Red meat consumption and risk of stroke in Swedish men13

Susanna C Larsson, Jarmo Virtamo, and Alicja Wolk

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 (24) 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 consumption in relation to stroke incidence or mortality are sparse
and results are inconsistent (912). 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 associated 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

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 4579 y and resided in the
rebro counties of central Sweden received
Vastmanland and O
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 excluded those with an erroneous or a missing national identification number and those with implausible values for total energy
intake (ie, 3 SDs from the loge-transformed mean energy intake). We further excluded men with a history of stroke, coronary 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 Institute 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 Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, 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.

Am J Clin Nutr 2011;94:41721. Printed in USA. 2011 American Society for Nutrition

417

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ABSTRACT
Background: Red and processed meat consumption has been implicated 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 4579 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 Discharge Registry. Consumption of processed meat, but not of fresh
red meat, was positively associated with risk of stroke. The multivariable 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 indicate that processed meat consumption is positively associated with
risk of stroke. The Cohort of Swedish Men is registered at clinicaltrials.gov as NCT01127711.
Am J Clin Nutr 2011;94:41721.

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 multiplied 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

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 subjects age (in mo) at start of follow-up, and exit
time was defined as a subjects age (in mo) at stroke diagnosis or
censoring. The multivariable model included the following variables: smoking status and pack-years of smoking (never; past ,20,

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 processed 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 association 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 consumption was statistically significantly positively associated
with risk of total stroke and cerebral infarction but not hemorrhagic 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 consumption was 1.19 (95% CI: 1.03, 1.39).

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Diet was assessed with a 96-item food-frequency questionnaire. 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 processed meat. Fresh red meat consumption was calculated by using
the frequency of consumption and age-specific portion size information of all types of fresh and minced pork, beef, and veal.
Processed meats included sausages, hot dogs, salami, ham, processed meat cuts, liver pate, and blood sausage. Total red meat
was the sum of fresh red meat and processed meat. The foodfrequency questionnaire has been validated for nutrients (14), but
not for food items, in 248 Swedish men aged 4074 y; the mean
Spearman correlation coefficients between estimates from the
dietary questionnaire and the mean of fourteen 24-h recall interviews 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 pate) to 133150 g (blood sausage).

2039, or 40 pack-years; or current ,20, 2039, or 40 packyears), education (less than high school, high school, or university), BMI (,20, 2024.9, 2529.9, or 30), total physical activity (quartiles), diabetes (yes or no), history of hypertension (yes
or no), aspirin use (yes or no), family history of myocardial infarction 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
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).

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MEAT CONSUMPTION AND STROKE

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
Characteristic

2
3

P value2

56.6 6 8.2
16.0
26.9
25.9 6 3.3
41.8 6 4.9
6.6
21.7
34.2
14.8

,0.001
,0.001
0.36
,0.001
0.56
0.11
0.59
,0.001
0.64

3199
11.8
33.9
27.4
10.5
0.4
1.7
3.1
4.5
6.0

6
6
6
6
6
6
6
6
6
6

746
8.9
7.1
3.8
1.9
0.4
1.1
1.5
2.4
3.1

Q1

Processed meat
P value2

Q5

63.4 6 9.8 56.6 6 8.4

15.7
18.7
26.5
26.6
25.8 6 3.4 25.9 6 3.3
41.9 6 4.9 41.6 6 4.8
5.5
6.0
22.8
21.2
31.1
33.0
13.8
14.6

,0.001 2348 6 777 3084 6 769

,0.001
8.9 6 8.3 11.9 6 9.0
0.37
33.8 6 9.2 33.8 6 7.1
,0.001 24.0 6 4.8 26.8 6 3.8
,0.001
9.6 6 2.5 10.4 6 2.0
,0.001
0.2 6 0.4 0.4 6 0.4
,0.001
1.4 6 1.2 1.7 6 1.1
,0.001
2.2 6 1.7 3.1 6 1.6
,0.001
4.2 6 2.6 4.3 6 2.4
,0.001
5.4 6 3.2 5.9 6 3.1

,0.001
,0.001
0.25
0.21
,0.001
0.21
0.007
0.006
0.48

Q1

Q5

P value2

61.6 6 9.9 58.3 6 8.5 ,0.001

23.3
13.4
,0.001
25.5
25.6
0.42
25.6 6 3.3 25.9 6 3.3 ,0.001
41.4 6 4.8 41.9 6 4.9 ,0.001
4.7
6.6
0.01
21.2
23.1
0.01
30.5
33.6
,0.001
14.4
15.1
0.60

,0.001 2368 6 781 3130 6 765 ,0.001

,0.001 10.0 6 9.0 10.9 6 8.8 ,0.001
0.62
33.6 6 9.4 33.8 6 6.9
0.92
,0.001 23.6 6 4.6 27.3 6 3.7 ,0.001
,0.001
9.6 6 2.5 10.5 6 1.9 ,0.001
,0.001
0.3 6 0.3 0.3 6 0.4 ,0.001
,0.001
1.5 6 1.3 1.6 6 1.1 ,0.001
,0.001
2.5 6 1.9 2.8 6 1.5 ,0.001
0.002
4.1 6 2.6 4.5 6 2.4 ,0.001
,0.001
5.4 6 3.2 6.0 6 3.0 ,0.001

MET, metabolic equivalent of energy expenditure (kcal/kg h).

P for trend across quintiles of meat consumption was calculated by using generalized linear models.
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 consumption. 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 association 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, 199820081
Red meat consumption (g/d)

Total stroke
Person-years
No. of cases
Age-adjusted
Multivariable3
Cerebral infarction
No. of cases
Age-adjusted
Multivariable3
Hemorrhagic stroke
No. of cases
Age-adjusted
Multivariable3
1

,62.5

62.588.3

88.4110.3

110.4136.1

136.2

P for trend2

80,842
644
1.00
1.00

79,858
554
1.03 (0.92, 1.15)
1.06 (0.94, 1.19)

82,414
466
1.03 (0.91, 1.16)
1.08 (0.95, 1.22)

82,086
361
0.96 (0.84, 1.10)
1.02 (0.89, 1.17)

82,441
384
1.10 (0.97, 1.25)
1.15 (1.00, 1.33)

0.33
0.10

515
1.00
1.00

420
0.97 (0.85, 1.11)
1.01 (0.88, 1.15)

357
0.99 (0.87, 1.14)
1.04 (0.90, 1.20)

279
0.94 (0.81, 1.09)
1.00 (0.85, 1.17)

278
1.01 (0.87, 1.17)
1.06 (0.90, 1.25)

0.91
0.53

75
1.00
1.00

89
1.36 (1.00, 1.84)
1.38 (1.01, 1.88)

56
0.99 (0.70, 1.39)
0.99 (0.69, 1.42)

56
1.09 (0.77, 1.55)
1.14 (0.79, 1.65)

74
1.52 (1.10, 2.12)
1.57 (1.09, 2.25)

0.06
0.06

Relative risks and 95% CIs were estimated by using Cox proportional hazards regression models.
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.
2

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Q5

Q1

Age (y)
63.2 6 9.83
Education, university (%)
18.4
Current smoker (%)
26.2
BMI (kg/m2)
25.7 6 3.3
Total physical activity (MET-h/d)
41.8 6 4.8
History of diabetes (%)
5.2
History of hypertension (%)
21.8
Aspirin use (%)
30.7
Family history of myocardial infarction (%)
13.6
Daily dietary intake
Energy (kcal)
2286 6 745
Alcohol (g)
9.0 6 8.4
Saturated fat (g)
33.7 6 9.4
Monounsaturated fat (g)
23.4 6 4.7
Polyunsaturated fat (g)
9.5 6 2.5
Fish (servings)
0.2 6 0.3
Fruit (servings)
1.4 6 1.2
Vegetables (servings)
2.2 6 1.7
Whole grains (servings)
4.2 6 2.6
5.3 6 3.1
Dairy foods (servings)

Fresh red meat

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, 199820081
Quintile
1

33.550.4

50.567.1

67.283.1

.83.1

P for trend2

82,887
77,510
91,027
75,694
526
434
413
359
0.96 (0.85, 1.07) 0.97 (0.86, 1.10) 0.89 (0.79, 1.01) 1.06 (0.93, 1.20)
0.98 (0.87, 1.10) 0.99 (0.87, 1.12) 0.92 (0.81, 1.05) 1.07 (0.93, 1.24)

0.94
0.77

419
332
311
259
0.98 (0.86, 1.12) 0.95 (0.83, 1.09) 0.87 (0.76, 1.00) 0.99 (0.85, 1.15)
1.01 (0.88, 1.15) 0.99 (0.85, 1.14) 0.91 (0.78, 1.06) 1.02 (0.87, 1.20)

0.30
0.63

68
62
61
70
0.89 (0.65, 1.22) 0.96 (0.69, 1.33) 0.88 (0.63, 1.23) 1.32 (0.96, 1.83)
0.88 (0.64, 1.22) 0.93 (0.66, 1.31) 0.86 (0.61, 1.23) 1.27 (0.90, 1.80)
20.132.1
32.242.1
42.257.0
57.1

0.19
0.26

80,692
80,725
80,339
80,676
504
475
409
453
1.06 (0.94, 1.19) 1.13 (1.00, 1.28) 1.07 (0.94, 1.21) 1.20 (1.06, 1.35)
1.08 (0.95, 1.22) 1.17 (1.03, 1.33) 1.12 (0.98, 1.28) 1.23 (1.07, 1.40)

0.007
0.004

395
349
314
341
1.05 (0.91, 1.20) 1.06 (0.92, 1.21) 1.04 (0.90, 1.20) 1.14 (0.99, 1.32)
1.07 (0.93, 1.23) 1.09 (0.94, 1.26) 1.10 (0.94, 1.28) 1.18 (1.01, 1.38)

0.08
0.03

69
81
57
73
1.14 (0.82, 1.59) 1.47 (1.06, 2.02) 1.10 (0.78, 1.57) 1.40 (1.01, 1.95)
1.18 (0.84, 1.66) 1.53 (1.09, 2.13) 1.14 (0.79, 1.64) 1.39 (0.97, 1.99)

0.07
0.15

Relative risks and 95% CIs were estimated by using Cox proportional hazards regression models.
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.
2

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 hypertension (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
(912). 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 statistically 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 consumption 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 experimental study, the intracellular iron chelator desferrioxamine
inhibited inflammation and atherosclerosis in mice, which suggests 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

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Fresh red meat (g/d) ,33.5

Total stroke
Person-years
80,523
No. of cases
677
Age-adjusted
1.00
Multivariable3
1.00
Cerebral infarction
No. of cases
528
Age-adjusted
1.00
Multivariable3
1.00
Hemorrhagic stroke
No. of cases
89
Age-adjusted
1.00
Multivariable3
1.00
Processed meat (g/d) ,20.1
Total stroke
Person-years
85,209
No. of cases
568
Age-adjusted
1.00
Multivariable3
1.00
Cerebral infarction
No. of cases
450
Age-adjusted
1.00
Multivariable3
1.00
Hemorrhagic stroke
No. of cases
70
Age-adjusted
1.00
Multivariable3
1.00

MEAT CONSUMPTION AND STROKE

The authors responsibilities were as followsSCL and AW: study concept 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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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). Furthermore, 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 policymakerssuch as low-fat deli turkey, ham, and
bolognamay 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 incident 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 observational design. Hence, we cannot entirely exclude the possibility 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 selfadministered 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 processed meat consumption with stroke risk merit investigation in
further prospective studies.

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