Where's the Beef?
Abstract & Commentary
By Ralph R. Hall, MD, FACP, FACSM, Professor of Medicine Emeritus, University of Missouri, Kansas City School of Medicine. Dr. Hall reports no financial relationships relevant to this field of study.
Synopsis: These studies support inclusion of beef in heart-healthy diets.
Source: de Souza RJ, et al. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: Results from the POUNDS LOST trial. Am J Clin Nutr 2012;95:614-625.
The authors studied the effect on LDL cholesterol of four cholesterol-lowering diets with varying amounts of lean beef: Dietary Approach to Stop Hypertension (DASH), 28 g beef/day; Beef in an Optimal Lean Diet (BOLD), 113 g beef/day; Beef in an Optimal Lean Diet plus additional protein (BOLD+), 153 g beef/day, compared to that of a healthy American diet (HAD).
Thirty-six hypercholesterolemic participants (with LDL cholesterol concentrations > 2.8 mmol/L) were randomly assigned to consume each of four diets, HAD (33% total fat, 12% saturated fatty acid [SFA], 17% protein, and 20 g beef/day), DASH (27% total fat, 6% SFA, 18% protein, and 28 g beef/day), BOLD (28% total fat, 6% SFA, 19% protein, and 113 g beef/day), and BOLD+ (28% total fat, 6% SFA: 27% protein, and 153 g beef/day) for 5 weeks.
There was a decrease in total cholesterol (TC) and LDL cholesterol concentrations (P > 0.05) after consumption of the DASH (-0.49 and 0.37, respectively), BOLD (-0.48, and -0.35 mmol/L, respectively), and BOLD+ (-0.50 and -0.345 mmol/L, respectively) diets compared to consumption of HAD (-0.22 and -0.14 mmol/L, respectively).
Apolipoprotein A1, C-111, and C-111 bound to apolipoprotein A1 particles decreased after BOLD and BOLD+ diets compared with after consumption of the HAD, and there was a greater decrease in apolipoprotein B after the consumption of the BOLD+ diet than after consumption of HAD.
LDL cholesterol and TC decreased after consumption of the DASH, BOLD, and BOLD+ diets when the baseline C-reactive protein (CRP) concentration was < 1 mg/L. With the BOLD and BOLD+ diets, LDL cholesterol and TC decreased when the baseline CRP concentration was > 1 mg/L.
Low-SFA heart-healthy dietary patterns that contain lean beef elicit favorable effects on cardiovascular disease (CVD) lipid and lipoprotein risk factors that are comparable to those elicited by a DASH dietary pattern.
These results, in conjunction with the beneficial effects on apolipoprotein CVD risk factors after consumption of the BOLD and BOLD+ diets, which were greater with the BOLD+ diet, provide support for including beef in a heart-healthy dietary pattern.
Commentary
The abstract did not include the subjects' adherence to the diet (calculated to be 93%) or that weights were measured daily to make certain there were no significant weight changes.
As the authors note, beef is a popular food. Patients often find that doing without beef is a major problem, making it difficult to follow dietary recommendations.
Red meat is limited in the DASH diet as a strategy to decrease SFA. The DASH diet is included in the study because it is "the gold standard of contemporary dietary recommendations."
There was a significant contrast between this study and previous studies in that despite the increase in CRP in some subjects, the LDL and TC were significantly decreased in the BOLD and BOLD+ diets.1
The authors discuss the difficulty in selecting cuts of lean beef. However, the new standards recently introduced for meat labels should help consumers in selecting cuts of beef that are lean.2 Still, another potential for selecting appropriate beef cuts is the use of grass-fed beef. Grass-fed beef results in more favorable effects on lipid metabolism than the usual corn-fed beef.3
Red meat has a poor reputation as a food due to the fact that the majority of the studies have included processed meats. Processed meats contain nitrosamines that have been shown to be toxic in beta cells, which is associated with an increase in the incidence of diabetes, and high amounts of advanced glycation end products that unfavorably affect inflammation and oxidative stress.4
Previous studies on the effects of red meat may not have accounted for the fat content of the meat. It appears that we can cautiously increase the amount of lean beef in our patients' diets. The most perplexing problem, however, is the ability of patients to follow whatever diet is prescribed.
References
1. Erlinger TP, et al. Inflammation modifies the effects of a reduced-fat low-cholesterol diet on lipids: Results from the DASH-sodium trial. Circulation 2003;108:150-154.
2. United States Department of Agriculture Food Safety and Inspection Service. FSIS Notice 77-11, Dec. 28, 2011. www.fsis.usda.gov/OPPDE/rdad/FSISNotices/77-11.pdf. Accessed March 9, 2012.
3. McAfee AJ, et al. Red meat from animals offered a grass diet increases plasma and platelet n-3 PUFA in healthy consumers. Br J Nutr 2011;105:80-89.
4. de Souza RJ, et al. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: Results from the POUNDS LOST trial. Am J Clin Nutr 2012;95:614-625.
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