Introduction
Meat is consumed across a variety of dietary patterns, influenced by culture, tradition, food preferences, socioeconomic status, personal beliefs, access, affordability, and more. Over the past several decades, food-based dietary guidelines have increasingly recommended reducing the consumption of animal-sourced foods, particularly red and processed meats, in favor of replacement with plant-based foods. These recommendations stem from a range of health, environmental, economic, and social considerations. The type and amount of meat included in modeled dietary patterns vary significantly, from complete exclusion in vegan and vegetarian diets to a primary reliance on animal proteins in low-carbohydrate, high-protein, or carnivore diets. Although there is great variation across dietary patterns, epidemiological evidence of dietary intake and related health outcomes indicates that multiple dietary patterns are associated with favorable health outcomes, rather than a single universal approach. It is well known that diet has a direct impact on health, and while nutrient needs are individualized based on age, gender, level of activity, and more, public health guidance is based on the totality of evidence supporting population-based needs (DGA, 2020). This review will examine a range of dietary patterns with varying levels of meat, along with evaluating the quality of evidence supporting each approach.
Nutritional Value of Meat
Animal-sourced foods, meat in particular, are a key source of numerous essential nutrients, including high-quality protein and bioavailable vitamins and minerals (Table 1). Data exists to help summarize the nutrient contribution of meat products to the global population. The DELTA Model is a computational model developed as a part of the Sustainable Nutrition Initiative that includes global data from food availability, food waste, demographic-based nutrient requirements, and nutrient bioavailability to calculate global per capita nutrient availability. The DELTA Model found that meat contributed to the global availability of 29 nutrients (Smith et al., 2022). Meat types included in this model were ruminant meat (about 25%), poultry and pig meat (about 30% of each), other meats (2%), and offal and animal fats (9%). Globally, meat made up about 7% of the total food mass available to consumers, providing 11% of total food energy availability, 29% of dietary fat, and 21% of protein availability. Additionally, meat contributed significantly to vitamin and mineral availability, providing 56% vitamin B12, 24% vitamin A, 19% zinc, 18% selenium, 15% thiamin (B1) and riboflavin (B2), 13% vitamin B6 and iron, 11% phosphorus, and 10% pantothenic acid (B5) and copper availability (Smith et al., 2022). As shown in Figure 1, meat accounts for only about 7% of the total food mass but provides anywhere from 10% to 56% of 12 key nutrients, indicating the removal of meat would remove over half of the global supply of vitamin B12, about a quarter of the supply of vitamin A and protein, and several other essential nutrients. According to the Food and Agriculture Organization (FAO), the broader category of animal-sourced foods contributes 18% of the global food energy and 34% of global protein consumption (FAO, 2021).
Key nutrients provided by meats and their role in health1
| Choline | Nervous system function and brain health, particularly related to memory function, and liver function |
| Copper | Energy production, metabolism, immune function, healthy blood vessels, nerves, and bones |
| Niacin | Metabolism, cholesterol and fatty acid synthesis, and antioxidant function |
| Iron | Growth, development, immune function and energy production, mainly by carrying oxygen throughout the body |
| Pantothenic Acid | Energy production, metabolism, synthesis of hormones, and nervous system function |
| Phosphorus | Energy production, cell function, and maintains strong bones and teeth |
| Protein | Structural support (muscle and other tissues), hormone production, enzyme production, immune function, and more |
| Riboflavin | Energy production, metabolism, and immune function |
| Selenium | Thyroid hormone metabolism, DNA synthesis, reproduction, and antioxidant function |
| Thiamin | Energy production and metabolism, particularly for converting carbohydrates into fuel for the body, and nervous system function |
| Vitamin B6 | Metabolism, immune function, and brain health |
| Vitamin B12 | Red blood cell production, metabolism, nervous system function, brain function, and synthesis of DNA, hormones, protein and lipids |
| Zinc | Immune function, growth and development, protein synthesis and DNA production |
Note: A 3-ounce serving of cooked meat, including beef, pork, lamb and poultry (NDB# 13364, 10093, 17227, and 5747, respectively) provides a good (10-19% of the daily value) or excellent (20% or more of the daily value) of the nutrients included.
National Institutes of Health (NIH). Office of Dietary Supplements: Fact Sheet for Health Professionals.
Percent contribution of meat to the global supply of nutrients based on data from the DELTA Model.
Nutrient needs vary across life stages, and meat provides numerous essential nutrients that nourish at every life stage. There are common nutrient shortfalls in vulnerable age groups, such as infants, adolescents, and aging adults. Across the life course, several nutrients of public health concern arise, including protein, iron, zinc, vitamin B12, choline, and phosphorus, particularly during periods of rapid growth, reproduction, and aging. During pregnancy and lactation, meeting needs for iron, folate, choline, iodine, and protein is critical to support maternal health and fetal development, with evidence suggesting nutrient adequacy during this period may influence long-term child health outcomes (DGA, 2020). Infancy and toddlerhood represent another sensitive window, as iron stores decline around 6 mos of age and complementary foods become essential to support neurodevelopment and growth. Inadequate intakes of iron, vitamin B12, and zinc during this stage can have lasting consequences. Accordingly, the World Health Organization and the 2020–2025 Dietary Guidelines for Americans identify meat and other iron- and zinc-rich foods as important complementary foods for infants and toddlers (WHO, 2023; DGA, 2020). Adolescence is characterized by increased nutrient needs but the lowest overall diet quality in the US, with underconsumption of protein and multiple micronutrients, particularly among adolescent girls (DGAC, 2020). Later in adulthood, maintaining muscle mass and function becomes a priority, as age-related muscle loss can impair mobility and quality of life; adequate intake of high-quality protein, alongside resistance exercise, is a key mitigation strategy. Vitamin B12 inadequacy also becomes more common with age, a nutrient found naturally only in animal-source foods (DGA, 2020). Across these life stages, animal-source foods, especially meat, provide a bioavailable source of protein, iron, zinc, vitamin B12, choline, phosphorus, and vitamin B6, helping address multiple nutrient shortfalls (Beal et al., 2017; Murphy and Allen, 2003).
Types and suggested amounts of meats included in a variety of common dietary patterns
| Dietary Pattern/ Score | Meat Categories | Suggested Amounts |
|---|---|---|
| Carnivore Diet1 | Red meat Poultry |
Up to 2 pounds/d for total meat to meet calorie requirement |
| Ketogenic Diet | Red meat Poultry |
Varies greatly |
| Low-Carb, High-Protein Diet | Red Meat Poultry |
Varies greatly |
| PURE Diet2 (Mente et al., 2023) |
Red Meat Poultry |
Healthiest diets included: 1.9 ounces of red meat/d 0.8 ounce of poultry/d |
| USDA Healthy US-Style Eating Pattern & Eat Healthy Your Way1 (2010–2015 DGA) |
Meat Poultry |
1.8 ounces meat/d 1.5 ounces poultry/d |
| DASH-Style Diet3 (Appel et al., 1997) |
Beef, pork, and ham Poultry |
∼1.5 ounces beef, pork, and ham/d ∼1.8 ounces poultry/d |
| Mediterranean Diet4 (Bach-Faig et al., 2011) |
White meat Red and processed meat |
∼1.1 oz white meat/d ∼<1.1 oz red and processed meat/d |
| EAT-Lancet Healthy5 Reference Diet (Willett et al., 2019) |
Beef and lamb Pork Chicken and other poultry |
0–0.5 ounce beef and lamb/d 0–0.5 ounce pork/d 0–2.0 ounces chicken or other poultry/d |
2,000 calorie diet
2,300 calorie diet
2,100 calorie diet
Calorie level not specified
2,500 calorie diet
Meat provides many essential nutrients to support growth, development, and overall health, but it is also important to consider dietary balance, particularly regarding nutrients of concern, such as saturated fat and cholesterol, to align with individual health needs and dietary guidelines. It is, however, important to note that the beneficial nutrients found in fresh, unprocessed meat typically outweigh those of concern. Animal-source foods are a natural source of saturated fat and cholesterol; however, research has shown that when meats, such as lean red meat or poultry, are consumed in healthy dietary patterns, they can help maintain healthy blood lipid levels (Sanders et al., 2024). Lean is a term defined by USDA as 100 grams of meat with less than 10 grams of total fat, less than or equal to 4.5 grams of saturated fat, and less than 95 milligrams of cholesterol. Intramuscular fat (marbling), external fat, and skin can all impact the lean point of meat products. Saturated fat research is nuanced, and emerging data suggest that when nutrients of concern, such as saturated fat, are consumed within the context of a whole food, the negative effect may be minimized (Astrup et al., 2020; Guasch-Ferré et al., 2019; Sanders et al., 2024). The concept of the whole food meat matrix suggests that the benefit from consuming meat is more than the sum of the individual nutrients, meaning there are bioactive compounds that may have unique benefits as the compounds within a whole food interact (Klurfeld, 2024).
Poultry, pork, beef, and sheep meat are the most commonly consumed meats globally. In fact, human anatomy, digestion, and metabolism indicate humans have relied on meat consumption for millions of years (Leroy et al, 2023). Evidence from the hunter-gatherer societies suggests that populations during that era consumed 45 to 65% of their energy from animal-sourced foods, including meat (Cordain, 2000). Diverging from evolutionary diets (primarily high-protein, low-carbohydrate) that contained greater amounts of meat, root plants, wild pulses, and a variety of nuts and fruits, with a shift toward a more refined diet of grains, may have resulted in unintended health consequences, such as a rise in critical nutrient inadequacies (Mann, 2007). The burden of malnutrition and nutrient deficiency is also, in part, a result of geographic and economic shifts (Beal et al., 2024). Roughly 42% of the world cannot afford a healthy diet, and those living in low- and middle-income countries, particularly vulnerable subpopulations in these areas, are at a higher risk of nutrient inadequacies (Beal et al., 2023). Socioeconomic status and availability of animal-source foods play critical roles in the amount of meat consumption across the world, which can ultimately impact protein and meat-specific micronutrient intake levels. Today, the availability of both total protein and animal-source proteins, like meat, differs markedly in income groups. In high-income countries, animal-sourced foods contribute 66% of all proteins, and in low-income countries, only 17% of proteins are animal-sourced (Ederer et al., 2023).
A reduction or elimination of meat in the diet without special consideration for nutrient requirements and food sources of those nutrients, or a lack of access to animal-source foods could result in the unintended consequences of accentuating micronutrient deficiencies and chronic disease, particularly in vulnerable populations such as children, women of childbearing age, older adults, or those who live in low- or middle-income countries (Beal et al., 2024). The assumption that meat can be replaced in the diet with plant-based foods (whole or processed), supplementation, or fortification may be an oversimplification of the unique combination of high-quality, essential amino acids, bioavailable micronutrients such as iron and zinc, vitamins that are only present in animal-source foods, low caloric cost relative to nutrients provided, and the benefit of the whole food matrix.
Certainty of Evidence on The Role of Meat in Health
Health professionals and consumers rely on high-quality evidence to guide nutrition decisions, making an understanding of study design and rigor critical. Research analyzing meat intake and health outcomes is complex and influenced not only by the demographics, genetics, sex, age, health status, lifestyle, and culture of the study participants, but also the nuances of meat products, including leanness, species, cut, preparation method, and more. Strong causal conclusions are generally derived from well-conducted, randomized, controlled trials (RCTs) or systematic reviews and meta-analyses thereof, with long-term RCTs being the gold standard, though costly and labor-intensive. In the absence of such trials, systematic reviews or meta-analyses of observational studies may provide insight, but limitations must be acknowledged. Observational studies (cohort, cross-sectional, case-control) have well-recognized strengths, namely large sample sizes and long latency periods, yet are prone to measurement error and bias from frequently used self-reported dietary intake and confounding lifestyle and behavioral factors, making causal inference challenging. These studies are most valuable for hypothesis generation or informing the design of larger RCTs. In summary, high-quality evidence, including systematic reviews and meta-analyses of randomized controlled trials support the role of meat in healthy dietary patterns to improve markers of cardiovascular disease and type 2 diabetes (Guasch-Ferré et al., 2019; Sanders et al., 2022; Sanders et al., 2024). However, when it comes to other diet-modifiable chronic diseases such as cancer, the evidence is less clear. For example, strong evidence from systematic reviews and meta-analyses of prospective cohort data suggests red and processed meat, but primarily processed meat, is associated with an increased risk of many types of cancer (Chan et al., 2011; Farvid et al., 2021). The International Agency for Research on Cancer (IARC) concluded that red meat was classified as a Group 2a carcinogen “based on limited evidence from epidemiological studies” that showed a positive association between increased red meat intake and colorectal cancer—stating that the evidence was limited because results were derived from observational data but the technically termed chance, bias or confounding could not be ruled out (WHO, 2015). Processed meat, according to the IARC, was listed as a Group 1 carcinogen based on “sufficient” evidence from epidemiological studies; however, there are no clinical trials to support this work, given the ethical concerns and long-term dietary study protocols that would be necessary (WHO, 2015). The sample size of the populations assessed in the cohort and prospective studies used by IARC provides strength of evidence, but limitations exist.
Another limitation of nutrition research and translation is the inaccurate use of meat terminology and processing classifications. The most common clustering of terms occurs when fresh and processed meats are combined as total meat (Gifford et al., 2017; O’Connor et al., 2020), even though they are compositionally different from one another and may have different impacts on health. While Monteiro et al. (2018) (NOVA), the American Meat Science Association (Seman et al., 2018), the University of North Carolina (Poti et al., 2015), the International Food and Information Council (Eicher-Miller et al., 2012), and the IARC (de Araújo et al., 2022) have all developed a processing classification system for foods, including meat products, there continues to be an inconsistent use of a single definition or classification system in nutrition research, making findings difficult to interpret. The NOVA classification system is one of the most widely used in the United States, yet there are nuances that must be addressed when applying the criteria to meat products in order to avoid misclassification (Van Elswyk et al., 2024). In addition to terminology, research methodology involving meat consumption can be further complicated because of the variation in meat amount, type, cut, leanness, intake amount, preparation method, and background diet, making it challenging to establish a safe upper limit of consumption (Johnston et al., 2023). Many large epidemiological studies rely on self-reported dietary intake data, such as food frequency questionnaires or 24-h dietary recalls. Food frequency questionnaires are designed to measure a person’s dietary intake over a set period of time and typically include broad food group categories (i.e., meat, dairy, grains, etc.), food items, frequency of consumption, portion size estimate, and preparation methods. Broad food group categories do not allow for detailed assessment of meat type, cut, or leanness, all factors that can impact composition. A gold standard for self-reported dietary intake assessment is the USDA Automated Multiple-Pass Method, which includes a quick list of all foods and beverages consumed in the previous 24 h, forgotten food prompts, time and eating occasion organization, and final review or probe for foods and beverages (Blanton et al. 2006). This method improves recall accuracy and allows for more precise nutrient intake estimation; however, a limitation is that it only captures short-term, 24-h intake rather than habitual intake (Blanton et al., 2006). Taken together, the certainty of evidence regarding meat and health outcomes is dependent on study design, exposure classification, and dietary assessment methodology, underscoring the need for careful interpretation of observational findings and additional interventional research where possible.
Meat in Dietary Pattern Models
Dietary patterns, primarily healthy dietary patterns, are developed to guide consumers on the quantities, proportions, variety, or combination of different foods and beverages to be consumed in a diet for a desired outcome (Davis et al., 2019). Typically, dietary patterns are developed through one of 2 approaches: food pattern modeling or dietary pattern analysis. Food pattern modeling, according to Davis et al. (2019), is defined as the process of developing daily or weekly amounts of foods from different food groups to meet specific criteria, such as nutrient adequacy. Examples of food pattern modeling include the US DGA approach through the Healthy US-Style Eating Pattern, which was developed to translate the guidelines into detailed recommendations based on energy needs and life stages. In some cases, food pattern models have been criticized because they do not directly account for the relationships between diet and health (Davis et al., 2019). Dietary pattern analysis, the second approach to developing dietary patterns, identifies and characterizes different dietary patterns in a population with special consideration for a specific health outcome (Davis et al., 2019). For example, the Mediterranean diet was developed to improve heart health, the (Dietitian’s Approach to Stop Hypertension) DASH diet was created to treat and prevent hypertension, and the low-carbohydrate diet was created to aid in weight loss and the regression of type 2 diabetes. Other, less common dietary patterns are used for specific clinical conditions, such as the ketogenic diet for epilepsy and other cognitive disorders. In some research studies, less-healthy dietary patterns are modeled or defined to compare outcomes from a “healthier” versus a “less-healthy” diet. For example, studies have categorized or defined the Average American Diet or the Western-Style Diet, which are typically high in processed foods, refined grains, sugar, sodium, and saturated fat, to be able to compare outcomes from healthier dietary patterns.
As the conversation continues to shift toward healthy, sustainable diets, scientists have worked to understand the role of meat in a variety of patterns through the lens of sustainability. The FAO of the United Nations defines sustainable food systems as “a food system that delivers food security and nutrition for all in such a way that the economic, social, and environmental bases to generate food security and nutrition for future generations are not compromised” (FAO, 2018). The delivery of nutrients to sustain human life and to support optimal health is sometimes minimized by the environmental impact or economic feasibility of food systems. Healthy, sustainable dietary patterns should not only protect against non-communicable diseases and meet nutrient needs but should go beyond that to help optimize health and well-being.
The type and quantity of meat considered or studied in food pattern modeling or dietary patterns vary. Diets that have been defined with a standard level of meat intake or have historically been analyzed with some level of meat and have related health outcomes will be discussed. For this review, dietary patterns will be split into 2 categories based on the approach used to develop the dietary pattern: food pattern modeling and dietary pattern analysis.
Food Pattern Modeling
2025–2030 Dietary Guidelines for Americans
The Dietary Guidelines for Americans are federal nutrition recommendations released in conjunction between USDA and the US Department of Health and Human Services every five years in the United States with a goal to promote health and prevent chronic disease. The DGA are written and informed based on the best available evidence at the time. There was a historic shift with the new 2025–2030 Dietary Guidelines for Americans, released in January 2026 with a strong, simple message, “eat real food”, and an updated real food pyramid. Priority messages in the new DGA include: 1) eat the right amount for you; 2) prioritize protein foods at every meal; 3) consume dairy; 4) eat vegetables and fruits throughout the day; 5) incorporate healthy fats; 6) focus on whole grains; 7) limit highly processed foods, added sugars, and refined carbohydrates; and 8) limit alcohol (USDA & USHHS, 2026). While there was not a referenced dietary pattern within the 2025–2030 DGA, daily serving goals were provided. For a 2,000-calorie level diet serving recommendations include 3–4 servings of protein foods, 3 servings of dairy, 3 servings of vegetables, 2 servings of fruit, 2–4 servings of whole grains, and 4.5 servings of health fats (USDA & USHHS, 2026). Changes from the 2020–2025 version of the DGA include an increase in total protein intake, increasing from 0.8 g of protein/kg body weight to 1.2–1.6 g protein/kg of body weight; prioritizing high-quality, nutrient-dense protein, such as red meat and poultry; and a nod to beef tallow, butter, and full-fat dairy as healthy fat options. Additionally, red meat and poultry were recognized with visual representation on the new real food pyramid (Figure 2).
The new food pyramid included in the 2025-2030 Dietary Guidelines for Americans, highlighting a push to “eat real food.”
USDA Healthy US-Style Eating Pattern 2020
The USDA Healthy US-Style Eating Pattern is the reference dietary pattern presented in DGA, which are federal recommendation released in conjunction between USDA and the US Department of Health and Human Services every 5 years in the United States to promote health and prevent chronic disease. The DGA is written and informed based on the best available evidence at the time, which is reviewed by an expert DGA committee. The 4 primary guidelines as part of the 2020–2025 DGA were 1) follow a healthy dietary pattern at every life stage; 2) customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations; 3) focus on meeting food group needs with nutrient-dense foods and beverages and stay within calorie limits; and 4) limit foods and beverages higher in added sugar, saturated fat, and sodium, and limit alcoholic beverages (USDA & USHHS, 2020). The development of the HUSS eating pattern was developed to translate science-based information in the DGA into practical nutrition guidance. The Healthy US-Style Eating Pattern presented in the 2020–2025 DGA recommends, at the 2,000-calorie level, 2.5 cups of vegetables, 2 cups of fruit, 6 ounces of grains, 3 cups of dairy, and 5.5-ounce equivalents of protein foods each day (DGA, 2020). Protein food ounce equivalents include 1 ounce of lean meat, poultry, or seafood; 1 egg; 1/4 cup cooked beans, peas, or tofu; 1 tablespoon peanut butter; or 1/2 ounce nuts or seeds (USDA & USHHS, 2020). Meat, poultry, and eggs, which are clustered in the HUSS dietary pattern, are modeled at different levels across calorie levels. For example, 23-ounce equivalents/week are recommended for the 1,600–1,800 calorie levels, 26-ounce equivalents/week at the 2,000-calorie level, up to 33-ounce equivalents/week at the 3,300-calorie level (DGA, 2020).
EAT-Lancet reference diet
The EAT-Lancet Commission consists of 19 Commissioners and 18 coauthors from 16 countries in the fields of human health, agriculture, political sciences, and environmental sustainability, with an aim to develop a universal healthy reference diet based on estimations of human health and environmental impact. The authors proposed the framework for the EAT-Lancet planetary diet in their 2019 report as globally applicable for all food cultures and production systems. The EAT-Lancet Commission called for “radical food system transformation”, coined the Great Food Transformation. The transformation is stated to “be guided by scientific targets that define the safe operating space for food systems: the combination of health diets and planetary systems and processes, which underpin human health and environmental sustainability” (Willett et al., 2019).
The referenced EAT-Lancet dietary pattern, based on evidence from controlled feeding trials, observational studies, and randomized trials, consists primarily of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils, while restricting seafood and poultry and excluding the majority of red meat, processed meat, added sugars, refined grains, and starchy vegetables. According to the commission, lose-lose diets that are unhealthy and environmentally unstable are high in red meat. The allowable intake range for beef and lamb, pork, and chicken and other poultry is 0–0.5 ounce, 0–0.5 ounce, and 0–2.0 ounces, respectively. According to the EAT-Lancet report, consumption of processed red meat was associated with an increased risk of death from all causes and cardiovascular disease, and unprocessed red meat was weakly associated with cardiovascular disease but more strongly associated with risk of type 2 diabetes and stroke. The association with these diseases, largely concluded based on observational data, was attributed to the high ratio of saturated to polyunsaturated fat, high levels of heat-induced carcinogens, and heme-iron in the EAT-Lancet report. Given these findings, the commission concluded that, “because intake of red meat is not essential and appears to be linearly related to total mortality and risks of other health outcomes in populations that have consumed it for many years, optimal intake might be 0 g/day” (Willett et al., 2019).
While the EAT-Lancet Commission recognizes animal proteins as a complete source of essential amino acids, they recommend a shift to vegetarian or pescatarian, primarily plant-based diets. Furthermore, while acknowledging the unique role of iron-rich foods in adolescent females, the commission recommends supplementation over consumption of red meat, regardless of red meat being one of the most bioavailable sources of iron. Also, following a nutrient adequacy analysis, the commission recognizes the referenced diet may not provide enough vitamin B12, making supplementation or fortification necessary.
A few limitations may exist in the development of the EAT-Lancet planetary diet. Protein recommendations for the reference diet were based on 0.8 grams per kilogram of body weight, which is the recommended level to avoid underconsumption and deficiency for most of the population; however, recent research has shown that for optimal health, particularly in vulnerable populations, such as adolescents and aging adults, this may be an underestimated value (Institute of Medicine, 2005; Kokura et al., 2024; Tagawa et al., 2021). A new analysis of the EAT-Lancet diet found that the diet may create gaps in iron, zinc and vitamin B12 intake, in adults and women of reproductive age, and that doubling the amount of animal-sourced foods (from 14% to 27% of total calories) would be required to meet adequate intake of iron, zinc and vitamin B12 in adults without supplementation (Beal et al., 2023; Leroy et al., 2025). Beal et al. (2023) and Leroy et al. (2025) recommended remodeling the EAT-Lancet dietary pattern to not only meet nutrient requirements at the lowest possible cost, but also to analyze diets that meet nutrient needs with the lowest environmental effects using lifecycle assessments.
PURE Study Healthy Diet Score
The Prospective Urban Rural Epidemiology (PURE) study is unique in that a reference diet was not developed as a result of the data analyzed, but rather a reference or scoring system to help identify a pattern of food intake associated with better health outcomes. The PURE study is an ongoing cohort study that has followed 166,726 adults and older adults aged 35 to 70 years in 21 low-, middle-, and high-income countries on 5 continents. Participants’ habitual food intake was recorded using country-specific food frequency questionnaires.
Mente et al (2023) worked to develop a diet score and essentially a reference dietary pattern based on outcomes related to all-cause mortality and major cardiovascular events from the PURE study and to replicate and validate the diet score/pattern in 5 independent studies. The healthy diet score was based on 6 food groups: fruits, vegetables, nuts, legumes, fish, and dairy, which have previously been shown to decrease risk of mortality. While meat was not included as one of the primary food group components, data were still collected from food frequency questionnaires for meat intake, allowing data analysis on meat intake across levels of diet quality. A value of 1 (healthy) was assigned when the participant’s intake of each food group was above the cohort median intake. Inversely, a score of 0 (unhealthy) was assigned when the intake was below that of the cohort population’s median intake. The diet score was not weighted across food groups and ranged from 0 to 6, with 6 being the healthiest. Following study participants for a median of 9.3 years, the authors found that a score ≥5 was associated with lower risks of mortality, myocardial infarction (heart attack), and stroke, particularly in lower-income countries. The PURE diet score is unique because, unlike diet scores based on a balance of protective and harmful foods, it is focused exclusively on the intake of protective foods. In addition, the PURE diet score was developed to be applicable across the world and socioeconomic classes. Based on the entire population in the PURE diet study, the average diet score was 2.95.
To translate findings from the PURE study to be used for dietary pattern recommendations, the mean intake for each food category was determined for individuals in the top 20% of the PURE diet score. The healthiest diets contained 5 servings (20 ounces) of fruits and vegetables, 0.5 serving (1.7 ounces) of legumes, 1.2 servings (1.0 ounce) of nuts, 0.3 serving (0.9 ounce) of fish, 2 servings (6.5 ounces) dairy (with 1.4 servings from whole-fat dairy), 0.5 (1.9 ounces) serving of red meat, and 0.3 serving (0.8 ounce) of poultry per day. The macronutrient distribution of the diet described above is approximately 56% energy from carbohydrates, 27% from fats (8.9% from saturated fat), and 17.2% from protein. Conversely, the least healthy diet was represented by lower intakes of all food groups, including red meat and poultry. Results from the PURE study indicate moderate amounts of meat, unprocessed red meat, and poultry can be included in healthy diets to decrease the risk of total mortality and cardiovascular disease. Overall, just a 20% increase in the PURE diet score led to an 8% lower risk of mortality and 6% lower risk of major cardiovascular disease (Mente et al., 2023). Iqbal et al. (2021) conducted a prospective cohort study using data from the PURE study, following 7,789 participants for 9.5 years, and found that up to about 8.8 ounces of unprocessed red meat intake or about 5.2 ounces of poultry intake per week were not significantly associated with total mortality or major cardiovascular disease incidents.
Dietary Pattern Analyses
Mediterranean diet
The Mediterranean diet is unique because there is not a single iteration or set definition for the dietary pattern, but rather it is characterized by the intake of foods from the olive-tree-growing region in the Mediterranean basin. The diets of people living in this part of the world were studied because they were known for low rates of cardiovascular disease and greater longevity (Trichopoulou et al., 2014). Key components of the diet include foods native to the area, such as vegetables, cereals (primarily whole grains), fruits, olive oil, legumes, fish, moderate intake of wine, and limited red and processed meats and sweets (Trichopoulou et al., 2014). The Mediterranean diet is known as a primarily plant-based dietary pattern with olive oil, which is a rich source of heart-healthy monounsaturated fats, as the primary source of dietary fat. One of the landmark studies, The Seven Countries Study, discovered the health benefits associated with adherence to a Mediterranean-style diet, including reduced risks of developing metabolic syndrome, type 2 diabetes, cardiovascular disease, and some forms of neurodegenerative diseases and cancers (Keys, 1980). As shown in Figure 3 below, the Mediterranean pyramid—updated in 2020 to address sustainability concerns—not only accounts for foods but also considers lifestyle factors such as regular physical activity, adequate rest, and camaraderie, which have been critical aspects of Mediterranean culture (1Serra-Majem et al., 2020). The pyramid was updated from a 2011 version (Bach-Faig et al., 2011) by emphasizing more strongly decreased consumption of red meat and dairy products for sustainability purposes. While there are multiple iterations of the Mediterranean diet, the pattern is characterized by an emphasis on food groups or categories, with flexibility for the individual foods consumed in each group. Since the pioneering studies in the late 1900s, the foods and nutrients grown and consumed in the Mediterranean region have evolved, and the diet has been adapted to meet the needs of different populations around the world.
The updated pyramid for a sustainable Mediterranean diet (Serra-Majem et al., 2020).
There are numerous Mediterranean diet adherence scores around the globe. In fact, one systematic review (Zaragoza-Marti et al., 2018) reported 28 different adherence scores. For the US alone, there are at least 9 scoring systems that have been used to assess the relationship between Mediterranean diet adherence and health outcomes. The role of meat, such as red and processed meat or white meat (poultry), within the dietary pattern varies across the scoring system. White meat and poultry are often considered neutral or positive in moderation, while red and processed meats commonly hinder the overall score (Hutchins-Wiese et al., 2022).
There is extensive research supporting the positive relationship between the Mediterranean diet and health outcomes (Keys, 1980; Trichopoulou et al., 2003; Estruch et al., 2018). In fact, a 2024 systematic review and meta-analysis of 4 randomized controlled trials found that the Mediterranean diet serves as an effective intervention for primary and secondary prevention of cardiovascular disease (Sebastian et al., 2024). Similarly, a systematic review and meta-analysis of 84 studies assessing the relationship between the Mediterranean diet and metabolic syndrome outcomes found that the Mediterranean diet led to a beneficial change in 18 out 28 metabolic syndrome components, including body weight, blood pressure, blood glucose management, markers of inflammation and more, as well as a lower risk of cardiovascular disease and stroke (Papadaki et al., 2020).
Numerous high-quality studies have shown that consumers have flexibility when choosing the types of protein to include in the Mediterranean diet to elicit beneficial effects on markers of heart health and more (Fleming et al., 2021; Fleming et al., 2025; O’Connor et al., 2018). Two randomized clinical trials analyzed the effect of substituting lean beef or pork (500 grams/week versus 200 grams/week in a Med-style diet (O’Connor et al., 2018)) or including up to 5.5 ounces/day (0.5, 2.5, and 5.5 ounces/day in a Med-style diet) found that participants did not have to reduce or eliminate lean red meat to improve blood lipid profiles (Fleming et al., 2021; O’Connor et al., 2018). A similar study with lean pork, looking at outcomes of cognitive health, found that a Mediterranean-style diet with lean pork (2–3 servings/week in a Med-diet versus a low-fat control diet) is well-adhered to by an older population and can lead to positive cognitive outcomes (Wade et al., 2019). Furthermore, Fleming et al. (2025) found that up to 5.5 ounces of lean beef per day, as part of a Mediterranean-style diet, can lower blood pressure, improve gut microbiota, and decrease trimethylamine N-oxide (TMAO), all markers of heart health. Findings from this work suggest the benefits of the Mediterranean diet can be maintained when lean beef or pork is one of the main protein sources. While few studies have looked at poultry within the context of a Mediterranean-style diet, several randomized controlled trials have found that lean chicken or poultry as the primary source of protein in the diet has a neutral effect on CVD risk factors (Connolly and Campbell, 2023).
DASH-style diet
The Dietary Approach to Stop Hypertension, or the DASH-style diet, was developed in the late 1990s as a nutritional strategy to improve blood pressure and ultimately cardiovascular health. Since its inception, the DASH diet has been promoted by organizations such as the National Heart, Lung, and Blood Institute and the Dietary Guidelines for Americans. A DASH-style dietary adherence score has since been developed to assess the association between DASH-dietary adherence and cardiovascular health (Fung et al., 2008). The adherence score is based on 8 categories of food and nutrient subgroups, including fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meats, sweetened beverages, and sodium, with a possible score ranging from 8 to 40. Fruits, vegetables, nuts and legumes, low-fat dairy, and whole grains were emphasized, while sodium, sweetened beverages, and red and processed meats were deemphasized. The original DASH trial placed a focus on decreasing saturated and total fat (Appel, 1997), which has evolved over the years to a reduction in red and processed meats. A corresponding score of 1 to 5 was given to each subcategory, either in ascending or descending order of consumption based on the foods deemed “beneficial” versus “harmful.” For example, a greater amount of fruit and vegetable consumption was assigned a score of 5 for each category, while a greater amount of red and processed meat was assigned a score of 1, negatively impacting the overall dietary adherence score. Red and processed meats were defined as beef, pork, lamb, deli meats, organ meats, hot dogs, and bacon. Food and nutrient subgroup scores were summed across the 8 categories for the final adherence score.
One study, based on food frequency questionnaires from women in the Nurses’ Health Study (1980–2004), found that women with the highest adherence to the DASH diet had a lower risk for coronary heart disease and stroke (Fung et al., 2008). In another, more recent systematic review and meta-analysis of 330 randomized controlled trials and over 5,500 subjects, Filippou et al. (2020) found that the DASH diet did in fact significantly reduce blood pressure.
Although the original DASH-style diet recommended a reduction in saturated and total fat, which translated to a decrease in red and processed meats, a landmark, high-quality randomized clinical trial that included varying levels of lean beef (20 grams, 28 grams, 113 grams, and 153 grams/day) within a DASH-style diet concluded that lean beef can be included in a DASH-style diet to elicit similar positive responses on markers of cardiometabolic health (et al., 2012). Similarly, another randomized clinical trial found that substituting lean pork for chicken and fish did not affect the benefits of the DASH-style diet, indicating lean pork can be enjoyed as part of a DASH diet to improve markers of heart health (Sayer et al., 2015).
Low-carb, high-protein diets
Low-carbohydrate diets are typically used as a strategy for weight loss or to improve markers of type 2 diabetes, sometimes with a goal of remission. Stemming from the Atkins Diet in the 1960s, the low-carb diet has taken a new shape and gained in popularity in the past several decades. Meat plays a critical role in many variations of the low-carb diet because it is essentially void of carbohydrates and an efficient source of protein and healthy fats. For approximately 175 calories, meat provides about 20 to 25 grams of protein, which is protein efficiency unmatched by other foods. While low-carb diets all restrict the level of carbohydrates to some extent, there is no consensus on the type or amount recommended. For reference, the Acceptable Macronutrient Distribution Range, or AMDR, for carbohydrates is 45 to 65% of total energy, or approximately 225 to 325 grams of carbohydrates for a 2,000-calorie diet. A general guideline categorizes low-carb diets as those providing less than approximately 25% of total energy from carbohydrates, while very low-carbohydrate diets typically supply less than 10% of total energy from carbohydrates (Oh et al., 2023). Protein and fat intake increase to account for calorie needs when carbohydrates are restricted. In cases where fat intake jumps to nearly three-quarters of energy intake in a very low-carb diet, it is often referred to as a ketogenic diet, which will be summarized below.
A 2012 systematic review and meta-analysis of clinical trials studying the effect of low-carb diets on cardiovascular risk factors included evidence from 17 clinical studies (Santos et al., 2012). Results from the meta-analysis revealed that a low-carb diet led to a significant decrease in body weight, body mass index, abdominal circumference, blood pressure, triglycerides, glucose, HbA1c, insulin, and C-reactive protein (a marker for inflammation). Additionally, high-density lipoprotein (HDL), often referred to as “good” cholesterol, improved (Santos et al., 2012). When comparing low-carb diets with control diets, there are nuances and great variation in the amount and type of carbohydrates in the study protocols. Additionally, long-term studies are needed to assess the long-term impact of low-carb diets on weight loss and other factors of health. The positive effects of the low-carb diet are often attributed to improved satiety with an increase in protein and fat, and improved blood sugar management.
The Beef WISE study analyzed the role of beef in Weight Improvement, Satisfaction, and Energy (WISE). This was a randomized controlled trial that assigned participants one of 2 high-protein diets: one with greater than 4 servings of beef weekly and one with no red meat, in addition to an exercise protocol. The carbohydrate intake was around 25% for phase 1 and increased slightly for phase 2 and 3, which is common for weight maintenance diets. Results indicated no difference between the 2 groups, indicating a high-protein, lower-carb diet, with lean beef or other protein sources, can help people lose weight, while maintaining muscle and improving heart health (Sayer et al., 2017).
Ketogenic diet
Ketogenic diets are a version of a low-carb diet, with a particular emphasis on high-fat intake to shift the body into ketosis. Ketosis is a state in which the body converts from using glucose as its main form of energy to using ketones, either those consumed as fat or those released from the body’s fat stores. Commonly, keto diets contain 70 to 80% of energy from fats, 15 to 20% from protein, and less than 10% from carbohydrates.
A systematic review and meta-analysis of 29 randomized controlled trials investigating the effect of very low-carbohydrate ketogenic diets (VLCKD) found a significant decrease in fasting blood sugar and HbA1c for adults with obesity. Furthermore, a VLCKD was associated with decreased insulin concentrations, triglyceride levels, and blood pressure and an increase in high-density lipoprotein (HDL). No changes were observed for total cholesterol or low-density lipoproteins. Criteria for study inclusion included intake of 50 grams or less per day, indicating dietary fat and protein were 95% percent of the energy source. Overall, findings from this systematic review and meta-analysis demonstrate that VLCKD may be an effective tool in improving glycemic control and markers of heart health in those with type 2 diabetes (Ghasemi et al., 2024).
Carnivore diet
The carnivore diet has seen a surge in popularity in recent years, driven by strong voices in the consumer media space such as Dr. Shawn Baker, Dr. Paul Saladino, and Mikhaila Peterson. Their advocacy, along with a growing body of anecdotal success stories and emerging research, has fueled widespread interest in this all-meat approach to nutrition. Self-reported survey response studies have shown potential benefits of the diet (Lennerz et al., 2021), but similar to the limitations of FFQ, self-reported surveys are subject to recall bias, misclassification error, and social/personal bias. Little to no clinical evidence analyzing the impact of the carnivore diet on health outcomes has been published. For example, on ClinicalTrials.gov, an online database of clinical research studies, there are zero results for studies with a carnivore diet as an intervention. For reference, there are 852 registered studies investigating the impact of low-carbohydrate diets, 569 for the Mediterranean diet, 439 for a ketogenic diet, and 173 for a DASH-style diet. An understanding of the potentially negative side effects or nutrient shortfalls is also unknown, given the lack of clinical intervention trials.
One study that summarized self-reported characteristics of those who followed a carnivore diet found that red meat (mostly beef), eggs, and nonmilk dairy, pork, poultry, and seafood were the most commonly consumed foods, in descending order. Participants in the study also reported health benefits with high satisfaction and few adverse effects (Lennerz et al., 2021). Findings should be interpreted with limitations in mind, including the observational nature of the data and self-reported data, which are at a high risk of bias.
As clinical nutrition research and interventions continue to evolve, there may be more clinical trials assessing the impact of carnivore diets on long-term health; yet, funders may not be motivated to support this type of research given the very small percentage of the population that follows a true carnivore diet, making it potentially less relevant to public health.
Conclusions
Meat is a nutrient-dense, bioavailable source of protein, vitamins, and minerals that plays an important role in meeting nutrient requirements across life stages. Evidence from observational studies, randomized controlled trials, and dietary pattern analyses demonstrates that meat, particularly lean meat, can be included as part of a variety of dietary patterns, such as the Mediterranean, DASH, low-carbohydrate, and other high-protein diets, without negatively affecting markers of cardiovascular or metabolic health. While some studies suggest associations between high intakes of processed red meat and certain chronic diseases, the quality of evidence is limited by observational study designs, inconsistent meat classification, and confounding factors.
Dietary patterns that incorporate moderate amounts of meat, alongside a variety of plant-based foods, support nutrient adequacy, including nutrients of concern such as iron, zinc, and vitamin B12, while also allowing flexibility for personal preference, culture, and sustainability considerations. Dietary patterns or guidance that restricts or excludes meat, such as vegan, vegetarian, or highly plant-based reference diets, may create nutrient gaps if substitutions or supplementation are not carefully planned, particularly for vulnerable populations such as infants, adolescents, women of reproductive age, and older adults.
Overall, the totality of evidence supports the inclusion of moderate amounts of meat within balanced dietary patterns to achieve nutrient adequacy and promote health. Future research is needed to refine the understanding of the long-term health effects of varying meat intake levels and to inform dietary guidance that balances nutrition, health outcomes, and sustainability considerations.
Competing Interest
The funder had no role in the design of this review, the writing of the manuscript, or the interpretation of the literature. E.G.M is a consultant to the National Cattlemen’s Beef Association, a contractor to the Beef Checkoff. C.L.G. has received previous research support funded by federal and checkoff (National Cattlemen’s Beef Association and Wyoming Beef Council) grants. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Acknowledgments
Author Mortensen was compensated by the American Meat Science Association for literature review, manuscript development, and writing.
Author Contribution
E. M.: conceptualization, original draft writing, editing; C. G.: review, writing, editing.
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