Vegan food geographies and the rise of Big Veganism

Veganism is the subject of an increasingly diverse body of social scientific research, yet it remains relatively understudied in geography. Meanwhile, contemporary cultural commentaries note how veganism has gone mainstream, with critics warning of veganism's corporate nature - expressed in the rise of what we term 'Big Veganism'. We argue that food geographers are well placed to examine these trends. We first review vegan studies work beyond geography that examines and critiques the mainstreaming of veganism. We focus on literature that explores multiple contested modes of veganism, veganism as praxis in place and the rise of corporate veganism as useful foundations for geographers to build on, particularly in light of currently unfolding developments in vegan cultures and practice. Taking this work forward, we identify four conceptual traditions from research in food geographies - following foodways, alternative food networks and the cultural and material politics of eating - to develop a 'vegan food geographies' programme that aims to advance critical geographic work on veganism and the emerging implications of its contemporary mainstreaming.

Plant-Based Diets and Cancer Risk: What is the Evidence?

PURPOSE OF REVIEW

The purpose of this review is to summarize the recent (past 5 years) available evidence regarding the association between plant-based diets on cancer risk from clinical trials and observational studies. Biological mechanisms and gaps in the current literature will also be discussed.

RECENT FINDINGS

There is a lack of intervention studies but there are abundant observational studies assessing the association between plant-based diets and cancer risk, including multiple longitudinal cohort studies and similar data from case-control studies that demonstrate a decreased overall cancer risk with plant-based diets. Case-control studies support a decreased risk of colorectal and breast cancers with plant-based diets, but results for specific cancers remain inconsistent in cohort studies. Current evidence from observational studies indicates an inverse association between plant-based diets and overall cancer risk. Future research should include intervention studies, address inconsistencies in dietary assessment methods and provide greater detail on underrepresented groups.

Animal board invited review: Animal source foods in healthy, sustainable, and ethical diets - An argument against drastic limitation of livestock in the food system

Animal source foods are evolutionarily appropriate foods for humans. It is therefore remarkable that they are now presented by some as unhealthy, unsustainable, and unethical, particularly in the urban West. The benefits of consuming them are nonetheless substantial, as they offer a wide spectrum of nutrients that are needed for cell and tissue development, function, and survival. They play a role in proper physical and cognitive development of infants, children, and adolescents, and help promote maintenance of physical function with ageing. While high-red meat consumption in the West is associated with several forms of chronic disease, these associations remain uncertain in other cultural contexts or when consumption is part of wholesome diets. Besides health concerns, there is also widespread anxiety about the environmental impacts of animal source foods. Although several production methods are detrimental (intensive cropping for feed, overgrazing, deforestation, water pollution, etc.) and require substantial mitigation, damaging impacts are not intrinsic to animal husbandry. When well-managed, livestock farming contributes to ecosystem management and soil health, while delivering high-quality foodstuffs through the upcycling of resources that are otherwise non-suitable for food production, making use of marginal land and inedible materials (forage, by-products, etc.), integrating livestock and crop farming where possible has the potential to benefit plant food production through enhanced nutrient recycling, while minimising external input needs such as fertilisers and pesticides. Moreover, the impacts on land use, water wastage, and greenhouse gas emissions are highly contextual, and their estimation is often erroneous due to a reductionist use of metrics. Similarly, whether animal husbandry is ethical or not depends on practical specificities, not on the fact that animals are involved. Such discussions also need to factor in that animal husbandry plays an important role in culture, societal well-being, food security, and the provision of livelihoods. We seize this opportunity to argue for less preconceived assumptions about alleged effects of animal source foods on the health of the planet and the humans and animals involved, for less top-down planning based on isolated metrics or (Western) technocratic perspectives, and for more holistic and circumstantial approaches to the food system.

Benefits of a plant-based diet and considerations for the athlete

Individuals may opt to follow a plant-based diet for a variety of reasons, such as religious practices, health benefits or concerns for animal or environmental welfare. Such diets offer a broad spectrum of health benefits including aiding in the prevention and management of chronic diseases. In addition to health benefits, a plant-based diet may provide performance-enhancing effects for various types of exercise due to high carbohydrate levels and the high concentration of antioxidants and phytochemicals found in a plant-based diet. However, some plant-based foods also contain anti-nutrional factors, such as phytate and tannins, which decrease the bioavailability of key nutrients, such as iron, zinc, and protein. Thus, plant-based diets must be carefully planned to ensure adequate intake and absorption of energy and all essential nutrients. The current narrative review summarizes the current state of the research concerning the implications of a plant-based diet for health and exercise performance. It also outlines strategies to enhance the bioavailability of nutrients, sources of hard-to-get nutrients, and sport supplements that could interest plant-based athletes.

Examining demographic characteristics and food access indicators from the location of vegan soul food restaurants in the south

Objective: There have been a number of soul food restaurants serving exclusively vegan meals opening up across the country to appeal to African Americans and others interested in eating healthier soul foods. This study determined the number of restaurants serving vegan soul foods in the South and identified the locations of these restaurants in order to understand the characteristics of the surrounding communities that they serve.Design: Two reviewers identified restaurants using standardized search criteria for menu items in the 16 states (and the District of Columbia) that are categorized as being in the South from the Census Bureau. Mean percentage of African Americans, poverty rates, and obesity rates by county where restaurants were located were collected via census data. Restaurants were classified as being in or out of a food desert zone using the United States Department of Agriculture's (USDA) food atlas map (0.5- and 1.0-mile radius). T-tests were conducted to test for differences in the census data between the restaurants that were considered to be in and out of a food desert zone.Results: Overall, 45 restaurants met the inclusion criteria. Counties where restaurants were located had a mean African American population of 36.5 ± 18.5%, mean poverty rate of 15.5 ± 3.85% and mean obesity rate of 26.8 ± 4.8%. More than one third (n = 18, 40.0%) of the restaurants were considered to be in a food desert zone. There were no significant differences in the mean population, obesity, and poverty rates between restaurants classified in a food desert zone and restaurants not located in a food desert zone.Conclusion: A significant number of restaurants were classified in food desert zones, implying their potential to provide healthier meals by serving vegan soul foods to residents in the surrounding neighborhoods. Future work should assess how these restaurants might influence healthier eating habits in their communities.

Vegans and vegetarians living in Nottingham (UK) continue to be at risk of iodine deficiency

Iodine is essential for thyroid hormone synthesis. Individuals adhering to vegan and vegetarian diets have been found to be vulnerable to iodine deficiency. Yet, iodine has not been monitored in these groups across time. This study aims to investigate iodine status, intake and knowledge in vegans, vegetarians and omnivores and determine changes between 2016-2017 and 2019. Dietary intake (µg/d) was estimated by 3-d food diaries and iodine FFQ. Urinary iodine concentration, analysed by inductively coupled plasma mass spectrometry, assessed iodine status according to WHO criteria. Iodine knowledge was scored by an adapted questionnaire. IBM SPSS was used for statistical analysis. Ninety-six adults (18-60 years) were recruited in October 2016-2017 (vegans: 12; vegetarians: 5; omnivores: 43) and June 2019 (vegans: 7; vegetarians: 10;omnivores: 19). Median dietary iodine was below the Reference Nutrient Intake for all groups. Vegans and vegetarians had the lowest iodine intake. Vegans had significantly lower iodine intake than omnivores (2016-2017, P = 0 032; 2019, P = 0 001). Omnivores had the highest iodine status (2016-2017, 79 4 µg/l; 2019, 72 4 µg/l) and vegans the lowest (2016-2017, 31 2 µg/l; 2019, 12 2 µg/l). Iodine knowledge was poor but did not differ between dietary groups (2016-2017, P = 0 219; 2019, P = 0 532). Vegans and vegetarians continue to be at risk of iodine deficiency. Further, iodine intake in the UK is poor independent of dietary choice. Iodine education is needed along with research into improving iodine nutrition at national level.

Consumption of a healthy plant-based diet is associated with a decreased risk of erectile dysfunction: a cross-sectional study of the National Health and Nutrition Examination Survey

PURPOSE

To investigate the association between the plant-based content of diet and erectile dysfunction in men from the National Health and Nutrition Examination Survey (NHANES).

METHODS

We collected de-identified information from the NHANES database on demographics, comorbidities, diet, and erectile dysfunction (ED). Exclusion criteria were age <20 or >70 years, incomplete plant-based diet index information, history of prostate cancer, or other missing information. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) were developed. A higher score on the PDI and hPDI is indicative of greater consumption of plant-based foods.

RESULTS

A total of 2549 men were analyzed, of those 1085 (42.6%) have good erectile function and 1464 (57.4%) have some degree of ED [usually have erections 521 (20.4%), sometimes have erection 690 (27.1%), or never have erections 253 (9.9%)]. The median age and BMI were 54 [41 - 64] years and 28.8 [25.5 - 32.6] kg/m², respectively. The median PDI and hPDI were 50 [46 - 54] and 50 [45 - 56], respectively. In multivariable adjusted logistic regression analysis, hPDI was negatively associated with ED (OR = 0.98, 95% CI: 0.96 - 0.99; p = 0.001). There was no association between PDI and ED.

CONCLUSION

In a well characterized national database, we showed that a healthful plant-based diet is associated with less chance of having erectile dysfunction. Whether interventions with a plant-based diet will improve erectile function remains to be studied.

What's your beef with meat substitutes? Exploring barriers and facilitators for meat substitutes in omnivores, vegetarians, and vegans

The overconsumption of meat has been related to negative health, environmental, and animal welfare effects. As such, many people are now reducing their meat consumption, and for some this includes increasing their consumption of meat substitutes. While research has discussed the barriers towards the adoption of meat substitutes, there is a lack of studies examining the differences between omnivores and veg*ns. The objective of this research is to explore the facilitators, barriers, and negotiations (i.e., tensions) that various dietary groups encounter with meat substitutes. Six focus groups were conducted and our analysis found clear tension between many influences in food choice. These tensions result in the influences (sensory preferences, meat substitutes' classification, health perceptions, and social/culture) being both facilitators and barriers dependent on the dietary group. Yet, there are also key facilitators across all dietary groups such as resources (packaging and labelling), and food context (restaurants, takeaways), as well as barriers such as the "vegan tax" (high price) and lack of trust. A main value negotiation was also exhibited by all dietary groups, balancing familiarity with food/meal freedom and versatility. We provide a reflection on the practical implications for meat substitute companies.

Intake of micronutrients and fatty acids of vegetarian, vegan, and omnivorous children (1-3 years) in Germany (VeChi Diet Study)

Purpose

There is an ongoing debate whether vegetarian (VG) and especially vegan (VN) diets are nutritionally adequate in early childhood. Hence, the Vegetarian and Vegan Children Study (VeChi Diet Study) aimed to assess the food and nutrient intake of VG and VN infants.

Methods

The study examined the diets of 1–3-year-old VG, VN, and omnivorous (OM) children (n = 430). Dietary intake was assessed via a 3-day weighed dietary record and compared between groups using ANCOVA. Lifestyle data were collected using a questionnaire. Here, the results of micronutrient and fatty acid intakes are presented.

Results

Most nutrient intakes (with and without supplements) differed significantly between VN children and the two other groups, with a more favourable overall micronutrient intake in VN, followed by VG children, [e.g., the highest intake of vitamin E (8.3 mg/d vs. VG 7.4 mg/d and OM 5.1 mg/d), vitamin B₁ (569 µg/d vs. VG 513 µg/d and OM 481 µg/d), folate (143 µg/d vs. VG 116 µg/d and OM 108 µg/d), magnesium (241 mg/d vs. VG 188 mg/d and OM 164 mg/d), and iron (8.9 mg/d vs. VG 7.3 mg/d and OM 6.0 mg/d)] as well as fat quality [highest intake of polyunsaturated fatty acids (8.7 E% vs. VG 6.9 E% and OM 4.5 E%) and lowest intake of saturated fatty acids (9.1 E% vs. VG 11.9 E% and OM 14.0 E%)]. In contrast, OM children had the highest intake of vitamin B₂ (639 µg/d vs. VG 461 µg/d and VN 429 µg/d), calcium (445 mg/d vs. VG 399 mg/d and VN 320 mg/d), iodine (47 µg/d vs. VG 33 µg/d and VN 31 µg/d), and DHA (35.4 mg/d vs. VG 16.6 mg/d and VN 18.4 mg/d). Without supplementation, OM children had the highest average vitamin B₁₂ intake (1.5 µg/d vs. VG 0.6 µg/d and VN 0.2 µg/d), whereas VN children had the highest average vitamin B₁₂ intake with supplementation (73.8 µg/d vs. VG 1.3 µg/d and OM 1.7 µg/d). Without supplementation, none of the groups’ median intakes met the harmonised Average Requirement (h-AR) for vitamin D and iodine. Moreover, VG and VN children did not achieve h-ARs for vitamin B₂, vitamin B₁₂, and iron—if a low absorption of iron is anticipated; VN children also did not do so for calcium.

Conclusion

In early childhood, VN and VG diets can provide most micronutrients in desirable amounts and a preferable fat quality compared to an OM diet. Special focus should be paid to (potentially) critical nutrients, particularly vitamin D, iodine, and DHA for all children regardless of diet, as well as vitamin B₂, vitamin B₁₂, calcium, and iron for VG and VN children.

Trail registration

This study was registered with the German Clinical Trials Register (DRKS00010982) on (September 2, 2016).

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02753-3.

Going veggie: Identifying and overcoming the social and psychological barriers to veganism

We conceptualize the journey to ethical veganism in the stages of the transtheoretical model of change, from precontemplation through contemplation, preparation, action, and maintenance. At each stage, we explore the psychological barriers to progressing towards veganism, discuss how they manifest, and explore ways to overcome them. It is hoped that this paper can be used as a guide for animal advocates to identify the stage an individual is at, and understand and overcome the social and psychological barriers they may face to progressing. We argue that, while many people are ignorant of the cruel practices entailed in animal farming, many deliberately avoid thinking about the issue, are unable to appreciate the scale of the issue, and simply tend to favour the status quo. When engaging with the issue of farm animal suffering, meat-eaters are largely driven by cognitive dissonance, which manifests as motivated reasoning aimed at protecting one's image of oneself and one's society. This is facilitated by confirmation bias and complicit media which cater to the preferred views of their meat-eating audience. Even once convinced of veganism, habit and willpower present further barriers to acting on those beliefs. This is all in the context of a speciesist and carnistic culture where meat consumption is normal, farming is noble, and vegans are 'others'. We locate and elucidate each of these biases within the stages of the transtheoretical model and discuss the implications of this model for animal advocates and for further research.

Green or clean? Perception of clean label plant-based products by omnivorous, vegan, vegetarian and flexitarian consumers

Consumers are increasingly interested in health and sustainability aspects of their diets. Meat reduction diets have gained popularity with some consumers, leading to an increase in plant-based products in the markets. Additionally, the demand for more natural and healthier products is associated with the clean label trend. But how these two trends relate to each other, has not yet been widely investigated. The aim of the present research was to explore the perception of different consumers (vegans, vegetarians, flexitarians and omnivores), towards clean label, plant-based products in order to better understand their motivations and attitudes. Consumers in Spain, followers of these four diets, participated in a projective mapping task - categorisation of twenty plant-based products (ten clean label and ten original products) - and answered a health and sustainability attitudes survey. The results showed that according to the diet followed by the consumers, they categorised and perceived the products differently, in line with their attitudes. Meat-reducer and avoider consumers paid more attention to quality and health and presented a greater concern for animal welfare and sustainability. Also, they focused on the clean label status for product categorization, while omnivores did not separate between original and clean label products. The present study shows a first exploration of how consumers with different relation to meat (frequent consumption-reduction-avoidance) perceive clean label plant-based products, in relation to their attitudes to health and sustainability, a building block on the way to support consumers in the transition to healthier, more sustainable diets.

Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets

Purpose of Review

The SARS-CoV-2-pandemic has caused mortality and morbidity at an unprecedented global scale. Many patients infected with SARS-CoV-2 continue to experience symptoms after the acute phase of infection and report fatigue, sleep difficulties, anxiety, and depression as well as arthralgia and muscle weakness. Summarized under the umbrella term “long-COVID,” these symptoms may last weeks to months and impose a substantial burden on affected individuals. Dietary approaches to tackle these complications have received comparably little attention. Although plant-based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID-19 outcomes, their role with regard to COVID-19 sequelae is yet largely unknown. Thus, this review sought to investigate whether a plant-based diet could reduce the burden of long-COVID.

Recent Findings

The number of clinical trials investigating the role of plant-based nutrition in COVID-19 prevention and management is currently limited. Yet, there is evidence from pre-pandemic observational and clinical studies that a plant-based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID-19. These include anxiety, depression, sleep disorders, and musculoskeletal pain. Adoption of a plant-based diet leads to a reduced intake in pro-inflammatory mediators and could be one accessible strategy to tackle long-COVID associated prolonged systemic inflammation.

Summary

Plant-based diets may be of general benefit with regard to some of the most commonly found COVID-19 sequelae. Additional trials investigating which plant-based eating patterns confer the greatest benefit in the battle against long-COVID are urgently warranted.

Veggie burgers in the EU market: a nutritional challenge?

Nutritional information of burgers launched in the EU market during 2020 was retrieved from their labels. Products were initially classified into four types: i.e., veggie, red meat-, fish- and poultry-based. Gluten, wheat, and soy were the most declared allergens regardless of the burgers type. Veggie burgers showed levels of energy, fat, and saturate fatty acids (SFA) similar to fish- and poultry-based burgers, but lower than red meat burgers. Compared to conventional burgers, veggie had higher amounts of carbohydrates and sugars and a lower content of proteins, but no difference in salt. Due to the high compositional intra-variability in the veggie burgers, vegetarian and vegan burgers were further analyzed separately. Vegan burgers had higher levels of energy, fat, SFA and protein than vegetarian burgers, but lower carbohydrates and sugars. Once again large differences in the nutritional parameters were observed in both vegan and vegetarian burger categories due to the wide range of ingredients and formulations employed in these types of products. A clear and comprehensive informative labeling is especially needed for vegan and vegetarian burgers to allow the consumer to make a rational decision based on the nutritional facts of these products.

Beyond "Meat Free Monday": A mixed method study of giving up eating meat

Increasing numbers of people are vegan, vegetarian, or reducing meat consumption. There has also been growth in campaigns such as Meat Free Monday (MFM) that encourage and support reduced meat consumption. We conducted a mixed-method exploration of the behaviour and beliefs associated with reducing or eliminating meat consumption. An online questionnaire was completed by an opportunistic sample of 655 people aged 18-82 who were registered on the MFM website, and were meat eaters at the time of registering. The key focus of quantitative analyses was comparisons between three groups: those who described themselves as "omnivores" who ate all meat at the time of completing the survey, those who ate only some meat, and those who had stopped eating meat since registering for MFM. The qualitative component entailed Interpretative Phenomenological Analysis of in-depth interviews with 18 people who had completed the questionnaire. The quantitative data revealed that people who had stopped eating meat since engaging with the MFM campaign had more positive attitudes toward being vegetarian or vegan, had been engaged with MFM for a longer time, and had used more elements of the MFM website. The qualitative data illustrated that individuals understood and appreciated MFM's aim of supporting people to make an initial change and then considering expanding on this. Interviewees highlighted the value and importance of campaign materials that helped them to turn their beliefs and motivation into enduring behaviour change. The observed associations between longer engagement with the campaign and greater behaviour change suggest that MFM and similar campaigns will maximise their impact if they can maintain people's active engagement: that this will necessitate deeper understanding of the forms of support and advice are most wanted and most effective.

A plant-based diet in overweight adults in a 16-week randomized clinical trial: The role of dietary acid load

BACKGROUND

Evidence suggests that changes in dietary acid load may influence body weight, body composition, and insulin sensitivity.

METHODS

Participants (n = 244) were randomly assigned to an intervention (vegan) (n = 122) or control group (n = 122) for 16 weeks. Before and after the intervention period, body composition was measured by dual X-ray absorptiometry. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index and predicted insulin sensitivity index (PREDIM). Repeated measure ANOVA was used for statistical analysis.

RESULTS

Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) decreased significantly in the vegan group with no change in the control group (treatment effect -24.7 mEq/day [95% CI -30.2 to -19.2]; p < 0.001; and -23.8 mEq/day [95% CI -29.6 to -18.0]; p < 0.001, respectively). Body weight decreased by 6.4 kg in the vegan group, compared with 0.5 kg in the control group (treatment effect -5.9 kg [95% CI -6.8 to -5.0]; Gxt, p < 0.001), largely due to a reduction in fat mass and visceral fat. HOMA-IR index decreased and PREDIM increased in the vegan group. After adjustment for energy intake, changes in PRAL and NEAP correlated positively with changes in body weight (r = +0.37; p < 0.001; and r = +0.37; p < 0.001, respectively), fat mass (r = +0.32; p < 0.001; and r = +0.32; p < 0.001, respectively), visceral fat (r = +0.19; p = 0.006; and r = +0.15; p = 0.03, respectively), and HOMA (r = +0.17; p = 0.02; and r = +0.20; p = 0.006, respectively), and negatively with changes in PREDIM (r = -0.22; p = 0.002; and r = -0.27; p < 0.001, respectively).

CONCLUSION

Dietary acid load as part of a plant-based diet was associated with changes in body weight, body composition, and insulin sensitivity, independent of energy intake. Mechanistic explanations suggest that the relationship may be causal.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT03698955.

Intake of vitamin B12 and other characteristics of women of reproductive age on a vegan diet in Australia

OBJECTIVE

(i) To examine demographic and health characteristics of women of reproductive age on a vegan diet in Australia and compare these to the general population; (ii) to identify sources and intake of vitamin B12 and compare intake to current recommendations and (iii) examine associations between participant characteristics and adequacy of vitamin B12 intake.

DESIGN

In this cross-sectional study, data were collected via an online survey. Demographic and health characteristics of women on a vegan diet were compared with women in the general population (using Australian Bureau of Statistics data). Intake of vitamin B12 was estimated using a FFQ and estimation of supplemental intake.

SETTING

Australia.

PARTICIPANTS

Participants (n 1530) were women aged 18-44 years who had been on a vegan diet for at least 6 months.

RESULTS

While BMI, smoking habits and intakes of fruit and vegetables compared favourably with the general population, 26 % of respondents had estimated intakes of vitamin B12 below recommendations. Analyses of relationships between vitamin B12 intake and participant characteristics revealed that the strongest predictor of intake was supplementation (P < 0·001); however, 25 % had not supplemented with vitamin B12 in the past 3 months.

CONCLUSIONS

The vitamin B12 intakes of a substantial proportion of Australian women of reproductive age consuming a vegan diet do not meet the recommended intake, which could adversely affect their health, and, if they are pregnant or lactating, that of their infants too. There is a need for further research in this area to identify effective strategies to address this situation.

Tensions within and between vegans and vegetarians: Meat-free motivations matter

Under the superordinate umbrella of "veg*n", vegans and vegetarians share a disavowal of meat consumption but differ regarding the use of animal products and by-products. Furthermore, within each subgroup there exist multiple motivations (or reasons) for diet choice, some with more moral overtones than others. Despite being on the same "team" relative to the meat-eating majority, there is tremendous potential for expressions of subgroup distinctiveness and tension. In an online sample of veg*ns, we asked participants to report on views of and experiences with veg*ns, including separately evaluating vegans and vegetarians for animal, environmental, health, or religious reasons (i.e., 8 groups). Overall vegan (vs. vegetarian) participants expressed more subgroup bias, with vegans consistently preferred over vegetarians. Both vegans and vegetarians preferred veg*ns with "ethical" motivations (animal or environmental), and reported negative experiences with their subgroup outgroups (i.e., vegetarians and vegans, respectively). Problematically, in terms of group cohesion, vegetarians reported elevated anxiety and vigilance in their interactions with animal vegans especially. Overall the results suggest that, despite sharing a superordinate category and goal, and despite recent calls for veg*nism to become a more inclusive and wider tent, substantial tensions exist that can disrupt group cohesion and productivity.

Vegetarians and omnivores with diagnosed eating disorders exhibit no difference in symptomology: a retrospective clinical chart review

PURPOSE

Past work suggests that vegetarianism is common in patients diagnosed with eating disorders (EDs), but the exact nature of this association is unclear, with reports conflicting as to whether vegetarianism is a risk factor for EDs, complicates ED treatment, or is wholly innocuous. Since vegetarianism has been on the rise, the need for current data on possible links with EDs is substantial.

METHODS

We collected data on demographics, vegetarian status, ED diagnosis, current body mass index (BMI), highest and lowest BMI, Eating Attitudes Test, and Multifactorial Assessment of Eating Disorders Symptoms scores at intake in 124 patients (84.7% women, 90.3% white, M_age = 23.92 ± 9.16 years) admitted to an intensive outpatient ED program.

RESULTS

We first compared omnivores (n = 72, 58.1%), meat-reducers (n = 27, 21.8%), vegetarians (n = 20, 16.1%), and vegans (n = 5, 4.0%) and found no significant differences in any demographic or outcome variable, with the exception that vegetarians reported significantly lower highest-ever BMI compared to meat-reducers (p = 0.03). To mirror past chart reviews, we then compared the combined groups of meat avoiders (n = 52, 41.9%) to the omnivores (n = 72, 58.1%) and found no significant differences in demographics or ED symptoms (all ps > 0.05).

CONCLUSION

Overall, data support that meat restriction does not imply greater ED severity.

LEVEL OF EVIDENCE

Level V, descriptive study, retrospective chart review.

Effect of a diet intervention on cardiometabolic outcomes: Does race matter? A randomized clinical trial

BACKGROUND & AIMS

In the U.S., Blacks as a group have an earlier onset, greater severity, and earlier mortality from cardiovascular disease than their White peers. The aim of this study was to test whether Black and White individuals experience similar cardiovascular risk reduction in response to a dietary intervention.

METHODS

In the course of a randomized trial assessing the effect of low-fat plant-based dietary intervention on cardiometabolic outcomes in overweight adults, this study compared the effects of a 16-week intervention in Black and White participants.

RESULTS

We randomly assigned 244 participants to the intervention (n = 122, including 60 Blacks and 57 Whites) or control (n = 122, including 53 Blacks and 60 Whites) groups. The full study was completed by 222 (91.0%) participants. There were no significant differences between Blacks and Whites in changes in body mass index (-2.3 kg/m2 in both races; p-value for the difference between Blacks and Whites p = 0.99), insulin resistance (Blacks -1.9, Whites -0.85; p = 0.30), total cholesterol (Blacks -0.73 mmol/L, Whites -0.69 mmol/L p = 0.89), LDL-cholesterol (Blacks -0.59 mmol/L, Whites -0.68 mmol/L p = 0.76), or any other measure.

CONCLUSIONS

Our data suggest that a healthful plant-based diet improves measures of cardiometabolic health independent of race.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT02939638.

Blood Type Is Not Associated with Changes in Cardiometabolic Outcomes in Response to a Plant-Based Dietary Intervention

BACKGROUND

Risk of cardiovascular disease is lower in individuals with blood type O and increased in individuals with blood type A, compared with those in other blood groups. However, little evidence is available regarding whether individuals with different blood types benefit from different diet recommendations.

OBJECTIVE

As part of a larger intervention trial using a low-fat vegan diet, this study ascertained whether changes in cardiometabolic outcomes were associated with ABO blood type.

DESIGN

A secondary analysis among intervention-group participants in a 16-week randomized clinical trial.

PARTICIPANTS/SETTING

In a larger study of overweight individuals randomly assigned to follow a low-fat vegan diet or to make no diet changes for 16 weeks, ABO blood typing was conducted on 68 intervention-group participants.

INTERVENTION

Intervention-group participants were asked to follow a low-fat vegan diet and attend weekly educational classes to aid in diet adherence.

MAIN OUTCOME MEASURES

Body weight, fat mass, visceral fat volume, blood lipid levels, fasting plasma glucose levels, and glycated hemoglobin concentrations.

STATISTICAL ANALYSES PERFORMED

Student t tests compared participants with blood type A to all other participants, and individuals with blood type O to all other participants.

RESULTS

There were no significant differences in any outcome between individuals of blood type A and all other participants, or between individuals of blood type O and all other participants. Mean body weight change was -5.7 kg for blood type A participants and -7.0 kg for all other participants (P = 0.09), and was -7.1 kg for type O participants and -6.2 kg for all other participants (P = 0.33). Mean total cholesterol decreased 17.2 mg/dL in the type A group and 18.3 mg/dL for all other participants (P = 0.90), and decreased 17.4 mg/dL among type O participants and 18.4 mg/dL for all other participants (P = 0.89).

CONCLUSIONS

Blood type was not associated with the effects of a plant-based diet on body weight, body fat, plasma lipid concentrations, or glycemic control.

Confirmatory factor analysis of the EDE-Q in vegans and omnivores: Support for the brief three factor model

The factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q) has proven difficult to replicate, including in vegans, whose eating behaviors differ from omnivores in important ways. We sought to assess fit of data from vegans and omnivores with the most recently proposed brief three-factor model of the EDE-Q, which retains only seven of the original 28 EDE-Q items. We examined fit indices of the EDE-Q brief three-factor model in vegans (i.e., individuals refraining from all animal products, n = 318) and omnivores (i.e., individuals not restricting intake of animal products, n = 200) in single-group confirmatory factor analyses (CFA). Configural and metric invariance across the two groups was examined in multi-group CFA. Data from omnivores exhibited good model fit. Fit in vegans was slightly worse, but still adequate and superior to alternative models. Findings from multi-group CFA supported configural, but not metric invariance across the two groups. We document satisfactory fit of data from vegans and omnivores with the EDE-Q brief three-factor model, suggesting that it is better suited for quantifying disordered eating than the original four-factor, full three-factor, or alternative two-, full one-, and brief one-factor versions, including in individuals who abstain from animal products.

Using consumption and reward simulations to increase the appeal of plant-based foods

The production of meat is a main contributor to current dangerous levels of greenhouse gas emissions. However, the shift to more plant-based diets is hampered by consumers finding meat-based foods more attractive than plant-based foods. How can plant-based foods best be described to increase their appeal to consumers? Based on the grounded cognition theory of desire, we suggest that descriptions that trigger simulations, or re-experiences, of eating and enjoying a food will increase the attractiveness of a food, compared to descriptions emphasizing ingredients. In Study 1, we first examined the descriptions of ready meals available in four large UK supermarkets (N = 240). We found that the labels of meat-based foods contained more references to eating simulations than vegetarian foods, and slightly more than plant-based foods, and that this varied between supermarkets. In Studies 2 and 3 (N = 170, N = 166, pre-registered), we manipulated the labels of plant-based and meat-based foods to either include eating simulation words or not. We assessed the degree to which participants reported that the description made them think about eating the food (i.e., induced eating simulations), and how attractive they found the food. In Study 2, where either sensory or eating context words were added, we found no differences with control labels. In Study 3, however, where simulation-based labels included sensory, context, and hedonic words, we found that simulation-based descriptions increased eating simulations and attractiveness. Moreover, frequent meat eaters found plant-based foods less attractive, but this was attenuated when plant-based foods were described with simulation-inducing words. We suggest that language that describes rewarding eating experiences can be used to facilitate the shift toward healthy and sustainable diets.

Postprandial effects of a meal low in sulfur amino acids and high in polyunsaturated fatty acids compared to a meal high in sulfur amino acids and saturated fatty acids on stearoyl CoA-desaturase indices and plasma sulfur amino acids: a pilot study

Objective

The sulfur amino acid (SAA) cysteine is positively related, whereas polyunsaturated fatty acids (PUFAs) are inversely related to activity of the lipogenic enzyme stearoyl-CoA desaturase (SCD). High SCD activity promotes obesity in animals, and plasma activity indices positively associates with fat mass in humans. SCD may thus be a target for dietary intervention with SAA restriction and PUFA enrichment with unknown potential benefits for body composition. We randomized ten healthy individuals to a meal restricted in SAAs and enriched with PUFAs (Cys/Met_low + PUFA) (n = 5) or a meal enriched in SAA and saturated fatty acids (Cys/Met_high + SFA) (n = 5). We measured plasma SCD activity indices (SCD16 and SCD18) and SAAs response hourly from baseline and up to 4 h postprandial.

Results

SCD16 was unchanged whereas SCD18 tended to increase in the Cys/Met_low + PUFA compared to the Cys/Met_high + SFA group (p_{time*group interaction} = 0.08). Plasma concentrations of total cysteine fractions including free and reduced cysteine decreased in the Cys/Met_low + PUFA compared to the Cys/Met_high + SFA group (both p_{time*group interaction} < 0.001). In conclusion, a meal low in SAA but high in PUFAs reduced plasma cysteine fractions but not SCD activity indices. This pilot study can be useful for the design and diet composition of future dietary interventions that targets SCD and SAA.

Trial registration ClinicalTrials.gov: NCT02647970, registration date: 6 January 2016

Maternal plant-based diet during gestation and pregnancy outcomes

PURPOSE

We aimed to explore the association of vegetarian-vegan diets and pregnancy outcomes.

METHODS

A retrospective, web-based study conducted in 2017. Women who delivered < 4 years prior to enrolment where eligible to participate. Participants were allocated to 3 groups based on their self-reported diet during pregnancy: omnivores, vegetarians or vegans. Outcomes of interest including birthweight centile, small for gestational age (SGA), large for gestational age (LGA), preterm birth (PTB), maternal excessive weight gain (EWG) and gestational diabetes (GDM) were compared between the groups.

RESULTS

Overall, 1419 women of which 234 vegans (16.5%), 133 vegetarian (9.4%) and 1052 omnivores (74.1%) were included in final analysis. Maternal vegan diet during pregnancy was associated with a lower birth weight centile as compared to omnivores (42.6 ± 25.9 vs. 52.5 ± 27.0 P < 0.001), a greater adjusted odds ratio (aOR) for SGA (aOR = 1.74; 95% CI 1.05, 2.86) but not with the risk of LGA (aOR = 0.55; 95% CI 0.30, 1.00). Further adjustment for BMI showed similar but nonsignificant associations for SGA and LGA as compared to the omnivore group. Vegan diet was associated with lower risk for maternal EWG (aOR = 0.61; 95% CI 0.44, 0.86) and modest nonsignificant association with GDM (aOR = 0.54 95% CI 0.28, 1.03) which was further attenuated by adjustment for pre-pregnancy BMI. Maternal diet group was not associated with the risk of PTB or low birth weight.

CONCLUSIONS

Maternal vegan diet is a protective factor from EWG but associated with a higher risk for SGA and lower birth weight centile. The association between vegan diet and fetal growth was mediated by maternal BMI.

Multiple Health Benefits and Minimal Risks Associated with Vegetarian Diets

PURPOSE OF REVIEW

Understand the current prevalence, health benefits, and health risks of vegetarian diets.

RECENT FINDINGS

Since the publishing of the Adventist Health Study 2 in 2013, there have been several prospective diet studies demonstrating and challenging the health benefits and risks of the vegetarian diet. The definition of the vegetarian diet has become more specific over time and requires standardization for research purposes. Despite an uptrend in sales rates of plant-based foods per year, a 2018 Gallup poll showed overall stagnation of the percentage of self-reported vegetarians and vegans compared to percentages obtained 6 years prior. Compared to the Adventist Health Study, more recent vegetarian diet studies have demonstrated significant although smaller risk reductions for mortality in cardiovascular disease, cerebrovascular disease, diabetes mellitus, and chronic kidney disease. Recent studies have correlated certain food groups with early death or increased longevity. In addition, the vegetarian health risks of deficiencies of protein, omega-3 fatty acids, vitamin D, vitamin B12, iron, calcium, and zinc are explored.

Participant characteristics and self-reported weight status in a cross-sectional pilot survey of self-identified followers of popular diets: Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey

Objective:

To describe characteristics of self-identified popular diet followers and compare mean BMI across these diets, stratified by time following diet.

Design:

Cross-sectional, web-based survey administered in 2015.

Setting:

Non-localised, international survey.

Participants:

Self-selected followers of popular diets (n 9019) were recruited to the survey via social media and email announcements by diet community leaders, categorised into eight major diet groups.

Results:

General linear models were used to compare mean BMI among (1) short-term (<1 year) and long-term (≥1 year) followers within diet groups and (2) those identifying as ‘try to eat healthy’ (TTEH) to all other diet groups, stratified by time following the specific diet. Participants were 82 % female, 93 % White and 96 % non-Hispanic. Geometric mean BMI was lower (P < 0·05 for all) among longer-term followers (≥1 year) of whole food, plant-based (WFPB), vegan, whole food and low-carb diets compared with shorter-term followers. Among those following their diet for 1–5 years (n 4067), geometric mean BMI (kg/m²) were lower (P < 0·05 for all) for all groups compared with TTEH (26·4 kg/m²): WFPB (23·2 kg/m²), vegan (23·5 kg/m²), Paleo (24·6 kg/m²), vegetarian (25·0 kg/m²), whole food (24·6 kg/m²), Weston A. Price (23·5 kg/m²) and low-carb (24·7 kg/m²).

Conclusion:

Our findings suggest that BMI is lower among individuals who made active decisions to adhere to a specific diet, particularly more plant-based diets and/or diets limiting highly processed foods, compared with those who simply TTEH. BMI is also lower among individuals who follow intentional eating plans for longer time periods.

Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring

Vegan diets – defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child’s previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).

Will the plant-based movement redefine physicians' understanding of chronic disease?

The world is experiencing a cataclysmically increasing burden from chronic illnesses. Chronic diseases are on the advance worldwide and treatment strategies to counter this development are dominated by symptom control and polypharmacy. Thus, chronic conditions are often considered irreversible, implying a slow progression of disease that can only be hampered but not stopped. The current plant-based movement is attempting to alter this way of thinking. Applying a nutrition-first approach, the ultimate goal is either disease remission or reversal. Hereby, ethical questions arise as to whether physicians' current understanding of chronic illness is outdated and morally reprehensible. In this case, physicians may need to recommend plant-based diets to every patient suffering from chronic conditions, while determining what other socioecological factors and environmental aspects play a role in the chronic disease process. This article provides insights to aspects of diet and chronic illness and discusses how the plant-based movement could redefine current understanding of chronic disease. The ethical justifications for recommending of a plant-based diet are analyzed. The article concludes that not advocating for plant-based nutrition is unethical and harms the planet and patients alike.

Oral health in a cohort of individuals on a plant-based diet: a pilot study

INTRODUCTION

Plant-based diets are associated with a lower: (i) body mass index, (ii) rates of death from ischemic heart disease, (iii) serum cholesterol, (iv) incidence of high blood pressure, (v) type II diabetes mellitus and cancer, with an overall longer life expectancy. However, little data concerning the oral health in individuals on a plant-based diet are available.

AIM

The aim of the present study was to investigate the general and clinical oral health status in a cohort of adults who had been following a plant-based diet for a minimum of 24 months.

MATERIAL AND METHODS

For this purpose, individuals were administered two questionnaires (a.Questionnaire investigating risk areas for oral diseases; b. Italian version of the Oral Health Impact Profile -14 (IOHIP-14)) by a dental hygienist and clinical examination of the oral cavity was carried out.

RESULTS

Seventy-seven adult individuals were enrolled. On average, they followed a plant-based diet for the last four years, had four meals a day and brushed their teeth twice a day. Fruit was the most frequently consumed food at breakfast by 48 of the participants. Thirty-four responders did not drink beer or wine, 65 did not drink spirits, 57 avoided carbonated beverages and 62 (80.5%) did not consume any highly-sugared beverages. Different dental therapies in the previous three years were reported in 36 of the responders. Overall, answers "never and almost never" to the IOHIP-14 questionnaire were observed in 87% to 100% of the individuals. Multiple logistic regression analysis revealed that fresh fruit consumption at lunch had a protective effect against caries (p<0.05).

CONCLUSIONS

In conclusion, this study showed that individuals on a plant-based diet have good overall oral health conditions. These features are in agreement with the behavior of these subjects towards an overall healthy life style.

Case report of nutritional rickets in an infant following a vegan diet

We report the case of a 13-month-old infant who was referred to the pediatric emergency department because of psychomotor regression with four bone fractures due to nutritional rickets. The reason was prolonged breastfeeding from a vegetarian mother followed by a vegan diet for the infant after weaning. Rickets is one of the many nutritional deficiencies that could affect infants fed vegan or vegetarian diets. These diets are a public health concern requiring adapted information that suggests alternative formulas made from rice or soy proteins and adapted supplementation after weaning.

Central retinal vein occlusion secondary to severe iron-deficiency anaemia resulting from a plant-based diet and menorrhagia: a case presentation

In this case presentation, we present a young vegan patient who developed a CRVO secondary to severe iron-deficiency anaemia (IDA) attributable to menstrual losses and limited iron intake. CRVO is a rare complication of IDA.

With rising calls for sustainable diets and rising evidence for a plant-based diet, there has been a rise in popularity of such diet forms. While there are ocular benefits from this diet trend, the potential for nutritional deficiencies including iron needs to be monitored especially in susceptible individuals. Iron is essential for retina metabolism and function; however, excess iron contributes to disease states in the eye. Therefore, supplementation needs to be judicious.

Which Is a Good Diet-Veg or Non-veg? Faith-Based Vegetarianism for Protection From Obesity-a Myth or Actuality?

INTRODUCTION

India ranks first among nations with the largest population of vegetarians, and 40% of Asian Indians are vegetarian. There seems to occur a "nutrition transition" among vegetarians in India with a decline in the consumption of whole plant food content and replacement with processed foods, fried foods, and refined carbohydrates. This study evaluates the association between the consumption of a vegetarian diet and the prevalence of morbid obesity necessitating bariatric surgery in Asian Indians.

MATERIAL AND METHODS

This is a retrospective cohort study analyzing records of 235 Indian patients suffering from morbid obesity and who underwent bariatric surgery at our center through the years 2015 to 2017. Pearson's chi-square test for independence of attributes was applied to analyze the difference between a number of vegetarians versus non-vegetarians undergoing bariatric surgery.

RESULTS

The difference in the number of vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for years 2015 and 2017, but the number was numerically higher for vegetarians. The difference was significantly higher for vegetarians in the year 2016. The difference in female vegetarians versus female non-vegetarians undergoing bariatric surgery was not significant for the year 2017 but was significantly higher for vegetarians during the years 2015 and 2016. The difference in male vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for all the years.

CONCLUSION

In an Asian Indian cohort, we found that vegetarian dietary patterns were associated with a higher incidence of morbid obesity culminating in bariatric surgery. Our study is a myth breaker that all vegetarian diets are healthy diets. Our findings can be utilized to discourage refined and processed food consumption and promote healthy vegetarian food choices.

Estimation of cadmium load from soybeans and soy-based foods for vegetarians

Soybeans, as legumes, belong among food items that contribute most to the dietary intake of the heavy metal cadmium (Cd). The consumption of soy-based foods may contribute significantly to Cd intake in vegetarians as probably the most frequent consumers of these foods. In this research, the weekly dietary intake of Cd from soy-based foods was investigated in 119 participants (including vegetarians, vegans, and non-vegetarians) in the Czech Republic by means of a semi-quantitative food frequency questionnaire (SFFQ) with personal assistance and the measurement of body weight. Cd content in soy-based foods available on the market was determined by means of atomic absorption spectrometry after microwave digestion. Tofu, as the most frequently consumed food item in the vegetarian/vegan group, contributed most to the total dietary Cd intake. It contained 7.6 ± 0.1 μg Cd/kg, while the highest Cd content was observed in tempeh (18.1 ± 0.4 μg/kg). The highest mean dietary Cd intake per week from soy-based foods was 0.4 μg/kg b.w. and was found in the vegan group. The consumption of soy-based foods was the lowest in the non-vegetarian group as was the dietary intake of Cd, which was 0.04 μg/kg b.w. per week.

Palatable disruption: the politics of plant milk

Plant-based milk alternatives-or mylks-have surged in popularity over the past ten years. We consider the politics and consumer subjectivities fostered by mylks as part of the broader trend towards 'plant-based' food. We demonstrate how mylk companies inherit and strategically deploy positive framings of milk as wholesome and convenient, as well as negative framings of dairy as environmentally damaging and cruel, to position plant-based as the 'better' alternative. By navigating this affective landscape, brands attempt to (re)make mylk as simultaneously palatable and disruptive to the status quo. We examine the politics of mylks through the concept of palatable disruption, where people are encouraged to care about the environment, health, and animal welfare enough to adopt mylks but to ultimately remain consumers of a commodity food. By encouraging consumers to reach for "plant-based" as a way to cope with environmental catastrophe and a life out of balance, mylks promote a neoliberal ethic: they individualize systemic problems and further entrench market mechanisms as solutions, thereby reinforcing the political economy of industrial agriculture. In conclusion, we reflect on the limits of the current plant-based trend for transitioning to more just and sustainable food production and consumption.

[Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association]

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used. There are few data on the medium and long-term health outcomes when removing all animal foods from the child's diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies. In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B₁₂ supplements at all ages, as well as other nutrients (iodine, iron, vitaminD₃, poly-unsaturated fatty acid n-3), when required. A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet.

A social identity needs perspective to Veg*nism: Associations between perceived discrimination and well-being among Veg*ns in Turkey

We examined the associations between perceived discrimination, social identity need satisfaction, and well-being among a sample of vegetarians and vegans (veg*ns) in Turkey. Drawing on the Rejection Identification Model, Motivated Identity Construction Theory, and the Social Cure approach, we tested whether perceived discrimination was related to the satisfaction of esteem, meaning, belonging, efficacy, distinctiveness, and continuity needs derived from veg*n group membership and whether the satisfaction of these needs, in turn, was associated with psychological well-being and self-esteem. A total of 350 veg*ns living in Turkey participated in an online study and completed measures of perceived discrimination based on veg*n group membership, veg*n identity need satisfaction, psychological well-being, and global level self-esteem. As expected, perceived discrimination was prevalent among Turkish veg*ns (more so among vegans) and was strongly associated with the greater satisfaction of all identity needs. In turn, the satisfaction of efficacy and continuity needs was related to greater well-being, showing an indirect association between perceived discrimination and well-being. Findings also showed that the satisfaction of the esteem need predicted (less strongly) lower levels of psychological well-being and self-esteem, indicating only some aspects of need satisfaction through veg*n identities to have positive implications for well-being. Findings are discussed in terms of the relevant socio-cultural environment, social identity theories, and stigmatization in the context of veg*n group membership.

A cross-sectional study of fatty acids and brain-derived neurotrophic factor (BDNF) in human milk from lactating women following vegan, vegetarian, and omnivore diets

PURPOSE

Essential fatty acids are critical for brain growth and neurodevelopment in infancy. Maternal diet and supplement use have a significant impact on the fat composition of human milk. The objective of this study is to assess supplement utilization patterns and fatty acid and brain-derived neurotrophic factor (BDNF) concentrations in the breast milk of women following vegan, vegetarian, and omnivore diet patterns.

METHODS

This is a cross-sectional, observational study of 74 lactating women in the United States following a vegan (n = 26), vegetarian (n = 22), or omnivore (n = 26) diet pattern. A single breast milk sample was collected from each participant and assessed for fatty acids and BDNF.

RESULTS

Median unsaturated fatty acids in the breast milk of vegan, vegetarian, and omnivores, as a percentage of total fatty acids, was 66.0, 57.8, and 56.2%, respectively (p < 0.001). Total omega-3 percentages were 2.29% for vegans, 1.55% for vegetarians, and 1.46% for omnivores (p < 0.001). Docosahexaenoic acid percentages were not different by diet pattern, but over 80% of participants had milk concentrations below 0.30% of total fatty acids. Reports of omega-3 supplements use (10/74) and weekly seafood consumption (3/74) were limited. BDNF was not detectable in any samples.

CONCLUSIONS

Breast milk from vegans had significantly higher unsaturated fat and total omega-3 fats, and lower saturated fats, trans fats, and omega-6 to omega-3 ratios than their vegetarian and omnivore counterparts. Docosahexaenoic acid concentrations in breast milk were low regardless of maternal diet pattern, and were reflective of low seafood intake and supplement use.

A defined, plant-based diet as a potential therapeutic approach in the treatment of heart failure: A clinical case series

BACKGROUND

Individuals diagnosed with congestive heart failure (CHF) have a 50% five-year mortality rate and approximately 650,000 new cases of CHF are diagnosed annually. Plant-based diets are known to improve plasma lipid concentrations, reduce blood pressure, and as part of a lifestyle intervention, lead to the regression of atherosclerotic lesions. However, a paucity of data exists with regards to plant-based diets in the treatment of CHF.

METHODS

Three patients diagnosed with CHF opted to undergo a dietary intervention consisting of a defined plant-based diet as an adjunct to standard medical treatment for CHF. Cardiac magnetic resonance imaging was performed. Patients' consumed the defined plant-based diet for an average of ˜79 days.

RESULTS

Follow-up cardiac magnetic resonance images revealed a 92% increase in ejection fraction [mean ± standard deviation for all data] (22.0 ± 6.9% vs 42.2 ± 18.4%), 21% reduction in left ventricular mass (214 ± 90 g vs 170 ± 102 g), 62% increase in stroke volume (55.8 ± 24.3 cc vs 90.3 ± 30.6 cc) and a 17% increase in cardiac output (3.6 ± 1.2 L/min vs 4.2 ± 1.6 L/min). In patient 1, 90-95% ostial stenosis of the left anterior descending artery nearly completely regressed following the dietary intervention. All patients subjectively reported significant clinical improvements, including less angina, shortness of breath and fatigue.

CONCLUSION

As an adjunct treatment, a defined plant-based diet may contribute to the reversal of cardiac morphological and functional abnormalities in the setting of CHF.

The effects of calorie restriction, intermittent fasting and vegetarian diets on bone health

Uncountable health care organizations, clinicians, and individuals are striving to prevent obesity and the many chronic medical conditions linked to it by advocating a healthy lifestyle that includes measures such as reducing dietary calorie intake (i.e., calorie restriction = CR and intermittent fasting = IF) or limiting/abolishing animal source foods (i.e., practices termed vegetarianism and veganism). Although these regimens are traditionally considered healthy, their real impact on bone health has yet to be established, and some studies have reported that they have negative effects on bone outcomes. The current work provides an overview of the studies carried out to examine the effect/s of CR, IF and vegetarian/vegan diets on bone health, and, in particular, on bone mineral density (BMD) and fracture risk. Although data on this subject are limited to small studies and there is no information specifically referring to fractures, CR, but not IF, seems to reduce BMD but does not seem to affect bone quality. Vegetarian diets (particularly vegan ones) are associated with significantly lower BMD values with respect to omnivorous ones and could, potentially, increase the risk of fractures. Given these considerations, individuals who decide to follow these diets should be aware of the risk of osteoporosis and of bone fractures and should introduce dietary sources of calcium and Vitamin D and/or supplementation. Future studies examining fracture/osteoporosis incidence in selected populations will be able expand our knowledge about the safety of these diets and the risks linked to them.

Dietary patterns and management of type 2 diabetes: A systematic review of randomised clinical trials

BACKGROUND AND AIM

The aim of the present review is to examine evidence from published studies on the effectiveness of six or more months of low carbohydrate, macrobiotic, vegan, vegetarian, Mediterranean and intermittent fasting (IF) diets compared to low fat diets on diabetes control and management.

METHODS AND RESULTS

In accordance with PRISMA guidelines, Cochrane CENTRAL, PubMed and Scopus databases were systematically searched for relevant studies. Twenty randomised controlled trials (RCTs) > 6 months that investigated the effectiveness of various dietary patterns on type 2 diabetes mellitus (T2DM) were included. Risk of bias was assessed using the Cochrane tool. There were no significant differences in glycemic control, weight and lipids for the majority of low carbohydrate diets (LCDs) compared to low fat diets (LFDs). Four out of fifteen LCD interventions showed better glycemic control while weight loss was greater in one study. The Mediterranean dietary pattern demonstrated greater reduction in body weight and HbA1c levels and delayed requirement for diabetes medications. The vegan and macrobiotic diet demonstrated improved glycemic control, while the vegetarian diet showed greater body weight reduction and insulin sensitivity.

CONCLUSIONS

Although more long-term intervention trials are required, mounting evidence supports the view that vegan, vegetarian and Mediterranean dietary patterns should be implemented in public health strategies, in order to better control glycemic markers in individuals with T2DM.

Exercise capacity of vegan, lacto-ovo-vegetarian and omnivorous recreational runners

Background

In search of the right nutrition for the athlete, numerous nutritional strategies and diets were discussed over time. However, the influence of plant-based diets, especially veganism, on exercise capacity has not been clarified.

Methods

We conducted a cross-sectional study to compare the exercise capacity of vegan (VEG, n = 24), lacto-ovo-vegetarian (LOV, n = 26) and omnivorous (OMN, n = 26) recreational runners. To determine maximal exercise capacity, participants performed an incremental exercise test on a bicycle ergometer until voluntary exhaustion. During the test capillary blood samples were taken at several time points for the measurement of arterial lactate [lac] and glucose [glc] concentrations. To determine nutrient intake, a 24 h dietary recall was conducted.

Results

The groups showed comparable training habits in terms of training frequency (mean 3.08 ± 0.90 time/wk., p = 0.735), time (mean 2.93 ± 1.34 h/wk., p = 0.079) and running distance (mean 29.5 ± 14.3 km/wk., p = 0.054). Moreover, similar maximum power output (P_maxBW) was observed in all three groups (OMN: 4.15 ± 0.48 W/kg, LOV: 4.20 ± 0.47 W/kg, VEG: 4.16 ± 0.55 W/kg; p = 0.917) and no differences regarding [lac] throughout the exercise test and maximum lactate could be observed between the groups (OMN: 11.3 ± 2.19 mmol/l, LOV: 11.0 ± 2.59 mmol/l, VEG: 11.9 ± 1.98 mmol/l; p = 0.648).

Conclusion

The data indicate that each examined diet has neither advantages nor disadvantages with regard to exercise capacity. These results suggest that a vegan diet can be a suitable alternative for ambitious recreational runners.

Trial registration

German Clinical Trials Register (DRKS00012377). Registered on 28 April 2017

Vegetarian diet and mental health: Cross-sectional and longitudinal analyses in culturally diverse samples

BACKGROUND

Vegetarianism is linked with better physical health, but also to increased anxiety and depression. The aim of the present study is to examine the relationship between vegetarianism and both positive and negative mental health, across cultures and over time.

METHOD

Self-report questionnaire data were obtained from a large-scale multi-national cross-sectional sample including 2007 representative adult members of the German population, 3020 representative adults from Russia, and 3038 representative adults from the USA. Participants for the longitudinal analyses include university students from Germany (1608) and China (12,744). Statistical models included multiple linear regression, longitudinal linear models and longitudinal logistic models.

RESULTS

Vegetarianism diet is not reliably related to positive or negative mental health in US and Russian representative samples or in German representative or student samples. Vegetarianism is related to slight increases over time in anxiety and depression in Chinese students.

CONCLUSIONS

Vegetarianism is not associated with mental health in the US, Russia, or Germany, but is associated with anxiety and depression in China in this study. Future studies should examine the nuances of vegetarianism in more detail and their links with mental health, including dietary composition and cultural beliefs and economic circumstances. Future researchers in this area may also want to consider the effects of experimental manipulation of diet on mental health outcomes over time.

Vegetarian Diets and the Risk of Diabetes

PURPOSE OF REVIEW

Worldwide, diabetes has increased steadily and in recent years, drastically. The majority of diabetes cases are type 2 (T2DM), caused by modifiable risk factors such as diet. Vegetarian diets have been studied over the past few decades for their preventative and therapeutic effects on diabetes and may be more beneficial than medication for diabetes management.

RECENT FINDINGS

A vegetarian diet characterized by whole plant foods is most beneficial for diabetes prevention and management. Vegetarian diets are inversely associated with risk of developing diabetes independent of the positive association of meat consumption with diabetes development. Vegetarian diets range from vegan (no animal products), lacto-ovo-vegetarian (no animal meat, but consumes milk and eggs), pesco-vegetarian (consumes fish), and semi-vegetarian (occasional meat consumption). There has been an observed difference in the extent of preventative and therapeutic effects of these different types of diets. The most important aspect of any of these types of diets is emphasizing whole grains, fruits and vegetables, legumes, and nuts and reducing saturated and trans fats.

Assessing antimicrobial resistance gene load in vegan, vegetarian and omnivore human gut microbiota

Massive antimicrobial use in animal farming is considered as the greatest contributor to the presence of antimicrobial-resistant bacteria (ARB) in food of animal origin. Nevertheless, sewage from treated animals may impact on vegetables grown on fertilised fields, but it is largely unknown whether and to what extent ARB are transferred to vegetables and the human gut. It could be hypothesised that food of animal and vegetal origin have a different role in ARB transfer to the human gut and that different diets could be characterised by different antimicrobial resistance gene (ARG) loads. This study included three groups comprising vegans (n = 26), vegetarians (n = 32) and omnivores (n = 43). Metadata regarding food consumption and anthropometric parameters were collected. Gut microbial communities were investigated by 16S rDNA analysis. Four ARGs (sul2, tetA, bla_TEM and strB) were quantified by qPCR. The results showed a lower total load of investigated ARGs in vegan diet (pairwise comparison adjusted results: omnivorous-vegan, P = 0.0119; omnivorous-vegetarian, P = 0.7416; and vegan-vegetarian, P = 0.0119). No significant differences in abundance of each gene separately were found between the three groups. Neither the amount of animal protein nor the occurrence of ARGs was significant in explaining differences in the gut microbial community of individuals, and a large proportion of the differences between community composition (PERMANOVA, 46.87%) was not explained by the analysed variables. The results support the role of omnivorous and vegetarian diets in accumulating ARGs, suggesting a possible role for animal-derived food consumption.

Quality of life of female and male vegetarian and vegan endurance runners compared to omnivores - results from the NURMI study (step 2)

Background

Health-related effects of a vegetarian or vegan diet are known to support parameters positively affecting exercise performance in athletes, whereas knowledge about psyche and wellbeing is sparse. Therefore, the aim of the Nutrition and Running High Mileage (NURMI) Study (Step 2) was to compare Quality of Life (QOL) scores among endurance runners following a vegetarian or vegan diet against those who adhere to an omnivorous diet.

Methods

The study was conducted following a cross-sectional design. A total of 281 recreational runners (159 women, 122 men) completed the WHOQOL-BREF questionnaire consisting of the domains physical health, psychological wellbeing, social relationships and environment, which generates scores on a scale from 4 to 20. Data analysis was performed using ANOVA.

Results

It was found that 123 subjects followed an omnivorous diet and 158 adhered to a vegetarian/vegan diet. There were 173 runners who met the inclusion criteria (‘NURMI-Runners’), among them 103 half-marathoners and 70 marathoners and ultramarathoners, as well as 108 10 km runners as control group. Overall QOL scores were high (~ 16.62 ± 1.91). Men had higher scores than women due to high scores in the physical health and psychological well-being dimensions. Adhering to an omnivorous diet affected environment scores for women and social relationships scores for men. A minor effect concerning race distance was observed in women, where half-marathoners had a higher environmental score than 10-km runners. A moderate diet×race distance interaction on environment scores was shown for men.

Conclusions

The results revealed that endurance runners had a high QOL regardless of the race distance or diet choice. These findings support the notion that adhering to a vegetarian or vegan diet can be an appropriate and equal alternative to an omnivorous diet.

Trial registration

ISRCTN73074080. Registered 12th June 2015, retrospectively registered.

The impact of vegan production on the kimchi microbiome

Despite previous inquiry into the fermentative bacterial community of kimchi, there has been little insight into the impacts of starting ingredients on the establishment and dynamics of the microbial community. Recently some industrial producers have begun to utilize vegan production methods that omit fermented seafood ingredients. The community-level impacts of this change are unknown. In this study, we investigated the differences in the taxonomic composition of the microbial communities of non-vegan kimchi and vegan kimchi prepared through quick fermentation at room temperature. In addition to tracking the community dynamics over the fermentation process, we looked at the impact of the constituent ingredients and the production facility environment on the microbial community of fermenting kimchi. Our results indicate that the bacterial community of the prepared vegan product closely mirrors the progression and final structure of the non-vegan final product. We also found that room temperature-fermented kimchi differs minimally from more traditional cold-fermented kimchi. Finally, we found that the bacterial community of the starting ingredients show a low relative abundance of the lactic acid bacteria in fermented kimchi, whereas the production facility is dominated by these bacteria.

A Comparison of Eating Attitudes Between Vegans/Vegetarians and Nonvegans/Nonvegetarians in Terms of Orthorexia Nervosa

This descriptive study was performed to compare signs of orthorexia nervosa and eating habits and attitudes of vegans/vegetarians and nonvegans/nonvegetarians. The study sample included 62 people, of whom 31 were vegan/vegetarian and 31 were nonvegan/nonvegetarian. Data were gathered with a personal characteristics form, Orthorexia Nervosa Evaluation Scale-11, Eating Attitudes Test-40 and Maudsley Obsessive Compulsive Inventory. There were not any significant differences between scores for Orthorexia Nervosa Evaluation Scale-11, Eating Attitudes Test-40 and Maudsley Obsessive Compulsive Inventory (p>0,05). As scores for Orthorexia Nervosa Evaluation Scale-11 decreased, predisposition to orthorexia nervosa increased. Therefore, although correlation coefficients were negative, they were considered positive. There was a significant, negative relation between Eating Habits Test-40 scores and Orthorexia Nervosa Evaluation Scale-11 scores (r=-0.290, p=0.002) and between Maudsley Obsessive Compulsive Inventory scores and Orthorexia Nervosa Evaluation Scale-11 scores (r=-0.319, p=0.012). As poor eating habits and obsessive symptoms increased, so did orthorectic symptoms. In light of obtained results, it seems that people become vegan/vegetarian mainly for ethical reasons and that veganism/vegetarianism is not associated with obsession of healthy eating.

Impact of vegan diets on gut microbiota: An update on the clinical implications

Numerous studies indicate that microbiota plays an important role in human health. Diet is a factor related to microbiota which also influences human health. The relationships between diet, microbiota, and human health are complex. This review focuses on the current literature on vegan diets and their unique impact on gut microbiota. We also report on the health benefits of a vegan diet for metabolic syndrome, cardiovascular disease, and rheumatoid arthritis concerning relevant impacts from gut microbiota. Despite evidence supporting the clinical relevance of vegan gut microbiota to human health, the whole mechanism awaits further investigation.

Ovo-vegetarian diet is associated with lower systemic blood pressure in Taiwanese women

OBJECTIVE

This study was designed to investigate blood pressure (BP) profiles among Taiwanese women with different dietary patterns.

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 269 non-hypertensive Taiwanese women, 40 years of age or older, were surveyed using structured questionnaires, and measurements of BP and physiological parameters were made. To assess differences among vegans, ovo-vegetarians, and meat eaters in terms of BP, demographic, and health behavior data, the chi-squared and Fisher's exact tests were employed for categorical variables, and analysis of variance and independent t-tests were performed for continuous variables. Multiple regression analysis was used to examine the relationship between BP and dietary patterns while controlling for potential confounding factors.

RESULTS

A significant difference was found among the three test groups in terms of age, education, employment, stress, and waist-hip ratio. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly differed among the three groups. After controlling for age, body weight, waist circumference, and hip circumference, the three groups were observed to be a significant risk factor of the SBP and DBP. The SBP and DBP of the ovo-vegetarian group were significantly lower than those of the meat-eater group. No significant differences were found between the vegan and meat-eater groups in terms of SBP and DBP.

CONCLUSION

Dietary pattern is a likely risk factor for SBP and DBP outcomes in Taiwanese women. In particular, the SBP and DBP of ovo-vegetarians are the lowest among the values observed for all dietary patterns. This finding suggests that an ovo-vegetarian diet is beneficial for long-term BP control and prevention of hypertension in females.