged 45–79 y who
had no history of cardiovascular disease or cancer at baseline. Meat
consumption was assessed with a self-administered questionnaire in
1997.
Results: During a mean follow-up of 10.1 y, 2409 incident cases of
stroke (1849 cerebral infarctions, 350 hemorrhagic strokes, and 210
unspecified strokes) were identified from the Swedish Hospital Dis-
charge Registry. Consumption of processed meat, but not of fresh
red meat, was positively associated with risk of stroke. The multi-
variable relative risks (RRs) of total stroke for the highest compared
with the lowest quintiles of consumption were 1.23 (95% CI: 1.07,
1.40; P for trend = 0.004) for processed meat and 1.07 (95% CI:
0.93, 1.24; P for trend = 0.77) for fresh red meat. Processed meat
consumption was also positively associated with risk of cerebral
infarction in a comparison of the highest with the lowest quintile
(RR: 1.18; 95% CI: 1.01, 1.38; P for trend = 0.03).
Conclusion: The findings from this prospective cohort of men in-
dicate that processed meat consumption is positively associated with
risk of stroke. The Cohort of Swedish Men is registered at clinical-
trials.gov as NCT01127711. Am J Clin Nutr 2011;94:417–21.
INTRODUCTION
Reduced consumption of red meat and avoidance of processed
meat has been recommended as a way to lower the risk of cancer
(1). Recent evidence has also indicated that high consumption of
red meat, particularly processed meat, may be a risk factor for
coronary heart disease (2–4) and type 2 diabetes (3). Red meat
consumption has been positively associated with blood pressure
(5), incidence of hypertension (6, 7), the metabolic syndrome (8),
and inflammation (8). Although red meat consumption may be
a risk factor for stroke, epidemiologic studies of red meat con-
sumption in relation to stroke incidence or mortality are sparse
and results are inconsistent (9–12). We recently reported on the
associations of red and processed meat consumption with stroke
incidence in the Swedish Mammography Cohort (12). In that
cohort of women, a high processed meat consumption was as-
sociated with a statistically significant increased risk of stroke
(12). To our knowledge, only 2 previous studies, 1 in the United
States (10) and 1 in Japan (11), have examined the relation
Am J Clin Nutr 2011;94:417–21. Printed in USA. Ó 2011 American Society for Nutrition
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between red meat consumption and stroke incidence (10) or
mortality (11) in men. For elucidating potential biological
mechanisms and guiding policy priorities, it is important to assess
fresh red meat and processed meat consumption separately in
relation to stroke risk. The aim of this study was to investigate the
associations of fresh red meat and processed meat consumption
with stroke incidence in a large prospective cohort of Swedish
men with 11 y of follow-up.
SUBJECTS AND METHODS
Study population
The Cohort of Swedish Men was initiated in the autumn of
1997, when all men who were aged 45–79 y and resided in the
Västmanland and Örebro counties of central Sweden received
a questionnaire that included ’350 items concerning diet and
other lifestyle factors. Of the 48,850 men (49% of the source
population) who returned a completed questionnaire, we ex-
cluded those with an erroneous or a missing national identifi-
cation number and those with implausible values for total energy
intake (ie, 3 SDs from the loge-transformed mean energy in-
take). We further excluded men with a history of stroke, coro-
nary heart disease, or cancer at baseline because these diseases
might have caused a change in diet. After these exclusions,
40,291 men remained for analysis. The study was approved by
the Regional Ethical Review Board at the Karolinska Institutet
(Stockholm, Sweden).
Baseline data collection
Information on education, body weight, height, smoking status
and history, physical activity, aspirin use, history of diabetes and
hypertension, family history of myocardial infarction before age
60 y, alcohol consumption, and diet was obtained in 1997 by
1
From the Division of Nutritional Epidemiology, National Institute of
Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SCL
and AW) and the Department of Chronic Disease Prevention, National In-
stitute for Health and Welfare, Helsinki, Finland (JV).
2
Supported by research grants from the Swedish Council for Working
Life and Social Research and the Swedish Research Council/Committee
for Infrastructure and by a Research Fellow grant from Karolinska Institutet
(to SCL).
3
Address correspondence to SC Larsson, Division of Nutritional Epide-
miology, National Institute of Environmental Medicine, Karolinska Institu-
tet, Box 210, SE-17177 Stockholm, Sweden. E-mail: susanna.larsson@ki.se.
Received March 1, 2011. Accepted for publication May 4, 2011.
First published online June 8, 2011; doi: 10.3945/ajcn.111.015115.
417
418 LARSSON ET AL
using a self-administered questionnaire. Body mass index (BMI)
was calculated by dividing the weight (in kg) by the square of
height (in m). Pack-years of smoking history were calculated as
the number of packs of cigarettes smoked per day multiplied by
the number of years of smoking. Participants reported their level
of activity at work, home/housework, walking/bicycling, and
leisure-time exercise in the year before study enrollment. The
questionnaire also included questions on inactivity (watching
television and reading) and hours per day of sleeping and sitting/
lying down. The time spent per day at each activity was mul-
tiplied by its typical energy expenditure requirements (expressed
in metabolic equivalents (METs) and added together to create
a MET-h/d (24-h) score (13).
Dietary assessment
Diet was assessed with a 96-item food-frequency question-
naire. Participants were asked to indicate how often, on average,
they had consumed various foods over the past year, with 8
predefined frequency categories ranging from never to 3 times/d.
We grouped meat into total red meat, fresh red meat, and pro-
cessed meat. Fresh red meat consumption was calculated by using
the frequency of consumption and age-specific portion size in-
formation of all types of fresh and minced pork, beef, and veal.
Processed meats included sausages, hot dogs, salami, ham, pro-
cessed meat cuts, liver paté, and blood sausage. Total red meat
was the sum of fresh red meat and processed meat. The food-
frequency questionnaire has been validated for nutrients (14), but
not for food items, in 248 Swedish men aged 40–74 y; the mean
Spearman correlation coefficients between estimates from the
dietary questionnaire and the mean of fourteen 24-h recall inter-
views were 0.65 for macronutrients and 0.62 for micronutrients
(14). The age-specific portion sizes (based on two 1-wk weighted
dietary records) for fresh red meat ranged from 97 to 147 g per
serving. For processed meat, the age-specific portion sizes ranged
from 15 to 24 g (liver paté) to 133–150 g (blood sausage).
Case ascertainment and follow-up
Incident cases of first stroke that occurred between 1 January
1998 and 31 December 2008 were ascertained by linkage of the
study cohort with the Swedish Hospital Discharge Registry,
which provides virtually complete coverage of the discharges.
The International Classification of Diseases 10th revision was
used to identify stroke events. Strokes were classified as cerebral
infarction (ICD-10 code I63), intracerebral hemorrhage (I61),
subarachnoid hemorrhage (I60), and unspecified stroke (I64).
Information on dates of death was obtained from the Swedish
Death Registry at Statistics Sweden.
Statistical analysis
Each participant accrued follow-up time from 1 January 1998
until the date of the first stroke event, death, or 31 December 2008,
whichever came first. We used Cox proportional hazard models
with age as the time scale to estimate the relative risks (RRs) with
95% CIs of stroke by quintiles of meat consumption. Entry time
was defined as a subject’s age (in mo) at start of follow-up, and exit
time was defined as a subject’s age (in mo) at stroke diagnosis or
censoring. The multivariable model included the following vari-
ables: smoking status and pack-years of smoking (never; past ,20,
20–39, or 40 pack-years; or current ,20, 20–39, or 40 pack-
years), education (less than high school, high school, or univer-
sity), BMI (,20, 20–24.9, 25–29.9, or 30), total physical ac-
tivity (quartiles), diabetes (yes or no), history of hypertension (yes
or no), aspirin use (yes or no), family history of myocardial in-
farction before 60 y of age (yes or no), and intakes of total energy
(in kcal/d, as a continuous variable) and quartiles of alcohol, fish,
fruit, and vegetables. In an additional multivariable model, we
further adjusted for intakes of whole grains and dairy foods.
Tests for linear trends across quintiles were conducted by
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modeling red meat consumption as a continuous variable in the
model with the median value of each quintile. We conducted
analyses stratified by a history of hypertension (yes or no) to
assess possible effect modification by this variable. Tests for
interaction were performed by using the log-likelihood ratio test.
The statistical analyses were performed by using SAS version 9.1
(SAS Institute Inc, Cary, NC). All P values were 2-sided, and P
values 0.05 were considered significant. We had 80% power to
detect an RR of 1.2 and 100% power to detect an RR of 1.3
for the highest compared with the lowest quintile (a = 0.05).
RESULTS
During a mean follow-up of 10.1 y, we ascertained 2409 incident
stroke cases, including 1849 cerebral infarctions, 350 hemorrhagic
strokes (281 intracerebral hemorrhages and 69 subarachnoid
hemorrhages), and 210 unspecified strokes. Compared with men in
the lowest quintiles of red meat, fresh red meat, and processed meat
consumption, those in the highest quintiles were younger and were
more likely to use aspirin (Table 1). High consumption of red
meat, fresh red meat, and processed meat was associated with
higher intakes of total energy, alcohol, monounsaturated fat,
polyunsaturated fat, fish, fruit, vegetables, whole grains, and dairy
foods. Men with a high consumption of total red meat and pro-
cessed meat were less likely to have a university education and had
a slightly higher BMI than did men with low consumption.
We observed no statistically significant dose-response asso-
ciation between total red meat consumption and risk of total
stroke, cerebral infarction, or hemorrhagic stroke (Table 2).
However, compared with men in the lowest quintile of red meat
consumption, those in the highest quintile had a statistically
significant increased risk of total stroke and hemorrhagic stroke.
Consumption of fresh red meat was not associated with total
stroke or any stroke subtype (Table 3). Processed meat con-
sumption was statistically significantly positively associated
with risk of total stroke and cerebral infarction but not hemor-
rhagic stroke after adjustment for other risk factors (Table 3).
The multivariable RR of total stroke for men in the highest
quintile of processed meat consumption compared with those in
the lowest quintile was 1.23 (95% CI: 1.07, 1.40). Additional
adjustment for consumption of whole grains and dairy foods did
not change the results materially. For example, the multivariable
RR of total stroke for the highest compared with the lowest
quintile of processed meat consumption was 1.23 (95% CI: 1.07,
1.41) after further adjustment for intakes of whole grains and
dairy foods. The results were not altered appreciably when men
with diabetes were excluded from the analysis. In men without
diabetes, the multivariable RR of total stroke in a comparison of
the highest with the lowest quintile of processed meat con-
sumption was 1.19 (95% CI: 1.03, 1.39).
 MEAT CONSUMPTION AND STROKE 419
TABLE 1
Age-standardized characteristics of 40,291 men in the cohort of Swedish men by quintile (Q) of total red meat, fresh red meat, and processed meat
consumption in 19971
Total red meat Fresh red meat Processed meat

Characteristic Q1 Q5 P value2 Q1 Q5 P value2 Q1 Q5 P value2

Age (y) 63.2 6 9.83 56.6 6 8.2 ,0.001 63.4 6 9.8 56.6 6 8.4 ,0.001 61.6 6 9.9 58.3 6 8.5 ,0.001
Education, university (%) 18.4 16.0 ,0.001 15.7 18.7 ,0.001 23.3 13.4 ,0.001
Current smoker (%) 26.2 26.9 0.36 26.5 26.6 0.25 25.5 25.6 0.42
BMI (kg/m2) 25.7 6 3.3 25.9 6 3.3 ,0.001 25.8 6 3.4 25.9 6 3.3 0.21 25.6 6 3.3 25.9 6 3.3 ,0.001

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Total physical activity (MET-h/d) 41.8 6 4.8 41.8 6 4.9 0.56 41.9 6 4.9 41.6 6 4.8 ,0.001 41.4 6 4.8 41.9 6 4.9 ,0.001
History of diabetes (%) 5.2 6.6 0.11 5.5 6.0 0.21 4.7 6.6 0.01
History of hypertension (%) 21.8 21.7 0.59 22.8 21.2 0.007 21.2 23.1 0.01
Aspirin use (%) 30.7 34.2 ,0.001 31.1 33.0 0.006 30.5 33.6 ,0.001
Family history of myocardial infarction (%) 13.6 14.8 0.64 13.8 14.6 0.48 14.4 15.1 0.60
Daily dietary intake
Energy (kcal) 2286 6 745 3199 6 746 ,0.001 2348 6 777 3084 6 769 ,0.001 2368 6 781 3130 6 765 ,0.001
Alcohol (g) 9.0 6 8.4 11.8 6 8.9 ,0.001 8.9 6 8.3 11.9 6 9.0 ,0.001 10.0 6 9.0 10.9 6 8.8 ,0.001
Saturated fat (g) 33.7 6 9.4 33.9 6 7.1 0.37 33.8 6 9.2 33.8 6 7.1 0.62 33.6 6 9.4 33.8 6 6.9 0.92
Monounsaturated fat (g) 23.4 6 4.7 27.4 6 3.8 ,0.001 24.0 6 4.8 26.8 6 3.8 ,0.001 23.6 6 4.6 27.3 6 3.7 ,0.001
Polyunsaturated fat (g) 9.5 6 2.5 10.5 6 1.9 ,0.001 9.6 6 2.5 10.4 6 2.0 ,0.001 9.6 6 2.5 10.5 6 1.9 ,0.001
Fish (servings) 0.2 6 0.3 0.4 6 0.4 ,0.001 0.2 6 0.4 0.4 6 0.4 ,0.001 0.3 6 0.3 0.3 6 0.4 ,0.001
Fruit (servings) 1.4 6 1.2 1.7 6 1.1 ,0.001 1.4 6 1.2 1.7 6 1.1 ,0.001 1.5 6 1.3 1.6 6 1.1 ,0.001
Vegetables (servings) 2.2 6 1.7 3.1 6 1.5 ,0.001 2.2 6 1.7 3.1 6 1.6 ,0.001 2.5 6 1.9 2.8 6 1.5 ,0.001
Whole grains (servings) 4.2 6 2.6 4.5 6 2.4 ,0.001 4.2 6 2.6 4.3 6 2.4 0.002 4.1 6 2.6 4.5 6 2.4 ,0.001
Dairy foods (servings) 5.3 6 3.1 6.0 6 3.1 ,0.001 5.4 6 3.2 5.9 6 3.1 ,0.001 5.4 6 3.2 6.0 6 3.0 ,0.001
1
MET, metabolic equivalent of energy expenditure (kcal/kg · h).
2
P for trend across quintiles of meat consumption was calculated by using generalized linear models.
3
Mean 6 SD (all such values).

When we analyzed total red meat consumption as a continuous
variable, the multivariable RR of total stroke was 1.07 (95% CI:
1.00, 1.14) for a 100-g/d increment of total red meat con-
sumption. The corresponding RRs were respectively 1.01 (95%
CI: 0.96, 1.06) and 1.08 (95% CI: 1.01, 1.15) for a 50-g/d increase
in fresh red meat and processed meat consumption.
Hypertension and diabetes may be intermediates of the as-
sociation between red meat consumption and stroke. When we
removed history of hypertension and diabetes variables from the
multivariable model, the RRs of total stroke in a comparison of
the highest with the lowest quintile of consumption were 1.06
(95% CI: 0.92, 1.23) for fresh red meat and 1.26 (95% CI: 1.10,

TABLE 2
Relative risks (95% CIs) of total stroke and stroke subtypes by total red meat consumption in 40,291 men in the cohort of
Swedish men, 1998–20081
Red meat consumption (g/d)

,62.5 62.5–88.3 88.4–110.3 110.4–136.1 136.2 P for trend2

Total stroke
Person-years 80,842 79,858 82,414 82,086 82,441
No. of cases 644 554 466 361 384
Age-adjusted 1.00 1.03 (0.92, 1.15) 1.03 (0.91, 1.16) 0.96 (0.84, 1.10) 1.10 (0.97, 1.25) 0.33
Multivariable3 1.00 1.06 (0.94, 1.19) 1.08 (0.95, 1.22) 1.02 (0.89, 1.17) 1.15 (1.00, 1.33) 0.10
Cerebral infarction
No. of cases 515 420 357 279 278
Age-adjusted 1.00 0.97 (0.85, 1.11) 0.99 (0.87, 1.14) 0.94 (0.81, 1.09) 1.01 (0.87, 1.17) 0.91
Multivariable3 1.00 1.01 (0.88, 1.15) 1.04 (0.90, 1.20) 1.00 (0.85, 1.17) 1.06 (0.90, 1.25) 0.53
Hemorrhagic stroke
No. of cases 75 89 56 56 74
Age-adjusted 1.00 1.36 (1.00, 1.84) 0.99 (0.70, 1.39) 1.09 (0.77, 1.55) 1.52 (1.10, 2.12) 0.06
Multivariable3 1.00 1.38 (1.01, 1.88) 0.99 (0.69, 1.42) 1.14 (0.79, 1.65) 1.57 (1.09, 2.25) 0.06
1
Relative risks and 95% CIs were estimated by using Cox proportional hazards regression models.
2
The test for trend was calculated by using the median red meat consumption in each quintile as a continuous variable.
3
The multivariable model was adjusted for age, smoking status, pack-years of smoking, education, BMI, total physical
activity, histories of diabetes and hypertension, aspirin use, family history of myocardial infarction, and intakes of total
energy, alcohol, fish, fruit, and vegetables.
420 LARSSON ET AL
TABLE 3
Relative risks (95% CIs) of total stroke and stroke subtypes by quintile of fresh and processed meat consumption in
40,291 men in the cohort of Swedish men, 1998–20081
Quintile

1 2 3 4 5 P for trend2

Fresh red meat (g/d) ,33.5 33.5–50.4 50.5–67.1 67.2–83.1 .83.1

Total stroke
Person-years 80,523 82,887 77,510 91,027 75,694
No. of cases 677 526 434 413 359

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Age-adjusted 1.00 0.96 (0.85, 1.07) 0.97 (0.86, 1.10) 0.89 (0.79, 1.01) 1.06 (0.93, 1.20) 0.94
Multivariable3 1.00 0.98 (0.87, 1.10) 0.99 (0.87, 1.12) 0.92 (0.81, 1.05) 1.07 (0.93, 1.24) 0.77
Cerebral infarction
No. of cases 528 419 332 311 259
Age-adjusted 1.00 0.98 (0.86, 1.12) 0.95 (0.83, 1.09) 0.87 (0.76, 1.00) 0.99 (0.85, 1.15) 0.30
Multivariable3 1.00 1.01 (0.88, 1.15) 0.99 (0.85, 1.14) 0.91 (0.78, 1.06) 1.02 (0.87, 1.20) 0.63
Hemorrhagic stroke
No. of cases 89 68 62 61 70
Age-adjusted 1.00 0.89 (0.65, 1.22) 0.96 (0.69, 1.33) 0.88 (0.63, 1.23) 1.32 (0.96, 1.83) 0.19
Multivariable3 1.00 0.88 (0.64, 1.22) 0.93 (0.66, 1.31) 0.86 (0.61, 1.23) 1.27 (0.90, 1.80) 0.26
Processed meat (g/d) ,20.1 20.1–32.1 32.2–42.1 42.2–57.0 57.1
Total stroke
Person-years 85,209 80,692 80,725 80,339 80,676
No. of cases 568 504 475 409 453
Age-adjusted 1.00 1.06 (0.94, 1.19) 1.13 (1.00, 1.28) 1.07 (0.94, 1.21) 1.20 (1.06, 1.35) 0.007
Multivariable3 1.00 1.08 (0.95, 1.22) 1.17 (1.03, 1.33) 1.12 (0.98, 1.28) 1.23 (1.07, 1.40) 0.004
Cerebral infarction
No. of cases 450 395 349 314 341
Age-adjusted 1.00 1.05 (0.91, 1.20) 1.06 (0.92, 1.21) 1.04 (0.90, 1.20) 1.14 (0.99, 1.32) 0.08
Multivariable3 1.00 1.07 (0.93, 1.23) 1.09 (0.94, 1.26) 1.10 (0.94, 1.28) 1.18 (1.01, 1.38) 0.03
Hemorrhagic stroke
No. of cases 70 69 81 57 73
Age-adjusted 1.00 1.14 (0.82, 1.59) 1.47 (1.06, 2.02) 1.10 (0.78, 1.57) 1.40 (1.01, 1.95) 0.07
Multivariable3 1.00 1.18 (0.84, 1.66) 1.53 (1.09, 2.13) 1.14 (0.79, 1.64) 1.39 (0.97, 1.99) 0.15
1
Relative risks and 95% CIs were estimated by using Cox proportional hazards regression models.
2
The test for trend was calculated by using the median red meat consumption in each quintile as a continuous variable.
3
The multivariable model was adjusted for age, smoking status, pack-years of smoking, education, BMI, total physical
activity, histories of diabetes and hypertension, aspirin use, family history of myocardial infarction, and intakes of total energy,
alcohol, fish, fruit, and vegetables. Fresh red meat and processed meat were included in the same multivariable model.

1.44) for processed meat. The associations of fresh red meat and
processed meat consumption (analyzed as continuous variables)
with risk of total stroke were not modified by history of hy-
pertension (P interaction  0.92).
The results were slightly weaker when we adjusted red meat
consumption for total energy intake using the residual method
(15). For example, the multivariable RR of total stroke for the
highest compared with the lowest quintile of energy-adjusted
processed meat consumption was 1.17 (95% CI: 1.03, 1.33).
DISCUSSION
In this prospective cohort of men, consumption of processed
meat, but not of fresh red meat, was statistically significantly
positively associated with risk of stroke. The risk of stroke increased
by 8% for every 50-g/d increase of processed meat consumption.
Only a few previous studies have examined the association
between red meat consumption and stroke incidence or mortality
(9–12). Results from this study are consistent with those of the
Swedish Mammography Cohort (12). In that cohort, women in
the highest quintile of processed meat consumption had a sta-
tistically significant 24% increased risk of cerebral infarction
compared with women in the lowest quintile (12). Results from
the Nurses’ Health Study also showed a statistically significant
positive association between red and processed meat consump-
tion and risk of cerebral infarction (P for trend = 0.005) (9). No
association between red meat consumption and incidence of
cerebral infarction or hemorrhagic stroke was observed in the
Health Professionals Follow-Up Study (10). In a cohort of
Japanese men and women, no association was observed between
consumption of fresh beef and pork or pork products (such as
ham and sausage) and total stroke mortality (11).
Red meat is a major source of bioavailable heme iron. Elevated
iron stores may cause oxidative injury and has been associated
with inflammation (16, 17), insulin resistance (18, 19), the
metabolic syndrome (20), and type 2 diabetes (21). In an ex-
perimental study, the intracellular iron chelator desferrioxamine
inhibited inflammation and atherosclerosis in mice, which sug-
gests a role of iron in atherogenesis (22). A high intake of
cholesterol, which is found in red meat, has been shown to raise
blood total and LDL-cholesterol concentrations (23, 24) and thus
may increase the risk of stroke (25, 26).
Sodium found in processed meats may explain the observed
positive association between processed meat consumption and risk
of total stroke and cerebral infarction. Reduced sodium intake has
been found to significantly lower blood pressure in hypertensive
 MEAT CONSUMPTION AND STROKE
individuals (27). Hypertension is one of the most important risk
factors for stroke. In a cohort study of 4304 men and women, high
consumption of red and processed meat was associated with an
increased risk of high blood pressure (6). Likewise, a cohort of
28,766 US women found a positive association between total red
meat consumption and incidence of hypertension (7). A high
sodium intake may also promote vascular stiffness (28). Fur-
thermore, a low-sodium diet has been shown to reduce oxidative
stress and improve vascular function in salt-sensitive individuals
(29). Given that consumption of processed meat but not of fresh
meat was positively associated with stroke risk, it is more likely
that sodium and/or nitrite in processed meat rather than heme iron
and cholesterol explain the observed association. These findings
imply that meats that are currently considered healthier by the
public and policymakers—such as low-fat deli turkey, ham, and
bologna—may increase the risk of stroke.
The major strengths of this study included its prospective and
population-based design and the virtually complete follow-up of
study participants by linkage with population-based Swedish
registers. Furthermore, this study included a large number of in-
cident stroke cases, leading to high statistical power. This was the
largest study to date on red and processed meat consumption in
relation to risk of stroke. A limitation of this study was its ob-
servational design. Hence, we cannot entirely exclude the possi-
bility that men with high consumption of red and processed meat
were at increased risk of stroke as a result of other unhealthy habits
and behaviors. However, our results persisted after adjustment for
potential confounders, including other dietary factors. Residual
confounding due to incomplete adjustment for other risk factors for
stroke may have led to either attenuated or exaggerated risk
estimates. Because diet was assessed with the use of a self-
administered food-frequency questionnaire, and only once (at
baseline), some measurement error in assessing meat consumption
was inevitable. Nondifferential misclassification would most likely
lead to an underestimation of the risk estimates for the associations
between meat consumption and risk of stroke.
In conclusion, the results from this prospective cohort of men
suggest that high consumption of processed meat may increase
the risk of stroke. The associations of fresh red meat and pro-
cessed meat consumption with stroke risk merit investigation in
further prospective studies.
The authors’ responsibilities were as follows—SCL and AW: study con-
cept and design; AW: data collection; SCL: statistical analyses and manuscript
writing; and SCL, JV, and AW: interpretation of results and critical revision of
manuscript. None of the authors had a personal or financial conflict of interest.
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