Is replacing red meat with other protein sources associated with lower risks of coronary heart disease and all-cause mortality? A meta-analysis of prospective studies

Abstract

Context A high amount of red meat consumption has been associated with higher risks of coronary heart disease (CHD) and all-cause mortality in a single food-exposure model. However, this model may overlook the potentially differential influence of red meat on these outcomes depending on the foods replaced by red meat. Objective A PRISMA-compliant meta-analysis of prospective observational studies was performed to quantify the risks of CHD and all-cause mortality associated with the replacement of total, unprocessed, or processed red meat with fish/seafood, poultry, dairy, eggs, nuts, and legumes. Data sources The PubMed and Web of Science databases were searched to identify relevant articles published in any language from database inception to October 30, 2021. Data extraction The prospective observational studies were considered relevant if they reported relative risks (RRs) and 95%CIs for the associations of interest. Data analysis Thirteen articles were included. A random-effects model was used to estimate the summary RRs and 95%CIs for the associations of interest. Replacing total red meat with poultry (RR, 0.88, 95%CI, 0.82–0.96; I2 = 0%), dairy (RR, 0.90, 95%CI, 0.88–0.92; I2 = 0%), eggs (RR, 0.86, 95%CI, 0.79–0.94; I2 = 7.1%), nuts (RR, 0.84, 95%CI, 0.74–0.95; I2 = 66.8%), or legumes (RR, 0.84, 95%CI, 0.74–0.95; I2 = 7.3%) was associated with a lower risk of CHD, whereas substituting fish/seafood (RR, 0.91, 95%CI, 0.79–1.04; I2 = 69.5%) for total red meat was not associated with the risk of CHD. The replacement of total red meat with fish/seafood (RR, 0.92, 95%CI, 0.89–0.96; I2 = 86.9%), poultry (RR, 0.92, 95%CI, 0.90–0.95; I2 = 61.6%), eggs (RR, 0.91, 95%CI, 0.87–0.95; I2 = 33.8%), or nuts (RR, 0.92, 95%CI, 0.87–0.97; I2 = 81.9%) was associated with a lower risk of all-cause mortality, whereas the substitution of dairy (RR, 0.97, 95%CI, 0.93–1.01; I2 = 33.9%) or legumes (RR, 0.97, 95%CI, 0.93–1.01; I2 = 53.5%) for total red meat was not associated with the risk of all-cause mortality. Lower risks of CHD and all-cause mortality were more consistently observed for processed red meat replacements than for unprocessed red meat replacements. The results did not materially change when the analyses of total, processed, and unprocessed red meat were restricted to the studies that used a uniform substitution amount per unit of 1 serving/d. Conclusion Keeping red meat, particularly processed red meat, consumption to a minimum along with increasing healthier alternative protein sources to replace red meat in the diet may contribute to the prevention of CHD and premature death. Systematic review registration PROSPERO registration no. CRD42021259446.

Substitution of Dairy Products and Risk of Death and Cardiometabolic Diseases: A Systematic Review and Meta-Analysis of Prospective Studies

“…Hidayat et al. [ 58 ] investigated whether substituting red meat with other protein sources is associated with lower risks of CAD and all-cause mortality and observed associations when processed red meat was substituted with dairy. These associations were rated with moderate certainty using the NutriGrade scoring system [ 59 ].…”

“…However, Hidayat et al. [ 58 ] did neither assess the risk of bias with the ROBINS-E tool nor did they investigate further NCD outcomes, such as CVD and T2D.…”

Nuts and seeds consumption and risk of cardiovascular disease, type 2 diabetes and their risk factors: a systematic review and meta-analysis

“…Previous SRs on nuts have not addressed this question. Hidayat et al recently published a meta-analysis regarding replacement of red meat with other protein sources, and concluded that replacing red meat with nuts was associated with lower risk of CHD and all-cause mortality ( 163 ).…”

Insulin resistance, combined with health-related lifestyles, psychological traits and adverse cardiometabolic profiles, is associated with cardiovascular diseases: findings from the BHMC study

“…It is possible that compared to those who strictly follow a vegan diet, people who prefer vegetarian food may be older and have more comorbidities with metabolic disorders, thus leading to a reverse causality. Evidence from observational studies and meta-analyses has confirmed that red meat intake is associated with incident CVDs and mortality, [32][33][34] which may be due to the high proportion of cholesterol and total energy intake. It is worth noting that reducing red meat consumption to a minimum while increasing the intake of healthier alternative proteins can help prevent CVDs.…”