Cohort studyindependent cross-checkabstract checked I-CHK-103 standard review
No link between poultry and death or heart disease in 21 countries
Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study.
Overview
Iqbal R et al.. Am J Clin Nutr 2021 · PMID 33787869 · DOI 10.1093/ajcn/nqaa448
In 134,297 people from 21 countries, poultry intake was not related to death or major heart disease.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Are unprocessed red meat, poultry and processed meat associated with mortality and major CVD?
- How was the study done?
Prospective multinational cohort (PURE), 21 low-, middle- and high-income countries
- How many people, animals or samples were studied?
134,297 participants; 7,789 deaths; 6,976 CVD events
- What was actually found?
No association between poultry intake and total mortality or major CVD (numbers for poultry not given in abstract). Processed meat >=150 g/wk vs 0: mortality HR 1.51 (1.08-2.10), major CVD HR 1.46 (1.08-1.98).
- How large was the observed effect?
No association between poultry intake and total mortality or major CVD (numbers for poultry not given in abstract). Processed meat >=150 g/wk vs 0: mortality HR 1.51 (1.08-2.10), major CVD HR 1.46 (1.08-1.98).
- What do the results mean in everyday life?
Chicken eaters in many countries did not have worse outcomes.
- What are the study's limitations?
Poultry results only qualitatively in abstract; Observational
- What does it say about Elawady's specific claim?
Contradicts an intrinsic harm of chicken.
- Do the results apply to Germany and Europe?
Includes European and non-European countries.
- What can explicitly not be concluded from this study?
Effect sizes for poultry cannot be read from the abstract.
Scientific in-depth review
1. Full reference
- Authors
- Iqbal R et al.
- Journal
- Am J Clin Nutr
- Year
- 2021
- Identifier
- PMID 33787869 DOI 10.1093/ajcn/nqaa448
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Are unprocessed red meat, poultry and processed meat associated with mortality and major CVD?
3. Study design and population
- Study design
- Cohort study – Prospective multinational cohort (PURE), 21 low-, middle- and high-income countries
- Population
Adults in 21 countries
- Country
21 countries (multinational)
- Period
median follow-up 9.5 y
- Sample size
134,297 participants; 7,789 deaths; 6,976 CVD events
- Inclusion and exclusion criteria
as described in the abstract
4. Methods and endpoints
- Exposure / intervention
Poultry intake (categories)
- Comparator
Low intake
- Endpoints
Total mortality; major CVD
- Statistical methods
as reported in the abstract
5. Actual results
- Results
No association between poultry intake and total mortality or major CVD (numbers for poultry not given in abstract). Processed meat >=150 g/wk vs 0: mortality HR 1.51 (1.08-2.10), major CVD HR 1.46 (1.08-1.98).
- Absolute risks
not reported
- Authors' conclusion
No significant associations of unprocessed red meat or poultry with mortality or major CVD.
6. Strengths
- Large, multinational including middle-income countries
- Country-specific validated FFQs
7. Weaknesses
- Poultry results only qualitatively in abstract
- Observational
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational; FFQ.
9. Assessment of the statistical interpretation
Null association in a cohort that includes lower- and middle-income settings.
10. Relevance to the specific claim
Tests poultry and health outcomes in diverse countries, closer to Middle-East dietary settings than US cohorts.
11. Independent contrary findings
12. Transferability to Germany and Europe
13. Overall methodological judgement
In 134,297 people from 21 countries, poultry intake was not related to death or major heart disease.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Chicken is forbidden because it is harmful in itself, not because of how it is raised (it is 'the pig of birds'); its fibres and waste products are hard to digest. – Studies contradicting or limiting the claim