Current Atherosclerosis Reports

, Volume 14, Issue 6, pp 515–524 | Cite as

Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes – An Updated Review of the Evidence

  • Renata Micha
  • Georgios Michas
  • Dariush MozaffarianEmail author
Nutrition (BV Howard, Section Editor)


Growing evidence suggests that effects of red meat consumption on coronary heart disease (CHD) and type 2 diabetes could vary depending on processing. We reviewed the evidence for effects of unprocessed (fresh/frozen) red and processed (using sodium/other preservatives) meat consumption on CHD and diabetes. In meta-analyses of prospective cohorts, higher risk of CHD is seen with processed meat consumption (RR per 50 g: 1.42, 95 %CI = 1.07–1.89), but a smaller increase or no risk is seen with unprocessed meat consumption. Differences in sodium content (~400 % higher in processed meat) appear to account for about two-thirds of this risk difference. In similar analyses, both unprocessed red and processed meat consumption are associated with incident diabetes, with higher risk per g of processed (RR per 50 g: 1.51, 95 %CI = 1.25–1.83) versus unprocessed (RR per 100 g: 1.19, 95 % CI = 1.04–1.37) meats. Contents of heme iron and dietary cholesterol may partly account for these associations. The overall findings suggest that neither unprocessed red nor processed meat consumption is beneficial for cardiometabolic health, and that clinical and public health guidance should especially prioritize reducing processed meat consumption.


Review Meat Red meat Processed meat Cardiovascular disease Diabetes 



R. Micha: none; G. Michas: none; D. Mozaffarian: Received ad hoc honoraria from Nutrition Impact, Unilever, and SPRIM.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• 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):2271–83. The first systematic review and meta-analysis that assessed relationships between unprocessed red and processed meat consumption and risk of incident coronary heart disease, stroke, and type 2 diabetes. This meta-analysis provided evidence that the effects of meat consumption on cardiometabolic outcomes might vary depending on the extent of processing i.e., whether or not the meat is fresh (unprocessed) or has been processed and preserved for long-term storage, typically by adding high amounts of salt, as well as other preservatives such as nitrates.PubMedCrossRefGoogle Scholar
  2. 2.
    Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol. 2011;58(20):2047–67.PubMedCrossRefGoogle Scholar
  3. 3.
    Turesky RJ, Le Marchand L. Metabolism and biomarkers of heterocyclic aromatic amines in molecular epidemiology studies: lessons learned from aromatic amines. Chem Res Toxicol. 2011;24(8):1169–214.PubMedCrossRefGoogle Scholar
  4. 4.
    Mozaffarian D. Chapter 48: Nutrition and Cardiovascular Diseases, in Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine. 2012: Philadelphia.Google Scholar
  5. 5.
    Institute of Medicine of the National Academies, Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease. 2010.Google Scholar
  6. 6.
    Micha R, Kalantarian S, Wirojratana P, et al. Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis. Eur J Clin Nutr. 2012;66(1):119–29.PubMedCrossRefGoogle Scholar
  7. 7.
    World Health Organization, Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation, in World Health Organ Tech Rep Ser. 916: i–viii. 2003: Geneva. p. 1–149.Google Scholar
  8. 8.
    Hill AB. The Environment and Disease: association or Causation? Proc R Soc Med. 1965;58:295–300.PubMedGoogle Scholar
  9. 9.
    World Cancer Research Fund/ American Institute for Cancer Research, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. 2007: Washington DC: AICR.Google Scholar
  10. 10.
    Whiteman D, Muir J, Jones L, et al. Dietary questions as determinants of mortality: the OXCHECK experience. Public Health Nutr. 1999;2(4):477–87.PubMedCrossRefGoogle Scholar
  11. 11.
    Ascherio A, Willett WC, Rimm EB, et al. Dietary iron intake and risk of coronary disease among men. Circulation. 1994;89(3):969–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Burke V, Zhao Y, Lee AH, et al. Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines. Prev Med. 2007;44(2):135–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Martinez-Gonzalez MA, Fernandez-Jarne E, Serrano-Martinez M, et al. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr. 2002;41(4):153–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Liu J, Stampfer MJ, Hu FB, et al. Dietary iron and red meat intake and risk of coronary heart disease in postmenopausal women. Am J Epidemiol. 2003;157:S100.Google Scholar
  15. 15.
    Sinha R, Cross AJ, Graubard BI, et al. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med. 2009;169(6):562–71.PubMedCrossRefGoogle Scholar
  16. 16.
    • Bernstein AM, Sun Q, Hu FB, et al. Major dietary protein sources and risk of coronary heart disease in women. Circulation. 2010;122(9):876–83. Bernstein and colleagues evaluated the association between unprocessed red and processed meat consumption and incidence of coronary heart disease in the Nurse’s Health Study cohort.PubMedCrossRefGoogle Scholar
  17. 17.
    • 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):555–63. Pan and colleagues evaluated the Nurse’s Health Study and the Health Professionals Follow-up Study cohort to assess the associations between unprocessed red and processed meat consumption and risk of CVD death.PubMedCrossRefGoogle Scholar
  18. 18.
    • Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011;94(4):1088–96. An updated meta-analysis, using the methods reported in our meta-analysis [1], which evaluated the relationship between unprocessed red and processed meat consumption and incident type 2 diabetes, including our previously identified studies plus updated findings from three Harvard cohorts [19–21].PubMedCrossRefGoogle Scholar
  19. 19.
    Fung TT, Schulze M, Manson JE, et al. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 2004;164(20):2235–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Schulze MB, Manson JE, Willett WC, et al. Processed meat intake and incidence of Type 2 diabetes in younger and middle-aged women. Diabetologia. 2003;46(11):1465–73.PubMedCrossRefGoogle Scholar
  21. 21.
    van Dam RM, Willett WC, Rimm EB, et al. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care. 2002;25(3):417–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Song Y, Manson JE, Buring JE, et al. A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women: the women's health study. Diabetes Care. 2004;27(9):2108–15.PubMedCrossRefGoogle Scholar
  23. 23.
    Villegas R, Shu XO, Gao YT, et al. The association of meat intake and the risk of type 2 diabetes may be modified by body weight. Int J Med Sci. 2006;3(4):152–9.PubMedCrossRefGoogle Scholar
  24. 24.
    • Fretts AM, Howard BV, McKnight B, et al. Associations of processed meat and unprocessed red meat intake with incident diabetes: the Strong Heart Family Study. Am J Clin Nutr. 2012;95(3):752–8. Fretts and colleagues evaluated relationships between unprocessed red and processed meat consumption and incident diabetes in the Strong Heart Family Study cohort, in a population of American Indians characterized by relative high rates of obesity and diabetes.PubMedCrossRefGoogle Scholar
  25. 25.
    Jakobsen MU, O'Reilly EJ, Heitmann BL, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009;89(5):1425–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Meyer KA, Kushi LH, Jacobs Jr DR, et al. Dietary fat and incidence of type 2 diabetes in older Iowa women. Diabetes Care. 2001;24(9):1528–35.PubMedCrossRefGoogle Scholar
  27. 27.
    Micha R, Mozaffarian D. Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids. 2010;45(10):893–905.PubMedCrossRefGoogle Scholar
  28. 28.
    Feskens EJ, Virtanen SM, Rasanen L, et al. Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care. 1995;18(8):1104–12.PubMedCrossRefGoogle Scholar
  29. 29.
    Galgani JE, Uauy RD, Aguirre CA, et al. Effect of the dietary fat quality on insulin sensitivity. Br J Nutr. 2008;100(3):471–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Riserus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Prog Lipid Res. 2009;48(1):44–51.PubMedCrossRefGoogle Scholar
  31. 31.
    de Oliveira Otto MC, Mozaffarian D, Kromhout D, et al. Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2012;96(2):397–404.PubMedCrossRefGoogle Scholar
  32. 32.
    Djousse L, Gaziano JM. Dietary cholesterol and coronary artery disease: a systematic review. Curr Atheroscler Rep. 2009;11(6):418–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Salmeron J, Hu FB, Manson JE, et al. Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr. 2001;73(6):1019–26.PubMedGoogle Scholar
  34. 34.
    Siri-Tarino PW, Sun Q, Hu FB, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535–46.PubMedCrossRefGoogle Scholar
  35. 35.
    Djousse L, Gaziano JM, Buring JE, et al. Egg consumption and risk of type 2 diabetes in men and women. Diabetes Care. 2009;32(2):295–300.PubMedCrossRefGoogle Scholar
  36. 36.
    Rajpathak S, Ma J, Manson J, et al. Iron intake and the risk of type 2 diabetes in women: a prospective cohort study. Diabetes Care. 2006;29(6):1370–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Lee DH, Folsom AR, Jacobs Jr DR. Dietary iron intake and Type 2 diabetes incidence in postmenopausal women: the Iowa Women's Health Study. Diabetologia. 2004;47(2):185–94.PubMedCrossRefGoogle Scholar
  38. 38.
    Zhao Z, Li S, Liu G, et al. Body iron stores and heme-iron intake in relation to risk of type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2012;7(7):e41641.PubMedCrossRefGoogle Scholar
  39. 39.
    Sacks FM, Campos H. Dietary therapy in hypertension. N Engl J Med. 2010;362(22):2102–12.PubMedCrossRefGoogle Scholar
  40. 40.
    He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002;16(11):761–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Singh G.M., Danaei G., Farzadfar F., et al., Effect sizes for cardiovascular disease and diabetes outcomes of metabolic risk factors for population-based comparative risk assessment (CRA). Int J Cardiol, 2012. Under Review.Google Scholar
  42. 42.
    Forstermann U. Oxidative stress in vascular disease: causes, defense mechanisms and potential therapies. Nat Clin Pract Cardiovasc Med. 2008;5(6):338–49.PubMedCrossRefGoogle Scholar
  43. 43.
    McGrowder D, Ragoobirsingh D, Dasgupta T. Effects of S-nitroso-N-acetyl-penicillamine administration on glucose tolerance and plasma levels of insulin and glucagon in the dog. Nitric Oxide. 2001;5(4):402–12.PubMedCrossRefGoogle Scholar
  44. 44.
    Portha B, Giroix MH, Cros JC, et al. Diabetogenic effect of N-nitrosomethylurea and N-nitrosomethylurethane in the adult rat. Ann Nutr Aliment. 1980;34(5–6):1143–51.PubMedGoogle Scholar
  45. 45.
    Gajdosik A., Gajdosikova A , Stefek M., et al., Streptozotocin-induced experimental diabetes in male Wistar rats. Gen Physiol Biophys, 1999. 18 Spec No: p. 54–62.Google Scholar
  46. 46.
    Virtanen SM, Jaakkola L, Rasanen L, et al. Nitrate and nitrite intake and the risk for type 1 diabetes in Finnish children. Childhood Diabetes in Finland Study Group. Diabet Med. 1994;11(7):656–62.PubMedCrossRefGoogle Scholar
  47. 47.
    Parslow RC, McKinney PA, Law GR, et al. Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis. Diabetologia. 1997;40(5):550–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Kleinbongard P, Dejam A, Lauer T, et al. Plasma nitrite concentrations reflect the degree of endothelial dysfunction in humans. Free Radic Biol Med. 2006;40(2):295–302.PubMedCrossRefGoogle Scholar
  49. 49.
    Pereira EC, Ferderbar S, Bertolami MC, et al. Biomarkers of oxidative stress and endothelial dysfunction in glucose intolerance and diabetes mellitus. Clin Biochem. 2008;41(18):1454–60.PubMedCrossRefGoogle Scholar
  50. 50.
    Binkova B, Smerhovsky Z, Strejc P, et al. DNA-adducts and atherosclerosis: a study of accidental and sudden death males in the Czech Republic. Mutat Res. 2002;501(1–2):115–28.PubMedGoogle Scholar
  51. 51.
    Lakshmi VM, Schut HA, Zenser TV. 2-Nitrosoamino-3-methylimidazo[4,5-f]quinoline activated by the inflammatory response forms nucleotide adducts. Food Chem Toxicol. 2005;43(11):1607–17.PubMedCrossRefGoogle Scholar
  52. 52.
    Bogen KT, Keating GA. U.S. dietary exposures to heterocyclic amines. J Expo Anal Environ Epidemiol. 2001;11(3):155–68.PubMedCrossRefGoogle Scholar
  53. 53.
    Anderson RN, Rosenberg HM. Disease classification: measuring the effect of the Tenth Revision of the International Classification of Diseases on cause-of-death data in the United States. Stat Med. 2003;22(9):1551–70.PubMedCrossRefGoogle Scholar
  54. 54.
    Mozaffarian D. Meat intake and mortality: evidence for harm, no effect, or benefit? Arch Intern Med. 2009;169(16):1537–8. author reply 1539.PubMedCrossRefGoogle Scholar
  55. 55.
    Salonen JT, Nyyssonen K, Korpela H, et al. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation. 1992;86(3):803–11.PubMedCrossRefGoogle Scholar
  56. 56.
    Kontogianni MD, Panagiotakos DB, Pitsavos C, et al. Relationship between meat intake and the development of acute coronary syndromes: the CARDIO2000 case-control study. Eur J Clin Nutr. 2008;62(2):171–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Tavani A, Bertuzzi M, Gallus S, et al. Risk factors for non-fatal acute myocardial infarction in Italian women. Prev Med. 2004;39(1):128–34.PubMedCrossRefGoogle Scholar
  58. 58.
    Dietary Guidelines Advisory Committee. 2010 Dietary Guidelines For Americans. 2010 [cited Jan 31, 2011]; Available from:
  59. 59.
    Steinfeld H., Gerber P.,Wassenaar T., et al. Livestock's Long Shadow: Environmental Issues and Options, FAO, Editor. 2006: Rome.Google Scholar
  60. 60.
    Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. [cited; Available from:
  61. 61.
    Griesenbeck JS, Steck MD, Huber Jr JC, et al. Development of estimates of dietary nitrates, nitrites, and nitrosamines for use with the Short Willet Food Frequency Questionnaire. Nutr J. 2009;8:16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Renata Micha
    • 1
    • 2
  • Georgios Michas
    • 3
  • Dariush Mozaffarian
    • 4
    • 5
    Email author
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Department of Food Science and TechnologyUnit of Human Nutrition, Agricultural University of AthensAthensGreece
  3. 3.Department of Internal MedicineGeneral Hospital of KalamataKalamataGreece
  4. 4.Departments of Epidemiology and NutritionHarvard School of Public HealthBostonUSA
  5. 5.Division of Cardiovascular Medicine and Channing Division of Network Medicine, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations