To the Editor: I was surprised and disappointed by the advertisement “Make Every Bite Count with Nutrient Dense Foods” from the National Cattlemen’s Beef Association in the April 2022 issue. This full-page promotion of beef for early childhood consumption, prominently endorsed by beef farmers and ranchers, came across as an anachronistic and egregious industry lobbying effort. That advertisement has no place in any medical publication, especially one that I otherwise hold in high regard and that I often reference in my practice as a family physician.

The advertisement touts meat as an excellent source of iron and zinc for developing infants. These are important nutritional elements, but I disagree that meat is a superior source to plants. A serving of cooked soybeans provides nearly twice the elemental iron as a serving of cooked beef (4.4 mg vs. 2.5 mg). Cooked lentils and spinach provide 3.3 mg and 3.2 mg of elemental iron per serving, respectively.¹ Although zinc is present at a higher concentration in beef than in plants, plant foods containing zinc offer a variety of edible offerings to infants and toddlers, thereby providing a much more nutritionally comprehensive menu.²

In a cohort study, approximately 9,000 children six months to eight years of age followed a vegetarian or nonvegetarian diet for 11 years.³ Researchers tracked height, weight, and blood levels of iron, vitamin D, and cholesterol. A vegetarian diet provided sufficient vitamin D and iron and did not hinder growth compared with nonvegetarian diets. No association was established between eating a vegetarian diet and being overweight or obese, which is noteworthy because of the growing obesity epidemic in the United States.

There is no contest between the superior health consequences of consuming plant-based foods compared with beef from an environmental standpoint. The land, water, and fossil fuel resources used to raise cattle for human consumption are exponentially greater than resources used in the agricultural production of vegetables, soy, legumes, and seeds. Moreover, because 80% to 90% of the world’s soy is fed to cattle, we could save a step and skip the cattle altogether.⁴

You would be hard pressed to find a professional medical recommendation for beef as a nutrient-dense food for adults. There is a scientific consensus that beef consumption has negative ramifications on cardiovascular health and risk of colorectal cancer.^5,6 Let us not be persuaded to steer our youngest and most vulnerable patients toward this personally and environmentally unhealthy dietary option.

In Reply: I thank Dr. Halsey for raising concerns about the paid advertisement on beef in American Family Physician (AFP). We recognize that these concerns are likely shared by many readers. Different standards apply to AFP’s educational and advertising content. The editorial team spends hours ensuring that our clinical content is evidence based and bias free. In fact, we have an entire collection on environmental health and climate change, including articles and editorials that discuss the benefits of eating less meat.¹ We try to stay an arm’s length away from the advertisements that appear in AFP to avoid any misconception that we endorse or have rigorously reviewed them. AFP advertising policies require that a brief review occur for nonpharmaceutical advertisements related to food, nutritional supplements, and other products not approved by the U.S. Food and Drug Administration to assess whether there is reasonable support for the claims made.² This review is not meant to ensure that the content meets the same stringent standards as our clinical content, because no advertisement would meet our criteria. The beef advertisement cited guidelines from medical and government organizations that list beef as a nutrient-dense option. I do not disagree with Dr. Halsey’s comments about this advertisement, but please know that the presence of any industry advertisement in the journal does not imply editorial endorsement.

Editor's Note: Dr. Sexton is editor-in-chief of AFP.