Introduction
Materials and methods
Summary of cohort studies of red meat and prostate cancer
Author and Year | Cohort | Exposure Variable (Definition) | Number of Exposed Cases | Analytical Comparison | Relative Risk Estimatea(95% CI) | Statistical Adjustment |
---|---|---|---|---|---|---|
Allen et al. 2008 | European Prospective Investigation into Cancer and Nutrition (EPIC) | Red meat | 371 | 5th quintile vs. 1 (median intake = 90 g/day) | 0.96 (0.82-1.12) | Stratified by center and adjusted for education, marital status, height, weight and energy intake |
Processed meat | 590 | 5th quintile vs. 1 (median intake = 88 g/day) | 0.93 (0.79-1.09) | |||
Allen et al. 2004 | Hiroshima and Nagasaki, Japan | Pork | 8 | Almost daily vs. <2 times/wk | 1.24 (0.61-2.54) | Age, calendar period, city of residence, radiation dose, and education level |
Chan et al. 2000 | ATBC Study (Finland) | Red meat | NR | Quintiles of intake: 5 vs. 1 | 0.7 (0.5-1.1) | Supplementation, education, and quintiles of age, BMI, energy and smoking |
Cross et al. 2007 | NIH-AARP Diet & Health Study | Red meat (all types of beef, pork, and lamb; including bacon, beef, cold cuts, ham, hamburger, hot dogs, liver, pork, sausage, and steak; meats added to mixtures, such as pizza, chili, lasagna, and stew) | Quintiles of intake: 5 vs. 1 62.7 g/1000 kcal vs. 9.8 | Age, sex, education, marital status, family hx of cancer, race, BMI, smoking, frequency of vigorous physical activity, total energy intake, alcohol intake, and fruit and vegetable consumption | ||
3,950 | All cases | 1.01 (0.96-1.07) | ||||
NR | Advanced cases | 1.15 (0.98-1.36) | ||||
Processed meat (bacon, red meat sausage, poultry sausage, luncheon meats, cold cuts, ham, hot dogs, meats added to mixtures, such as pizza, chili, lasagna, and stew) | Quintiles of intake: 5 vs. 1 22.6 g/1000 kcal vs. 1.6 | |||||
4,196 | All cases | 1.02 (0.97-1.07) | ||||
NR | Advanced cases | 1.22 (1.05-1.43) | ||||
Cross et al. 2005 | PLCO Cancer Screening Trial | Red meat (all beef, pork, and lamb [processed & non-processed]) | Quintiles of intake: 5 vs. 1 | Age, race, study center, family hx of prostate cancer, hx of diabetes, number of screening exams during follow-up, smoking status, physical activity, aspirin use, BMI, and intake of total energy, supplemental vitamin E, lycopene | ||
NR | All cases | 0.91 (0.73-1.12) | ||||
NR | Incident cases | 0.81 (0.62-1.06) | ||||
NR | Advanced cases | 0.92 (0.66-1.29) | ||||
Processed meat (Ham, hot dogs, liver, cold cuts, sausage, bacon) | Quintiles of intake 5 vs. 1 | |||||
NR | All cases | 1.14 (0.93-1.39) | ||||
NR | Incident cases | 1.16 (0.91-1.50) | ||||
NR | Advanced cases | 1.37 (0.99-1.90) | ||||
Gann et al. 1994 * | Physician's Health Study | Beef, pork or lamb as a main dish | NR | Consumption: ≥5-6 times/wk vs. ≤1-3 times/month | 2.51 (0.93-6.74) | Matched by age and smoking status |
Hsing et al. 1990 | Lutheran Brotherhood Society Cohort | Meat (beef, bacon, fresh pork, and smoked ham) | Mortalities | Intake (times/month) | Age and tobacco use | |
27 | >39 vs. <17 | 0.8 (0.5-1.3) | ||||
Koutros et al. 2008 | Agricultural Health Study (Iowa and North Carolina) | Quintiles of intake: 5 vs. 1 | Adjusted for age, state of residence, race, family hx of prostate cancer, and smoking status | |||
Red meat | 105 | All cases | 1.10 (0.85-1.43) | |||
95 | Incident cases | 1.11 (0.84-1.46) | ||||
21 | Advanced cases | 0.89 (0.50-1.60) | ||||
Bacon/sausage | 140 | All cases | 0.98 (0.78-1.24) | |||
125 | Incident cases | 0.90 (0.70-1.15) | ||||
21 | Advanced cases | 0.69 (0.40-1.18) | ||||
Le Marchand et al. 1994 | Hawaii | Pork | NR | Quantile of intake 4 vs. 1 (range for cohort 0-118 g/wk) | 1.1 (0.7-1.7) | Age, ethnicity, and income |
Beef | Tertile of intake 3 vs. 1 (range for cohort 210-381 g/wk) | Age, ethnicity, and income by proportional hazards regression | ||||
NR | All cases | 1.6 (1.1-2.4) | ||||
NR | Diagnosis age ≤72.5 yrs | 2.2 (1.2-4.1) | ||||
NR | Diagnosis age >72.5 yrs | 1.4 (0.8-2.5) | ||||
NR | Diagnosis age ≤72.5 yrs, localized stage prostate cancer | 2.7 (NR) | ||||
NR | Diagnosis age >72.5 yrs, localized stage prostate cancer | 2.0 (NR) | ||||
NR | Diagnosis age ≤72.5 yrs, regional and distant stage prostate cancer | 1.4 (NR) | ||||
NR | Diagnosis age >72.5 yrs, regional and distant stage prostate cancer | 0.8 (NR) | ||||
Processed meat | NR | Quantiles of intake 4 vs. 1(range for cohort 0-129 g/wk) | 1.2 (0.8-1.9) | |||
Michaud et al. 2001 | Health Professionals Follow-Up Study | Red meat (processed meats; bacon; hot dogs; hamburger; beef, pork, or lamb as a sandwich, mixed dish or main dish) | Quintiles 5 vs. 1 | 0.91 (0.75-1.1) | Age, calories, calcium, smoking, tomato sauce, vigorous exercise, saturated fat and alpha-linolenic fat | |
315 | Prostate cancer excluding stage A1 | |||||
104 | Advanced prostate cancer | 1.15 (0.80-1.7) | ||||
55 | Metastatic prostate cancer | 1.50 (0.88-2.5) | Also adjusted for period, in addition to covariates above | |||
Beef, pork or lamb (main dish) | 38 | Intake of 5+ vs. 0/wk, metastatic prostate cancer | 1.35 (0.72-2.5) | Age, calories, calcium, smoking, tomato sauce, vigorous exercise, saturated and alpha linolenic fat | ||
Intake of 2+ vs. 0/wk, | ||||||
Beef, pork or lamb (sandwich or mixed dish) | 64 | Metastatic prostate cancer | 0.96 (0.62-1.5) | |||
Hamburger | 68 | Metastatic prostate cancer | 1.08 (0.66-1.8) | |||
Processed meats | 71 | Metastatic prostate cancer | 1.39 (0.94-2.1) | Age, calories, calcium, smoking, tomato sauce, vigorous exercise, saturated fat, and alpha-linolenic fat | ||
Bacon | 50 | Metastatic prostate cancer | 1.33 (0.89-2.0) | |||
Hot dogs | 15 | Metastatic prostate cancer | 0.85 (0.48-1.5) | |||
Mills et al. 1989 | Seventh Day Adventists | Beef hamburger | 43 | Consumed ≥1 time/wk vs. never | 1.07 (0.73-1.59) | Age |
Beef steak | 17 | 0.81 (0.72-1.50) | ||||
Other beef and veal | 32 | 1.09 (0.71-1.67) | ||||
Beef index | 63 | 1.21 (0.83-1.75) | ||||
Neuhouser et al. 2007 | CARET | Red meat | Quartiles of intake: high vs. low | Age, energy intake, BMI, smoking, family hx of prostate cancer | ||
NR | Prostate cancer | 0.76-1.62§ (NR) | ||||
Park et al. 2007 | Multiethnic Cohort Study | Quintile of intake: 5 vs. 1 | ||||
Red meat (beef, pork, and lamb) | NR | Total prostate cancer | 0.97 (0.87-1.07) | Time on study, ethnicity, family hx of prostate cancer, education, BMI, smoking status, energy intake | ||
NR | Nonlocalized or high-grade cancer | 0.95 (0.79-1.14) | ||||
226 | African Americans | 1.05 (0.86-1.27) | Time on study, family hx of prostate cancer, education, BMI, smoking status, energy intake | |||
109 | Japanese Americans | 1.04 (0.82-1.31) | ||||
270 | Latinos | 0.87 (0.72-1.06) | ||||
115 | Whites | 0.83 (0.65-1.05) | ||||
Beef | NR | Total prostate cancer | 0.98 (0.88-1.08) | Time on study, ethnicity, family hx of prostate cancer, education, BMI, smoking status, energy intake | ||
NR | Nonlocalized or high-grade cancer | 0.97 (0.81-1.16) | ||||
Pork | NR | Total prostate cancer | 0.97 (0.88-1.08) | |||
NR | Nonlocalized or high-grade cancer | 0.92 (0.76-1.11) | ||||
Processed meat (processed red meat and processed poultry) | Quintile of intake: 5 vs. 1 | |||||
NR | Total prostate cancer | 1.01 (0.91-1.12) | Time on study, ethnicity, family hx of prostate cancer, education, BMI, smoking status, energy intake | |||
NR | Nonlocalized or high-grade cancer | 0.92 (0.77-1.11) | ||||
373 | African Americans | 1.00 (0.83-1.20) | Time on study, family hx of prostate cancer, education, BMI, smoking status, energy intake | |||
181 | Japanese Americans | 1.09 (0.88-1.34) | ||||
134 | Latinos | 0.86 (0.69-1.08) | ||||
157 | Whites | 1.02 (0.82-1.27) | ||||
Rodriguez et al. 2006 | Cancer Prevention Study II | Total processed plus unprocessed red meat (includes both processed meat and red meat) | Intake: ≥657 vs. <246 g/wk | Age at entry, total calorie intake, BMI, education, family hx of prostate cancer, hx of PSA testing, and hx of diabetes | ||
27 | All prostate cancer, Blacks | 2.0 (1.0-4.2) | ||||
1,239 | All prostate cancer, Whites | 1.0 (0.9-1.0) | ||||
56 | Metastatic prostate cancer, Whites | 0.8 (0.5-1.3) | ||||
Unprocessed red meat | Intake: ≥423 vs. <137 g/wk | |||||
20 | All prostate cancer, Blacks | 1.7 (0.8-3.9) | ||||
1,557 | All prostate cancer, Whites | 1.0 (0.9-1.1) | ||||
69 | Metastatic prostate cancer, Whites | 0.8 (0.5-1.2) | ||||
Processed meats (includes both cooked processed meat and lunchmeat) | Intake ≥247 vs. <59 g/wk | |||||
28 | All prostate cancer, Blacks | 2.4 (1.2-4.9) | ||||
765 | All prostate cancer, Whites | 1.0 (0.9-1.1) | ||||
37 | Metastatic prostate cancer, Whites | 1.1 (0.7-1.7) | ||||
Cooked processed meat | Intake ≥165 vs. <38 g/wk | |||||
29 | All prostate cancer, Blacks | 2.7 (1.3-5.3) | ||||
369 | All prostate cancer, Whites | 1.0 (0.9-1.2) | ||||
21 | Metastatic prostate cancer, Whites | 1.2 (0.7-2.1) | ||||
Lunchmeat | Intake ≥56 g/wk vs. none | |||||
29 | All prostate cancer, Blacks | 1.0 (0.6-1.9) | ||||
1,845 | All prostate cancer, Whites | 1.0 (1.0-1.1) | ||||
88 | Metastatic prostate cancer, Whites | 1.0 (0.7-1.5) | ||||
Rohrmann et al. 2007 | CLUE II | Red meat (hamburgers, beef, beef stew, pork, hot dogs, ham/lunch meats, bacon, sausages) | Tertile of daily consumption (3 vs. 1) | Age, energy intake, consumption of tomato products, BMI at age 21, and intake of saturated fat | ||
51 | Total prostate cancer | 0.87 (0.59-1.32) | ||||
12 | High-stage prostate cancer | 0.87 (0.39-1.93) | ||||
17 | Low-stage prostate cancer | 0.60 (0.31-1.18) | ||||
Beef (beef, beef stew, pork, hot dogs, ham/lunch meats, bacon, sausages) | Consumption: >5 vs. ≤1 times/wk | |||||
84 | Total prostate cancer | 1.16 (0.74-1.81) | ||||
18 | High-stage prostate cancer | 0.83 (0.36-1.92) | ||||
35 | Low-stage prostate cancer | 1.72 (0.79-3.79) | ||||
Pork | Consumption: ≥1 times/wk vs. never | |||||
39 | Total prostate cancer | 1.17 (0.77-1.78) | ||||
12 | High-stage prostate cancer | 1.98 (0.87-4.53) | ||||
15 | Low-stage prostate cancer | 0.88 (0.46-1.70) | ||||
Processed meats | Consumption : >5 vs. ≤1 times/wk | |||||
96 | Total prostate cancer | 1.53 (0.98-2.39) | ||||
27 | High-stage prostate cancer | 2.24 (0.90-5.59) | ||||
32 | Low-stage prostate cancer | 1.30 (0.62-2.74) | ||||
Consumption : ≥1 vs. <1 times/wk | ||||||
Sausages | 43 | Total prostate cancer | 1.16 (0.79-1.73) | Age, energy intake, saturated fat intake, consumption of tomato products, and BMI at age 21 | ||
17 | High-stage prostate cancer | 2.83 (1.34-5.99) | ||||
14 | Low-stage prostate cancer | 0.75 (0.39-1.44) | ||||
Bacon | 74 | Total prostate cancer | 1.32 (0.91-1.93) | |||
22 | High-stage prostate cancer | 2.10 (0.97-4.53) | ||||
31 | Low-stage prostate cancer | 1.35 (0.74-2.44) | ||||
Ham/lunch meat | 115 | Total prostate cancer | 1.54 (1.01-2.33) | |||
30 | High-stage prostate cancer | 1.94 (0.82-4.56) | ||||
43 | Low-stage prostate cancer | 2.00 (0.94-4.25) | ||||
Hot dogs | 45 | Total prostate cancer | 1.12 (0.73-1.73) | |||
13 | High-stage prostate cancer | 1.71 (0.70-4.14) | ||||
18 | Low-stage prostate cancer | 0.96 (0.50-1.88) | ||||
Schuurman et al. 1999** | Netherlands Cohort Study | Continuous variables of 25 g/day increments | Age, family hx of prostate cancer, socioeconomic status, total fresh meat and poultry | |||
Beef | NR | All tumors | 1.00 (0.89-1.12) | |||
NR | Localized tumors | 0.95 (0.80-1.12) | ||||
NR | Advanced tumors | 0.92 (0.77-1.10) | ||||
Pork | NR | All tumors | 1.06 (0.96-1.18) | |||
NR | Localized tumors | 1.16 (1.00-1.34) | ||||
NR | Advanced tumors | 1.06 (0.91-1.23) | ||||
Minced meat (beef and pork) | NR | All tumors | 0.86 (0.74-1.01) | |||
NR | Localized tumors | 0.84 (0.66-1.07) | ||||
NR | Advanced tumors | 0.90 (0.71-1.14) | ||||
Continuous variables of 5 g/day increments | ||||||
Liver | NR | All tumors | 0.92 (0.82-1.04) | |||
NR | Localized tumors | 0.99 (0.85-1.17) | ||||
NR | Advanced tumors | 0.79 (0.63-0.99) | ||||
Other meat (horsemeat, lamb, mutton, and veal) | NR | All tumors | 1.06 (0.99-1.15) | |||
NR | Localized tumors | 1.04 (0.93-1.16) | ||||
NR | Advanced tumors | 1.09 (0.98-1.21) | ||||
Cured meat (boiled ham, bacon. Lean meat products including smoked beef, and other sliced cold meats) | 123 | Quintiles of intake 5 vs. 1 36 g/day vs. 0 | 1.37 (1.00-1.89) | Age, family hx of prostate cancer and socioeconomic status | ||
NR | Continuous variables of 15 g/day increments Advanced tumors | 1.00 (0.88-1.14) | ||||
Severson et al. 1989 | Hawaii | Ham, bacon, sausage | 35 | ≥5/vs. ≤1 times/wk | 1.11 (0.75-1.65) | Age |
Wu et al. 2006 | US Health Professionals | Total red meat (hamburger, beef, lamb, and pork as main dish; beef, lamb, & pork as main dish or mixed dish) | Intake quintile 5 vs. 1 | Age, height, smoking, family hx of prostate cancer, race, hx of vasectomy, vigorous exercise, BMI, alcohol intake, and total energy intake | ||
41 | Age <65 yrs old | 2.12 (1.18-3.78) | ||||
72 | Age ≥65 yrs old | 1.21 (0.85-1.74) | ||||
Processed meats (salami, bologna, or other processed meat sandwiches; sausage, kielbasa, hot dogs, and bacon) | Intake quintile 5 vs. 1 | |||||
34 | Age <65 years old | 0.85 (0.47-1.56) | ||||
79 | Age ≥65 years old | 1.51 (1.00-2.26) |
Summary of Meta-Analysis Results for Red and Processed Meat Intake and Prostate Cancer
Model | # Studies | SRRE (95% CI) | P-Heterogeneity |
---|---|---|---|
Red Meat
| |||
Total model (includes individual red meat items) | 15 | 1.00 (0.96-1.05) | 0.264 |
Red meat specific variable only ("red meat" as a food group) | 11 | 0.98 (0.93-1.04) | 0.353 |
Studies published during 2000-2009 | 10 | 0.99 (0.95-1.03) | 0.593 |
Studies published prior to 2000 | 5 | 1.13 (0.92-1.37) | 0.108 |
Studies that adjusted for at least three of the following factors: energy, smoking, family history of cancer, age, race | 9 | 0.99 (0.95-1.03) | 0.536 |
Le Marchand removed (13 food item questionnaire) | 13 | 0.99 (0.95-1.03) | 0.401 |
Gann removed (outlier study) | 13 | 0.99 (0.95-1.04) | 0.364 |
Advanced prostate cancer | 8 | 1.01 (0.94-1.09) | 0.657 |
100 g increment (total prostate cancer)* | 9 | 1.00 (0.95-1.05) | 0.007 |
100 g increment (advanced cancer)* | 5 | 0.97 (0.91-1.02) | 0.571 |
Processed Meat
| |||
Total model | 11 | 1.05 (0.99-1.12) | 0.088 |
Michaud removed (data for metastatic prostate cancer only) | 10 | 1.04 (0.98-1.11) | 0.113 |
Studies published during 2000-2009 [Note: these are also the studies that adjusted for at least three of the following factors: energy, smoking, family history of cancer, age, race] | 8 | 1.04 (0.97-1.11) | 0.085 |
Studies published prior to 2000 [Note: these studies did not simultaneously adjust for three of the above factors] | 3 | 1.25 (1.00-1.54) | 0.705 |
Advanced prostate cancer | 8 | 1.10 (0.95-1.27) | 0.032 |
30 g increment (total prostate cancer) | 10 | 1.02 (1.00-1.04) | 0.274 |
30 g increment (advanced cancer) | 6 | 1.01 (0.90-1.14) | 0.020 |