Red meat is defined as beef, veal, pork, lamb, mutton, horse, or goat meat.1 Processed meat refers to meat that has been transformed through salting, curing, fermentation, smoking, and other processes with the goal of enhancing flavor or prolonging preservation, and includes bacon and hot dogs. There is some evidence that the consumption of red or processed meats may have a deleterious effect on health, including cardiovascular health and an increased risk of cancer. Some studies have demonstrated that a higher intake of red meat is associated with elevations in blood pressure2 and cholesterol.3 Some, but not all, evidence suggests that the risk of heart disease and cancer can be lowered by substituting white meat for red meat.4–8 Plant-based foods appear to confer the lowest risk.9,10
A working group from ten countries met at the International Agency for Research on Cancer in 2015 to evaluate the available data on the carcinogenicity of red and processed meat. They assessed over 800 studies, with emphasis given to prospective cohort studies and high-quality population-based case-control studies.1 Multiple studies reported a positive association between colorectal cancer risk and consumption of red11,12 and processed11,13–16 meat. A meta-analysis of colorectal cancer in ten cohort studies reported a significant dose-response relationship: a 17% increased risk per 100 g/day of red meat, and an 18% increased risk per 50 g/day of processed meat.17 Positive associations were also seen between red meat consumption and cancers of the pancreas and prostate, and between processed meat consumption and cancer of the stomach. On the basis of this large data review, the working group concluded that there was sufficient epidemiological evidence for the carcinogenicity of processed meat. They classified processed meat as “carcinogenic” on the basis of its association with colorectal cancer. Chance and confounding could not be ruled out with the same degree of confidence for the data on red meat. They concluded there was limited evidence for the carcinogenicity of red meat, since several high-quality studies found no clear association, and ultimately classified red meat as “probably carcinogenic”.
Another meta-analysis was conducted by Kim et al. to analyze the association between red, processed, and white meat with the incidence of gastric cancer.5 The analysis included 43 studies, 11 cohort and 32 case-control studies (n=1,764,894). The relative risk (RR) for the development of gastric cancer was 1.41 (95% confidence interval [CI] [1.21 – 1.66]) among the highest consumers of red meat, and 1.57 (95% CI [1.37 – 1.81]) among the highest consumers of processed meats compared to the lowest consumers. White meat consumption was negatively associated with gastric cancer risk (RR 0.80, 95% CI [0.69 – 0.92]).
Pan et al. studied two cohorts from the Health Professionals Follow-up Study (n=37,698) and the Nurse’s Health Study (n= 83,644) who had no cardiovascular disease (CVD) or cancer at baseline.4 In this prospective observational study, diet was assessed at baseline from validated food history questionnaires and reassessed at 4-year intervals. Adjusting for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) for CVD mortality with a one-serving per day increase in unprocessed red meat was 1.18 (95% CI [1.13 – 1.23]) and for processed red meat was 1.21 (95% CI [1.13 – 1.31]). Based on the dietary data, they also estimated that substituting one serving per day of other proteins (fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for one serving per day of red meat was associated with a 7% to 19% lower mortality risk.
Micha et al. conducted a systematic review and meta-analysis of available research on the association of red meat consumption with coronary heart disease (CHD), stroke, and diabetes risk among healthy adults.18 Twenty studies (total n= 1,218,380) met their inclusion criteria, of which 17 were prospective cohort studies and three were case-control studies. Based on data from five studies, processed meat was associated with a 42% higher risk of CHD. The RR per 50 gram serving per day was 1.42 (95% CI [1.07 – 1.89], p=0.04). Red meat was not associated with CHD based on the four studies that included the relevant data.
Zhong et al. pooled data from six prospective cohort studies (total n= 29,682) to measure the additional risk from adding two servings per week of various protein sources, including processed meat, unprocessed red meat, poultry, and fish.6 Each additional two servings per week of processed meat increased the risk of incident CVD by 7% (absolute risk difference [ARD] 1.74%). Each additional two servings per week increased the risk of all-cause mortality by 3% (ARD 0.90%) over 30 years of follow-up. Each additional two servings per week of unprocessed red meat increased the risk of incident CVD by 3% (ARD 0.62%); each additional two servings per week increased the risk of all-cause mortality by 3% (ARD 0.76%). Each additional two servings per week of poultry increased the risk of incident CVD by 4% (ARD 1.03%) but were not significantly associated with all-cause mortality. An advantage of this study was the standardization of the food history data to minimize the heterogeneity among the various cohorts studied. While the effect sizes were small, the study supports the recommendation that lowering one’s consumption of red and white meat can lower risk.
Sinha et al. conducted a prospective study of the relationship between meat consumption and mortality.7 They mailed questionnaires to 3.5 million members of the American Association of Retired Persons and more than one-half million responded. During the 10-year follow-up, 47,976 male deaths and 23,276 female deaths occurred. The questionnaire sought data on diet as well as other lifestyle issues that might confound the relationship. These included personal and family history of cancer, body mass index, smoking history, physical activity, alcohol use, fruit and vegetable consumption, and hormone therapy among women. These confounding variables were considered when computing adjusted HR. The adjusted HR for overall mortality during 10 years of follow-up for men and women in the highest quintile of red meat consumption compared to those in the lowest quintile was 1.31 (95% CI [1.27 – 1.35]) and 1.36 (95% CI [1.30 – 1.43), respectively. For processed meat consumption, the comparable HR were 1.16 (95% CI [1.12 – 1.20) and 1.25 (95% CI [1.20 – 1.31). In addition, comparing the highest and lowest quintiles, the HR for the risk of CVD was also elevated for men and women who consumed red meat (1.27, 95% CI [1.20 – 1.35] and 1.50, 95% CI [1.37 – 1.65]) and processed meat (1.09, 95% CI [1.03 – 1.15] and 1.38, 95% CI [1.26 – 1.51]). Of note, comparing the highest and lowest quintiles of men who consumed white meat, there was an inverse relationship between total mortality (HR 0.92, [95% CI 0.89 – 0.94], p<0.0001) and cancer mortality (HR 0.84, CI [0.80 – 0.88], p<0.001). There was a small increased risk for CVD mortality in men with a higher intake of white meat (HR 1.0, 95% CI [1.00 – 1.11], p=0.009). Comparable HRs for women consuming white meat were 0.92 (95% CI [0.88 – 0.96, p<0.005) for all mortality, and 0.89 (95% CI [0.83 – 0.95, p=0.001) for cancer mortality. There was no significant relationship between white meat consumption and CVD mortality among women.
Kappeler et al. analyzed data from 17,611 participants in the Third National Health and Nutrition Examination Survey (NHANES III) and found no significant association between the consumption of red meat and mortality.8 During the 15-year follow-up period there were 3,683 deaths. There was a tendency toward an inverse relationship between men who consumed white meat and the risk of all-cause mortality (p for trend=0.02), but no such association with women.
A Plant-Based Diet
When lowering one’s risk, it is not always enough to avoid certain foods. It is important to substitute less ideal foods with more ideal foods. Schwingshakl et al. analyzed data from a systematic literature review to estimate the risk reduction potential from consumption of 12 different food groups.9 The risk of all-cause mortality decreased with each additional daily serving of whole grains (RR 0.92, 95% CI [0.89 – 0.95]), vegetables (RR 0.96, 95% CI [0.95 – 0.98]), fruits (RR 0.94, 95% CI [0.92 – 0.97]), nuts (RR 0.76, 95% CI [0.69 – 0.84]), and fish (RR 0.93, 95% CI [0.88 – 0.98]). The consumption of red (RR 1.10, 95% CI [1.04 – 1.18]) and processed meat (RR 1.23, 95% CI [1.12 – 1.36]) was associated with an increased risk of all-cause mortality in a linear dose-response analysis.
- Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015;16(16):1599-1600.
- Steffen LM, Kroenke CH, Yu X, et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr. 2005;82(6):1169-77; quiz 1363.
- Wolmarans P, Benadé AJ, Kotze TJ, Daubitzer AK, Marais MP, Laubscher R. Plasma lipoprotein response to substituting fish for red meat in the diet. Am J Clin Nutr. 1991;53(5):1171-1176.
- Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med. 2012;172(7):555-563.
- Kim SR, Kim K, Lee SA, et al. Effect of red, processed, and white meat consumption on the risk of gastric cancer: an overall and dose response meta-analysis. Nutrients. 2019;11(4).
- Zhong VW, Van Horn L, Greenland P, et al. Associations of processed meat, unprocessed red meat, poultry, or fish intake with incident cardiovascular disease and all-cause mortality. JAMA Intern Med. February 2020.
- Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med. 2009;169(6):562-571.
- Kappeler R, Eichholzer M, Rohrmann S. Meat consumption and diet quality and mortality in NHANES III. Eur J Clin Nutr. 2013;67(6):598-606.
- Schwingshackl L, Schwedhelm C, Hoffmann G, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2017;105(6):1462-1473.
- Aune D. Plant foods, antioxidant biomarkers, and the risk of cardiovascular disease, cancer, and mortality: A review of the evidence. Adv Nutr. 2019;10(Supplement_4):S404-S421.
- Norat T, Bingham S, Ferrari P, et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005;97(12):906-916.
- English DR, MacInnis RJ, Hodge AM, Hopper JL, Haydon AM, Giles GG. Red meat, chicken, and fish consumption and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2004;13(9):1509-1514.
- Oba S, Shimizu N, Nagata C, et al. The relationship between the consumption of meat, fat, and coffee and the risk of colon cancer: a prospective study in Japan. Cancer Lett. 2006;244(2):260-267.
- Bernstein AM, Song M, Zhang X, et al. Processed and unprocessed red meat and risk of colorectal cancer: analysis by tumor location and modification by time. PLoS One. 2015;10(8):e0135959.
- Cross AJ, Sinha R. Meat-related mutagens/carcinogens in the etiology of colorectal cancer. Environ Mol Mutagen. 2004;44(1):44-55.
- Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA. 2005;293(2):172-182.
- Chan DSM, Lau R, Aune D, et al. Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS One. 2011;6(6):e20456.
- Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-2283.