Red meat consumption and its association with cardiovascular disease, type 2 diabetes, and cancer in Ethiopian adults: a systematic review

Ethiopia is undergoing an epidemiological transition with rising non communicable diseases (NCDs) alongside persistent infectious diseases. Red meat consumption is increasing due to urbanization and income growth, including traditional raw meat preparations (kurt, kitfo). However, no systematic review has synthesized evidence on red meat intake and NCDs in Ethiopian adults. To systematically review associations between red meat consumption (unprocessed, processed, raw) and cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer in Ethiopian adults. Methods: We searched PubMed, Scopus, Web of Science, CINAHL, AJOL, Google Scholar, and Ethiopian institutional repositories from inception. Cross sectional, case control, and cohort studies reporting red meat intake and CVD, T2D, or cancer in Ethiopian adults (≥18 years) were included. Quality was assessed using AXIS (cross sectional) and Newcastle Ottawa Scale (cohort/case control). Findings were synthesized narratively. Certainty of evidence was rated using GRADE. Findings: Three cross sectional studies (total n = 2,203) met inclusion criteria. Two studies reported positive associations between red meat intake (unprocessed and raw) and hypertension (ORs: 1.67–1.89). One study associated processed meat (quanta) with T2D (OR = 2.01). No studies examined cancer. All studies had high risk of bias (non validated dietary assessment, residual confounding). Certainty of evidence was very low for all outcomes. No prospective cohorts or dose response analyses were identified. Ethiopian evidence on red meat and NCDs is scarce, low quality, and insufficient for causal inference. Positive associations are suggested but not confirmed. Urgent investment in prospective cohort studies with validated dietary tools and biomarker validation (e.g., Neu5Gc). Public health messaging should balance NCD risk against food safety (raw meat infections) and nutritional benefits (iron/protein for undernourished populations). Ethiopian dietary guidelines require context specific updates.