Research gaps in evaluating the relationship of meat and health

• The epidemiology of meat and health is only part of the totality of evidence.
• Existing observational studies have a variety of limits that must be considered.
• It is not clear if the association of meat intake with chronic diseases is causative.
• Many factors correlate with high meat consumption.
• The degree of certainty linking meat with adverse health effects is modest, at best.

Humans evolved as omnivores and it has been proposed that cooking meat allowed for evolution of larger brains that has led to our success as a species. Meat is one of the most nutrient dense foods, providing high-quality protein, heme iron, zinc, and vitamins B6 and B12. Despite these advantages, epidemiologic studies have linked consumption of red or processed meat with obesity, type 2 diabetes, cardiovascular diseases, and cancers of multiple organs. Most observational studies report small, increased relative risks. However, there are many limitations of such studies including inability to accurately estimate intake, lack of prespecified hypotheses, multiple comparisons, and confounding from many factors – including body weight, fruit/vegetable intake, physical activity, smoking, and alcohol – that correlate significantly either positively or negatively with meat intake and limit the reliability of conclusions from these studies. The observational studies are heterogeneous and do not fulfill many of the points proposed by AB Hill in 1965 for inferring causality; his most important factor was strength of the association which in dietary studies is usually < 1.5 but is not considered adequate in virtually all other areas of epidemiology outside nutrition. Accepting small, statistically significant risks as “real” from observational associations, the field of nutrition has a long list of failures including beta-carotene and lung cancer, low-fat diets and breast cancer or heart disease that have not been confirmed in randomized trials. Moderate intake of a variety of foods that are enjoyed by people remains the best dietary advice.