Beef and Heart Disease: Should it be
What is For Dinner?
Presentation notes by Michael A. Roussell, PhD
Michael Roussell, PhD
“Dr. Mike” is known for transforming complex nutritional concepts into
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in the nutritional treatments for cardiovascular disease.
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Part 1: Red, Meat, Lean Beef, & Heart Disease
Cardiovascular Disease (CVD) Overview

CVD is the leading cause of death in the United States

Risk Factors for CVD are separated into two categories: modifiable and nonmodifiable
o
Non-Modifiable: Age, Gender, Genetics
o
Modifiable: Smoking, Obesity/Diabetes, Elevated Total Cholesterol (TC),
Elevated Low Density Lipoprotein Cholesterol (LDL-C), Reduced High
Density Lipoprotein Cholesterol (HDL-C), Elevated Blood Pressure

Reducing risk of CVD focuses on reducing LDL-C

There is a direct relationship between LDL-C and consumption of saturated fat (% of
energy)

3 of the 4 types of saturated fat increase LDL-C. Stearic acid is slightly
hypocholestermic. Stearic acid is found in higher amounts in beef and dairy
products.
Heart Healthy Diets – Current Recommendations
The DASH (Dietary Approaches to Stop Hypertension) diet is currently held as the gold
standard of heart healthy diets
Characteristics of the DASH diet

Macronutrient Breakdown (% of energy)
o Carbohydrates = 58%
o Protein = 18%
o Fat = 27%
o Saturated Fat = 7%
o Monounsaturated Fat = 10%
o Polyunsaturated Fat = 8%

Food Based Recommendations
o 6-8 servings of grains per day
o 4-5 servings of fruits per day
o 4-5 servings of vegetables per day
o 2-3 servings of low/non-fat dairy per day
o 2 servings of lean meats, fish, poultry per day
o 4-5 servings of nuts, seeds, and legumes per week
o 5 or less servings of sweets and added sugars per week
o Low in Saturated Fat (<7% of total calories)
o Low in red meat
Higher Protein Version of the DASH diet – OmniHeart

Macronutrient Breakdown (% of energy)
o Carbohydrates = 48%
o Protein = 25%
o Fat = 27%
o Saturated Fat = 6%
o Monounsaturated Fat = 13%
o Polyunsaturated Fat = 8%
A Heart Healthy Diet
~4~
Michael A Roussell, Ph.D.
Lean Beef In A Heart Healthy Diet


Despite public health efforts to reduce saturated fat intake, over the past 20 years,
saturated fat intake has remained essentially the same (on a grams/day basis).
The lack of success in reducing saturated fat intake in the general population may
be do to adherence not education.
Examples of poor adherence hurting conclusions, findings, and outcomes



MRFIT Study
Women’s Health Initiative (Low Fat Diet Arm)
Adherence to statin use is only 49%
o 25% of non-adherence is intentional
Improving adherence is an essential strategy




People know eating fried food two meals a day isn’t good for them, but they don’t
know what to do instead.
“Strategies can no longer ignore the individual’s taste preferences, familial eating
patterns, social/economic constraints on food choice, ethnicity, and literacy. More
research into making healthy foods more preferred is critical” – Giddings et al, 2009
A survey reported that 96% of Americans enjoy eating beef
A 1999 free living study reported better adherence to a Step 1 diet containing lean
red meat vs. poultry diet over the course of the 12 week intervention.
Lean Beef’s changing role in the American diet


Over the past century the total fat content of beef has decreased by 44% and the
saturated fat content has decreased by 29%.
Red meat is 7th and 9th on the list of top contributors of saturated fat in the
American diet.
There are 29 cuts of beef that meet the USDA’s guidelines for lean. (Italics = most popular
supermarket cuts. Bold= used in BOLD Study).


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
Sirloin Tip Center Roast & Steak



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
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
Chuck Shoulder Steak
Bottom Round Steak
Top Loin Steak
Shoulder Petite Tender &
Medallions
Flank Steak
Shoulder Center Steak
Tri-Tip Roast & Steak
Tenderloin Roast & Steak
T-Bone Steak
A Heart Healthy Diet
~5~
Eye Round Roast & Steak
Sirloin Tip Side Steak
Top Round Roast & Steak
Bottom Round Roast & Steak
Top Sirloin Steak
Brisket
95% Lean Ground Beef
Round Tip Roast & Steak
Round Steak
Shank Cross Cuts
Chuck Shoulder Pot Roast
Michael A Roussell, Ph.D.
Lean Beef/Red Meat Abbreviated Research Review
The Diet~CVD Biological Connection
Increased saturated fat intakes  Increased LDL-C  Increased CVD risk
Common Assumption/Belief
Saturated fat = Beef
Different Definitions of Beef


Red meat. Red meat: hamburger, beef hot dog, processed meat and processed meat
sandwich, bacon, beef/pork/lamb as a mixed and main dish.
Lean Beef. According to government guidelines, a serving qualifies as "lean" if it has
less than 10g total fat, 4.5g or less saturated fat and less than 95mg cholesterol per
3.5 oz. serving.
Population Based Studies
NIH-AARP Diet & Health Study Cohort (Sinha et al, 2009)
Q1
Q2
Q3
Q4
Q5
Women
0.3 oz
0.7
1.1
1.5
2.3
Deaths
1,173
1,155
1,101
1,027
900
Adjusted Model
1.00
1.13
1.26
1.39
1.50
Men
0.3
0.7
1.1
1.5
2.3
Deaths
1,997
2,304
2,703
3,256
3,961
Adjusted Model
1.00
0.99
1.08
1.18
1.27
P for
trend
< 0.0001
< 0.0001
Relative Risk of Coronary Heart Disease per 100g/d of red meats (Micha et al, 2010)
Characteristic
RR
Whiteman (1999)
0.51
Ascherio (19994)
1.03
Burke (2007)
0.69
Martinez-Gozalez (2002)
1.60
Overall (two-stage estimation)
0.95
Overall (one-stage estimation)
1.00
95% CI
0.221.20
0.801.33
0.801.33
0.942.74
0.641.40
0.811.23
%
Weight
14.20
38.20
23.20
24.40
100.00
Replacement of 1 Serving/d of Red Meat with a Different Protein (Bernstein et al, 2010)
Protein Source
RR Reduction
95% CI
Nuts
30%
17-42%
Fish
24%
6-39%
Chicken
19%
3-33%
Low Fat Dairy
13%
6-19%
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
Clinical Trials
Beef vs. Poultry and/or Fish
Reference
Flynn et al (1981)
Study Design
5 oz/d beef, poultry & fish
Scott et al (1994)
3 oz/d beef vs. chicken in a
Step I diet.
Davidson et al (1999)
6 oz/d lean red vs. white
meat/d in Step I diet.
Hunninghake et al
(2000)
Beauchesne-Rondeau
(2003)
≥6 oz/d as lean red vs. white
in Step I diet.
≥6 oz/d as beef, chicken,
white fish in Step I diet.
Results Regarding Beef
Similar serum lipids in
men; lower TG in women#
Similar lipid-lowering
effects of both diets.*#
Similar lipid-lowering
effects of both diets#
Similar lipid-lowering
effects of both diets#
Similar lipid-lowering
effects of all 3 diets.*
# Free Living Study; *Subjects only males.
A Heart Healthy Diet
~8~
Michael A Roussell, Ph.D.
Part 2: The BOLD Diet – Clinical Findings and Practical Applications
The Beef in an Optimal Lean Diet (BOLD) Study
Study Objective

To evaluate heart healthy diets (SFA <7%) with lean beef as a main protein source
(BOLD & BOLD+), in lowering CVD risk in individuals with moderate
hypercholesterolemia (LDL-C >110mg/dL) versus an Average American Diet (AAD)
and a DASH Diet.
Hypotheses



DASH, BOLD, & BOLD+ Diets will decrease total cholesterol, and LDL-C compared
to AAD.
DASH, BOLD, & BOLD+ Diets will lower total cholesterol and LDL-C similarly.
DASH, BOLD, & BOLD+ Diets will significantly reduce systolic blood pressure
compared to AAD.
Recruitment Criteria

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
30-64 year old
LDL-C ≥ 110 mg/dL
BMI <37 kg/m2
No History of CVD
No Recent Weight Loss
Non Smoker
Not prescribed lipid lowering medication
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
BOLD Study Diets. Energy (based on 2100 kcal meal plans)
Nutrient Composition (% of energy), and Food Group Servings1
Diets
Nutrient Targets, kcal %
HAD
DASH
BOLD
BOLD+
Calories
Protein (g)
Carbohydrate (g)
2097
19 (100.5)
49 (257.0)
2106
19 (98.4)
50 (265.0)
2100
19 (99.6)
54 (287.4)
2104
28 (145.6)
46 (243.7)
Fat (g)
33 (77.0)
27 (64.4)
28 (65.8)
28 (66.6)
Cholesterol, mg
SFA (g)
287
12 (27.9)
188
6 (15.2)
168
6 (15.4)
193
6 (14.5)
PUFA (g)
7 (15.5)
8 (18.9)
7 (16.5)
7 (16.1)
MUFA (g)
Fiber, g
Sodium, mg
Potassium, mg
Calcium, mg
Magnesium, mg
Food Groups, Serving/d
Fruit and juices
11 (25.9)
24
3243
3259
993
308
9 (21.8)
36
2982.8
4247
1140
403
11 (25.2)
32
2712
3998
936
392
12 (29.3)
38
3344
4417
1060
429
3.1
4.1
4.5
3.4
Vegetables
3.2
4.3
3.9
4.6
Grains
Low-fat dairy products
8.3
1.2
4.5
2.3
5.6
1.8
5.3
4.7
High fat dairy products
0.7
0.1
0.0
0.0
Legumes, nuts, seeds, &
0.6
2.1
1.3
4.2
other vegetable protein
Beef
0.7
1.0
4.0
5.4
Poultry, Pork & fish
3.7
3.7
1.0
1.0
Egg & egg product
0.24
0.2
0.1
0.9
substitutes
Fats & Oils
5.4
4.0
4.3
1.4
1
Based on 2100 kcal per day
2
Average across a 6 day menu cycle
3
All values were determined by using NUTRTIONST PRO (Axxya Systems LLC, Stafford, TX).
HAD, Healthy American Diet; DASH, Dietary Approaches to Stop Hypertension Diet; BOLD, Beef in an
Optimal Lean Diet; BOLD+, Beef in an Optimal Lean Diet Plus additional protein; SFA, saturated fatty
acid, MUFA, monounsaturated fatty acid, PUFA, polyunsaturated fatty acid.
A Heart Healthy Diet
~10~
Michael A Roussell, Ph.D.
Sample BOLD Diet Day (2100kcal)
Breakfast
Regular Instant oatmeal
Blueberries
Lowfat yogurt
Orange juice
Skim milk
28g (1 packet)
75g (1/2 cup)
170g (6 oz)
235g (~6 oz)
245g (8 oz)
Lunch
BOLD—Basic Meatballs
Marinara Sauce
Plain sandwich roll
Romaine Lettuce
Broccoli florets
Baby carrots
Ranch dressing
Lowfat cottage cheese
165g (3 meatballs)
62.5g (1/2 cup)
43.0g (1 roll)
20.0g (2 leaves, for sandwich)
40.0g (1/2 cup for dipping)
60.0g (~6 carrots for dipping)
28.0g (~2Tbsp for dipping)
113.g (1/2 cup)
Dinner
BOLD—Southwest Skillet
Beef, Top Round, Select
Low carb wheat tortillas
Romaine Lettuce
Low fat shredded cheddar
Red bell pepper
250g (from Southwest Beef Skillet Recipe)
85.0g (3 oz to be added to Southwest Skillet)
86.0g (2, 6” tortillas)
84.0g (for fajitas toppings)
28.0g (3 Tbsp for fajita topping)
50.0g (for fajita topping)
Snack
Smooth peanut butter
Celery stalks
Apple
24.0g (1.5 Tbsp)
100.0g (3 stalks to top w/pb)
138.0g (1 medium apple)
A Heart Healthy Diet
~11~
Michael A Roussell, Ph.D.
Basic BOLD Meatballs Recipe
Ingredients:
 1 pound ground beef
 ½ cup soft bread crumbs
 2 egg whites, slightly beaten
 2 Tbsp finely chopped onion
 1 tsp minced garlic
 ½ tsp salt
 Pepper to taste
How to Prepare:
 Preheat oven. Spray a metal baking sheet with non-stick cooking spray.
 Combine all ingredients in a large mixing bowl.
 Shape into 12 2-inch meatballs.
 Bake in 400 oven for 17 to 19 minutes, to medium doneness and centers are no
longer pink, let cool.
Southwest Beef Skillet Recipe
Ingredients:
 1 Tbsp olive oil
 1 envelope ORTEGA taco seasoning mix
 2 tsp minced garlic
 1 jar (16 oz) salsa, mild, medium or hot
 1 can (15 oz) black beans
 ½ cup frozen (or canned) corn
 ½ cup water
How to Prepare:



Heat oil in stockpot, add garlic and heat through.
Add salsa, black beans, corn, water, and taco seasoning.
Heat through and portion as directed, and combined with portioned and
cooked top round.
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
Baseline characteristics of study participants (n=36)1
Males (n=15)
Females (n=21)
Combined
49 ± 1.8 (39-63)
50 ± 2.0 (45-97)
50 ± 1.4
BMI (kg/m2)
27.3 ± 0.7 (19.4-35.5)
24.8 ± 0.5 (19.4-35.5) a
25.7 ± 0.5
TC (mmol/L)
5.02 ± 0.14 (3.98-6.16)
5.74 ± 0.22 (4.58-7.38)a
5.46 ± 0.12
LDL-C (mmol/L)
3.31 ± 0.14 (2.46-2.46)
3.78 ± 0.12 (3.00-4.84)a
3.6 ± 0.1
HDL-C (mmol/L)
1.16 ± 0.05 (0.91-1.55)
1.45 ± 0.08 (0.88-2.30)a
1.34 ± 0.06
Non-HDL-C
3.87 ± 0.14 (3.04-5.05)
4.28 ± 0.13 (3.43-5.33)a
4.11 ± 0.19
TG (mmol/L)
1.18 ± 0.10 (0.55-1.88)
1.07 ± 0.06 (0.68-1.95)
1.12 ± 0.05
Glucose (mmol/L)
4.82 ± 0.10 (3.83-5.55)
4.60 ± 0.08 (4.05-5.38)a
4.7 ±0.09
12 ± 1.9 (7-23)
13 ± 0.961 (9-17)
12 ± 0.97
1.43 ± 0.4 (5.4-0.3)
1.34 ± 0.3 (4.5-0.3)
1.4 ± 0.2
Characteristic
Age (y)
Insulin (ìU/mL)
CRP (mg/L)
1 Mean
±SEM (range).Baseline values were measured prior to consuming any
study food.
aTwo-sample t-test was used to determine significant (p<0.05) differences
between genders (SAS version 9.2; SAS Institute Inc, Cary, NC).
TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; HDL-C, high
density lipoprotein cholesterol; TG, triglycerides; SBP, systolic blood pressure;
DBP, diastolic blood pressure.
Effect of Diet on Lipids and Lipoproteins1
HAD (n=33)
DASH (n=35)
BOLD (n=34)
BOLD+ (n=34)
TC, mmol/L
5.25 ± 0.09a
4.98 ± 0.09b
4.99 ± 0.09b
4.96 ± 0.09b
TG, mmol/L2
1.06 ± 0.06
1.08 ± 0.06
1.05 ± 0.07
1.00 ± 0.05
LDL-C, mmol/L
3.44 ± 0.08a
3.22 ± 0.07b
3.23 ± 0.07b
3.23 ± 0.07b
HDL-C, mmol/L
1.32 ± 0.05a
1.22 ± 0.04b
1.24 ± 0.04b
1.24 ± 0.04b
Non-HDL-C, mmol/L
3.89 ± 0.07a
3.71 ± 0.08b
3.70 ± 0.08b
3.66 ± 0.07b
1 Values
are mean ± SEM.
values reported. Data were log transformed to achieve normality when
testing for significant differences.
2 Raw
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
The MIXED procedure (version 9.2; SAS Institute Inc, Cary, NC) was used to test
the effects of diet. Values in the same row with different superscripts are
significantly different, Dunnett adjusted p<0.05.
HAD, Healthy American Diet; DASH, Dietary Approaches to Stop Hypertension
Diet; BOLD, Beef in an Optimal Lean Diet; BOLD+, Beef in an Optimal Lean Diet
Plus additional protein; TC, total cholesterol; LDL-C, low density lipoprotein
cholesterol; HDL-C, high density lipoprotein cholesterol; TG, triglycerides.
Effect of Diet on Endothelial Function and Vascular Reactivity1
HAD
DASH
BOLD
BOLD+
FRHI
0.65 ± 0.05 0.66 ± 0.05 0.64 ± 0.05
0.62 ± 0.05
RHI
2.21 ± 0.09 2.19 ± 0.10 2.31 ± 0.09
2.13 ± 0.11
AI 2
14.47 ± 3.6a 13.56 ± 3.3a 10.37± 3.0b
13.48 ± 3.0a
21.97 ± 5.0 22.71 ± 2.4 19.62± 4.1
17.72 ± 4.1
Risk for CVD, AI2
No risk for CVD, AI2 6.08 ± 4.5a 3.86 ± 3.7a
0.03 ± 26b
8.48 ± 4.4a
1All
values are mean ± SEM.
values reported. Data were log transformed to achieve normality when testing
for significant differences. Risk for CVD, female ≥55y, males ≥45; No Risk For CVD,
female <55y, males <45
The MIXED procedure (version 9.2; SAS Institute Inc, Cary, NC) was used to test the
effects of diet. Values in the same row with different superscripts are significantly
different, adjusted p<0.05.
HAD, Healthy American Diet; DASH, Dietary Approaches to Stop Hypertension Diet;
BOLD, Beef in an Optimal Lean Diet; BOLD+, Beef in an Optimal Lean Diet Plus
additional protein; FRHI, Framingham reactive hyperemia index; RHI, reactive
hyperemia index; AI, augmentation index.
2Raw
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
Effect of Diet on Apolipoproteins1
HAD
DASH
BOLD
BOLD+
Apo A1, mg/dL
135.9 ± 2.1a 133.73 ± 2.1a,b 130.6 ± 1.2b 130.11 ± 2.1b
ApoB, mg/dL
92.8 ± 1.5a
91.0 ± 1.5a,b
91.1 ± 1.5a,b
88.6 ± 1.5b
Apo C-III, mg/dL
8.5 ± 0.2a
8.21 ± 0.2a,b
7.94 ± 0.2b,c
7.71 ± 0.2c
Apo C-III HP, mg/dL
2.62 ± 0.1
2.6 ± 0.1
2.5 ± 0.1
2.43 ± 0.1
Apo C-III HS, mg/dL
5.83 ± 0.2a
5.59 ± 0.2a,b
5.4 ± 0.1b
5.30 ± 0.2b
1 Values
are mean ± SEM.
The MIXED procedure (version 9.2; SAS Institute Inc, Cary, NC) was used to test the
effects of diet. a,b,cValues in the same row with different superscripts are significantly
different, Tukey adjusted p<0.05.
HAD, Healthy American Diet; DASH, Dietary Approaches to Stop Hypertension Diet;
BOLD, Beef in an Optimal Lean Diet; BOLD+, Beef in an Optimal Lean Diet Plus
additional protein; Apo A1, apolipoprotein A1; Apo B, apolipoprotein B; Apo C-III,
apolipoprotein C-III; Apo C-III HP, apolipoprotein C-III heparin precipitated; Apo C-III HS,
apolipoprotein C-III heparin supernate.
Effect of Diet on C-Reactive Protein, TC, and LDL-C Change1,2
HAD
DASH
BOLD
BOLD+
1.14 ± 0.19
1.07 ± 0.15
1.0 ± 0.18
0.92 ± 0.09
Baseline CRP <1 mg/L
-0.35 ± 0.13a, ŧ
-0.73 ± 0.13b, ŧ
-0.47 ± 0.13a,b, ŧ
Baseline CRP ≥1 mg/L
-0.08± 0.14a
-0.20 ± 0.14a
-0.53 ± 0.13b,c, ŧ
-0.54 ± 0.14b, ŧ
Baseline CRP <1 mg/L
-0.19 ± 0.08a
-0.47 ± 0.10b, ŧ
-0.29 ± 0.08a, ŧ
-0.31 ± 0.10a, ŧ
Baseline CRP ≥1 mg/L
-0.07 ± 0.13a
-0.21 ± 0.13a
-0.38 ± 0.13a, ŧ
-0.39 ± 0.16a, ŧ
CRP (mg/L)
TC Change (mg/dL)
-0.49 ± 0.13a,b,
ŧ
LDL-C Change (mg/dL)
1 All
values are
±SEM.
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
2 Change
from baseline. Baseline CRP <1 mg/L; n=21. Baseline CRP ≥1 mg/L; n=15. There
was no significant effect of diet (p<0.05) on CRP levels. DIET*baseline CRP, p = 0.0008
(LDL-C change), p = 0.0009 (TC change). CRP was log transformed to achieve normality.
Actual values are presented in the table above. . a,b,cValues in the same row with different
superscripts are significantly different, adjusted p<0.05. ŧ significantly different from zero
(p<0.05) (MIXED procedure, version 9.2; SAS Institute Inc, Cary, NC).
CRP, C-reactive protein; TC=total cholesterol; LDL-C, low density lipoprotein cholesterol.
CRP stratification is based on American Heart Association CRP cutpoints (29).
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
Helping People Implement Significant Dietary Change
Keys to Implementing Dietary Change



Slow and small changes – Gradual changes allow for maximum compliance and
success over the long term. Clients/Patients under estimate how hard it is to
consistently implement even simple changes. Start small/simple and build on those
successes with more strategies and changes.
Actionable Change – Translating information/data into actionable habits is key for
implementation. “Eat less saturated fat” is not actionable as people don’t eat
saturated fat, they eat food. “Exercise more” is not actionable while “Take you dog
for a 20 minute walk before and after work” is actionable.
Modify Current Behaviors – Creating new behaviors is difficult as habits cannot be
eliminated, but new habits and overwrite old ones. If a client is eating beef, find
ways to modify the cut, portion, or cooking method to make it fit into a heart healthy
diet.
Implement Dietary Change Regarding Lean Beef
Choose The Lean Cuts





Many of Americans’ favorite cuts such as Top Sirloin, Tenderloin, Strip Steak and 90
percent lean Ground Beef are lean
29 cuts meet lean criteria
67% of the beef sold in supermarkets is lean.
Top favorites are Top Loin (NY Strip), Filet, Mignon, Top Sirloin
18 of the 25 most popular cuts sold are lean (Top Round Steak, Top Loin (NY Strip),
T-Bone)
Cook Using Appropriate Temperatures and Techniques
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Cooking moist and juicy lean beef is guaranteed with cooking to the proper
temperature and using the proper cooking method.
Proper temperatures:
o Well – 170 F (Well Done – 170 F for Ground Beef)
o Medium – 160 F (always 160 F for Ground Beef)
o Medium Rare – 145 F
Moist-Heat (Braise and Stewing)
o Pot roasts, flank, round, eye round, chuck shoulder, brisket.
Dry-Heat (broil, stir-fry, grill)
o Sirloin, tenderloin, T-Bone, Tri-Tip
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
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Marinating the less tender cuts (the ones good for moist heat cooking) makes them
better for dry-heat cooking methods.
Select Appropriate Portions
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The best type of BOLD eating incorporates lean beef in the context of meals rich in
fruits, vegetables, and some whole grains.
In the BOLD study, participants that ate 2100 kcal per day at 4 or 5.4 ounces
depending if they were on the BOLD or BOLD+ diets respectively. Intakes of lean
beef scaled up from that depending on calorie intake.
Top Level Summary
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Lean beef can be included in a heart-healthy diet while meeting recommended
current targets for saturated fat intake.
Results are similar to those observed for the currently advised DASH Diet.
It is clear that lean beef can be part of a heart-healthy diet and beneficially affect
major CVD risk factors.
Dietary Patterns for Optimal Wellness
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Are dietary patterns ones that people will adhere to?
In order to help clients make significant and lasting dietary changes we need to find
strategies that allow them to incorporate their own personal and socio-economical
preferences.
In order to help clients make significant and lasting dietary changes we need to find
strategies that allow them to incorporate their own personal and socio-economical
preferences.
This most likely requires a nutrition re-education regarding portion sizes and
preparation methods.
A Heart Healthy Diet
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Michael A Roussell, Ph.D.
Highlighted References & Resources
2010 Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory
Committee on the Dietary Guidelines for Americans. In: United States Department of
Agriculture, ed., 2010.
Adult Treatment Panel III Final Report. Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults. Circulation 2002;106(25):3143-421.
American Dietetic Association, National Cattleman's Beef Association, Chamberlain R,
Hornick B. The Healthy Beef Cookbook: Steaks, Salads, Stir-fry, and More - Over 130
Luscious Lean Beef Recipes for Every Occasion 1ed. Hoboken, NJ: John Wiley & Sons, Inc,
2005.
Appel LJ, Sacks FM, Carey VJ, et al. Effects of Protein, Monounsaturated Fat, and
Carbohydrate Intake on Blood Pressure and Serum Lipids: Results of the OmniHeart
Randomized Trial. JAMA 2005;294(19):2455-64. doi: 10.1001/jama.294.19.2455.
Ascherio A, Willett W, Rimm E, Giovannucci E, Stampfer M. Dietary iron intake and risk of
coronary disease among men. Circulation 1994;89(3):969-74. doi: 10.1161/01.cir.89.3.969.
Beauchesne-Rondeau E, Gascon A, Bergeron J, Jacques H. Plasma lipids and lipoproteins
in hypercholesterolemic men fed a lipid-lowering diet containing lean beef, lean fish, or
poultry. Am J Clin Nutr 2003;77(3):587-93.
Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC. Major Dietary
Protein Sources and Risk of Coronary Heart Disease in Women. Circulation
2010;122(9):876-83. doi: 10.1161/circulationaha.109.915165.
Burke V, Zhao Y, Lee AH, et al. Health-related behaviours as predictors of mortality and
morbidity in Australian Aborigines. Preventive Medicine 2007;44(2):135-42. doi:
10.1016/j.ypmed.2006.09.008.
Davidson MH, Hunninghake D, Maki KC, Kwiterovich PO, Jr., Kafonek S. Comparison of
the Effects of Lean Red Meat vs Lean White Meat on Serum Lipid Levels Among Freeliving Persons With Hypercholesterolemia: A Long-term, Randomized Clinical Trial. Arch
Intern Med 1999;159(12):1331-8. doi: 10.1001/archinte.159.12.1331.
Flynn M, Heine B, Nolph G, et al. Serum lipids in humans fed diets containing beef or fish
and poultry. The American journal of clinical nutrition 1981;34(12):2734-41.
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Grundy SM, Cleeman JI, Merz CNB, et al. Implications of Recent Clinical Trials for the
National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation
2004;110(2):227-39. doi: 10.1161/01.cir.0000133317.49796.0e.
Howard BV, Van Horn L, Hsia J, et al. Low-Fat Dietary Pattern and Risk of Cardiovascular
Disease. JAMA: The Journal of the American Medical Association 2006;295(6):655-66. doi:
10.1001/jama.295.6.655.
Hunninghake DB, Maki KC, Kwiterovich PO, Jr., Davidson MH, Dicklin MR, Kafonek SD.
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. J Am Coll Nutr 2000;19(3):351-60.
Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, Marti A, Martinez JA,
Martín-Moreno JM. Mediterranean diet and reduction in the risk of a first acute myocardial
infarction: an operational healthy dietary score. European Journal of Nutrition
2002;41(4):153-60. doi: 10.1007/s00394-002-0370-6.
Mensink RP, Zock PL, Kester ADM, Katan MB. Effects of dietary fatty acids and
carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and
apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77(5):1146-55.
Micha R, Wallace SK, Mozaffarian D. Red and Processed Meat Consumption and Risk of
Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus: A Systematic Review and
Meta-Analysis. Circulation 2010;121(21):2271-83. doi: 10.1161/circulationaha.109.924977.
National Cattleman's Beef Association. 29 Cuts of Lean Beef.
http://www.beefitswhatsfordinner.com/leanbeef.aspx.
Obarzanek E, Sacks FM, Vollmer WM, et al. Effects on blood lipids of a blood pressurelowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Clin Nutr
2001;74(1):80-9.
Roussell MA, Hill AM, Gaugler TL, et al. Beef in an Optimal Lean Diet study: effects on
lipids, lipoproteins, and apolipoproteins. The American journal of clinical nutrition 2012.
doi: 10.3945/ajcn.111.016261.
Scott LW, Dunn JK, Pownall HJ, et al. Effects of Beef and Chicken Consumption on Plasma
Lipid Levels in Hypercholesterolemic Men. Arch Intern Med 1994;154(11):1261-7. doi:
10.1001/archinte.1994.00420110109012.
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Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat Intake and Mortality:
A Prospective Study of Over Half a Million People. Arch Intern Med 2009;169(6):562-71.
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Whiteman D, Muir J, Jones L, Murphy M, Key T. Dietary questions as determinants of
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doi:10.1017/S136898009900066X.
Willett WC. The WHI joins MRFIT: a revealing look beneath the covers. The American
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Michael A Roussell, Ph.D.