| Summary: | Background: Processed meat intake may increase the risk of chronic obstructive pulmonary disease (COPD). However, the magnitude of this association may depend on smoking and unhealthy diet. Our aims were to determine whether processed meat intake increased the risk of COPD among middle-aged women, and to estimate the combined impact of high processed meat intake, smoking and unhealthy diet on the risk of COPD. Methods: Analyses included 87,032 registered nurses from the Nurses' Health Study II (baseline mean age 36.8 years). Over 2,296,894 person-years (1991–2017), we documented 634 incident cases of COPD. Cumulative average of processed meat intake (every 4 years) was divided into never/almost never, <1 or ≥ 1 servings/week. A score was created to study the impact of 3-risk lifestyle factors. Findings: In multivariable-adjusted Cox proportional hazards models, after careful adjustment for smoking and unhealthy diet, we observed a positive association between processed meat intake and the risk of COPD: Hazard Ratio (HR, 95%CI) for ≥1 servings/week vs. never/almost never = 1.29 (1.00–1.65). In analyses stratified according to smoking or unhealthy diet, processed meat intake was associated with increased risk of COPD only among ever smokers (HR 1.37 [1.01–1.86]), and among women with unhealthy diet (HR 1.39 [1.04–1.85]). The multivariable-adjusted HR for COPD in participants with all 3 high-risk lifestyle factors compared with none was 6.32 (3.67–10.87). Interpretation: Processed meat intake was associated with elevated risk of developing COPD in middle-aged women, especially in presence of other high-risk lifestyle factors (smoking, unhealthy diet). Fundings: US CDC and NIH. Keywords: Epidemiology, Diet, Respiratory diseases
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