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Red Meat Consumption Increases Risk of Nonalcoholic Fatty Liver Disease in Women

Key findings

  • This nationwide U.S. prospective study of 77,795 female registered nurses examined the relationship between red meat consumption and subsequent risk of developing nonalcoholic fatty liver disease (NAFLD) over 20 years of follow-up
  • Higher intake of red meat, including both unprocessed and processed red meat, was associated with a significant, dose-dependent increased risk of developing NAFLD even after adjustment for numerous covariates (HR, 1.20 to 1.52)
  • Body mass index was estimated to account for 66% of the association
  • Substituting either nuts or whole grains for red meat was associated with a modestly but significantly lower risk of NAFLD

Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent in developed and developing countries alike. The Western diet has been proposed to play a role, and two recent studies demonstrated a positive association between NAFLD and red meat intake. However, both were cross-sectional.

Researchers at Massachusetts General Hospital recently became the first to confirm a relationship between NAFLD and red meat consumption in a large-scale prospective study. Andrew T. Chan, MD, MPH,director of cancer epidemiology in the Mass General Cancer Center, chief of the Clinical and Translational Epidemiology Unit, vice chair for clinical research in the Division of Gastroenterology, and professor of Medicine at Harvard Medical School, Tracey G. Simon, MD, MPH, hepatologist in the division and assistant professor of Medicine at Harvard Medical School, and colleagues published the details in Clinical Nutrition.


The team examined data on 77,795 participants in the ongoing Nurses' Health Study, which in 1989 enrolled 116,430 U.S. female registered nurses ages 25–42. Every two years they complete detailed questionnaires about lifestyle, medical history and disease outcomes, and every four years they complete a food frequency questionnaire. For this study, follow-up continued through June 30, 2015.

Red Meat Consumption and NAFLD

After adjustment for multiple covariates, red meat intake was significantly associated with a "dose-dependent" increased risk of developing NAFLD. Compared with ≤1 serving/week (P for trend <0.0001):

  • 2–4 servings/week—HR, 1.20
  • 5–6 servings/week—HR, 1.31
  • 1 serving/day—HR, 1.41
  • ≥2 servings/day—HR, 1.52
  • Per 1 serving/day increase—HR, 1.31

Significant and positive gradients of increasing risk were observed for both unprocessed and processed red meat consumption. The risk of NAFLD did not increase according to the level of poultry or fish intake.

Mediation Analysis

After further adjustment for body mass index, the associations between NAFLD and total red meat, unprocessed red meat and processed red meat were no longer statistically significant. BMI was estimated to account for 66% (P<0.0001) of the association between red meat consumption and NAFLD risk.

Substitution Analyses

Replacing one serving of red meat with certain other foods was associated with a significantly lower relative risk of NAFLD:

  • One serving of nuts—6% reduction
  • One serving of whole grains—5% reduction
  • One serving of plant-based proteins (nuts, whole grains, or legumes)—6% reduction

Counseling Patients

Public health officials and clinicians should encourage the minimization of red meat consumption as part of efforts to address obesity and prevent NAFLD.

greater risk of nonalcoholic fatty liver disease in women who consumed 1 serving of red meat per day

greater risk of nonalcoholic fatty liver disease in women who consume ≥2 servings of red meat per day

Visit the Division of Gastroenterology

Refer a patient to the Division of Gastroenterology

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