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Description:
Dietary guideline recommendations require consideration of the certainty in the evidence, the magnitude of potential benefits and harms, and explicit consideration of people's values and preferences. A set of recommendations on red meat and processed meat consumption was developed on the basis of 5 de novo systematic reviews that considered all of these issues.
Methods:
The recommendations were developed by using the Nutritional Recommendations (NutriRECS) guideline development process, which includes rigorous systematic review methodology, and GRADE methods to rate the certainty of evidence for each outcome and to move from evidence to recommendations. A panel of 14 members, including 3 community members, from 7 countries voted on the final recommendations. Strict criteria limited the conflicts of interest among panel members. Considerations of environmental impact or animal welfare did not bear on the recommendations. Four systematic reviews addressed the health effects associated with red meat and processed meat consumption, and 1 systematic review addressed people's health-related values and preferences regarding meat consumption.
Recommendations:
The panel suggests that adults continue current unprocessed red meat consumption (weak recommendation, low-certainty evidence). Similarly, the panel suggests adults continue current processed meat consumption (weak recommendation, low-certainty evidence).
Primary Funding Source:
None. (PROSPERO 2017: CRD42017074074; PROSPERO 2018: CRD42018088854)
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Author, Article and Disclosure Information
Grant Support: Dr. El Dib received a São Paulo Research Foundation (FAPESP) (2018/11205-6) scholarship and funding from the National Council for Scientific and Technological Development (CNPq) (CNPq 310953/2015-4) and the Faculty of Medicine, Dalhousie University.
Disclosures: Dr. Johnston received a grant from Texas A&M AgriLife Research to fund investigator-driven research related to saturated and polyunsaturated fats within the 36-month reporting period required by the International Committee of Medical Journal Editors, as well as funding received from the International Life Science Institute (North America) that ended before the 36-month reporting period. Dr. de Souza reports personal fees and nonfinancial support from the World Health Organization; personal fees from the Canadian Institutes of Health Research/Health Canada and McMaster Children's Hospital; grants from the Canadian Foundation for Dietetic Research, Canadian Institutes of Health Research, Hamilton Health Sciences Corporation, and Hamilton Health Sciences Corporation/Population Health Research Institute outside of the submitted work. He also reports other support from the College of Family Physicians of Canada, Royal College (speaking at a recent conference), and he has served on the Board of Directors of the Helderleigh Foundation. Dr. Patel reports grants from the National Institutes of Health, Sanofi, and the National Science Foundation; personal fees from XY.health, Inc, doc.ai, Janssen, and the US Centers for Disease Control and Prevention; and nonfinancial support from Microsoft, Inc, and Amazon, Inc, during the conduct of the study and equity in XY.health, Inc, outside the submitted work. A summary of disclosures is provided in the Appendix Table. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1621.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
>Reproducible Research Statement: Study protocol: Available at PROSPERO (www.crd.york.ac.uk/prospero/) (CRD42017074074). Statistical code and data set: Available upon request from Dr. Johnston (e-mail, [email protected]).
Corresponding Author: Bradley C. Johnston, PhD, Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Room 404, 5790 University Avenue, Halifax, Nova Scotia, Canada, B3H 1V7; e-mail, [email protected].
Current Author Addresses: Dr. Johnston: Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Room 404, 5790 University Avenue, Halifax, Nova Scotia, Canada B3H 1V7.
Ms. Zeraatkar and Dr. Guyatt: Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
Dr. Han: Department of Preventive Medicine, College of Medicine, Chosun University, 309 Philmun-daero, Dong-gu, Gwangju 61452, Korea.
Dr. Vernooij: Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht 3511 DT, the Netherlands.
Ms. Valli and Dr. Alonso-Coello: Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica de Sant Pau (IIB Sant Pau-CIBERESP), Carrer de Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
Dr. El Dib: Institute of Science and Technology, São José dos Campos, Avenida Engenheiro Francisco José Longo, 777, Jardim São Dimas, São Paulo 12245-000, Brazil.
Ms. Marshall: Cochrane Consumer Group, 6 Horomona Road, Wellington 5034, New Zealand.
Dr. Stover: Texas A&M AgriLife Research, College of Agriculture and Life Sciences, Texas A&M University, Agriculture and Life Sciences Building, 600 John Kimbrough Boulevard, Suite 510, College Station, TX 77843-2142.
Dr. Fairweather-Taitt: Norwich Medical School, University of East Anglia, Norwich Research Park, Floor 2, Bob Champion Research and Education Building, James Watson Road, Norwich NR4 7UQ, United Kingdom.
Dr. Wojcik: Department of Medical Sociology, Jagiellonian University Medical College, 7 Kopernika Street, 31-034 Kraków, Poland.
Mr. Bhatia: 1503-33 Shore Breeze Drive, Etobicoke, Ontario M8V 0G1, Canada.
Dr. de Souza: Population Health Research Institute, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
Dr. Brotons: Sardenya Primary Health Care Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya 466, Barcelona 08025, Spain.
Dr. Meerpohl: Institute for Evidence in Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, Freiburg 79110, Germany.
Dr. Patel: Department of Biomedical Informatics, Harvard University, 10 Shattuck Street, Room 302, Boston, MA 0211521
Dr. Djulbegovic: City of Hope, 1500 East Duarte Road, Duarte, CA 91010.
Dr. Bala: Department of Hygiene and Dietetics, Jagiellonian University Medical College, 7 Kopernika Street, 31-034 Kraków, Poland.
Author Contributions: Conception and design: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, C. Valli, P. Alonso-Coello, M.M. Bala, G.H. Guyatt.
Analysis and interpretation of the data: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, C. Valli, R. El Dib, C. Marshall, P.J. Stover, S. Fairweather-Taitt, G. Wójcik, F. Bhatia, R. de Souza, C. Brotons, J. Meerpohl, C.J. Patel, B. Djulbegovic, P. Alonso-Coello, M.M. Bala, G.H. Guyatt.
Drafting of the article: B.C. Johnston.
Critical revision of the article for important intellectual content: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, C. Valli, R. El Dib, C. Marshall, P.J. Stover, S. Fairweather-Taitt, G. Wójcik, F. Bhatia, R. de Souza, C. Brotons, J. Meerpohl, C.J. Patel, B. Djulbegovic, P. Alonso-Coello, M.M. Bala, G.H. Guyatt.
Final approval of the article: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, C. Valli, R. El Dib, C. Marshall, P.J. Stover, S. Fairweather-Taitt, G. Wójcik, F. Bhatia, R. de Souza, C. Brotons, J. Meerpohl, C.J. Patel, B. Djulbegovic, P. Alonso-Coello, M.M. Bala, G.H. Guyatt.
Provision of study materials or patients: B.C. Johnston.
Statistical expertise: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, R. El Dib, G.H. Guyatt.
Administrative, technical, or logistical support: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, C. Valli, R. El Dib, B. Djulbegovic, P. Alonso-Coello, M.M. Bala, G.H. Guyatt.
Collection and assembly of data: B.C. Johnston, D. Zeraatkar, M.A. Han, R.W.M. Vernooij, C. Valli, R. El Dib, B. Djulbegovic.
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