Replacing red and processed meat with lean or fatty fish and all-cause and cause specific mortality in Norwegian women. The Norwegian Women and Cancer Study (NOWAC): a prospective cohort study.

Nordic Nutrition Recommendations recommend reducing red and processed meat and increasing fish consumption, but the impact of this replacement on mortality is understudied. This study investigated the replacement of red and processed meat with fish in relation to mortality. Of 83 304 women in the NOWAC Study, 9 420 died during a median of 21.0 years of follow-up. The hazard ratios (HRs) for mortality were estimated using Cox Proportional Hazards regression with analyses stratified on red and processed meat intake due to non-linearity. Higher processed meat (>30 grams/day), red and processed meat (>50 grams/day), and fatty fish consumption were associated with higher mortality, while red meat and lean fish consumption were neutral or beneficial. Among women with higher processed meat intake (>30 grams/day), replacing 20 grams/day with lean fish, was associated with lower all-cause (HR 0.92, 95% CI 0.89-0.96), cancer (HR 0.92, 95% CI 0.88-0.97) and CVD mortality (HR HR 0.82, 95% CI 0.74-0.90), while replacing with fatty fish was associated with lower CVD mortality (HR 0.87, 95% CI 0.77-0.97), but not with all-cause or cancer mortality. Replacing processed meat with fish among women with lower processed meat intake (≤30 grams/day) or replacing red meat with fish was not associated with mortality. Replacing processed meat with lean or fatty fish may lower the risk of premature deaths in Norwegian women, but only in women with high intake of processed meat. These findings suggest that interventions to reduce processed meat intake should target high consumers.