Public Health Nutrition: 18(6), 1084–1090
doi:10.1017/S1368980014001165
A case–control study on red meat consumption and risk of stroke
among a group of Iranian adults
Parvane Saneei1, Mohammad Saadatnia2, Forough Shakeri3, Masumeh Beykverdi1,
Ammar Hassanzadeh Keshteli4,5 and Ahmad Esmaillzadeh1,*
1
Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan
University of Medical Sciences, Isfahan, PO Box 81745-151, Islamic Republic of Iran: 2Isfahan Neuroscience
Research Center, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran: 3Medical Students’
Research Center, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran: 4Integrative Functional
Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran:
5
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Submitted 8 October 2013: Final revision received 16 April 2014: Accepted 6 May 2014: First published online 13 June 2014
Abstract
Objective: We aimed to examine the association between red meat consumption
and stroke in a group of Iranian adults.
Design: A hospital-based case–control study.
Setting: The study included stroke patients and hospital-based controls. Usual
dietary intakes of participants were assessed by means of a validated 168-item
semi-quantitative FFQ. Total red meat consumption was calculated by summing
up the consumption of red, processed and visceral meats.
Subjects: One hundred and ninety-five cases were stroke patients hospitalized in
the neurology ward and 195 controls were recruited from patients hospitalized in
other wards with no history of cerebrovascular diseases or neurological disorders.
Results: Participants with stroke were older, more likely to be male and less likely
to be obese. Individuals in the highest tertile of red meat intake were 119 % more
likely to have stroke (OR = 2·19; 95 % CI 1·33, 3·60) compared with those in the
lowest tertile. After controlling for age, sex and total energy intake, the association
between red meat consumption and stroke was strengthened (OR = 2·72; 95 % CI
1·53, 4·83). This association remained significant even after further controlling for
physical activity and smoking as well as dietary intakes. Additional adjustments for
BMI, diabetes, hypertension and hyperlipidaemia did not influence the association
significantly (OR = 2·51; 95 % CI 1·19, 5·09).
Conclusions: Consumption of red meat was associated with greater odds of having
stroke in a group of Iranian adults.
Stroke is a leading cause of death and disability worldwide
and will impose a great burden on health-care systems in
future decades(1,2). Despite numerous epidemiological data
on stroke prevalence in the USA and Western countries(1,2),
little information is available from population-based
studies in developing countries(3). Findings from prior
investigations in Iran have revealed that the incidence of
stroke is greater than in most Western countries, with
stroke occurring at younger ages and ischaemic stroke
being more prevalent than other subtypes(4). Therefore,
primary prevention of stroke is of great priority in these
countries.
Dietary intake of several nutrients and foods has
previously been linked to stroke; therefore, dietary
modification may be a crucial way to reduce risk of stroke.
Meat is widely used in the diet globally and is a main
*Corresponding author: Email esmaillzadeh@hlth.mui.ac.ir
Keywords
Red meat
Stroke
Diet
Iran
source of protein and some other nutrients in most diets.
Earlier evidence from epidemiological studies has indicated that high consumption of red meat, particularly
processed meat, might contribute to cancer(5), CHD(6),
type 2 diabetes(7) and the metabolic syndrome(8). High
intake of red meat is also significantly associated with the
prevalence of hypertension(9) and dyslipidaemia(8), two
well-known risk factors for stroke.
Epidemiological data on the relationship between
red meat consumption and stroke are sparse and
inconsistent(10–13). A published meta-analysis of cohort
studies reported no significant association between consumption of red and processed meats and stroke(14);
whereas findings from another recent meta-analysis of
five cohort studies revealed that high red meat intake
is associated with a 9 % increase in the risk of stroke(15).
© The Authors 2014
Red meat consumption and stroke
Each of these two meta-analyses included only one
investigation conducted in an Asian population, which
may not reflect the associations that typically exist in the
Middle Eastern region. In a prospective cohort study of
51 683 Japanese adults(16) that was not included in the
previously mentioned meta-analyses(14,15), the authors
found no link between moderate consumption of meat
(including beef, pork, poultry, liver and processed meat)
and mortality from stroke. Therefore, further evidence is
required to clarify the possible relationships.
Almost all previous studies on the relationship between
red meat intake and stroke have been done in developed
countries, where dietary intakes of red and processed
meats are high. Data in this regard are lacking from
developing nations, in particular from the Middle Eastern
populations whose dietary intakes of meat might be low to
moderate. Moreover, the major sources of red meat intake
in these countries are different from those developed
countries, where pork is a major source of red meat intake.
Some studies have indicated that the source of red
meat intake may contribute to the association between
red meat intake and CVD events(17). Furthermore, the
dietary intakes of Iranians are greatly different from
those in Western countries(18) and investigating the red
meat–stroke association in this diversified mixed diet
might provide additional information. Since findings from
epidemiological studies are better replicated in a different
range of dietary intakes in different populations, we
hypothesized that red meat intake might contribute to
the increasing prevalence of stroke among the Iranian
population. Given the paucity of data on diet–disease
relationships in the understudied population of the Middle
East, we examined the association between red meat
consumption and stroke in a group of Iranian adults.
Materials and methods
Participants
The current hospital-based case–control study included
195 stroke patients and 195 hospital controls. All participants were recruited from Alzahra University Hospital,
Isfahan, Iran. Data about all cases and controls in the study
were collected between January and December 2008.
Data on each pair of cases and controls were collected at
the same time. Cases were selected through a convenience
non-random sampling procedure. They were stroke
patients who were hospitalized in the neurology ward
of Alzahra University Hospital. Controls were selected
from hospitalized patients in orthopaedic or surgical wards
of this centre. They were without a prior history of
cerebrovascular accident or any neurological disorders
and were not hospitalized owing to vascular-related
conditions. The participation rate in the study was 100 %
for cases and 93 % for controls. Written informed consent
was obtained from each participant.
1085
Assessment of dietary intake
A validated 168-item FFQ was used to assess the intakes of
foods usually consumed by the participants over the previous year(19). All questionnaires were administered by
trained dietitians. The quantity of the food consumed was
assessed by asking a standard common portion size. As
brain damage or impaired memory is the most common
sequela of stroke and recalls of dietary intakes from these
patients might be distorted, we asked their family members to help complete the FFQ. The reported frequency as
well as the portion size was double checked with the
person responsible for cooking at home. The daily
frequency of foods was calculated by dividing weekly
frequency consumption by seven and monthly frequency
by thirty, and the average daily intake of foods and
beverages was calculated by multiplying the portion size
by the daily frequency of consumption. Total energy
intake was calculated by summing up energy intakes from
all foods. Total red meat consumption was calculated by
summing up the consumption of red meat (beef, veal,
mutton, lamb), processed meat (sausages, hamburgers,
hot dogs) and visceral meats (lamb’s liver, kidney, heart).
Assessment of stroke
Patients aged >45 years with first ever symptomatic acute
stroke diagnosed by a neurologist and confirmed by
brain computerized tomography scanning or MRI were
included. Patients with head trauma, primary intracranial
haemorrhage, or subarachnoid or subdural haemorrhage
were excluded. Data were collected by prospective chart
review from January 2008 to December 2008. The study
protocol was approved by the Regional Bioethics
Committee of Isfahan University of Medical Sciences.
Assessment of other variables
Required information on non-dietary variables such as
socio-economic and demographic characteristics (sex,
age, education and occupation), past and family medical
history, physical activity and smoking status was collected
by the use of questionnaires. Height measurement was
done in bare feet, weight measurement was done in light
clothing and, finally, BMI (kg/m2) was calculated as
weight divided by height squared.
Statistical methods
To ensure normal distribution of variables, we applied the
Kolmogrov–Smirnov test. We used two approaches in data
analysis: (i) all comparisons were done between cases and
controls; and (ii) all comparisons were also performed
across tertiles of red meat consumption. Student’s t test
was used for comparing the means of continuous variables
between cases and controls. The χ2 test was applied to
the compare distribution of participants between the
two groups in terms of categorical variables. Energyadjusted amounts of red meat intake were calculated
using the residual method. Then, tertile cut-off points of
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P Saneei et al.
energy-adjusted red meat intake were used for categorizing participants. General characteristics and dietary intakes
of participants between cases and controls as well as
across tertiles of red meat intake were compared by the
use of ANOVA and the χ2 test, where appropriate. All
dietary intakes were obtained using general linear models
with age and total energy intake as covariates. The logistic
regression method was used to examine the associations
between red meat consumption and risk of stroke.
Estimates are presented in four models. The first model
was adjusted for age (continuous), sex (categorical) and
total energy intake (continuous). In the second model, we
controlled for physical activity (continuous) and smoking
(never, ex-smokers, daily smokers). Additional adjustments were made for dietary intakes (including whole and
refined grains, vegetables, fruits, low-fat and high-fat dairy,
hydrogenated vegetable oil, butter and margarine, nuts
and legumes, sugar-sweetened beverages and potato, all
as continuous variables) in the third model. Finally, we
further adjusted for BMI (continuous), diabetes (yes or
no), hypertension (yes or no) and hyperlipidaemia (yes or
no) in the fourth model. When the analyses were done
across tertiles of red meat intake, the first tertile of red
meat consumption was considered as the reference. The
overall trend of odds ratios across tertiles of red meat
consumption was examined through the use of tertile
categories as an ordinal variable in the model. Statistical
analyses were performed by using the statistical software
package SPSS version 16·0. For all analyses, a value of
P < 0·05 was considered as statistically significant.
Results
All participants with energy intake less than 3347 kJ
(800 kcal) or more than 17 573 kJ (4200 kcal) were
considered as under- and over-reporters, respectively.
Overall, eleven participants could be excluded due to
being under- and over-reporters. As in our preliminary
analysis the exclusion of this small group of participants
did not significantly influence our findings, we decided
not to exclude any FFQ.
General characteristics of the study participants based
on case and control groups as well as across tertiles of
energy-adjusted red meat intake are indicated in Table 1.
Participants with stroke were more likely to be male (60 %
v. 47 %, P < 0·05) and older (67·9 (SE 1·0) years v. 61·5
(SE 0·8) years, P < 0·001) than controls. They had lower
weight (69·5 (SE 0·9) kg v. 72·4 (SE 1·1) kg, P < 0·05), BMI
(25·2 (SE 0·3) kg/m2 v. 28·5 (SE 1·0) kg/m2, P < 0·05) and
were less likely to be obese (11·3 % v. 29·2 %, P < 0·001)
compared with controls. Hypertension was more prevalent
among those with stroke than among controls (65·8 % v.
27·2 %, P < 0·001). In addition, compared with those in the
lowest category, participants in the highest category of red
meat consumption had higher weight and were more likely
Table 1 General characteristics of the study participants based on case and control groups as well as across tertiles of energy-adjusted red
meat intake*; Iranian adults aged > 45 years, January–December 2008
Cases (n 195)
Mean
Age (years)
Weight (kg)
BMI (kg/m2)
Physical activity (MET-min/d)
Male (%)
Current smoker (%)
Obesity† (%)
Hypertension (%)
Hyperlipidaemia (%)
Controls (n 195)
Mean
SE
67·9
69·5
25·2
4766
60
14
29
66
22
1·0
0·9
0·3
55·5
–
–
–
–
–
P‡
SE
61·5
72·4
28·4
3951
47
6
11
27
19
0·8
1·1
1·0
49·1
–
–
–
–
–
< 0·001
0·05
0·01
0·43
0·01
0·01
< 0·001
< 0·001
0·49
Tertile of energy-adjusted red meat intake
T1 (lowest)
Age (years)
Weight (kg)
BMI (kg/m2)
Physical activity (MET-min/d)
Male (%)
Current smoker (%)
Obesity† (%)
T2
Mean
SE
Mean
62·3
66·4
26
4167
38
5
19
1·0
1·1
0·5
1173
–
–
–
64·7
73·3
27·4
3006
52
8·5
27
T3 (highest)
SE
1·0
1·1
0·4
566
–
–
–
Mean
SE
P‡
62·4
73·6
27·5
5884
70
16
15·5
1·1
1·3
1·5
848
–
–
–
0·01
< 0·001
0·54
0·08
< 0·001
0·01
0·06
MET, metabolic equivalent of task.
*Data are means and their standard errors unless indicated otherwise. P < 0·05 was considered as statistically significant.
†BMI ≥ 30·0 kg/m2.
‡Obtained by the use of ANOVA or the χ2 test, where appropriate.
Red meat consumption and stroke
1087
70
Prevalence of stroke (%)
60.5
60
48.0
50
41.0
40
30
20
10
0
T1
T2
T3
Tertile of energy-adjusted red meat intake
Fig. 1 Prevalence of stroke across tertiles of energy-adjusted
red meat intake among group of Iranian adults aged >45 years,
January–December 2008 (P = 0·007, ANOVA)
to be male, physically active and current smokers. No
significant differences were found in terms of mean BMI
and prevalence of obesity across tertiles of red meat intake.
The use of medication among cases was listed as follows:
aspirin 12·0 %, persantine 1·3 %, warfarin 5·2 %, plavix
1·5 %, antihypertensives 26·3 %, statins 7·7 %, oral hypoglycaemic agents 8·8 %, insulin 2·1 %, other drugs 19·8 %.
The prevalence of stroke across tertiles of energyadjusted red meat intake is shown in Fig. 1. Red meat
intake was associated with high prevalence of stroke; such
that individuals in the top tertile of red meat intake had
higher stroke prevalence compared with those in the
bottom tertile (60·5 % v. 41·0 %, P = 0·007).
Dietary intakes of the study participants based on case
and control groups as well as across tertiles of energyadjusted red meat consumption are provided in Tables 2
and 3, respectively. Cases with stroke had higher intakes
Table 2 Dietary intakes of the study participants based on case and control groups*; Iranian adults aged > 45 years, January–
December 2008
Cases (n 195)
Total energy intake (kJ/d)
Total energy intake (kcal/d)
Whole and refined grains (g/d)
Vegetables (g/d)
Red and processed meat (g/d)
Low-fat dairy (g/d)
High-fat dairy (g/d)
Hydrogenated oil and butter (g/d)
Sugar-sweetened beverages (g/d)
Fruits (g/d)
Nuts and legumes (g/d)
Controls (n 195)
Mean
SD
Mean
SD
P†
8686
2076
292
248
82
270
132
19
47
359
46
4092
977
168
172
226
208
208
36
86
413
48
8828
2110
326
285
57
340
74
19
47
281
38
3617
866
191
222
68
281
124
30
87
240
36
0·71
0·07
0·06
0·14
0·01
0·01
0·93
0·99
0·02
0·04
*Data for energy intake are adjusted for age. Data for other dietary variables are adjusted for age and total energy intake. P < 0·05 was considered as statistically
significant.
†Obtained by the use of ANCOVA.
Table 3 Dietary intakes of the study participants across tertiles of energy-adjusted red meat intake*; Iranian adults aged >45 years,
January–December 2008
Tertile of energy-adjusted red meat intake
T1 (lowest)
Total energy intake (kJ/d)
Total energy intake (kcal/d)
Whole and refined grains (g/d)
Vegetables (g/d)
Red and processed meat (g/d)
Low-fat dairy (g/d)
High-fat dairy (g/d)
Hydrogenated oil and butter (g/d)
Sugar-sweetened beverages (g/d)
Fruits (g/d)
Nuts and legumes (g/d)
T2
T3 (highest)
Mean
SD
Mean
SD
Mean
SD
P†
7929
1895
287
236
7
277
93
26
31
260
33
3682
880
208
198
4
231
180
40
61
370
31
8238
1969
307
238
18
350
85
21
44
306
39
3397
812
153
184
4
279
156
32
65
376
36
10117
2418
333
325
89
292
130
17
66
394
53
4155
993
174
204
269
229
185
30
118
317
54
< 0·001
0·12
< 0·001
< 0·001
0·05
0·09
0·15
0·01
0·01
< 0·001
*Data for energy intake are adjusted for age. Data for other dietary variables are adjusted for age and total energy intake. P < 0·05 was considered as statistically
significant.
†Obtained by the use of ANCOVA.
1088
P Saneei et al.
of high-fat dairy, fruits, legumes and nuts, and lower intake
of low-fat dairy than the controls. Higher consumption of
red meat was associated with higher intakes of energy,
fruit and vegetables, low-fat dairy, sugar-sweetened
beverages, nuts and legumes, and grains. No significant
differences were found for other dietary variables across
tertiles of red meat intake.
Crude and multivariable-adjusted odds ratios for stroke
based on case and control groups as well as across tertiles
of energy-adjusted red meat intake are indicated in
Tables 4 and 5, respectively. Red meat intake was
significantly associated with the risk of stroke; such that
each tertile of red meat intake was related to 90 %
increased odds of stroke, after adjustment for confounders
(OR = 1·90; 95 % CI 1·71, 2·85). Moreover, in the crude
model, individuals in the highest tertile of red meat intake
were 119 % more likely to have stroke (OR = 2·19; 95 % CI
1·33, 3·60) compared with those in the lowest tertile.
After controlling for age, sex and total energy intake, the
association between red meat consumption and stroke was
strengthened (OR = 2·72; 95 % CI 1·53, 4·83). This association remained significant even after further controlling for
physical activity and smoking as well as dietary intakes.
Additional adjustments for BMI, diabetes, hypertension and
hyperlipidaemia did not influence the association significantly; such that participants in the highest tertile of red
meat consumption had 151 % greater odds of stroke than
those in the lowest tertile (OR = 2·51; 95 % CI 1·19, 5·09).
Discussion
In the present case–control study, we found that consumption of red meat was significantly and positively
associated with the risk of stroke among a group of Iranian
adults. This unfavourable relationship was significant after
controlling for different confounding variables, indicating
a covariate-independent association. To the best of our
knowledge, the current investigation is the first one
reporting the association between red meat intake and risk
of stroke in a Middle Eastern population.
Stroke is an important cause of mortality and disability
globally. Among various dietary components suggested as
important modifiable risk factors for stroke, red meat
consumption is inconsistently associated with stroke(14–16).
While earlier studies have found a positive association
between red meat intake and increased risk of stroke,
even at a low intake of one serving per day(11,13), red meat
intake was not significantly related to incident stroke in
other investigations(12,17). Our study indicated that high
consumption of red meat is significantly associated with
greater odds of stroke. This is in line with a recently
published meta-analysis that summarized the existing
evidence from epidemiological studies in North America,
Europe and Japan. Findings from the meta-analysis
revealed a 15 % increased risk of stroke for red and processed meat intake, 9 % for red meat intake and 14 % for
processed meat intake(15). Such findings have also been
reported in prospective cohort studies. In the Nurses’
Health Study and the Health Professionals Follow-Up
Study, high consumption of both processed and unprocessed red meat was associated with a greater risk of
stroke(20). The positive association between red meat
Table 4 Multivariate-adjusted odds ratios for stroke based on case
and control groups*; Iranian adults aged >45 years, January–
December 2008
Controls (n 195)
Crude
Model
Model
Model
Model
1†
2‡
3§
4||
Cases (n 195)
OR
OR
1·00
1·00
1·00
1·00
1·00
1·95
2·08
1·93
2·11
1·90
95 % CI
1·76,
1·66,
1·59,
1·63,
1·71,
3·25
3·11
2·89
2·82
2·85
*P < 0·05 was considered as statistically significant.
†Adjusted for age, sex and energy intake.
‡Further control for physical activity and smoking.
§Further adjustments for whole and refined grains, vegetables, fruits, low-fat
dairy, high-fat dairy, hydrogenated vegetable oil, butter and margarine, nuts
and legumes, sugar-sweetened beverages and potato intake.
||Additionally adjusted for BMI, diabetes, hypertension and hyperlipidaemia.
Table 5 Multivariate-adjusted odds ratios for stroke across tertiles of energy-adjusted red meat intake; Iranian adults aged >45 years,
January–December 2008
T1 < 12 g/d
Crude
Model
Model
Model
Model
1*
2†
3‡
4§
T2 = 12–26 g/d
OR
OR
1·00
1·00
1·00
1·00
1·00
1·30
1·48
1·56
1·79
1·68
T3 > 26 g/d
95 % CI
0·80,
0·87,
0·91,
0·97,
0·95,
2·13
2·52
2·68
3·27
3·44
OR
2·19
2·72
2·55
2·16
2·51
95 % CI
1·33,
1·53,
1·42,
1·08,
1·19,
3·60
4·83
4·56
4·28
5·09
Ptrend||
0·01
0·01
0·01
0·02
0·01
*Adjusted for age, sex and energy intake.
†Further control for physical activity and smoking.
‡Further adjustments for whole and refined grains, vegetables, fruits, low-fat dairy, high-fat dairy, hydrogenated vegetable oil, butter and margarine, nuts and
legumes, sugar-sweetened beverages and potato intake.
§Additionally adjusted for BMI, diabetes, hypertension and hyperlipidaemia.
||Obtained by the use of tertile categories of red meat intake as an ordinal variable in the model. P < 0·05 was considered as statistically significant.
Red meat consumption and stroke
intake and stroke has not been indicated in all previous
studies. In a meta-analysis in 2010, a null association
between red meat intake and risk of stroke was suggested(14). However, in this meta-analysis only three
cohort studies, containing small number of stroke cases
(n 2300), were included. A large prospective cohort study
conducted among the Japanese population also reported
no association between moderate amounts of meat
consumption, up to 100 g/d, and stroke(16). These investigators had included unprocessed poultry in the total
meat calculation; however, high intake of poultry was
associated with a lower risk of stroke(20). Therefore, lack
of a clear description of types of meat might contribute to
the discrepancies observed between studies.
In the current study, we had only nineteen cases of
haemorrhagic stroke and the other 176 cases had ischaemic stroke. When we excluded cases with haemorrhagic
stroke from the analyses, the results strengthened (top v.
bottom tertile of red meat intake: OR = 2·97; 95 % CI 1·41,
6·24, P = 0·004). Most previous studies have suggested
that meat consumption is associated with ischaemic
stroke, not with haemorrhagic stroke(15). The different
aetiologies of stroke subtypes may be linked differently to
risk factors including dietary factors. In addition, the
number of patients with haemorrhagic stroke included in
most studies was smaller than the number with ischaemic
subtype, and thus may limit statistical power and the
ability to detect a modest association between meat intake
and haemorrhagic stroke. In terms of the types of red meat
intake, earlier studies have found stronger associations
with processed meats than with unprocessed meats(15,20).
In the present study, the red meat category was computed
by summing up both processed and unprocessed red
meats. We did not include poultry and fish intake in this
computation. However, as consumption of processed
meats was low (mean: 2·24 g/d), we did not consider that
as a separate category.
Several potential mechanisms may explain the adverse
effect of red meat consumption on stroke. Red meat is a
major source of haem Fe. In an experimental study,
the intracellular Fe chelator, desferrioxamine, has been
suggested to inhibit inflammation and atherosclerosis,
suggesting a potential role of Fe in atherosclerosis(21).
Elevated haem Fe stores may cause oxidative injury.
Epidemiologically, Fe intake has been associated with
increased risk of atherosclerosis(22), insulin resistance(23),
type 2 diabetes(23) and CHD(14); all may contribute to the
increased risk of stroke. Processed and unprocessed red
meats contain high amounts of dietary cholesterol, which
has been shown to have adverse effects on serum lipid
profiles and subsequently may increase the risk of
stroke(22). Furthermore, consumption of red meat was
positively associated with risk of hypertension(9), the
strongest well-known risk factor for stroke. Na content of
processed meats may also explain the positive association
observed between meat consumption and risk of stroke(24).
1089
Our findings should be interpreted in the context of
potential limitations. Due to the case–control design of the
study, causality cannot be inferred. Misclassification of the
study participants, as a result of using an FFQ for dietary
assessment, could be considered a concern, as it is in
most nutritional epidemiology studies. However, the FFQ
had previously been validated(19). In addition, due to
using an FFQ for assessing intakes, we could not exactly
measure individuals’ salt intake in order to include it in
principal component analysis or make adjustment for it. As
we used hospital-based controls in the study, we cannot
claim with certainty that controls are representative of
healthy adults. In the present study, we did not collect data
on cooking methods that might alter health effects of red
or processed meats(25). Despite the comprehensive
adjustment for confounders in our analyses, some other
confounders such as waist circumference and family
history of stroke could not be considered due to the lack
of data in this regard. In addition, we cannot exclude the
possibility of residual confounding. Finally, since we did
not perform scanning or imaging in control participants,
some controls who might have experienced a silent
asymptomatic ischaemic stroke could not be excluded.
However, they had no such history, and their examinations
were normal.
Conclusion
In conclusion, we found that consumption of red meat
was associated with greater odds of stroke in a group of
Iranian adults. This association was independent of
potential confounders. Further prospective investigations
are needed to confirm this finding.
Acknowledgements
Financial support: This study was supported by a grant
from the Isfahan University of Medical Sciences, Islamic
Republic of Iran (no. 187028 IUMS). Financial support for
conception, design, data analysis and manuscript drafting
comes from the Food Security Research Center, Isfahan
University of Medical Sciences, Isfahan, Iran. The Food
Security Research Center of Isfahan University of Medical
Sciences had no role in the design, analysis or writing of
this article. Conflict of interest: None. Authorship: P.S.,
M.S., A.H.K. and A.E. contributed in the conception,
design, statistical analyses and drafting of the manuscript.
F.S., A.H.K. and M.S. contributed in data collection. M.B.
helped in manuscript drafting. All authors read and
approved the final version of the manuscript. A.E. supervised the study. Ethics of human subject participation: All
participants provided informed written consent. The study
was approved by the Regional Bioethics Committee of
Isfahan University of Medical Sciences.
1090
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