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ReviewsNovember 19, 2019

Health-Related Values and Preferences Regarding Meat Consumption

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A Mixed-Methods Systematic Review
Author, Article and Disclosure Information
https://doi.org/10.7326/M19-1326

Abstract

This article has been corrected. The original version (PDF) is appended to this article as a Supplement.

Background:

A person's meat consumption is often determined by their values and preferences.

Purpose:

To identify and evaluate evidence addressing health-related values and preferences regarding meat consumption.

Data Sources:

MEDLINE, EMBASE, Web of Science, Centre for Agriculture and Biosciences Abstracts, International System for Agricultural Science and Technology, and Food Science and Technology Abstracts were searched from inception to July 2018 without language restrictions.

Study Selection:

Pairs of reviewers independently screened search results and included quantitative and qualitative studies reporting adults' health-related values and preferences regarding meat consumption.

Data Extraction:

Pairs of reviewers independently extracted data and assessed risk of bias.

Data Synthesis:

Data were synthesized into narrative form, and summaries were tabulated and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Of 19 172 initial citations, 41 quantitative studies (38 addressed reasons for meat consumption and 5 addressed willingness to reduce meat consumption) and 13 qualitative studies (10 addressed reasons for meat consumption and 4 addressed willingness to reduce meat consumption) were eligible for inclusion. Thirteen studies reported that omnivores enjoy eating meat, 18 reported that these persons consider meat an essential component of a healthy diet, and 7 reported that they believe they lack the skills needed to prepare satisfactory meals without meat. Omnivores are generally unwilling to change their meat consumption. The certainty of evidence was low for both “reasons for meat consumption” and “willingness to reduce meat consumption in the face of undesirable health effects.”

Limitation:

Limited generalizability of findings to lower-income countries, low-certainty evidence for willingness to reduce meat consumption, and limited applicability to specific types of meat (red and processed meat).

Conclusion:

Low-certainty evidence suggests that omnivores are attached to meat and are unwilling to change this behavior when faced with potentially undesirable health effects.

Primary Funding Source:

None. (PROSPERO: CRD42018088854)

People need to choose from a wide range of foods on a daily basis to meet their nutritional requirements (1). Consumption of different foods may yield both desirable and undesirable health effects (2). In light of recent studies showing an association between consumption of unprocessed red meat and processed meat and adverse health consequences, including increased risk for cancer (3), all-cause (4) and cardiovascular mortality (5), and stroke (6), dietary guidelines have generally endorsed limiting meat intake (7–9). However, these guidelines have neglected to identify and incorporate their target populations' values and preferences on meat consumption (10–13), which are major influences on what foods people eat (14–16). Understanding people's health-related values and preferences on meat consumption may improve the trustworthiness of dietary recommendations (17).

Therefore, we conducted a systematic review addressing people's health-related values and preferences on meat consumption. This review was done as part of Nutritional Recommendations and Accessible Evidence Summaries Composed of Systematic Reviews (NutriRECS), an initiative that aims to develop trustworthy nutritional recommendations (18). We performed 4 parallel systematic reviews addressing the following: experimental (19) and observational evidence (20) on the effect of red and processed meat on cancer and cardiometabolic outcomes, observational studies on the effect of red and processed meat on cancer outcomes (21), and the effect of varying red and processed meat dietary patterns on cardiometabolic and cancer outcomes (22). On the basis of these reviews, we developed recommendations for red and processed meat and health outcomes (23).

Methods

We registered the protocol with PROSPERO (CRD42018088854) (24) and adhered to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement (25).

Data Sources and Searches

We designed and conducted a search in MEDLINE (via PubMed), EMBASE (via Ovid), Web of Science (Institute for Scientific Information), Centre for Agriculture and Biosciences Abstracts (via CABI), International System for Agricultural Science and Technology, and Food Science and Technology Abstracts from inception to July 2018, and an updated search of MEDLINE and EMBASE through June 2019. We combined search terms related to meat consumption, consumer behavior, and values and preferences with the controlled vocabulary from each database. We did not restrict our search by publication status, language, or date of publication (Supplement Table 1). We also reviewed reference lists of the included articles and relevant systematic reviews.

Study Selection

We included studies exploring health-related values and preferences on meat consumption if more than 80% of participants were adults (aged ≥18 years). We considered quantitative (that is, cross-sectional design), qualitative (that is, participant interviews, focus groups), and mixed-methods studies. If studies did not report the participants' ages, we assumed that more than 80% were aged 18 years or older. We included only studies done in Europe, Australia, Canada, the United States, and New Zealand because we considered them to be homogeneous countries reflecting similar socioeconomic characteristics and values. We excluded studies that focused on meat alternatives (for example, cultured, in vitro, functional products, or genetically modified), types (for example, organic), quality (composition, sensory quality or palatability factors, or origin), safety (for example, food handling, chemical hazards or contamination, or storing or preserving), industry (for example, market research to inform or meet consumers' demands), consumption trends, and specific populations (for example, cancer survivors or pregnant women).

Before beginning each aspect of the review process, we conducted calibration exercises in which reviewers assessed the same articles and discussed any disagreement, leading to a clarification and a common understanding of criteria and process. After calibration, teams of 2 reviewers independently screened titles and abstracts of all retrieved references. Subsequently, teams of 2 reviewers independently reviewed the full text of articles deemed potentially eligible during title and abstract screening. In cases of disagreement, reviewers reached consensus with assistance from a third reviewer.

Data Extraction and Quality Assessment

We used 2 ad hoc data extraction forms for quantitative and qualitative research (Supplement Tables 2 and 3). After calibration exercises similar to the ones described earlier, teams of reviewers independently abstracted information from each study, including study identification, objectives or research questions, population characteristics, design and methods, risk of bias or methodological limitations, and findings. In cases of disagreement, reviewers reached consensus with assistance from a third reviewer.

For quantitative studies, we used an adapted version of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess risk of bias of studies on importance of outcomes or values and preferences (26). We considered 5 items grouped in 3 domains: selection of participants, missing outcome data, and measurement instruments' validity. We rated studies as having high risk of bias if the measurement instrument was not validated or was unclear, and as having moderate risk if it was validated but 2 or more items had high risk of bias. For qualitative studies, we used the Critical Appraisal Skills Programme qualitative research checklist, which consists of the following items: aim of the research, qualitative methodology appropriateness, research design, appropriate recruitment strategy, data collection, investigator and participants' relationship, ethical issues, data analysis, findings, and value of the research (27). We rated studies as having “serious methodological limitations” if more than 2 items had serious concerns and as having “moderate methodological limitations” if they had 2 items with serious concerns. Reviewers independently assessed risk of bias or methodological limitations. In cases of disagreement, reviewers reached consensus with assistance from a third reviewer.

Data Synthesis and Analysis

We synthesized results from studies using a 4-step approach that involved simultaneous quantitative and qualitative data collection and analysis. First, we selected 2 to 3 eligible articles per study design, identified key themes, and coded them in categories. Second, we used these categories to design ad hoc data extraction forms. Third, using an iterative process, we compared the key themes of the categories identified across all studies and developed analytic themes. Fourth, we applied the critical meta-narrative synthesis to transform the quantitative data into qualitative data (28, 29). For the last step, we used 4 systematic profiles and several critical questions to extract the identified narratives and to guide our synthesis of data (Supplement Table 4).

We synthesized and narratively reported the findings according to participants' meat consumption. We defined those who consumed meat as omnivores and analyzed them separately from persons who typically avoided meat, whom we defined as vegetarians, including lacto-ovo vegetarians or low-meat consumers.

For quantitative studies, we assessed the certainty of evidence for each review finding according to GRADE domains (risk of bias, imprecision, inconsistency, indirectness, and publication bias) (30, 31). For qualitative studies, we assessed the certainty of evidence according to GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) domains (methodological limitations, relevance, coherence, and adequacy) (32). Findings were initially considered as high certainty and were downgraded (from high to very low) by 1 or more levels if serious or several minor or moderate concerns were detected in 1 or more domains.

Role of the Funding Source

The study received no funding.

Results

The search yielded 19 172 articles, of which 456 were deemed potentially eligible on the basis of title and abstract. We excluded 402 studies (Supplement Table 5). After full-text appraisal, we included 41 quantitative (33–73) and 13 qualitative studies (74–86). The Figure presents the flow diagram with the search results and selection of studies.

Figure. Evidence search and selection.

AGRIS = International System for Agricultural Science and Technology; CAB = Centre for Agriculture and Biosciences; FSTA = Food Science and Technology Abstracts.

Study Characteristics

Table 1 presents the characteristics of the 54 included studies. Of the 41 quantitative studies, 21 were done in Europe, 11 in the United States, 7 in Australia, 1 in Canada, and 1 in New Zealand. Eighteen studies were done between 1988 and 2009, and 23 were done between 2011 and 2019. Of the 13 qualitative studies, 7 were done in Europe, 3 in the United States, and 3 in Australia. Six were done between 1991 and 2010, and 7 were done between 2011 and 2018. The number of participants ranged from 100 to 22 935 (aged 18 to >65 years) in the quantitative studies and from 19 to 460 (aged 16 to >75 years) in the qualitative studies. Among the included studies, 41 reported data on meat in general, 6 reported data on both meat in general and red meat, and 7 reported data on red meat only.

Table 1. Characteristics of the Included Studies
Table 1—Continued
Findings

We identified 2 main themes: reasons for meat consumption (38 quantitative [62 963 participants] and 10 qualitative [419 participants]) and willingness to reduce meat consumption in the face of undesirable health effects (5 quantitative [8983 participants] and 4 qualitative [616 participants]). Table 2 shows the main findings and their certainty (Supplement Tables 6 and 7). Of the quantitative studies, 23 of 38 (60.5%) reporting “reason for meat consumption” and 5 of 5 (100%) reporting “willingness to reduce meat consumption in the face of undesirable health effects” were assessed as having high risk of bias due to lack of validation of the measurement instruments (Supplement Table 8). Of the qualitative studies, 1 of 12 (8.3%) reporting “reason for meat consumption” had serious methodological limitations due to lack of reporting of the investigator and participants' relationship, lack of detail about the data analysis process, and unclear reporting of findings (Supplement Table 9).

Table 2. Review Finding Table and Certainty of Evidence
Reasons for Meat Consumption
Quantitative Studies

Nineteen studies reported on reasons for omnivores' meat consumption (35, 38, 42, 45–47, 56–59, 65–73). Most consumed meat because they enjoyed it (38, 46, 56–59, 65, 66, 71), they perceived it as being part of a complete and healthy diet (38, 42, 47, 56–59, 65, 66, 68–73), and they considered it part of their culture (58, 71). In addition, lack of food alternatives and lack of cooking skills to prepare a tasty dish without meat were often reported as barriers to reducing meat consumption (38, 45, 59, 65, 69).

Ten studies reported that, overall, men had a more positive attitude toward meat consumption than women (34–36, 38, 51, 52, 65, 66, 68, 69) and that they considered meat as part of a healthy diet and their culture (36, 38, 48, 69). Women were substantially more concerned about health consequences (34, 36, 38, 51, 65, 66) and more frequently avoided eating meat because of health and ethical concerns (34, 40, 52). Three studies reported inconsistent results on how elderly persons value meat consumption (51, 65, 66). In 2 studies, these persons noted potential undesirable health consequences (51) and the presence of diet-related diseases (66) as important reasons to reduce meat consumption. Another study, however, reported that older people were no more concerned about health than younger people, with both groups believing that meat was necessary for maintaining health (65).

Seventeen studies reported on reasons for avoiding meat among vegetarians or low-meat consumers. All participants reported health (for example, risk for cancer, heart diseases) as 1 of the main reasons for avoiding meat (37–39, 41, 43, 45, 46, 49–51, 54, 55, 60–63, 67). Other reasons for avoiding meat included animal welfare or environmental concerns (37, 43, 46, 51, 54, 55, 60–63, 67, 69).

The overall certainty of the evidence was rated as low because 20 of 38 (53%) studies proved to be at high risk of bias due to lack of validation of the measurement instruments and likely selectivity of study populations.

Qualitative Studies

Three studies reported on the reasons omnivores consume meat (74, 77, 83): enjoyment (74, 77), the perception that meat was part of a healthy diet (74, 77, 83), and the belief that it was part of their culture (77). Lack of food alternatives and cooking skills to prepare a tasty dish without meat were often mentioned as barriers to reducing consumption (74, 77).

Two studies reported that older people believe that aging is associated with a decline in food intake and thus a reduction in meat consumption, with a particular focus on red meat (76, 84). Many elderly participants viewed fish as a healthier alternative to red meat and were aiming to regularly incorporate fish into their diet (76). Most older people believed that people ate too much meat and that it was the cause of the increase in the frequency of cancer, high blood pressure, diabetes, and heart disease (84).

Six studies explored reasons for avoiding meat among vegetarians and low-meat consumers and suggested that motivations for vegetarianism and meat avoidance vary and change over time (81, 85). Persons might initially avoid meat because of 1 motivation or concern (for example, health) and later integrate other beliefs or reasons to support their behavior (for example, animal welfare and environmental concerns) (78, 82). For many vegetarians, concern about health (for example, to avoid genetic health problems, such as heart disease) was the primary motivation to stop eating meat, but ethical concerns (for example, animal welfare) were also often reported as a major reason (73–75, 78, 81, 85).

The overall certainty of the evidence was rated as low because of methodological limitations due to lack of reporting of the investigator and participants' relationship (8 of 10 [80%] studies), limited information on the data analysis process and the likely selectivity of study populations (3 of 10 [30%] studies), and adequacy concerns (small number of participants).

Willingness to Change Meat Consumption in the Face of Health Concerns
Quantitative Studies

Five studies evaluated willingness to change meat consumption when faced with health concerns (36, 42, 44, 53, 64). One study provided participants with a World Health Organization report on the risk for colorectal cancer associated with red meat consumption (42). Another study provided participants with a fictional newspaper article reporting potentially undesirable health effects of meat consumption, including risk for stroke, heart attack, diabetes, and cancer (36). In both studies, most participants reported that they would not reduce meat consumption in the future, partially because they mistrusted the information provided (36, 42). In 1 study, many of the participants believed additives used in the production process were the real health problem rather than the meat consumption itself (42). Men attached greater importance to possible barriers for reducing meat consumption, considering it as part of a healthy diet and their culture, whereas most women expressed environmental concerns and animal welfare as motivations for reducing meat consumption (36).

Two additional studies asked participants what changes they would make to improve or maintain their health, and meat reduction was not among the most frequently reported; other dietary or lifestyle changes, such as exercise or eating more fruits and vegetables, were, among 10 options, selected more often (44, 53). One study that asked what future changes participants would make specifically regarding meat consumption found that most, especially men, had no intention of changing meat consumption (64). Many participants already believed that they had reduced their meat consumption in the past and did not plan any further reductions (64).

The overall certainty of the evidence was rated as low because all studies proved to be at high risk of bias due to lack of validation of the measurement instruments, and for indirectness because 3 of 5 (60%) studies did not inform participants about the undesirable health effects of meat consumption and the likely selectivity of populations.

Qualitative Studies

Four studies evaluated willingness to change meat consumption in the face of health concerns (77, 79, 80, 86). Two studies asked participants how they perceived the possibility of changing meat consumption habits to minimize undesirable health effects. Most participants reported that they would not reduce consumption (79, 80). One study asked participants their opinion about consumption of fewer animal-derived products and consuming more plant-based foods. Participants were concerned about reducing meat consumption because they perceived meat as an important component of a healthy diet (77). Reasons participants reported not desiring to change consumption included belief that they already ate small quantities and did not need to reduce further (this reason was more frequently cited when discussing reduction of red meat than other types of meat) (80), that they had already reduced meat consumption in the past (80), that the consequences of meat consumption were trivial compared with other behaviors (for example, smoking tobacco) (79, 80), and that they did not trust the available scientific information (79). In another study, participants were presented with nutritional information about lamb meat and then asked about their future meat consumption intentions. Most participants believed they would continue with their current consumption, with the most common reasons being the belief that they needed protein and the enjoyment of eating meat (86).

The overall certainty of the evidence was rated as low because of methodological limitations due to lack of reporting of the investigator and participants' relationship (3 of 4 [75%] studies), because of concerns in relevance due to not informing participants about the undesirable health effects of meat consumption and the likely selectivity of populations (4 of 4 [100%] studies), and because of adequacy concerns (small number of participants).

Discussion

Key findings from our systematic review include the reasons omnivores consume meat: They consider meat an essential component of a healthy diet, they enjoy eating meat, they feel that meat is a part of their traditions, and they believe they lack the knowledge and cooking skills to prepare an adequate meal without meat. Study participants' willingness to change meat consumption in response to health concerns is generally low. Our findings were consistent across the 2 bodies of evidence (quantitative and qualitative research). The overall certainty of evidence was low, predominantly because of risk of bias or methodological limitations, lack of validation of the questionnaires, issues of indirectness or relevance, and issues of adequacy.

Strengths of this review include explicit eligibility criteria, an extensive search, and duplicate assessment of eligibility and risk of bias or methodological limitations. The use of 2 complementary bodies of evidence (mixed-methods) and the use of the GRADE approach to assess the certainty of the evidence allowed greater confidence in the interpretation of results (87).

This study also has limitations. We included studies done only in Europe, Australia, Canada, the United States, and New Zealand, reflecting food values and preferences of populations living in high-income countries. Therefore, we cannot generalize these findings to other populations. In addition, the studies reporting willingness to reduce meat consumption in the face of health concerns did not provide participants with sufficient information about the certainty of the evidence, nor about the effect meat consumption has on health. Studies failed to consistently report participants' socioeconomic status, educational level, and religious beliefs, precluding exploration of the effect of these characteristics on dietary values and preferences. Another limitation is related to the applicability of our results to the NutriRECS red meat recommendation because most of the included studies do not focus on red or processed meat, but rather meat in general. Finally, our systematic review focuses only on the influence of health effects and does not address other reasons that influence meat consumption, such as animal welfare and environmental concerns.

We performed a search of MEDLINE through June 2019 to identify relevant previous reviews. More recent study results are consistent with those of earlier studies: During the past 2 decades, omnivores have remained highly attached to meat, and willingness to change consumption has remained generally low (88, 89). Regarding prior systematic reviews, 1 review evaluated omnivores' perceptions and behaviors regarding protein consumption in general and not red meat in particular (88). That systematic review concluded that omnivores' willingness to change consumption in terms of reducing or substituting meat (for example, by eating insects or meat substitutes) is low. One recent narrative review evaluated psychological aspects of meat consumption in general and concluded that eating meat is entrenched in Western culture (89), which is consistent with our findings. Other existing narrative reviews explored motivations for consuming or avoiding meat and suggested, in keeping with our results, that the reasons for consuming meat are complex and diverse and may vary according to age and sex (90, 91).

Our findings have direct implications for stakeholders making both public health and clinical nutritional recommendations. Our results highlight the inappropriateness of assuming that informed persons would choose to reduce meat consumption on the basis of small and distant health benefits, particularly if the benefits are uncertain (10, 92). The results suggest that it may be similarly inappropriate to assume that informed persons would choose to modify their preferred diet in other ways on the basis of small and uncertain health benefits. However, studies generally did not present the possible adverse health consequences of meat consumption in ways that captured the current evidence and its uncertainty. Optimal insight into people's values and preferences, and in particular into willingness to reduce meat consumption, requires such a presentation. Subsequent research should address this issue.

Appendix: Members of the NutriRECS Working Group

Members of the NutriRECS Working Group who authored this work are: Claudia Valli, MSc (Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica de Sant Pau [IIB Sant Pau-CIBERESP], Barcelona, Spain); Montserrat Rabassa, PhD (Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica de Sant Pau [IIB Sant Pau-CIBERESP], Barcelona, Spain); Bradley C. Johnston, PhD (McMaster University, Hamilton, Ontario, and Dalhousie University, Halifax, Nova Scotia, Canada); Ruben Kuijpers, MSc (Wageningen University, Wageningen, the Netherlands); Anna Prokop-Dorner, PhD (Jagiellonian University Medical College, Krakow, Poland); Joanna Zajac, PhD (Jagiellonian University Medical College, Krakow, Poland); Dawid Storman, MD (Jagiellonian University Medical College, Krakow, Poland); Monika Storman, MD (Medical University of Warsaw, Warsaw, and Jagiellonian University Medical College, Krakow, Poland); Malgorzata M. Bala, MD, PhD (Jagiellonian University Medical College, Krakow, Poland); Ivan Solà, MSc (Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica de Sant Pau [IIB Sant Pau-CIBERESP], Barcelona, Spain); Dena Zeraatkar, MSc (McMaster University, Hamilton, Ontario, Canada); Mi Ah Han, PhD (School of Medicine, Chosun University, Gwangju, Republic of Korea); Robin W.M. Vernooij, PhD (Dalhousie University, Halifax, Nova Scotia, Canada, and Netherlands Comprehensive Cancer Organisation [IKNL], Utrecht, the Netherlands); Gordon H. Guyatt, MD (McMaster University, Hamilton, Ontario, Canada); Pablo Alonso-Coello, MD, PhD (Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica de Sant Pau [IIB Sant Pau-CIBERESP], Barcelona, Spain, and McMaster University, Hamilton, Ontario, Canada).

Members of the NutriRECS Working Group who contributed to this work but did not author it: Mateusz Swierz, MSc (Jagiellonian University Medical College, Krakow, Poland); Agnieszka Król, MSc (Jagiellonian University Medical College, Krakow, Poland); Katarzyna Jasińska, MSc (Jagiellonian University Medical College, Krakow, Poland); Alvin Leenus, BHSc (McMaster University, Hamilton, Ontario, Canada); Calvin Lo, BHSc (University of British Columbia, Vancouver, British Columbia, Canada); Michele Monroy, ND, MSc (School of Public Health, University of Saskatchewan, Canada); Arnav Agarwal, MD (University of Toronto, Toronto, Ontario, Canada); Corinna Steiner, BHSc (Hochschule Furtwangen University, Furtwangen im Schwarzwald, Germany); Juan Du, MSc (Servicio de Epidemiología Clínica y Salud Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain).

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Richard M Fleming, PhD, MD, JD (FHHI-OI-Camelot); Matthew R Fleming, BS, NRP (FHHI-OI-Camelot); Tapan K Chaudhuri, MD (Eastern Virginia Medical School)28 February 2020
What Health-Related Values and Preferences should we be looking at regarding meat consumption – or for that matter anything else?
The authors conclude – suggest actually - that omnivores “attached to meat are unwilling to change this behavior with potentially undesirable health effects.” If this were a valid argument for surrendering evidence-based medicine to human behavior, physicians should stop seeing patients and little if any money or effort should be spent to address socially harmful behavior. After all, if people are unwilling to change – why waste our time and money?

We should simply abandon our efforts to reduce smoking, excessive drinking, violence in the home, road rage, playing chicken, driving without seat belts or motorcycle helmets, opioid addition, obesity, child abuse, bullying, cyber stalking, shootings, - well you get the picture.

When paramedics arrive on scene, rather than wasting valuable time and resources, they should get back into the ambulance and not render aid in instances of self-inflicted harm caused by these behaviors. That will dramatically reduce health care costs while avoiding recidivism, e.g. with the opioid crisis.

Instead of taking that approach; however – the approach taken by the authors - we as a society have decided to address harmful behaviors to the best of our ability by determining which behaviors are harmful to ourselves, our patients, friends, families and those addicted – clearly someone unwilling to stop a behavior shown to be harmful to them could be considered to be addicted to that behavior – to such behaviors and endeavor to change that behavior.

So it is puzzling, why would the authors suggest that a behavior shown to increase coronary artery disease and at least certain cancers, should just be accepted and not addressed, merely because the omnivores “attached to meat are unwilling to change this behavior with potentially undesirable health effects”?

We await an answer.
Richard M Fleming, PhD, MD, JD (FHHI-OI-Camelot); Matthew R Fleming, BS, NRP (FHHI-OI-Camelot); William C. Dooley, MD (OUHSC); Tapan K Chaudhuri, MD (Eastern Virginia Medical School)(28 February 2020
What Health-Related Values should we be looking at regarding meat – or anything else – we consume?
Comparisons of the publications by Zhong [1], Rubin [2], and Johnston [3] would suggest that the currently available research - surrounding the impact of diets, meat and health – leaves us with the equivalent of a secondary school food fight [4], providing little or no scientific evidence-based medicine to support conclusions.

E.g. it is well established that cholesterol plays an important role in the development of the inflammatory process known as coronary artery disease [5]. Measurement of changes in inter alia weight, cholesterol, CRP, fibrinogen, and homocysteine alone without measurement of the actual tissue impact – viz. coronary artery disease – provides limited information about the actual impact of diet or red meat upon our health or hearts [6].

While some initial investigations into the measureable impact various diets and foods have on our health does exist, the results to date have been semi-quantitative and we need further absolute quantification [7] to provide accurate, consistent and reproducible results – to resolve the continued confusion.

We can and should do better than a mere food fight. It is time to quantitatively measure the real effect our diets are having on our public health.

References:

1. 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. Published online February 03, 2020. doi:10.1001/jamainternmed.2019.6969
2. Rubin R. Backlash Over Meat Dietary Recommendations Raises Questions About Corporate Ties to Nutrition Scientists. JAMA. Published online January 15, 2020. doi:10.1001/jama.2019.21441.
3. Johnston BC, Zeraatkar D, Han MA, et al. Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium. Ann Intern Med 2019. DOI: 10.7326/M19-1621.
4. Dyer O. Food fight: controversy over red meat guidelines rumbles on. BMJ 2020;368, doi.org/10.1136/bmj.m397
5. Fleming RM. Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY. 1999, pp. 787-798.
6. Fleming RM, Harrington GM. What is the Relationship between Myocardial Perfusion Imaging and Coronary Artery Disease Risk Factors and Markers of Inflammation? Angiology 2008;59:16-25.
7. Fleming RM, Fleming MR, Dooley WC, Chaudhuri TK. Invited Editorial. The Importance of Differentiating Between Qualitative, Semi-Quantitative and Quantitative Imaging – Close Only Counts in Horseshoes. Eur J Nucl Med Mol Imaging. DOI:10.1007/s00259-019-04668-y. Published online 17 January 2020 https://link.springer.com/article/10.1007/s00259-019-04668-y

Disclosures: FMTVDM issued to first author. First author, authored the "Inflammation and Heart Disease" Theory.

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