Health effects associated with consumption of processed meat, sugar-sweetened beverages and trans fatty acids: a Burden of Proof study

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  • Monteiro, C. A. et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 22, 936–941 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  • Lane, M. M. et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. Br. Med. J. https://doi.org/10.1136/bmj-2023-077310 (2024).

  • Mendoza, K. et al. Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies. Lancet Reg. Health Am. 37, 100859 (2024).

    PubMed  PubMed Central  Google Scholar 

  • Srour, B. et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). Br. Med. J. https://doi.org/10.1136/bmj.l1451 (2019).

  • Brauer, M. et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 403, 2162–2203 (2024).

    Article  Google Scholar 

  • Deveci, G. & Tek, N. A. N-Nitrosamines: a potential hazard in processed meat products. J. Sci. Food Agric. 104, 2551–2560 (2024).

    Article  CAS  PubMed  Google Scholar 

  • Lee, J.-G. et al. Effects of grilling procedures on levels of polycyclic aromatic hydrocarbons in grilled meats. Food Chem. 199, 632–638 (2016).

    Article  CAS  PubMed  Google Scholar 

  • Zheng, W. & Lee, S.-A. Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr. Cancer 61, 437–446 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • López-Hernández, L. et al. Identifying predictors of the visceral fat index in the obese and overweight population to manage obesity: a randomized intervention study. Obes. Facts 13, 403–414 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  • Huang, Y. et al. Associations of visceral adipose tissue, circulating protein biomarkers, and risk of cardiovascular diseases: a Mendelian randomization analysis. Front. Cell Dev. Biol. 10, 840866 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  • Marques, M. D. et al. Relation between visceral fat and coronary artery disease evaluated by multidetector computed tomography. Atherosclerosis 209, 481–486 (2010).

    Article  CAS  PubMed  Google Scholar 

  • Oostindjer, M. et al. The role of red and processed meat in colorectal cancer development: a perspective. Meat Sci. 97, 583–596 (2014).

    Article  PubMed  Google Scholar 

  • Bellamri, M., Walmsley, S. J. & Turesky, R. J. Metabolism and biomarkers of heterocyclic aromatic amines in humans. Genes Environ. 43, 29 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lala, P. K. & Chakraborty, C. Role of nitric oxide in carcinogenesis and tumour progression. Lancet Oncol. 2, 149–156 (2001).

    Article  CAS  PubMed  Google Scholar 

  • Moorthy, B., Chu, C. & Carlin, D. J. Polycyclic aromatic hydrocarbons: from metabolism to lung cancer. Toxicol. Sci. 145, 5–15 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rao, C. V. Nitric oxide signaling in colon cancer chemoprevention. Mutat. Res. 555, 107–119 (2004).

    Article  CAS  PubMed  Google Scholar 

  • Sánchez-Pimienta, T. G., Batis, C., Lutter, C. K. & Rivera, J. A. Sugar-sweetened beverages are the main sources of added sugar intake in the Mexican population. J. Nutr. 146, 1888S–1896S (2016).

    Article  PubMed  Google Scholar 

  • Vartanian, L. R., Schwartz, M. B. & Brownell, K. D. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am. J. Public Health 97, 667–675 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  • Lara-Castor, L. et al. Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries. Nat. Commun. 14, 5957 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stender, S., Astrup, A. & Dyerberg, J. Ruminant and industrially produced trans fatty acids: health aspects. Food Nutr. Res. 52, 1651 (2008).

    Article  Google Scholar 

  • Mozaffarian, D. et al. Dietary intake of trans fatty acids and systemic inflammation in women. Am. J. Clin. Nutr. 79, 606–612 (2004).

    Article  CAS  PubMed  Google Scholar 

  • Bendsen, N. T., Christensen, R., Bartels, E. M. & Astrup, A. Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies. Eur. J. Clin. Nutr. 65, 773–783 (2011).

    Article  CAS  PubMed  Google Scholar 

  • Mozaffarian, D., Katan, M. B., Ascherio, A., Stampfer, M. J. & Willett, W. C. Trans fatty acids and cardiovascular disease. N. Engl. J. Med. 354, 1601–1613 (2006).

    Article  CAS  PubMed  Google Scholar 

  • Naghavi, M. et al. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 403, 2100–2132 (2024).

    Article  Google Scholar 

  • Zheng, P. et al. The Burden of Proof studies: assessing the evidence of risk. Nat. Med. 28, 2038–2044 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br. Med. J. https://doi.org/10.1136/bmj.n71 (2021).

  • Ericson, U. et al. Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Am. J. Clin. Nutr. 101, 1065–1080 (2015).

    Article  CAS  PubMed  Google Scholar 

  • Fretts, A. M. et al. Associations of processed meat and unprocessed red meat intake with incident diabetes: the Strong Heart Family Study. Am. J. Clin. Nutr. 95, 752–758 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gu, X. et al. Red meat intake and risk of type 2 diabetes in a prospective cohort study of United States females and males. Am. J. Clin. Nutr. 118, 1153–1163 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  • Kurotani, K. et al. Red meat consumption is associated with the risk of type 2 diabetes in men but not in women: a Japan Public Health Center-based Prospective Study. Br. J. Nutr. 110, 1910–1918 (2013).

    Article  CAS  PubMed  Google Scholar 

  • Lajous, M. et al. Processed and unprocessed red meat consumption and incident type 2 diabetes among French women. Diabetes Care 35, 128–130 (2012).

    Article  PubMed  Google Scholar 

  • Liu, M. et al. Quantity and variety of food groups consumption and the risk of diabetes in adults: a prospective cohort study. Clin. Nutr. 40, 5710–5717 (2021).

    Article  CAS  PubMed  Google Scholar 

  • Männistö, S., Kontto, J., Kataja-Tuomola, M., Albanes, D. & Virtamo, J. High processed meat consumption is a risk factor of type 2 diabetes in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention study. Br. J. Nutr. 103, 1817–1822 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  • Mari-Sanchis, A. et al. Meat consumption and risk of developing type 2 diabetes in the SUN project: a highly educated middle-class population. PLoS ONE 11, e0157990 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Montonen, J. et al. Food consumption and the incidence of type II diabetes mellitus. Eur. J. Clin. Nutr. 59, 441–448 (2005).

    Article  CAS  PubMed  Google Scholar 

  • Papier, K. et al. Meat consumption and risk of 25 common conditions: outcome-wide analyses in 475,000 men and women in the UK Biobank study. BMC Med. 19, 53 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Son, J., Lee, Y. & Park, K. Effects of processed red meat consumption on the risk of type 2 diabetes and cardiovascular diseases among Korean adults: the Korean Genome and Epidemiology Study. Eur. J. Nutr. 58, 2477–2484 (2019).

    Article  CAS  PubMed  Google Scholar 

  • Song, Y., Manson, J. E., Buring, J. E. & Liu, S. A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women. Diabetes Care 27, 2108–2115 (2004).

    Article  CAS  PubMed  Google Scholar 

  • Steinbrecher, A., Erber, E., Grandinetti, A., Kolonel, L. & Maskarinec, G. Meat consumption and risk of type 2 diabetes: the Multiethnic Cohort. Public Health Nutr. 14, 568–574 (2011).

    Article  CAS  PubMed  Google Scholar 

  • Van Woudenbergh, G. J. et al. Meat consumption and its association with C-reactive protein and incident type 2 diabetes. Diabetes Care 35, 1499–1505 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  • Villegas, R. et al. The association of meat intake and the risk of type 2 diabetes may be modified by body weight. Int. J. Med. Sci. https://doi.org/10.7150/ijms.3.152 (2006).

  • The InterAct Consortium. Association between dietary meat consumption and incident type 2 diabetes: the EPIC-InterAct study. Diabetologia 56, 47–59 (2013).

    Article  Google Scholar 

  • Al-Shaar, L. et al. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. BMJ https://doi.org/10.1136/bmj.m4141 (2020).

  • Bernstein, A. M. et al. Major dietary protein sources and risk of coronary heart disease in women. Circulation 122, 876–883 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Burke, V. et al. Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines. Prev. Med. 44, 135–142 (2007).

    Article  CAS  PubMed  Google Scholar 

  • Haring, B. et al. Dietary protein intake and coronary heart disease in a large community based cohort: results from the Atherosclerosis Risk in Communities (ARIC) study. PLoS ONE 9, e109552 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  • Iqbal, R. et al. Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study. Am. J. Clin. Nutr. 114, 1049–1058 (2021).

    Article  CAS  PubMed  Google Scholar 

  • Key, T. J. et al. Consumption of meat, fish, dairy products, and eggs and risk of ischemic heart disease: a prospective study of 7198 incident cases among 409 885 participants in the Pan-European EPIC Cohort. Circulation 139, 2835–2845 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Møller, S. P., Mejborn, H., Christensen, A. I., Biltoft-Jensen, A. & Thygesen, L. C. Meat consumption, stratified by dietary quality, and risk of heart disease. Br. J. Nutr. 126, 1881–1887 (2021).

    Article  PubMed  Google Scholar 

  • Nagao, M. et al. Meat consumption in relation to mortality from cardiovascular disease among Japanese men and women. Eur. J. Clin. Nutr. 66, 687–693 (2012).

    Article  CAS  PubMed  Google Scholar 

  • Saito, E. et al. Association between meat intake and mortality due to all-cause and major causes of death in a Japanese population. PLoS ONE 15, e0244007 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Whiteman, D., Muir, J., Jones, L., Murphy, M. & Key, T. Dietary questions as determinants of mortality: the OXCHECK experience. Public Health Nutr. 2, 477–487 (1999).

    Article  CAS  PubMed  Google Scholar 

  • Bernstein, A. M. et al. Processed and unprocessed red meat and risk of colorectal cancer: analysis by tumor location and modification by time. PLoS ONE 10, e0135959 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  • Bostick, R. M. et al. Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 5, 38–52 (1994).

    CAS  PubMed  Google Scholar 

  • Chao, A. Meat consumption and risk of colorectal cancer. JAMA 293, 172 (2005).

    Article  CAS  PubMed  Google Scholar 

  • Cross, A. J. et al. A large prospective study of meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association. Cancer Res. 70, 2406–2414 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • English, D. R. et al. Red meat, chicken, and fish consumption and risk of colorectal cancer. Cancer Epidemiol. Biomarkers Prev. 13, 1509–1514 (2004).

    Article  PubMed  Google Scholar 

  • Etemadi, A. et al. Anatomical subsite can modify the association between meat and meat compounds and risk of colorectal adenocarcinoma: findings from three large US cohorts. Int. J. Cancer 143, 2261–2270 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Flood, A. Meat, fat, and their subtypes as risk factors for colorectal cancer in a prospective cohort of women. Am. J. Epidemiol. 158, 59–68 (2003).

    Article  PubMed  Google Scholar 

  • Gilsing, A. M. J. et al. Vegetarianism, low meat consumption and the risk of colorectal cancer in a population based cohort study. Sci. Rep. 5, 13484 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Islam, Z. et al. Meat subtypes and colorectal cancer risk: a pooled analysis of 6 cohort studies in Japan. Cancer Sci. 110, 3603–3614 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Knuppel, A. et al. Meat intake and cancer risk: prospective analyses in UK Biobank. Int. J. Epidemiol. 49, 1540–1552 (2020).

    Article  PubMed  Google Scholar 

  • Larsson, S. C., Rafter, J., Holmberg, L., Bergkvist, L. & Wolk, A. Red meat consumption and risk of cancers of the proximal colon, distal colon and rectum: the Swedish Mammography Cohort. Int. J. Cancer 113, 829–834 (2005).

    Article  CAS  PubMed  Google Scholar 

  • Lin, J. Dietary fat and fatty acids and risk of colorectal cancer in women. Am. J. Epidemiol. 160, 1011–1022 (2004).

    Article  PubMed  Google Scholar 

  • Mehta, S. S. et al. A prospective analysis of red and processed meat consumption and risk of colorectal cancer in women. Cancer Epidemiol. Biomarkers Prev. 29, 141–150 (2020).

    Article  PubMed  Google Scholar 

  • Mejborn, H., Møller, S. P., Thygesen, L. C. & Biltoft-Jensen, A. Dietary intake of red meat, processed meat, and poultry and risk of colorectal cancer and all-cause mortality in the context of dietary guideline compliance. Nutrients 13, 32 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  • Norat, T. et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J. Natl Cancer Inst. 97, 906–916 (2005).

    Article  PubMed  Google Scholar 

  • Ollberding, N. J., Wilkens, L. R., Henderson, B. E., Kolonel, L. N. & Le Marchand, L. Meat consumption, heterocyclic amines and colorectal cancer risk: the Multiethnic Cohort Study. Int. J. Cancer 131, E1125–E1133 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • O’Sullivan, D. E. et al. Combinations of modifiable lifestyle behaviours in relation to colorectal cancer risk in Alberta’s Tomorrow Project. Sci. Rep. 10, 20561 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  • Pietinen, P. et al. Diet and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control 10, 387–396 (1999).

    CAS  PubMed  Google Scholar 

  • Bhupathiraju, S. N. et al. Caffeinated and caffeine-free beverages and risk of type 2 diabetes. Am. J. Clin. Nutr. 97, 155–166 (2013).

    Article  CAS  PubMed  Google Scholar 

  • Dhingra, R. et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 116, 480–488 (2007).

    Article  PubMed  Google Scholar 

  • Eshak, E. S. et al. Soft drink, 100% fruit juice, and vegetable juice intakes and risk of diabetes mellitus. Clin. Nutr. 32, 300–308 (2013).

    Article  CAS  PubMed  Google Scholar 

  • Fagherazzi, G. et al. Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am. J. Clin. Nutr. 97, 517–523 (2013).

    Article  CAS  PubMed  Google Scholar 

  • Gardener, H., Moon, Y. P., Rundek, T., Elkind, M. S. V. & Sacco, R. L. Diet soda and sugar-sweetened soda consumption in relation to incident diabetes in the Northern Manhattan Study. Curr. Dev. Nutr. 2, nzy008 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirahatake, K. M. et al. Cumulative intake of artificially sweetened and sugar-sweetened beverages and risk of incident type 2 diabetes in young adults: the Coronary Artery Risk Development In Young Adults (CARDIA) Study. Am. J. Clin. Nutr. 110, 733–741 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  • Huang, M. et al. Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospective Women’s Health Initiative observational study. Am. J. Clin. Nutr. 106, 614–622 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Montonen, J., Järvinen, R., Knekt, P., Heliövaara, M. & Reunanen, A. Consumption of sweetened beverages and intakes of fructose and glucose predict type 2 diabetes occurrence. J. Nutr. 137, 1447–1454 (2007).

    Article  CAS  PubMed  Google Scholar 

  • O’Connor, L. et al. Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages. Diabetologia 58, 1474–1483 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  • Odegaard, A. O., Koh, W.-P., Arakawa, K., Yu, M. C. & Pereira, M. A. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am. J. Epidemiol. 171, 701–708 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  • Palmer, J. R. et al. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch. Intern. Med. 168, 1487–1492 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  • Pan, A. et al. Plain-water intake and risk of type 2 diabetes in young and middle-aged women. Am. J. Clin. Nutr. 95, 1454–1460 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Papier, K. et al. Consumption of sugar-sweetened beverages and type 2 diabetes incidence in Thai adults: results from an 8-year prospective study. Nutr. Diabetes 7, e283 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Paynter, N. P. et al. Coffee and sweetened beverage consumption and the risk of type 2 diabetes mellitus: the Atherosclerosis Risk in Communities Study. Am. J. Epidemiol. 164, 1075–1084 (2006).

    Article  PubMed  Google Scholar 

  • Sakurai, M. et al. Sugar-sweetened beverage and diet soda consumption and the 7-year risk for type 2 diabetes mellitus in middle-aged Japanese men. Eur. J. Nutr. 53, 251–258 (2014).

    Article  CAS  PubMed  Google Scholar 

  • Siqueira, J. H. et al. Consumption of sugar-sweetened soft drinks and risk of metabolic syndrome and its components: results of the ELSA-Brasil study (2008–2010 and 2012–2014). J. Endocrinol. Invest. 46, 159–171 (2022).

    Article  PubMed  Google Scholar 

  • Torres-Ibarra, L. et al. Regular consumption of soft drinks is associated with type 2 diabetes incidence in Mexican adults: findings from a prospective cohort study. Nutr. J. 19, 126 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Viana Dias, J. P. et al. Consumption of sweetened beverages is associated with the incidence of type 2 diabetes in Brazilian adults (CUME project). Nutr. Metab. Cardiovasc. Dis. 33, 789–796 (2023).

    Article  CAS  PubMed  Google Scholar 

  • The InterAct consortium. Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Diabetologia 56, 1520–1530 (2013).

    Article  Google Scholar 

  • Eshak, E. S. et al. Soft drink intake in relation to incident ischemic heart disease, stroke, and stroke subtypes in Japanese men and women: the Japan Public Health Centre-based study cohort I. Am. J. Clin. Nutr. 96, 1390–1397 (2012).

    Article  CAS  PubMed  Google Scholar 

  • Warfa, K., Drake, I., Wallström, P., Engström, G. & Sonestedt, E. Association between sucrose intake and acute coronary event risk and effect modification by lifestyle factors: Malmö Diet and Cancer Cohort Study. Br. J. Nutr. 116, 1611–1620 (2016).

    Article  CAS  PubMed  Google Scholar 

  • Pacheco, L. S. et al. Sugar-sweetened beverage intake and cardiovascular disease risk in the California Teachers Study. J. Am. Heart Assoc. 9, e014883 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  • Collin, L. J., Judd, S., Safford, M., Vaccarino, V. & Welsh, J. A. Association of sugary beverage consumption with mortality risk in US adults: a secondary analysis of data from the REGARDS Study. JAMA Netw. Open 2, e193121 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  • Yang, B. et al. Added sugar, sugar-sweetened beverages, and artificially sweetened beverages and risk of cardiovascular disease: findings from the Women’s Health Initiative and a network meta-analysis of prospective studies. Nutrients 14, 4226 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mullee, A. et al. Association between soft drink consumption and mortality in 10 European countries. JAMA Intern. Med. 179, 1479–1490 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  • Keller, A. et al. Substitution of sugar-sweetened beverages for other beverages and the risk of developing coronary heart disease: results from the Harvard Pooling Project of Diet and Coronary Disease. Prev. Med. 131, 105970 (2020).

    Article  PubMed  Google Scholar 

  • Pacheco, L. S. et al. Sugar- or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in US adults. Preprint at medRxiv https://doi.org/10.1101/2023.04.17.23288711 (2023).

  • Laake, I. et al. A prospective study of intake of trans-fatty acids from ruminant fat, partially hydrogenated vegetable oils, and marine oils and mortality from CVD. Br. J. Nutr. 108, 743–754 (2012).

    Article  CAS  PubMed  Google Scholar 

  • Li, Y. et al. Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease. J. Am. Coll. Cardiol. 66, 1538–1548 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Oomen, C. M. et al. Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study. Lancet 357, 746–751 (2001).

    Article  CAS  PubMed  Google Scholar 

  • Pietinen, P. et al. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am. J. Epidemiol. 145, 876–887 (1997).

    Article  CAS  PubMed  Google Scholar 

  • Virtanen, J. K., Mursu, J., Tuomainen, T.-P. & Voutilainen, S. Dietary fatty acids and risk of coronary heart disease in men: the Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscler. Thromb. Vasc. Biol. 34, 2679–2687 (2014).

    Article  CAS  PubMed  Google Scholar 

  • Xu, J. et al. Dietary fat intake and risk of coronary heart disease: the Strong Heart Study. Am. J. Clin. Nutr. 84, 894–902 (2006).

    Article  CAS  PubMed  Google Scholar 

  • Bouvard, V. et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 16, 1599–1600 (2015).

    Article  PubMed  Google Scholar 

  • Stern, M. C. et al. Genome-wide gene–environment interaction analyses to understand the relationship between red meat and processed meat intake and colorectal cancer risk. Cancer Epidemiol. Biomarkers Prev. 33, 400–410 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • WHO Manual on Sugar-Sweetened Beverage Taxation Policies to Promote Healthy Diets (World Health Organization, 2022).

  • Andreyeva, T., Marple, K., Marinello, S., Moore, T. E. & Powell, L. M. Outcomes following taxation of sugar-sweetened beverages: a systematic review and meta-analysis. JAMA Netw. Open 5, e2215276 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  • World Health Organization Guideline: Sugars intake for adults and children (WHO Department of Nutrition for Health and Development (NHD), 2015).

  • Dietary Guidelines for Americans, 2020–2025 9th edn (US Department of Agriculture and US Department of Health and Human Services, 2020).

  • Countdown to 2023: WHO 5-Year Milestone Report on Global Trans Fat Elimination 2023 (World Health Organization, 2024).

  • Freedman, L. S., Schatzkin, A., Midthune, D. & Kipnis, V. Dealing with dietary measurement error in nutritional cohort studies. J. Natl Cancer Inst. 103, 1086–1092 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  • Kipnis, V. et al. Effect of measurement error on energy-adjustment models in nutritional epidemiology. Am. J. Epidemiol. 146, 842–855 (1997).

    Article  CAS  PubMed  Google Scholar 

  • Dahm, C. C. Correcting measurement error in dietary exposure assessments: no piece of cake. Am. J. Clin. Nutr. 112, 11–12 (2020).

    Article  PubMed  Google Scholar 

  • McCullough, L. E. & Byrd, D. A. Total energy intake: implications for epidemiologic analyses. Am. J. Epidemiol. 192, 1801–1805 (2023).

    Article  PubMed  Google Scholar 

  • Willett, W. C., Howe, G. R. & Kushi, L. H. Adjustment for total energy intake in epidemiologic studies. Am. J. Clin. Nutr. 65, 1220S–1228S (1997).

    Article  CAS  PubMed  Google Scholar 

  • Day, N. E. et al. Correlated measurement error—implications for nutritional epidemiology. Int. J. Epidemiol. 33, 1373–1381 (2004).

    Article  CAS  PubMed  Google Scholar 

  • GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 403, 2133–2161 (2024).

    Article  Google Scholar 

  • Kassem, H. et al. Investigation and assessment of AI’s role in nutrition—an updated narrative review of the evidence. Nutrients 17, 190 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  • Zheng, J., Wang, J., Shen, J. & An, R. Artificial intelligence applications to measure food and nutrient intakes: scoping review. J. Med. Internet Res. 26, e54557 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  • Lo, F. P.-W. et al. AI-enabled wearable cameras for assisting dietary assessment in African populations. npj Digit. Med. 7, 356 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  • Burgess, S., Foley, C. N., Allara, E., Staley, J. R. & Howson, J. M. M. A robust and efficient method for Mendelian randomization with hundreds of genetic variants. Nat. Commun. 11, 376 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lai, W., Li, G., Peng, D., Li, N. & Wang, W. Mendelian randomization study reveals the relationship between dietary factors and respiratory diseases. Sci. Rep. 13, 22601 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lescinsky, H. et al. Health effects associated with consumption of unprocessed red meat: a Burden of Proof study. Nat. Med. 28, 2075–2082 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stanaway, J. D. et al. Health effects associated with vegetable consumption: a Burden of Proof study. Nat. Med. 28, 2066–2074 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stevens, G. A. et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet 388, e19–e23 (2016).

    Article  PubMed  Google Scholar 

  • Pan, A. et al. Red meat consumption and mortality: results from 2 prospective cohort studies. Arch. Intern. Med. 172, 555–563 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  • de Souza, R. J. et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. Br. Med. J. 351, h3978 (2015).

    Article  Google Scholar 

  • Zhang, Y.-B., Jiang, Y.-W., Chen, J.-X., Xia, P.-F. & Pan, A. Association of consumption of sugar-sweetened beverages or artificially sweetened beverages with mortality: a systematic review and dose–response meta-analysis of prospective cohort studies. Adv. Nutr. 12, 374–383 (2021).

    Article  CAS  PubMed  Google Scholar 

  • Zheng, P., Barber, R., Sorensen, R. J. D., Murray, C. J. L. & Aravkin, A. Y. Trimmed constrained mixed effects models: formulations and algorithms. J. Comput. Graph. Stat. 30, 544–556 (2021).

    Article  Google Scholar