Reply to Consavage Stanley, K.; Kraak, V.I. Comment on "Lau et al. Trends in Beef Intake in the United States: Analysis of the National Health and Nutrition Examination Survey, 2001-2018. Nutrients 2023, 15, 2475".

We thank the authors [...].

Trends in Beef Intake in the United States: Analysis of the National Health and Nutrition Examination Survey, 2001-2018.

Evidence-based dietary advice regarding meats (including beef), requires accurate assessment of beef and other red meat intakes across life stages. Beef intake is subject to misclassification due to the use of broad categories such as "red and processed meat". In the current study, intake trends for total beef (i.e., any beef type) and specific beef types (fresh lean, ground, processed) among Americans participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2018 (n = 74,461) were characterized and usual intake was assessed using NHANES 2011-2018 (n = 30,679). The usual intake amounts of beef were compared to those of relevant protein food subgroups modeled in the Healthy U.S.-Style Dietary Pattern (HDP) reported in the 2020-2025 Dietary Guidelines for Americans (DGA). Total per capita beef consumption declined an average of 12 g (p < 0.0001) for ages 2-18 years and 5.7 g (p = 0.0004) for ages 19-59 years per 2-yr NHANES cycle, over the 18-year timeframe, while remaining unchanged for Americans aged 60+ years. On a per capita basis, Americans aged 2 years and older consumed 42.2 g (1.5 ounces) of total beef per day. Fresh lean beef per capita consumption was 33.4 g (1.2 ounces) per day. Per capita intake was similar across all age groups and below the daily HDP modeled amount of 3.7 ounce equivalents for the "Meats, Poultry, Eggs" (MPE) subgroup, while approximately 75% of beef consumers' intakes of total beef was within HDP modeling. Evidence from intake trends suggests beef is not overconsumed by the majority of Americans but rather within the amounts for MPE and red meat modeled in the HDP of the DGA at the 2000-calorie level.

Iron-Rich Complementary Foods: Imperative for All Infants.

Nearly 1 in 5 (18%) infants in the United States is not consuming sufficient iron. A deficiency of iron during early life may be associated with long-term neurodevelopmental consequence(s). The 2020-2025 Dietary Guidelines for Americans (DGA) are the first DGA to address recommendations for children under 2 y of age. The 2020 Dietary Guidelines Advisory Committee scientific report includes food-group combinations emphasizing iron-rich foods for 6-12-mo-old infants, but these examples did not meet criteria to establish DGA recommended dietary patterns; consequently, iron-rich dietary patterns for ages 6-12 mo are not provided in the 2020-2025 DGA. The 2020-2025 DGA encourage iron-rich foods by 6 mo of age while emphasizing the importance "particularly for infants fed human milk." Early feeding transitions are dynamic and milk feeding groups are rarely static or exclusive such that emphasizing milk feeding groups may become confusing. Risk-to-benefit favors iron-rich complementary feeding for all infants.

A Systematic Review of Renal Health in Healthy Individuals Associated with Protein Intake above the US Recommended Daily Allowance in Randomized Controlled Trials and Observational Studies.

A systematic review was used to identify randomized controlled trials (RCTs) and observational epidemiologic studies (OBSs) that examined protein intake consistent with either the US RDA (0.8 g/kg or 10-15% of energy) or a higher protein intake (≥20% but <35% of energy or ≥10% higher than a comparison intake) and reported measures of kidney function. Studies (n = 26) of healthy, free-living adults (>18 y old) with or without metabolic disease risk factors were included. Studies of subjects with overt disease, such as chronic kidney, end-stage renal disease, cancer, or organ transplant, were excluded. The most commonly reported variable was glomerular filtration rate (GFR), with 13 RCTs comparing GFRs obtained with normal and higher protein intakes. Most (n = 8), but not all (n = 5), RCTs reported significantly higher GFRs in response to increased protein intake, and all rates were consistent with normal kidney function in healthy adults. The evidence from the current review is limited and inconsistent with regard to the role of protein intake and the risk of kidney stones. Increased protein intake had little or no effect on blood markers of kidney function. Evidence reported here suggests that protein intake above the US RDA has no adverse effect on blood pressure. All included studies were of moderate to high risk of bias and, with the exception of 2 included cohorts, were limited in duration (i.e. <6 mo). Data in the current review are insufficient to determine if increased protein intake from a particular source, i.e., plant or animal, influences kidney health outcomes. These data further indicate that, at least in the short term, higher protein intake within the range of recommended intakes for protein is consistent with normal kidney function in healthy individuals.

A Research Communication Brief: Gluten Analysis in Beef Samples Collected Using a Rigorous, Nationally Representative Sampling Protocol Confirms That Grain-Finished Beef Is Naturally Gluten-Free.

Knowing whether or not a food contains gluten is vital for the growing number of individuals with celiac disease and non-celiac gluten sensitivity. Questions have recently been raised about whether beef from conventionally-raised, grain-finished cattle may contain gluten. To date, basic principles of ruminant digestion have been cited in support of the prevailing expert opinion that beef is inherently gluten-free. For this study, gluten analysis was conducted in beef samples collected using a rigorous nationally representative sampling protocol to determine whether gluten was present. The findings of our research uphold the understanding of the principles of gluten digestion in beef cattle and corroborate recommendations that recognize beef as a naturally gluten-free food.

Inclusion of red meat in healthful dietary patterns.

Dietary patterns are an important concept in dietary recommendations. The Western pattern is most commonly defined as a diet characterized by high intakes of refined grains, sugar and red meat, and has been shown to be associated with increased risks for certain types of cancer, coronary heart disease, diabetes, and obesity. However, isolating the independent effects of individual foods on health outcomes is central to helping individuals choose foods to build healthier dietary patterns to which they can adhere. Red meat is a popular source of high quality protein and provides a variety of essential nutrients that improve overall diet quality. It is also a source of saturated fatty acids, which observational evidence suggests are associated with heart disease, although recent data challenge this. Several studies have shown that lean red meat can be successfully included in recommended heart-healthy dietary patterns without detriment to blood lipids. Furthermore, increased dietary protein has been shown to promote healthy body weight and composition, in part by increasing satiety, and to improve vitality and stamina.

Impact of grass/forage feeding versus grain finishing on beef nutrients and sensory quality: the U.S. experience.

Studies of forage and/or grass feeding of cattle versus grain finishing have been conducted in varying regions throughout the world but generalization of these results to beef from U.S. cattle may not be appropriate. In particular, available grass/forage variety and form as well as cattle breed have a significant impact on the nutritional profile of beef. The current review summarizes the nutritional characteristics of beef as reported from the limited number of studies comparing U.S. grass/forage-fed versus grain-finished cattle and estimates the intake of key nutrients that might be expected from consumption of U.S. beef from either feeding system. In addition, many studies report changes in fatty acids solely as a percentage of total fatty acids. Since grass/forage feeding typically results in a leaner product; the current review compares the fatty acid profile of beef from grass/forage feeding to that of grain-finished cattle on a mg/100 g of meat basis.

The evolution of lean beef: identifying lean beef in today's U.S. marketplace.

Changes in cattle breeding and management coupled with extensive trimming of visible fat from retail cuts have resulted in the wide-spread availability of lean beef to U.S. consumers. Despite these changes, there is limited awareness regarding the reduced total fat content and the favorable fatty acid profile of beef. Relative to the calories it contributes, the impact of beef on the nutritional quality of the American diet via its contribution of protein and certain key micronutrients is often under appreciated. The following discussion documents the progressive reduction in fat content of U.S. beef during the past 30 years, highlights ongoing efforts to update United States Department of Agriculture nutrient data for beef, and summarizes findings from randomized controlled trials of beef and plasma lipid outcomes. Beef is a popular, nutrient-dense food and the availability of at least 29 lean cuts of beef in the U.S. marketplace can help consumers meet their cardiovascular health goals.