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

Nature Medicine (2025)Cite this article

Previous research suggests detrimental health effects associated with consuming processed foods, including processed meats, sugar-sweetened beverages (SSBs) and trans fatty acids (TFAs). However, systematic characterization of the dose–response relationships between these foods and health outcomes is limited. Here, using Burden of Proof meta-regression methods, we evaluated the associations between processed meat, SSBs and TFAs and three chronic diseases: type 2 diabetes, ischemic heart disease (IHD) and colorectal cancer. We conservatively estimated that—relative to zero consumption—consuming processed meat (at 0.6–57 g d−1) was associated with at least an 11% average increase in type 2 diabetes risk and a 7% (at 0.78–55 g d−1) increase in colorectal cancer risk. SSB intake (at 1.5–390 g d−1) was associated with at least an 8% average increase in type 2 diabetes risk and a 2% (at 0–365 g d−1) increase in IHD risk. TFA consumption (at 0.25–2.56% of daily energy intake) was associated with at least a 3% average increase in IHD risk. These associations each received two-star ratings reflecting weak relationships or inconsistent input evidence, highlighting both the need for further research and—given the high burden of these chronic diseases—the merit of continuing to recommend limiting consumption of these foods.

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The findings of this study were based on data from public repositories and published literature, with systematic searches conducted in PubMed (https://pubmed.ncbi.nlm.nih.gov), Embase (https://www.embase.com) and Web of Science (https://www.webofscience.com) using the search strings provided in Supplementary Information. The estimates produced in this study are accessible via the Burden of Proof visualization tool (https://vizhub.healthdata.org/burden-of-proof/). The relevant studies were identified through a systematic literature review, and citations for all input studies are listed in the main text as references27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103. Study characteristics for all input data used in the analyses are also provided in Supplementary Table 5. The template for the data collection form is provided in Supplementary Table 4.

This study was a secondary analysis of existing data obtained through systematic reviews using meta-analytic methods. The study did not involve primary data collection, randomization, blinding or determination of sample size. Analyses were carried out using R version 4.0.5 and Python version 3.10.9. Code used for data processing (https://github.com/ihmeuw-msca/burden-of-proof/tree/main/risks/processed_foods) and for running the Burden of Proof models (https://github.com/ihmeuw-msca/bopforge) is publicly available online.

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Research reported in this publication was supported by the Gates Foundation (OPP1152504). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the final report, or the decision to publish.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

Demewoz Haile, Kassandra L. Harding, Susan A. McLaughlin, Charlie Ashbaugh, Vanessa Garcia, Nora M. Gilbertson, Hewan Kifle, Marie C. Parent, Reed J. D. Sorensen, Simon I. Hay, Aleksandr Y. Aravkin, Peng Zheng, Jeffrey D. Stanaway, Christopher J. L. Murray & Michael Brauer

Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA

Nora M. Gilbertson, Marie C. Parent, Simon I. Hay, Peng Zheng, Jeffrey D. Stanaway & Christopher J. L. Murray

Department of Applied Mathematics, University of Washington, Seattle, WA, USA

Aleksandr Y. Aravkin

School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada

Michael Brauer

Search author on:PubMed Google Scholar

D.H., S.I.H., M.B., C.A. and J.D.S. managed the estimation or publications process. D.H., K.L.H. and C.J.L.M. wrote the first draft of the paper. D.H. had primary responsibility for applying analytical methods to produce estimates. D.H. and H.K. had primary responsibility for seeking, cataloging, extracting or cleaning data and designing or coding figures and tables. D.H., V.G., M.C.P, R.J.D.S., J.D.S. and C.J.L.M. provided data or critical feedback on data sources. D.H., R.J.D.S., P.Z., N.M.G. and A.Y.A. developed methods or computational machinery. D.H., K.L.H., V.G., A.Y.A., J.D.S., M.B. and S.I.H. provided critical feedback on methods or results. D.H., K.L.H., S.A.M. C.J.L.M. and M.B. drafted the work or revised it critically for important intellectual content. D.H., C.A. and S.I.H. managed the overall research enterprise.

Correspondence to Demewoz Haile.

The authors declare no competing interests.

Nature Medicine thanks Yan-Bo Zhang and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Ming Yang, in collaboration with the Nature Medicine team.

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Template is from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.

The panels show the log(relative risk) function, the relative risk function, and a modified funnel plot showing the residuals (relative to 0) on the x-axis and the estimated standard error that includes the reported standard error and between-study heterogeneity on the y-axis. RR relative risk, UI uncertainty interval.

Supplementary Methods, Data sources, Results and Tables 1–17.

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Haile, D., Harding, K.L., McLaughlin, S.A. et al. Health effects associated with consumption of processed meat, sugar-sweetened beverages and trans fatty acids: a Burden of Proof study. Nat Med (2025). https://doi.org/10.1038/s41591-025-03775-8

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Received: 01 November 2024

Accepted: 16 May 2025

Published: 30 June 2025

DOI: https://doi.org/10.1038/s41591-025-03775-8

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