Poultry consumption and chronic disease risk: evidence from substitution analyses

Substitution analyses assessing the isocaloric replacement of one food with another offer a valuable method for evaluating poultry within the dietary risk spectrum for chronic diseases. Despite its global popularity, poultry has received less systematic attention as a reference comparator relative to red and processed meat. This review synthesizes findings from prospective cohort studies, a randomized controlled trial, and meta-analyses, with poultry as a comparator for cardiovascular disease, coronary heart disease, type 2 diabetes, and all-cause mortality. Studies were identified through a search of PubMed from database inception to March 2026, yielding 33 studies and meta-analyses. Replacing red or processed meat with poultry was associated with lower cardiometabolic risk, though not uniformly across outcomes and populations; substituting poultry with plant-based foods such as nuts and whole grains was associated with further reductions in cardiovascular and diabetes risk. A single randomized controlled feeding trial found no cholesterol-lowering benefit for poultry compared to red meat. In contrast, analyses of absolute poultry intake rather than substitution linked greater consumption to increased gastrointestinal risks, which were attenuated after adjustment for body mass index. Comparisons with eggs, dairy, and fish were outcome-dependent. The evidence base is largely observational and was rated as low to very low certainty in the underlying meta-analyses. Poultry occupies an intermediate position in the protein landscape—lower in relative risk than red and processed meat for most cardiometabolic outcomes, but higher than nuts, whole grains, and legumes—consistent with its role as a transitional, rather than terminal, substitution target within plant-forward dietary patterns.