Pork consumption and its relationship to human nutrition and health: a scoping review

Abstract

Pork is a frequently consumed red meat that provides substantial amounts of energy, macronutrients, and micronutrients to the diet. Its role in human nutrition and health is controversial and a plethora of data exist in the peer-reviewed scientific literature. Therefore, we conducted a scoping review of clinical and population-based studies to assess the effects of pork consumption on human nutrition and health. Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Data were extracted from 86 studies, including 16 randomized controlled trials, 1 uncontrolled trial, 7 cohort studies, 4 nonrandomized controlled trials, 4 case-cohort and nested case-control studies, 33 case-control studies, and 21 cross-sectional studies. Intervention studies were conducted in healthy individuals and were short to moderate in duration. The effect of pork intake on patients’ nutrient status was the most commonly assessed outcome. The majority of observational studies assessed the effect of pork on cancer incidence, but no studies assessed the effects of pork on inflammation or oxidative stress. No interventional studies explored diabetes mellitus risk, and only one study assessed cancer risk associated with pork consumption. Several micronutrients in pork, including zinc, iron, selenium, choline, thiamin, and vitamins B6 and vitamin B12, are thought to influence cognitive function and may prove to be a unique area of research. To date, there is a dearth of high-quality randomized controlled trials assessing the effects of pork intake on disease risk factors and outcomes. This review helps highlight the many research gaps that future studies should be designed to address.

Full text

Meat and Muscle Biology™
Pork Consumption and Its Relationship to Human
Nutrition and Health: A Scoping Reviewa
Laura Paige Penkert1
,
2, Ruogu Li1
,
2, Jing Huang1
,
2, Anil Gurcan3, Mei Chung1
,
2, and Taylor C. Wallace4
,
5*
1Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA 02111, USA
2Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
3Department of Environmental Policy and Planning, School of Engineering, Tufts University, Somerville, MA 02155, USA
4Think Healthy Group, Washington, DC 20036, USA
5Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 20035, USA
*Corresponding author. Email: taylor.wallace@me.com (Taylor C. Wallace)
aFunding for this study was provided through an unrestricted educational grant from National Pork Board to Think Healthy
Group. The funder had no role in the study selection, data extraction, data analysis, or writing of the manuscript. The
authors report no other conflicts of interest. The authors thank Ms. Christina West for her formatting and editorial services.
Abstract: Pork is a frequently consumed red meat that provides substantial amounts of energy, macronutrients, and micro-
nutrients to the diet. Its role in human nutrition and health is controversial, and a plethora of data exist in the peer-reviewed
scientific literature. Therefore, we conducted a scoping review of clinical and population-based studies to assess the effects
of pork consumption on human nutrition and health. Results are reported according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses extension for scoping reviews. Data were extracted from 86 studies, including 16
randomized controlled trials, 1 uncontrolled trial, 7 cohort studies, 4 nonrandomized controlled trials, 4 case-cohort and
nested case-control studies, 33 case-control studies, and 21 cross-sectional studies. Intervention studies were conducted in
healthy individuals and were short (<1 mo) to moderate (1 to 6 mo) in duration. The effect of pork intake on patients’
nutrient status was the most commonly assessed outcome. Most observational studies assessed the effect of pork on cancer
incidence, but no studies assessed the effects of pork on cognition or inflammation/oxidative stress. No interventional stud-
ies explored diabetes mellitus risk, and only 1 study assessed cancer risk associated with pork consumption. Several micro-
nutrients in pork, including zinc, iron, selenium, choline, thiamin, and vitamins B
6
and vitamin B
12
, are thought to influence
cognitive function, and this may prove to be an exciting area of emerging research. To date, there is a dearth of high-quality
randomized controlled trials assessing the effects of pork intake on disease risk factors and outcomes. The scientific liter-
ature contains mostly observational studies, a large majority being case-controlled and cross-sectional analyses. Of note,
there is a lack of studies examining isolated effects of processed pork intake on human health. Future clinical trials should
address the role of pork consumption in health outcomes, intermediate outcomes, and validated biomarkers.
Key words: pork, meat, health policy, scoping review, diet
Meat and Muscle Biology 5(1): 43, 1–22 (2021) doi:10.22175/mmb.12953
Submitted 29 June 2021 Accepted 17 September 2021
Introduction
Pork is a red meat that is consumed frequently across
the globe. Cross-sectional analyses of the 2006–2016
United States National Health and Nutrition Exami-
nation Survey data sets showed that approximately
19.4%, 16.5%, and 16.1% of adults in the U.S.
consume pork, fresh pork, and fresh lean pork, respec-
tively (An et al., 2019). Both pork tenderloin and pork
sirloin meet the American Heart Association (2021)
Heart Health Checkmark criteria, which means that
they contain ≤5 g of fat, ≤2 g of saturated fat, and
≤480 mg of sodium per label serving. A 4-ounce
raw, boneless, lean pork chop (top loin) provides
approximately 144 kcal of energy, 25.3 g of protein,
© 2021 Paige Penkert, et al. www.meatandmusclebiology.com
This is an open access article distributed under the CC BY license (https://creativecommons.org/licenses/by/4.0/)

3.86 g of fat (1.36 g of saturated fat), and substantial
amounts of iron, zinc, selenium, magnesium, phospho-
rus, potassium, thiamin, riboflavin, niacin, pantothenic
acid, choline, and vitamins B
6
and B
12
to the diet
(FoodData Central identifier 168251) (U.S. Depart-
ment of Agriculture Agricultural Research Service,
2019). Increased lean pork rather than total pork intake
was recently associated with improved nutrient intakes
of protein, magnesium, potassium, selenium, zinc,
phosphorus, thiamin, riboflavin, niacin, and vitamin
B
6
and with lesser increases in daily total energy, satu-
rated fat, and sodium intakes among U.S. adults (An
et al., 2019). Aside from the effects of pork on nutrient
intakes, there is a plethora of scientific evidence regard-
ing the effects of pork intake on human nutrition and
health. Recent randomized controlled trials have
shown that the addition of lean pork to both the Medi-
terranean diet and the Dietary Approaches to Stop
Hypertension diet does not affect the demonstrated
benefits of these diets on established biomarkers of
cardiovascular disease (Sayer et al., 2015;Wade et al.,
2019). The addition of an average of 3 servings of lean
pork to a Mediterranean-style diet pattern in older
adults has been suggested to improve cognitive out-
comes (Wade et al., 2019). However, evidence on the
health effects of pork is heterogenous and in many
cases conflicting.
The use of systematic methodologies for reviewing
evidence continues to increase in the nutrition science
field. Scoping reviews (otherwise known as evidence
mapping) are a relatively new and important tool used
to systematically characterize the range of research
activity in broad topic areas and are used to guide
research priority setting and whether evidence is suffi-
cient for systematic reviews and meta-analyses. They
are less exhaustive but utilize rigorous systematic
and replicable methodologies that allow for a better
understanding of the extent and distribution of evi-
dence in a broad area, highlighting where evidence and
evidence gaps exist (Hetrick et al., 2010;Althuis and
Weed, 2013;Wang et al., 2016). Although scoping
reviews are conducted for different purposes compared
with systematic reviews, they are still rigorous and
transparent in their methodology to ensure trustworthy
results (Munn et al., 2018). Purposes for conducting
a scoping review may include the following: (1) to
identify the types of available evidence in a given field,
(2) to clarify concepts and definitions in the scientific
literature, (3) to examine how research is conducted on
a certain topic or in a certain field, (4) to identify key
characteristics or factors related to a concept, (5) to
serve as a precursor to systematic review, and/or
(6) to pinpoint and analyze knowledge gaps (Arksey
and O’Malley, 2005;Anderson et al., 2008;Levac
et al., 2010;Peters et al., 2015;Wang et al., 2016;
Munn et al., 2018). Scoping reviews are also extremely
useful in helping groups prioritize research agendas,
particularly when resources are limited and a plethora
of heterogenous evidence exists.
Therefore, our research objective was to conduct a
scoping review of clinical and population-based studies
assessing the effects of pork consumption in relation to
human nutrition and health.
Materials and Methods
We created a literature database and performed
evidence mapping following methods described else-
where (Wang et al., 2016). We reported the results
according to the Preferred Reporting Items for System-
atic Reviews and Meta-Analyses extension for scoping
reviews (Tricco et al., 2018).
Definitions of fresh, processed, and mixed
pork
The American Meat Science Association (AMSA)
Lexicon for the standardization of various terms used
in meat sciences was adopted for these analyses
(Seman et al., 2018). Fresh pork wasdefined as products
that met the AMSA standards for “minimal processing,”
wherein raw, uncooked meat products have not been sig-
nificantly altered compositionally and contain no added
ingredients but may have been reduced in size by fabri-
cation, mincing, grinding, and/or a meat recovery sys-
tem (Seman et al., 2018). Processed pork was defined
as products that met the AMSA standards for “further
processing,”which entails any process wherein meat
products undergo a transformation, beyond minimal
processing, containing approved ingredients and may
be subjected to a preservation or processing step(s)
through the application of salting, curing, fermentation,
thermal processing (smoking and/or cooking), batter/
breading, or other processes to enhance sensory, quality,
and safety attributes. These products may include ready-
to-cook and ready-to-eat products (Seman et al., 2018).
Mixed pork was defined as a combination of fresh and
processed pork.
Literature search and selection
We developed search strategies with the help of
university librarians. We searched Ovid Medline from
1946 to present, Embase from 1974 to present, and
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
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Cochrane Central from 1910 to present (Appendix A).
No restrictions were set regarding languages or out-
come terms. Additional articles were found via refer-
ence mining.
After duplicated citations were removed in Endnote,
we uploaded titles and abstracts to Rayyan (https://
rayyan.qcri.org) for double independent abstract screen-
ing. Two independent reviewers screened all abstracts to
exclude irrelevant abstracts such as narrative reviews,
systematic reviews, case studies, letters to the editor, eco-
logical studies, and conference proceedings or abstracts.
We included studies conducted in participants of all ages
looking at pork consumption compared with any compa-
rator. Because many study population details were not
described in the abstracts, we only excluded those
abstracts that clearly stated nonpork primary exposures
and outcomes not related to health or nutrition. We then
retrieved the full-text articles of all potentially relevant
abstracts and performed full-text screening according
to our inclusion and exclusion criteria (Table 1).
Two reviewers discussed all discrepancies and disagree-
ments during both abstract and full-text screening phases
and resolved discrepancies via consensus. If no consen-
sus could be reached, a third reviewer or the entire
research team resolved the remaining discrepancies.
We recorded the primary reason for exclusion of
all full-text articles (Appendix B). Studies in Appen-
dix Bwere “set aside due to processed meat”if they
did not specify whether the processed meat was pork
or other meat.
Data extraction
We performed data extraction on all included full-
text articles. We extracted information on study char-
acteristics (i.e., study design and sample size), study
participant characteristics (i.e., age, health status, and
gender), intervention characteristics (i.e., pork source,
dose, and form of administration), and a list of analyzed
outcomes. Data were extracted by one reviewer and
spot checked by a second team member.
We did not perform a risk-of-bias assessment of
included studies in the scoping review.
Data analysis and charting
We used one study as our unit of analysis. We
treated multiple studies reported in one publication
as separate studies in the analysis. To allow for fre-
quency analysis and identification of research gaps,
outcomes were classified into categories based on bio-
markers and indicators for health outcomes. The out-
come categories were cancer, cardiovascular disease
risk, diabetes risk, cognitive function, weight status
and body composition, nutrient status, inflammation,
oxidative stress, and other (Table 2). All other health
outcomes that could not be grouped into these prede-
fined outcome categories were grouped into an “other”
outcome category.
To summarize the characteristics of the included
studies, we conducted descriptive analyses on study
design, country, sample size, study population
Table 1. Study eligibility criteria for full-text screening
Parameter Inclusion Criteria Exclusion Criteria
Populations of interest Any human participants None
Interventions or exposures
of interest
Consumption of pork products alone or
in combination with other foods/dietary patterns
Articles assessing foods other than pork or dietary
patterns not including pork
Articles that only specify red meat or sausage without
identifying pork as a component
Studies that do not include dietary assessment
(i.e., studies using self-report only)
Comparators of interest Any or no comparator None
Outcomes of interest Any health-related outcomes including nutrition
deficiency/insufficiency
Food safety outcomesFood allergy outcomes
irrespective of measure
Articles looking singularly at the effect of pork
on overall nutrient status
Hunger and satiety outcomes
Study designs of interest Any interventional and observational study design Narrative reviews
Systematic reviews
Meta-analyses
Letters to the editor
Case studies
Ecological studies
Conference proceedings or abstracts
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 3 www.meatandmusclebiology.com

characteristics, health outcome categories assessed in
the studies, and funding source.
To visualize gaps in research, we created bubble
plots (a type of weighted scatterplot) grouping studies
by health outcome, study design, and pork category
(fresh pork, processed pork, and mixed sources).
Results
We screened a total of 1,967 abstracts identified
through literature searches in the Medline, Cochrane,
and Embase databases. A total of 318 full-text articles
were retrieved for full-text screening. After excluding
194 articles (see Appendix Bfor exclusion reasons), we
included 126 studies (published in 124 articles) for data
extraction. Of these 126 articles, we set aside 40 (see
Appendix Bfor exclusion reasons).
We included 85 studies (in 83 publications) in the
final scoping review (Lubin et al., 1981;Lakritz et al.,
1982;Miller et al., 1983;Hislop et al., 1986;Kaul et al.,
1986;Kune et al., 1987;Steineck et al., 1988;Olsen
et al., 1989;Kneller et al., 1991;Richardson et al.,
1991;Swanson et al., 1992;Abe et al., 1993;Yu et al.,
1993;Goldbohm et al., 1994;Lohsoonthorn and
Danvivat, 1995;Wilkens et al., 1996;Ambrosone et al.,
1998;Bode et al., 1998;Takashima et al., 1998;Kidd
et al., 1999;Smit et al., 1999;Sung et al., 1999;
Breslow et al., 2000;Matsuo et al., 2001;Baech et al.,
2003;Hu et al., 2003;Markaki et al., 2003;Nomura
et al., 2003;Chiu and Gapstur, 2004;Toporcov et al.,
2004;Brink et al., 2005;Radosavljevi´c et al., 2005;
Sakauchi et al., 2005;Milias et al., 2006;Pitsavos et al.,
2006;Rubio et al., 2006;Sato et al., 2006;Xu et al.,
2006;Dosil-Díaz et al., 2007;Hu et al., 2007a;
2007b;Leidy et al., 2007;Li et al., 2007;Brunt et al.,
2008;Borawska et al., 2009;Campbell and Tang,
2010;Gilsing et al., 2012;McArthur et al., 2012;
Murphy et al., 2012;Semba et al., 2012;Celada et al.,
2013;Egeberg et al., 2013;Nolan-Clark et al.,
2013;Pierre et al., 2013;Murphy et al., 2014;
Poomphakwaen et al., 2014;Samman et al., 2014;
Wang et al., 2014;Yazawa et al., 2014;Gong et al.,
2015;Zou et al., 2015;Angelo et al., 2016;Charlton
et al., 2016;Khorosh et al., 2016;Beals et al., 2017;
Gong et al., 2017;Harrold et al., 2017;Hu et al.,
2017;Kehlet et al., 2017;Martínez-Sánchez et al.,
2017;Park et al., 2017;Song et al., 2017;Vulcan et al.,
2017;Bartáková et al., 2018;Torres-Sánchez et al.,
2018;Tricco et al., 2018;Xu et al., 2018;Gacek and
Wojtowicz, 2019;Saliba et al., 2019;Sheng et al.,
2019;Sneyd and Cox, 2020;Wedekind et al., 2020;
American Heart Association, 2021). These included
16 randomized controlled trials, 1 uncontrolled trial, 7
cohort studies, 4 nonrandomized controlled trials, 4
case-cohort and nested case-control studies, 33 case-
control studies, and 20 cross-sectional studies.
Figure 1 outlines each stage of the literature search
and selection process.
Study characteristics
Many studies investigated the effects of pork con-
sumption on various outcome categories. Figure 2
shows the cumulative frequency of studies published
every 5 y from 1988 to 2020. As shown in Figure 2,
there was a significant increasing trend in the number
of publications reporting cancer outcomes from 1988
Table 2. List of outcome categories
Outcome Category Definition
Cancer Bladder cancer; breast cancer; colorectal cancer; esophageal cancer; gastric cancer; larynx cancer; lung
cancer; malignant lymphoma; non-cardia gastric cancer; oral cancer; pancreatic cancer; prostate carcinoma;
renal cell carcinoma; thyroid cancer; urinary system cancer; urothelial cancer
Cardiovascular disease risk Arterial compliance; blood lipids profile; blood pressure; hypercholesterolemia; hypertension
Diabetes risk Blood/plasma/serum glucose; GDM; insulin status; metabolic syndromes; type 2 diabetes
Cognitive function Appetite; cognitive function scores; mood
Weight status and body composition Anthropometrics; body composition; BMI; bone mineral density; muscle mass; obesity; weight
Nutrient status Iron absorption or status; nitrogen balance; protein metabolites; serum folate; vitamin B12 status; zinc
status
Inflammation and oxidative stress Inflammatory status; monocyte activation markers; muscle inflammation markers; oxidative stress markers
Other Alcoholic liver diseases; blood urine nitrogen; blood cadmium concentration; blood nitrosamine
concentration; body strength; carboxymethyl-lysine; cholesterol gallstones; energy expenditure;
Epstein-Barr virus; forearm fracture; gout; glomerular filtration rate; health-related quality of life;
hemoglobin; homocysteine; life satisfaction; N-nitrosodimethylamine; pigment gallstones; polymorphisms
of vitamin D metabolism genes; urinary PhIP
BMI =body mass index; GDM =gestational diabetes mellitus; PhIP =2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine.
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
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to 2020. Meanwhile, the number of publications
reporting cardiovascular disease risk and nutrient
status outcomes experienced a steady increase. The
research published in other outcome categories,
including diabetes mellitus risk factors, weight status
and body composition, cognitive function, and
inflammation and oxidative stress, emerged at the
beginning of the 21st century and has increased since
then.
Interventional studies
Among the 85 included studies, 21 were interven-
tional studies (Table 3). Of these, 76.19% were random-
ized control trials, 19.05% were nonrandomized control
trials, and 4.76% were uncontrolled trials. Of the
includedinterventional studies,the average participant’s
mean age was 39.51 y (range, 1.49 to 82.69 y). Most
studies had a duration of 1 to 6 mo (52.38%); 28.57%
of studies were >1 mo in duration, whereas only 3 stud-
ies were longer than 6 mo. Within the 4 pork interven-
tion categories, 28.57% were exclusive fresh meat,
14.29% provided only processed meat, 38.10% were
mixed pork sources, and the other studies (19.05%)
did not specify pork category. The majority of funding
sources came from industry (33.33%) and mixed
sources (38.10%). One-third of the interventional stud-
ies were conducted in Europe, 28.57% in North
America, and 23.81% in Oceania. Only a few articles
were from China (9.52%) and other Asian countries
(4.76%). Nutrition status was the most frequently stud-
ied outcome among interventional studies, followed by
weight status and body composition (28.57%) and
cardiovascular heart disease risk (28.57%). Some
Figure 1. Literature search and study selection process. RCT =randomized controlled trial.
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
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studies focused on inflammation (14.29%), cancer
(4.76%), and cognitive function (4.76%), whereas
38.1% studied other outcomes. Only 3 interventional
studies isolated effects of processed pork intake.
Figure 2. Cumulative frequency of published studies by outcome categories. CVD =cardiovascular disease; DM =diabetes mellitus.
Table 3. Summary of study characteristics of
interventional studies
Characteristic Interventional Study (N =21)
Design
Randomized controlled trial 16 (76.19)
Non–randomized controlled trial 4 (19.05)
Uncontrolled trial 1 (4.76)
Sample size, n (range) 42.86 (1–180)
Mean age, y (range)a39.51 (1.49–82.69)
Intervention duration
<1 mo 7 (33.33)
1–6 mo 11 (52.38)
6–12 mo 2 (9.52)
≥1 y 1 (4.76)
Pork category
Fresh meat only 6 (28.57)
Mixed 8 (38.10)
Processed meat only 3 (14.29)
Not specified 4 (19.05)
Baseline health status
100% healthy 19 (90.48)
Generally healthyb0 (0.00)
With disease conditionc2 (9.52)
Not reported 0 (0.00)
Funding source
Academic 0 (0.00)
Government 0 (0.00)
Industry 7 (33.33)
Nonprofit 1 (4.76)
Mixed sources 8 (38.10)
Not reported 5 (23.81)
Table 3. (Continued )
Characteristic Interventional Study (N =21)
Region
North America 6 (28.57)
South America 0 (0.00)
China 2 (9.52)
Other Asia 1 (4.76)
Oceania 5 (23.81)
Europe 7 (33.33)
Outcome categoriesd
Cancer 1 (4.76)
Cardiovascular disease risk factors 7 (33.33)
Diabetes mellitus risk factors 6 (28.57)
Nutrient status 10 (47.62)
Weight status and body composition 9 (42.86)
Cognitive function 3 (14.29)
Inflammation and oxidative stress 4 (19.05)
Other 6 (28.57)
Data are presented as n(%) unless indicated otherwise.
aMean age represents the average of the reported mean age for each
included study. The median age was used if the mean age was not
reported. The midpoint of the reported age range was used if neither mean
age nor median age was reported. One study did not report mean age,
median age, or age range.
bGenerally healthy: ≤20% of the population have diseases.
cWith disease conditions: >20% of the population have diseases.
dSome studies examined multiple outcomes, which generates percentages
that sum to >100%.
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Observational studies
A total number of 64 observational studies were
included. Most were cross-sectional studies and case-
control studies (82.81%). Cohort studies (17.19%)
include prospective and retrospective cohort studies,
case-cohort studies, and nested case-control studies
(Table 4). The average participant’s mean age was
53.7 y. About half of the included studies specified
the type of pork exposure. For instance, 15.62% reported
fresh pork as the only exposure, 9.38% reported proc-
essed pork exposure only (i.e., bacon, ham, and other
processed pork product), and 25% reported mixed expo-
sure of fresh and processed pork. More than half of the
included studies reported the funding source. Of these,
7.81% were supported by multiple funding resources.
As for studies reporting a single funding source, govern-
ment funding was the most common (29.69%), followed
by nonprofit (9.38%) and industry (6.25%) funding.
Included studies were conducted across the globe, with
32.81% conducted in North American countries,
26.56% in European countries, and 20.31% in China.
No cohort studies were identified as being conducted
in the South America region or the Oceania region.
The most commonly reported outcome was cancer
(60.9%), followed by cardiovascular disease risk factors
(10.93%) and weight status and body composition out-
come (7.81%). Cancer and weight status and body com-
position were the only 2 outcomes reported in cohort
studies. Only 6 case-control and 6 cross-sectional studies
isolated effects of processed pork intake, with the large
majority focusing on cancer incidence.
Identifying research gaps related to study
design and pork categorization
Figure 3 shows the differences in outcome catego-
ries explored by interventional studies and observatio-
nal studies. Nutrient status outcomes were the most
frequently explored in interventional studies. These
included nutrient status biomarkers for protein/amino
acids, folate iron, vitamin B
6
, vitamin B
12
, and zinc.
We did not find studies assessing pork’s contribution
to selenium or thiamin status. Cancer outcomes were
the most frequently explored in observational studies.
Very few observational studies explored inflammation,
oxidative stress, or cognitive function associated with
pork consumption. Only one interventional study
assessed the role of pork intake with cancer outcomes.
As expected, sample sizes were much larger for obser-
vational studies compared with interventional studies.
Figure 4 shows the differences in health outcomes
reported by categorization of pork as fresh pork,
processed pork, and mixed pork sources. Studies that
included fresh pork as the main exposure of interest
reported on almost all outcome categories, with the
largest number of fresh pork studies reporting on
cancer risk. Studies that included processed pork as
the main exposure of interest primarily reported on
cancer risk, with 1 study reporting on weight status
and body composition and 1 study reporting on cardio-
vascular disease risk. Studies that included mixed pork
sources as the main exposure of interest reported on all
outcomes, and cancer was the most frequently investi-
gated outcome. Figure 5 shows differences in cancer
outcome sites reported by categorization of pork as
fresh pork, processed pork, and mixed pork sources.
Cancers of the gastrointestinal tract were frequent sites
to be assessed across observational studies.
Discussion
Scoping reviews are a replicable, systematic, and
evidence-based approach used to identify, collect,
and evaluate the characteristics of the existing peer-
reviewed literature. Here, we highlight research gaps
and opportunities for systematic reviews in relation
to the effects of pork consumption on human nutrition
and health. The scientific literature contains mostly
observational studies, a large majority being case-
controlled and cross-sectional analyses. To date, there
are a dearth of high-quality randomized controlled
trials assessing effects of pork intake on disease risk
factors and outcomes. The effect of pork intake on
patients’nutrient status was the most assessed out-
come. No interventional studies explored diabetes
mellitus risk, and only 1 study assessed cancer risk
associated with pork consumption. The single “cancer
risk”intervention sought to investigate whether cured
meat modulates biomarkers of cancer risk and whether
specific agents can suppress cured meat–induced pre-
neoplastic lesions in rats and associated biomarkers
in rats and humans. Data from this study suggest
that the addition of calcium carbonate to the diet or
α-tocopherol to cured meat may reduce colorectal
cancer risk associated with cured meat intake among
observational studies (Pierre et al., 2013). Along the
same lines, regular consumption of biopeptides con-
tained in dry-cured ham but absent in cooked ham were
shown to impair platelet and monocyte activation and
levels of plasmatic P-selected, monocyte chemoattrac-
tant protein-1 and interleukin-6 in healthy subjects
(Martínez-Sánchez et al., 2017). Surprisingly, there
was a dearth of observational studies and absence of
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Table 4. Summary of study characteristics of observational studies
Characteristic Combined (N =64)
Cross-Sectional and Case-Control
Studies (n =53)
Cohort Studiesa
(n =11)
Number of studies 64 (100) 53 (82.81) 11 (17.19)
Sample size, mean (range) 7,851 (46–64,539) 4,456 (46–56,237) 24,205 (3,500–64,539)
Mean age, yb53.71 53.44 54.92
Follow-up duration, y
2–5 NA NA 1 (9.09)
5–10 NA NA 3 (27.27)
10–15 NA NA 4 (36.36)
≥15 NA NA 3 (27.27)
Pork category
Fresh meat only 10 (15.62) 8 (15.09) 2 (18.18)
Mixed 16 (25.00) 13 (24.53) 3 (27.27)
Processed meat only 6 (9.38) 6 (11.32) 0 (0.00)
Not specified 32 (50.00) 26 (49.06) 6 (54.55)
Baseline health status
100% healthy NA NA 3 (27.27)
Generally healthycNA NA 2 (18.18)
With disease conditionsdNA NA 3 (27.27)
Not reported NA NA 3 (27.27)
Funding source
Academic 1 (1.56) 1 (1.89) 0 (0.00)
Government 19 (29.69) 15 (28.30) 4 (36.36)
Industry 4 (6.25) 4 (7.55) 0 (0.00)
Nonprofit 6 (9.38) 4 (7.55) 2 (18.18)
Mixed sources 5 (7.81) 4 (7.55) 1 (9.09)
Not reported 29 (45.31) 25 (47.17) 4 (36.36)
Region
North America 21 (32.81) 19 (35.83) 2 (18.18)
South America 2 (3.12) 2 (3.77) 0 (0.00)
China 13 (20.31) 12 (22.64) 1 (9.09)
Other Asia 8 (12.50) 6 (11.32) 2 (18.18)
Oceania 3 (4.69) 3 (5.66) 0 (0.00)
Europe 17 (26.56) 11 (20.75) 6 (54.55)
Outcome categoriese
Cancer 39 (60.94) 29 (54.72) 10 (90.91)
Cardiovascular disease risk factors 7 (10.94) 7 (13.21) 0 (0.00)
Diabetes mellitus risk factors 3 (4.96) 3 (5.66) 0 (0.00)
Nutrient status 1 (1.56) 1 (1.56) 0 (0.00)
Weight status and body composition 5 (7.81) 4 (7.55) 1 (9.09)
Cognitive function 0 (0.00) 0 (0.00) 0 (0.00)
Inflammation and oxidative stress 0 (0.00) 0 (0.00) 0 (0.00)
Other 12 (18.5) 12 (22.64) 0 (0.00)
Data are presented as n(%) unless indicated otherwise.
aCohort studies include prospective cohort study, retrospective cohort study, case-cohort study, and nested case-control study.
bMean age represents the average of reported mean age for each included study. The median age was used if the mean age was not reported. The midpoint of
the reported age range was used if neither mean age nor median age was reported. Fifteen studies did not report mean age, median age, or age range.
cGenerally healthy: ≤20% of the population have diseases.
dWith disease conditions: >20% of the population have diseases.
eSome studies examined multiple outcomes, which generates percentages that sum to >100%.
NA =not applicable.
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 8 www.meatandmusclebiology.com

Figure 4. Bubble plot of health outcome categories by pork categorization. Each bubble in the figure represents one study, and the size of the bubble is
proportional to the study sample size. Categories specified as “other”were not included in this bubble plot. CVD =cardiovascular disease; DM =diabetes mellitus.
Figure 3. Bubble plot of health outcome categories by study design. Each bubble in the figure represents one study, and the size of the bubble is propor-
tional to the study sample size. CVD =cardiovascular disease; DM =diabetes mellitus.
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 9 www.meatandmusclebiology.com

prospective cohort studies that examined the role of
processed pork on cancer incidence and other health
outcomes. Many food frequency questionnaires (FFQ)
used in observational analyses are currently not able
to quantify intake of fresh and processed pork. This is
an important research gap that needs to be addressed
among FFQ and when designing future observational
research.
Although rural Chinese toddlers consuming forti-
fied cereal had higher vitamin B
12
levels in one study,
those receiving 50 g of pork per day had higher cogni-
tive scores (Sheng et al., 2019). However, a separate
quasi-experimental study did not find any advantages
of pork versus chicken on cognitive function in healthy
older adults, suggesting that the type of dietary protein
during aging may not impact cognitive function
(Charlton et al., 2016). The inclusion of 2 to 3 weekly
servings of fresh, lean pork in the Mediterranean diet
was shown to lead to improved cognitive performance
over a 24-wk period, as indicated by higher processing
speed performance and emotional role functioning.
The Mediterranean diet, which is rich in high-selenium
foods such as seafood and nuts, has been associated
with a lower risk of age-related cognitive decline
(Scarmeas et al., 2006;Hardman et al., 2016).
Several micronutrients in pork, including zinc, iron,
selenium, choline, thiamin, and vitamins B
6
and vita-
min B
12
, are thought to influence cognitive function
and may prove to be an exciting emerging area of
research. Future prospective cohort investigations
could greatly help in the design of larger, long-duration
randomized clinical trials that assess outcomes (e.g.,
Alzheimer’s dementia incidence).
Most observational studies assessed the effect of
pork on cancer incidence, followed by cardiovascular
disease, weight status and body composition, type 2
diabetes, and nutrient status. No prospective cohort
studies assessed the effects of pork on cardiovascular
disease, type 2 diabetes, cognition, inflammation/oxi-
dative stress, or nutrient status.
Our study has several strengths and weaknesses.
The main strength of this review is the thorough, sys-
tematic search strategy and detailed analysis of charac-
teristics reported in the included studies. This review is
Figure 5. Bubble plot of cancer outcome sites by pork categorization. Each bubble in the figure represents one study, and the size of the bubble is
proportional to the study sample size.
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 10 www.meatandmusclebiology.com

limited by the availability of manuscripts to online
searches in the English language. Another limitation
important to note is that scoping reviews do not typi-
cally include quality (risk of bias) appraisal of included
studies, and therefore there can be substantial amounts
of poor-quality research. Observational studies failed
to indicate whether the AMSA lexicon for “minimal
processing and “further processing”was adopted, in
the same way we categorized products as “fresh”or
“processed”pork. The inability of current FFQ to dis-
tinguish between fresh and processed pork poses addi-
tional major limitations to our analyses.
Conclusions
Few conclusions can be drawn from studies evalu-
ating the effects of pork on human nutrition and health.
Several micronutrients in pork, including zinc, iron,
selenium, choline, thiamin, and vitamins B
6
and vita-
min B
12
, are thought to influence cognitive function,
and this may prove to be an exciting area of emerging
research. To date, there is a dearth of high-quality ran-
domized controlled trials assessing the effects of pork
intake on disease risk factors and outcomes. The scien-
tific literature contains mostly observational studies,
a large majority being case-controlled and cross-
sectional analyses. Of note, there is a lack of studies
examining isolated effects of processed pork intake
on human health. Future clinical trials should address
the role of pork consumption in health outcomes, inter-
mediate outcomes, and validated biomarkers.
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Appendices
Appendix A. Search Strategies
A1. Medline
Database: Ovid MEDLINE(R) <1946 to
December Week 5 2020>
Search Strategy:
———————————————————
1 exp Pork Meat/ (172)
2(“Boston butt”or Loin or Pancetta or Collops
or Gammon or Bacon or Sausage or Charcuterie or
Terrines or Galantines or Pates or Confit or Jamon or
Feijoada or Bakkwa or Charsiu or Lechan).af. (10575)
3 pork.af. (8253)
4 2 or 3 (17988)
5 diet.mp. or exp Diet/ (486323)
6 4 and 5 (1902)
7 1 or 6 (2051)
8 limit 7 to (english language and humans) (1022)
A2. EmBase
Embase
Session Results
::: ::: ::: ::: ::: ::: ::: ::: ::: ::: ::: ::: :::.
No.,Query,Results
#10, #8 NOT #9, 905
#9, #8 AND [medline]/lim, 1445
#8,"#7 AND [english]/lim AND [humans]/
lim”,2350
#7,"#1 OR #6",5405
#6,"#4 AND #5",2544
#5,"'diet'/exp OR diet”,776986
#4,"#2 OR #3",25289
#3,"pork”,11334
#2,"'boston butt’OR loin OR pancetta OR collops
OR gammon OR bacon OR sausage OR charcuterie
OR terrines OR galantines OR pates OR confit OR jamon
OR feijoada OR bakkwa OR charsiu OR lechan”,15043
#1,"'pork'/exp”,3373
A3. Cochrane Central
Database: EBM Reviews - Cochrane Central
Register of Controlled Trials <December 2020>,
Global Health <1910 to 2021 Week 04>
Search Strategy:
1 exp Pork Meat/ (0)
2(“Boston butt”or Loin or Pancetta or Collops or
Gammon or Bacon or Sausage or Charcuterie or
Terrines or Galantines or Pates or Confit or Jamon or
Feijoada or Bakkwa or Charsiu or Lechan).af. (10058)
3 pork.af. (22967)
4 2 or 3 (29840)
5 diet.mp. or exp Diet/ (363335)
6 4 and 5 (2885)
7 1 or 6 (2885)
8 limit 7 to (english language and humans) [Limit
not valid in CCTR,Global Health; records were
retained] (2166)
9 limit 8 to (“review”or “review literature”or
“review of reported cases”or review, academic or
review, multicase or review, tutorial) [Limit not valid
in Global Health; records were retained] (2001)
10 8 not 9 (165)
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 15 www.meatandmusclebiology.com

Appendix B. Excluded articles with
reasons for exclusion
First Author
(Year) Title Reason for Exclusion
Alves-Santos (2018) Dietary patterns and their association with adiponectin and leptin concentrations throughout
pregnancy: a prospective cohort
Pork cannot be isolated
Anonymous (1994) Dietary and other risk factors of ulcerative colitis. A case-control study in Japan.
Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan
Set aside due to
processed meat
Armstrong (1998) Nasopharyngeal carcinoma in Malaysian Chinese: salted fish and other dietary exposures Pork cannot be isolated
Aro (1994) Factors affecting the selenium intake of people in Transbaikalian Russia No human subjects
Asakura (2014) Estimation of food portion sizes frequently consumed by children 3-6 y old in Japan No health outcome
Baker (1986 Urine mutagenicity as an indicator of exposure to dietary mutagens formed during cooking
of foods
No exposure of interest
Balder (2005) Dietary patterns associated with male lung cancer risk in the Netherlands Cohort Study Pork cannot be isolated
Barth (2001) Food intake of patients with atopic dermatitis No outcome of interest
Beals (2016) Anabolic sensitivity of postprandial muscle protein synthesis to the ingestion of a protein-
dense food is reduced in overweight and obese young adults
No exposure of interest
Bingham (1996) Does increased endogenous formation of N-nitroso compounds in the human colon explain
the association between red meat and colon cancer?
Pork cannot be isolated
Bingham (1996) Does increased endogenous formation of N-nitroso compounds in the human colon explain
the association between red meat and colon cancer?
Duplicate
Butler (2006) Prospective study of dietary patterns and persistent cough with phlegm among Chinese
Singaporeans
Pork cannot be isolated
Campbell (1999) Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance-
training-induced changes in body composition and skeletal muscle in older men
Pork cannot be isolated
Caselli (2014) Test-based exclusion diets in gastro-esophageal reflux disease patients: a randomized
controlled pilot trial
Pork cannot be isolated
Celada (2014) Omega-3 enriched frankfurters and pâtés intake decrease TXA2 level and N-6/N-3 in
volunteers at increased cardiovascular risk: a placebo-controlled study
Abstract only
Cempaka (2019) Dysregulated iron metabolism-associated dietary pattern predicts an altered body
composition and metabolic syndrome
Pork cannot be isolated
Chan (2004) Postprandial glucose response to Chinese foods in patients with type 2 diabetes Pork cannot be isolated
Charlton (2011) Pork, beef and chicken have similar effects on acute satiety and hormonal markers of
appetite
No outcome of interest
Chatzivagia (2019) Nutrition transition in the post-economic crisis Greece: assessing the nutritional gap of food
insecure individuals. A case-control study
Pork cannot be isolated
Chen (2020) The risk of urinary tract infection in vegetarians and non-vegetarians: a prospective study Pork cannot be isolated
Coates (2009) Regular consumption of n-3 fatty acid-enriched pork modifies cardiovascular risk factors Pork cannot be isolated
Coelho Nde (2015) Dietary patterns in pregnancy and birth weight Pork cannot be isolated
Cui (2007) Dietary patterns and breast cancer risk in the Shanghai Breast Cancer Study Pork cannot be isolated
Cuparencu (2020) The anserine to carnosine ratio: an excellent discriminator between white and red meats
consumed by free-living overweight participants of the PREVIEW study
PDF not found
Davidson (1999) Comparison of the effects of lean red meat vs lean white meat on serum lipid levels among
free-living persons with hypercholesterolemia: a long-term, randomized clinical trial
Pork cannot be isolated
de Gavelle (2018) Patterns of protein food intake are associated with nutrient adequacy in the general French
adult population
No outcome of interest
Deneo-Pellegrini
(2015)
Meat consumption and risk of squamous cell carcinoma of the lung: a case-control study in
Uruguayan men
Pork cannot be isolated
Di Pietro (2007) Breast cancer in southern Brazil: association with past dietary intake Pork cannot be isolated
Dixon (2004) Dietary patterns associated with colon and rectal cancer: results from the Dietary Patterns
and Cancer (DIETSCAN) Project
Pork cannot be isolated
Dolara (1984) Urinary mutagens in humans after fried pork and bacon meals No exposure of interest
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 16 www.meatandmusclebiology.com

(Continued )
First Author
(Year) Title Reason for Exclusion
Endoh (2015) Interactions between psychological stress and drinking status in relation to diet among
middle-aged men and women: a large-scale cross-sectional study in Japan
Pork cannot be isolated
Erhardt (2002) Alcohol, cigarette smoking, dietary factors and the risk of colorectal adenomas and
hyperplastic polyps–a case control study
No exposure of interest
Erkkila (2014) Effect of fatty and lean fish intake on lipoprotein subclasses in subjects with coronary heart
disease: a controlled trial
Pork cannot be isolated
Etemadi (2017) Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the
NIH-AARP Diet and Health Study: population based cohort study
Pork cannot be isolated
Favero (1998) Diet and risk of breast cancer: major findings from an Italian case-control study Set aside due to
processed meat
Flynn (1982) Dietary “meats”and serum lipids PDF not found
Franceschi (1999) The role of energy and fat in cancers of the breast and colon-rectum in a southern European
population
Set aside due to
processed meat
Franceschi (1995) Influence of food groups and food diversity on breast cancer risk in Italy Set aside due to
processed meat
French (1994) Food intake and physical activity: a comparison of three measures of dieting No exposure of interest
Friedenberg (2010) Population-based survey: body mass index at age 18 is strongly predictive of adulthood
obesity
Abstract only
Fung (2004) Dietary patterns, meat intake, and the risk of type 2 diabetes in women Pork cannot be isolated
Gacek (2014) Individual differences as predictors of dietary patterns among menopausal women with
arterial hypertension
Set aside due to
processed meat
Giles (1994) Dietary factors and the risk of glioma in adults: results of a case-control study in Melbourne,
Australia
Pork cannot be isolated
Giovannucci (1994) Intake of fat, meat, and fiber in relation to risk of colon cancer in men Pork cannot be isolated
Gorder (1986) Dietary intake in the Multiple Risk Factor Intervention Trial (MRFIT): nutrient and food
group changes over 6 y
Pork cannot be isolated
Guallar-Castillon
(2013)
The Southern European Atlantic Diet is associated with lower concentrations of markers of
coronary risk
Pork cannot be isolated
Gunasekeera (2016) Treatment of Crohn’s disease with an IgG4-guided exclusion diet: a randomized controlled
trial
No outcome of interest
Hansen (2015) A long-term fatty fish intervention improved executive function in inpatients with antisocial
traits and a history of alcohol and drug abuse
Pork cannot be isolated
Hansen (2014) Fish consumption, sleep, daily functioning, and heart rate variability Pork cannot be isolated
Hansen (2014) Reduced anxiety in forensic inpatients after a long-term intervention with Atlantic salmon Pork cannot be isolated
Hartung (1980) Relation of diet to high-density-lipoprotein cholesterol in middle-aged marathon runners,
joggers, and inactive men
PDF not found
Harvala (2019) Hepatitis E virus in blood donors in England, 2016 to 2017: from selective to universal
screening
No outcome of interest
Hebert (1998) The effect of dietary exposures on recurrence and mortality in early stage breast cancer Pork cannot be isolated
Heningburg (2015) Nutritional intake assessment in patients with urolithiasis: a decision impact analysis Pork cannot be isolated
Henry (2002) Brief communication: energy and protein intake in a sample of hospitalized elderly in
Hong Kong
No outcome of interest
Hernandez (2015) An estimation of the carcinogenic risk associated with the intake of multiple relevant
carcinogens found in meat and charcuterie products
No human subjects
Hobbs (2018) Associations between red and processed meat consumption and cardiometabolic risk markers
among British adults
Pork cannot be isolated
Hogan (2012) Effects of protein quantity and source (animal versus plant) on indices of mood and fed-state
large neutral amino acids and tryptophan profile
PDF not found
Houston (1997) Lifestyle and dietary practices influencing iron status in university women Pork cannot be isolated
Hunninghake (2000) Incorporation of lean red meat into a National Cholesterol Education Program Step I diet: a
long-term, randomized clinical trial in free-living persons with hypercholesterolemia
Pork cannot be isolated
Ifejika (2016) Swipe out Stroke: Feasibility and efficacy of using a smart-phone based mobile application
to improve compliance with weight loss in obese minority stroke patients and their carers
Study protocol
Ishizuka (1993) Influence of meals and night shifts on health Pork cannot be isolated
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 17 www.meatandmusclebiology.com

(Continued )
First Author
(Year) Title Reason for Exclusion
Jacobson (1983) Increased excretion of malonaldehyde equivalents in the urine after consumption of cooked,
stored meats
PDF not found
Jacques (1992) Effects on plasma lipoproteins and endogenous sex hormones of substituting lean white fish
for other animal-protein sources in diets of postmenopausal women
Pork cannot be isolated
Jakic (2010) Are lipoprotein disturbances in chronic hemodialyzed patients only renal failure related? Abstract only
Jonsson (2016) Diet in 1-year-old farm and control children and allergy development: results from the
FARMFLORA birth cohort
No outcome of interest
Jung (2010) The influence of dietary patterns on acne vulgaris in Koreans No outcome of interest
Kassier (2016) Colon cancer and the consumption of red and processed meat: An association that is
medium, rare or well done?
an review article
Kato (1987) Per capita foods/nutrients intake and mortality from gastrointestinal cancers in Japan Set aside due to
processed meat
Kato (1987) Relationship between westernization of dietary habits and mortality from breast and ovarian
cancers in Japan
Set aside due to
processed meat
Kiefer (2005) Eating and dieting differences in men and women No outcome of interest
Kim (2017) Red meat and chicken consumption and its association with high blood pressure and obesity
in South Korean children and adolescents: a cross-sectional analysis of KSHES, 2011-2015
Pork cannot be isolated
Kimura (2007) Meat, fish and fat intake in relation to subsite-specific risk of colorectal cancer: the Fukuoka
Colorectal Cancer Study
Pork cannot be isolated
Kjaerheim (1998) The role of alcohol, tobacco, and dietary factors in upper aerogastric tract cancers: a
prospective study of 10,900 Norwegian men
Pork cannot be isolated
Kocic (1997) Diet and breast cancer PDF not found
Komorniak (2019) What are the diets of patients before bariatric surgery? Pork cannot be isolated
Lacaille (2000) Responses of plasma lipoproteins and sex hormones to the consumption of lean fish
incorporated in a prudent-type diet in normolipidemic men
Pork cannot be isolated
Landi (2019) Daily meat consumption and variation with aging in community-dwellers: Results from
Longevity Check-Up 7 þproject
Pork cannot be isolated
Lang (2018) Impact of individual traits, saturated fat, and protein source on the gut microbiome Pork cannot be isolated
Langsetmo (2010) Dietary patterns in Canadian men and women ages 25 and older: relationship to
demographics, body mass index, and bone mineral density
Pork cannot be isolated
Lankinen (2009) Fatty fish intake decreases lipids related to inflammation and insulin signaling–a lipidomics
approach
Pork cannot be isolated
Larsson (2006) Processed meat consumption, dietary nitrosamines and stomach cancer risk in a cohort of
Swedish women
Pork cannot be isolated
Lee (2005) Breast cancer and dietary factors in Taiwanese women Pork cannot be isolated
Levi (1998) Food groups and risk of oral and pharyngeal cancer Pork cannot be isolated
Levi (2000) Food groups and oesophageal cancer risk in Vaud, Switzerland Set aside due to
processed meat
Levi (1999) Food groups and colorectal cancer risk Set aside due to
processed meat
Li (2016) Effects of dietary protein source and quantity during weight loss on appetite, energy
expenditure, and cardio-metabolic responses
Pork cannot be isolated
Li (2015) Prospective cohort study of cured meat intake and asthma symptom score in the EGEA
study
PDF not found
Li (2007) Dietary mutagen exposure and risk of pancreatic cancer Pork cannot be isolated
Li (2016) Effects of dietary protein source and quantity on glycemic control in energy-restricted
overweight and obese adults
PDF not found
Lin (2010) Red meat and heterocyclic amine intake, metabolic pathway genes, and bladder cancer risk Abstract only
Lindqvist (2009) Herring (Clupea harengus) intake influences lipoproteins but not inflammatory and
oxidation markers in overweight men
Pork cannot be isolated
Lindqvist (2007) Herring (Clupea harengus) supplemented diet influences risk factors for CVD in overweight
subjects
Pork cannot be isolated
Linseisen (2002) Meat consumption in the European Prospective Investigation into Cancer and Nutrition
(EPIC) cohorts: results from 24-hour dietary recalls
No outcome of interest
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 18 www.meatandmusclebiology.com

(Continued )
First Author
(Year) Title Reason for Exclusion
Liu (2019) Fat from dairy foods and ‘meat’consumed within recommended levels is associated with
favourable serum cholesterol levels in institutionalised older adults
Pork cannot be isolated
Lizcano (2020) The impact of lean pork meat consumption on cardiovascular risk Non-English study
Lyon (1993) Dietary intake as a risk factor for cancer of the exocrine pancreas Pork cannot be isolated
Ma (2000) Zinc and copper intakes and their major food sources for older adults in the 1994-96
Continuing Survey of Food Intakes by Individuals (CSFII)
No outcome of interest
Magee (2005) Associations between diet and disease activity in ulcerative colitis patients using a novel
method of data analysis
No outcome of interest
Manara (2013) Is gout still the rich and dissolute men’s disease? Results from the KING study of the Italian
Society for Rheumatology (SIR)
Abstract only
Mannisto (2005) Dietary patterns and breast cancer risk: results from three cohort studies in the DIETSCAN
project
Pork cannot be isolated
Martin (2016) Maternal dietary patterns are associated with lower levels of cardiometabolic markers during
pregnancy
Pork cannot be isolated
McArthur (2011) Inclusion of pork meat in the diets of young women reduces snack food consumption and
increases fruit and vegetable intakes
No outcome of interest
McKay (2015) Whole eggs enhance antioxidant activity when combined with energy dense, cooked
breakfast foods
PDF not found
McNaughton (2011) An energy-dense, nutrient-poor dietary pattern is inversely associated with bone health in
women
Pork cannot be isolated
Minami (1993) Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of
dietary and reproductive factors
Pork cannot be isolated
Miyake (2018) Dietary patterns and depressive symptoms during pregnancy in Japan: baseline data from the
Kyushu Okinawa Maternal and Child Health Study
Pork cannot be isolated
Miyake (2011) Maternal dietary patterns during pregnancy and risk of wheeze and eczema in Japanese
infants aged 16–24 mo: the Osaka Maternal and Child Health Study
Pork cannot be isolated
Montoro Garcia
(2016)
Dry-cured ham, its effects on human blood pressure and cardiovascular risk: a clinical study Abstract only
Moon (2015) Application of instrumental neutron activation analysis to assess dietary intake of selenium
in Korean adults from meat and eggs
No human subjects
Mozaffarian (2006) Dietary fish and n-3 fatty acid intake and cardiac electrocardiographic parameters in humans No outcome of interest
Mrazova (2020) The effect of consumption of pork enriched by organic selenium on selenium status and lipid
profile in blood serum of consumers
No exposure of interest
Mubiru (2017) Exposure assessment of epoxy fatty acids through consumption of specific foods available in
Belgium
No outcome of interest
Nagao (2012) Meat consumption in relation to mortality from cardiovascular disease among Japanese men
and women
Pork cannot be isolated
Narasaki (2020) Phosphatemic index is a novel evaluation tool for dietary phosphorus load: a whole-foods
approach
PDF not found
Nestel (1976) Effect of dietary polyunsaturated pork on plasma lipids and sterol excretion in man PDF not found
Nielsen (2018) Protein from meat or vegetable sources in meals matched for fiber content has similar effects
on subjective appetite sensations and energy intake-a randomized acute cross-over meal test
study
No outcome of interest
Nicklas et al. (1995) Impact of meat consumption on nutritional quality and cardiovascular risk factors in young
adults: the Bogalusa Heart Study
Pork cannot be isolated
No author (2017) Foodomics application: analysis of dietary components of the DASH diet pre and post
consumption
PDF not found
Norrish (1999) Heterocyclic amine content of cooked meat and risk of prostate cancer No outcome of interest
O’Connor (2018) Adopting a Mediterranean-style eating pattern with different amounts of lean unprocessed
red meat does not influence short-term subjective personal well-being in adults with
overweight or obesity
Pork cannot be isolated
O’Connor (2018) A Mediterranean-style eating pattern with lean, unprocessed red meat has cardiometabolic
benefits for adults who are overweight or obese in a randomized, crossover, controlled
feeding trial
Pork cannot be isolated
Okubo (2019) Hardness of the habitual diet and its relationship with cognitive function among 70-year-old
Japanese elderly: findings from the SONIC Study
No outcome of interest
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 19 www.meatandmusclebiology.com

(Continued )
First Author
(Year) Title Reason for Exclusion
Oliveira (2010) Adherence to the Southern European Atlantic Diet and occurrence of nonfatal acute
myocardial infarction
Pork cannot be isolated
Olsen (2020) Nutritional status in patients with inflammatory rheumatic diseases (IRD) Pork cannot be isolated
Omura (1987) Geographical distribution of cerebrovascular disease mortality and food intakes in Japan Ecological study
Ouellet (2008) Dietary cod protein reduces plasma C-reactive protein in insulin-resistant men and women Pork cannot be isolated
Ouellet (2007) Dietary cod protein improves insulin sensitivity in insulin-resistant men and women: a
randomized controlled trial
Pork cannot be isolated
Palacios (2018) A lean pork-containing breakfast reduces hunger and glycemic response compared with a
refined carbohydrate-containing breakfast in adults with prediabetes
Pork cannot be isolated
Parada (2017 Grilled, barbecued, and smoked meat intake and survival following breast cancer Pork cannot be isolated
Park (2017) Unprocessed meat consumption and incident cardiovascular diseases in Korean adults: the
Korean Genome and Epidemiology Study (KoGES)
Pork cannot be isolated
Patterson (1988) Food choices and the cancer guidelines Pork cannot be isolated
Pestitschek (2013) Selenium intake and selenium blood levels: a novel food frequency questionnaire Pork cannot be isolated
Petermann-Rocha
(2020)
Diet-quality and its association with cardiovascular diseases and cancer incidence and all-
cause mortality: a prospective cohort study from UK Biobank
Pork cannot be isolated
Plagens-Rotman
(2016)
Odds ratio analysis in women with endometrial cancer Pork cannot be isolated
Porter Starr (2019) Impact on cardiometabolic risk of a weight loss intervention with higher protein from lean
red meat: combined results of 2 randomized controlled trials in obese middle-aged and older
adults
Pork cannot be isolated
Pu (2000) Prostate cancer in Taiwan: epidemiology and risk factors Set aside due to
processed meat
Pupillo (2018) Amyotrophic lateral sclerosis and food intake Set aside due to
processed meat
Pupillo (2017) Amyotrophic lateral sclerosis and food intake in Italy Set aside due to
processed meat
Radosavljevic (2004) Non-occupational risk factors for bladder cancer: a case-control study PDF not found
Rahman (2007) Dietary factors and cognitive impairment in community-dwelling elderly Pork cannot be isolated
Ramadass (2017) Faecal microbiota of healthy adults in south India: comparison of a tribal & a rural
population
Pork cannot be isolated
Ramel (2012) Effects of two different types of fast food on postprandial metabolism in normal and
overweight subjects
Pork cannot be isolated
Reeves (2017) A service evaluation of adult patients given advice to reduce intake of dietary vasoactive
amines
Pork cannot be isolated
Robbins (2014 Association of egg consumption and calcified atherosclerotic plaque in the coronary arteries:
the NHLBI Family Heart Study
No exposure of interest
Rodriguez (2006) Meat consumption among Black and White men and risk of prostate cancer in the Cancer
Prevention Study II Nutrition Cohort
Pork cannot be isolated
Rothman (2019) Nutritional status and food intake of women residing in rural and urban areas of Lesotho Pork cannot be isolated
Salgado (2011) Association of dietary factors and development of inflammatory bowel disease (IBD) in Rio
de Janeiro, Brazil
Abstract only
Sarcinelli (2003) Dietary and reproductive determinants of plasma organochlorine levels in pregnant women
in Rio de Janeiro
No outcome of interest
Schlegel-Zawadzka
(2002)
Comparative analysis of zinc status, food products’frequency intake and food habits of
11-year-old healthy children
No outcome of interest
Seely (1985) Relation between pork consumption and cirrhosis PDF not found
Sharma (2013) Contribution of meat to vitamin B12, iron and zinc intakes in five ethnic groups in the USA:
implications for developing food-based dietary guidelines
Pork cannot be isolated
Shi (2018) Association between dietary patterns, cadmium intake and chronic kidney disease among
adults
Pork cannot be isolated
Shi (2011) Dietary pattern and weight change in a 5-year follow-up among Chinese adults: results from
the Jiangsu Nutrition Study
Pork cannot be isolated
Shin (2018) Identifying dietary patterns associated with mild cognitive impairment in older Korean adults
using reduced rank regression
Pork cannot be isolated
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 20 www.meatandmusclebiology.com

(Continued )
First Author
(Year) Title Reason for Exclusion
Shin (2007) Empirically derived major dietary patterns and their associations with overweight in Korean
preschool children
Pork cannot be isolated
Shulten (2009) The role of diet in the management of gout: a comparison of knowledge and attitudes to
current evidence
Pork cannot be isolated
Smigielski (2013) The effect of selected lifestyle factors and diet on mortality of men with documented
physical fitness in the city of Lodz
Pork cannot be isolated
Sone (1998) Comparison of diets among elderly female residents in two suburban districts in Chiang Mai
Province, Thailand, in dry season–survey on high- and low-risk districts of lung cancer
incidence
Pork cannot be isolated
Song (2004) A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly
women: the women’s health study
Pork cannot be isolated
Stajic (2016) Impact of dietary habits and mental health on nutritional status of adolescents PDF not found
Stefańska (2016) The effectiveness of a weight loss diet in a group of overweight and obese women with
recurrent depressive disorders
Pork cannot be isolated
Sturtzel (2018) Effects of an enhanced iron dense foods offering in the daily meals served in geriatric
institutions on measures of iron deficiency anemia
Pork cannot be isolated
Su (2015) Trends in dietary cholesterol intake among Chinese adults: a longitudinal study from the
China Health and Nutrition Survey, 1991-2011
No outcome of interest
Tamae (2018) The associations of reactive oxygen metabolites and biological antioxidant potentials with
related factors among youth
Pork cannot be isolated
Tan (2010) Energy expenditure does not differ, but protein oxidation rates appear lower in meals
containing predominantly meat versus soy sources of protein
Pork cannot be isolated
Teng (2014) Food sources of protein and risk of incident gout in the Singapore Chinese health study Pork cannot be isolated
Varraso (2007) Prospective study of cured meats consumption and risk of chronic obstructive pulmonary
disease in men
Pork cannot be isolated
Velie (2005) Empirically derived dietary patterns and risk of postmenopausal breast cancer in a large
prospective cohort study
Pork cannot be isolated
Villar (2017) Sodium consumption patterns according to sociodemographic characteristics in an
Ecuadorian population: results from the Latin American study of nutrition and health
(ELANS)
No exposure of interest
Vincent (2017) Herring and chicken/pork meals lead to differences in plasma levels of TCA intermediates
and arginine metabolites in overweight and obese men and women
Pork cannot be isolated
Vitariusova (2010) Food intake, leisure time activities and the prevalence of obesity in schoolchildren in
Slovakia
No outcome of interest
Voon (2011) Is there an influence of dietary habits on breast density as seen on digital mammograms? Pork cannot be isolated
Vulcan (2017) Intake of different types of red meat, poultry, and fish and incident colorectal cancer in
women and men: results from the Malmö diet and cancer study
Abstract only
Wade (2020) Can we modify the Mediterranean diet for non-Mediterranean populations Results from two
randomised controlled trials
Abstract only
Wang (2013) Joint association of dietary pattern and physical activity level with cardiovascular disease
risk factors among Chinese men: a cross-sectional study
Pork cannot be isolated
Willett (1990) Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study
among women
Pork cannot be isolated
Wu (1999) Food sources of weight, calories, and three macro-nutrients - NAHSIT 1993-1996 No outcome of interest
Wytiaz (2015) Foods provoking and alleviating symptoms in gastroparesis: patient experiences No outcome of interest
Xu (2018) Dietary patterns, dietary lead exposure and hypertension in the older Chinese population Pork cannot be isolated
Xu (2017) Dietary pattern, serum magnesium, ferritin, C-reactive protein and anaemia among older
people
Pork cannot be isolated
Yan (1989) Epidemiological studies of nasopharyngeal cancer in the Guangzhou area, China.
Preliminary report
Pork cannot be isolated
Yaw (2014) Diet and physical activity in relation to weight change among breast cancer patients Abstract only
Yu (2016) Food groups consumed by infants and toddlers in urban areas of China No outcome of interest
Zhang (2019) The Japanese dietary pattern is associated with longer disability-free survival time in the
general elderly population in the Ohsaki Cohort 2006 Study
Pork cannot be isolated
Zhang (2016) Association between dietary patterns and blood lipid profiles among Chinese women Pork cannot be isolated
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 21 www.meatandmusclebiology.com

(Continued )
First Author
(Year) Title Reason for Exclusion
Zhang (2015) Dietary patterns and their associations with general obesity and abdominal obesity among
young Chinese women
Pork cannot be isolated
Zhang (2015) Dietary patterns and their associations with childhood obesity in China Pork cannot be isolated
Zhang (2012) Dietary inclusion of salmon, herring and pompano as oily fish reduces CVD risk markers in
dyslipidaemic middle-aged and elderly Chinese women
Pork cannot be isolated
Zhang (2010) Inclusion of Atlantic salmon in the Chinese diet reduces cardiovascular disease risk markers
in dyslipidemic adult men
Pork cannot be isolated
Zhang (2000) Intakes of fruits, vegetables, and related nutrients and the risk of non-Hodgkin’s lymphoma
among women
Pork cannot be isolated
Zhang (1999) Dietary fat and protein in relation to risk of non-Hodgkin’s lymphoma among women Pork cannot be isolated
Zhen (2018) Dietary pattern is associated with obesity in Chinese children and adolescents: data from
China Health and Nutrition Survey (CHNS)
Pork cannot be isolated
Zheng (1998) Well-done meat intake and the risk of breast cancer No outcome of interest
Zhou (2016) Higher-protein diets improve indexes of sleep in energy-restricted overweight and obese
adults: results from 2 randomized controlled trials
Pork cannot be isolated
Meat and Muscle Biology 2021, 5(1): 43, 1–22 Paige Penkert et al. Pork consumption, human nutrition, and health
American Meat Science Association. 22 www.meatandmusclebiology.com