Importance 尽管已经建立了肉类加工进食与心血管疾病（CVD）和全因死亡率之间的关联，但不确定的未加工红肉，家禽或鱼类消费与CVD和全因死亡率之间的关联。

Objective 识别加工肉，未加工红肉，家禽或鱼的摄入与发生CVD和全因死亡率的关系。

Design, Setting, and Participants 这项队列研究分析了美国6项前瞻性队列研究中成年参与者的个人水平数据。收集了1985年至2002年的基线饮食数据。参与者的随访至2016年8月31日。数据分析从2019年3月25日至2019年11月17日进行。

Exposures 加工肉，未加工红肉，家禽或鱼的摄入量为连续变量。

Main Outcomes and Measures 每次摄入2份CVD的危险比（HR）和30年绝对风险差（ARD）（冠心病，中风，心力衰竭和CVD死亡的综合终点）和全因死亡率对于单调联想而言，则为每周一次；对于非单调联想而言，则为每周2比0份。

Results 在29682名参与者中（基线时的平均[SD]年龄，53.7 [15.7]岁； 13 168 [44.4％]名男性；以及9101 [30.7％]名自我识别为非白人），6963名CVD事件和8875名参与者-在19.0（14.1-23.7）年的中位（四分位间距）随访期间判定死亡原因。加工肉，未加工红肉，家禽或鱼的摄入与CVD的发生和全因死亡率之间的关系是单调的（P为非线性nonlinear≥.25），但加工肉的摄入量与入射CVD的非单调的相关性（P为非线性= .006）。未经加工的红肉（经调整的HR，1.03 [95％CI，1.04-1.11]；经调整的ARD，1.74％[95％CI，0.85％-2.63％]；未加工的红肉（经调整的HR，1.03 [95％CI， 1.01-1.06]；调整后的ARD，0.62％[95％CI，0.07％-1.16％]）或家禽（调整后的HR，1.04 [95％CI，1.01-1.06]；调整后的ARD，1.03％[95％CI， 0.36％-1.70％]与入射CVD显着相关。鱼的摄入量与发生的CVD并没有显着相关性（校正后的HR，1.00 [95％CI，0.98-1.02]；校正后的ARD，0.12％[95％CI，-0.40％至0.65％]。或未经加工的红肉（经调整的HR，1.03 [95％CI，1.02-1.05];经调整的ARD，0.90％[95％CI，0.43％-1.38％];进食未经加工的红肉（经调整的HR，1.03 [95％CI，95％CI， 1.01-1.05]；调整后的ARD为0.76％[95％CI，0.19％-1.33％]与全因死亡率显着相关。或鱼（调整后的HR，0.99 [95％CI，0.97.97];调整后的ARD，-0.28％[95％CI，-1.00％至0.44％];家禽（调整后的HR，0.99 [95％CI，0.97-1.02];调整后的ARD，-0.28％[95％CI，-1.00％至0.44％]） -1.01]；调整后的ARD，-0.34％[95％CI，-0.88％至0.20％]与全因死亡率没有显着相关。

Conclusions and Relevance 这些发现表明，在美国成年人中，加工肉，未加工红肉或家禽（而不是鱼类）的摄入量较高与发生CVD的风险增加有显着相关，而加工肉或未加工红肉的摄入量较高，但是而非家禽或鱼类，与全因死亡率的小幅增加显着相关。这些发现对公共卫生有重要影响，应进一步调查。

以上为中文翻译

Importance Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, or fish consumption with CVD and all-cause mortality are still uncertain.Objective To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality.Design, Setting, and Participants This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019.Exposures Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables.Main Outcomes and Measures Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations.Results Among the 29 682 participants (mean [SD] age at baseline, 53.7 [15.7] years; 13 168 [44.4%] men; and 9101 [30.7%] self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 [95% CI, 1.04-1.11]; adjusted ARD, 1.74% [95% CI, 0.85%-2.63%]), unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.06]; adjusted ARD, 0.62% [95% CI, 0.07%-1.16%]), or poultry (adjusted HR, 1.04 [95% CI, 1.01-1.06]; adjusted ARD, 1.03% [95% CI, 0.36%-1.70%]) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 [95% CI, 0.98-1.02]; adjusted ARD, 0.12% [95% CI, -0.40% to 0.65%]). Intake of processed meat (adjusted HR, 1.03 [95% CI, 1.02-1.05]; adjusted ARD, 0.90% [95% CI, 0.43%-1.38%]) or unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.05]; adjusted ARD, 0.76% [95% CI, 0.19%-1.33%]) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 [95% CI, 0.97-1.02]; adjusted ARD, -0.28% [95% CI, -1.00% to 0.44%]) or fish (adjusted HR, 0.99 [95% CI, 0.97-1.01]; adjusted ARD, -0.34% [95% CI, -0.88% to 0.20%]) was not significantly associated with all-cause mortality.Conclusions and Relevance These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.