Plant-based diets: a review of the definitions and nutritional role in the adult diet

Association Between Orthorexia and Plant-Based Diets-Is There a Vicious Cycle?

Nowadays, social media and rapidly changing dietary trends encourage people to constantly-often excessively-control their diet, which leads to an increased risk of developing eating disorders, including orthorexia nervosa (ON). At the same time, more and more people reduce or give up consumption of meat and other animal products, adopting different types of plant-based (vegetarian) diets. The following paper aimed to demonstrate the significant similarities between orthorexia and plant-based diets and to highlight the necessity of developing new or adapting existing diagnostic tools for orthorexia considering the lifestyle characteristics of vegetarians, especially vegans. It remains unclear whether vegetarianism increases the risk of developing ON or whether the development of ON increases the chances of switching to a plant-based diet. However, based on the available literature, a positive association can be shown between the two. On the one hand, a vegetarian diet may be a cover for ON, but on the other, vegetarians, as a group avoiding specific food products, may be wrongly perceived as disordered. Thus, it is important to distinguish ON from the so-called healthy orthorexia (HO), which is a non-pathological interest in healthy eating, to avoid overdiagnosis and stigmatization of people using healthy alternative diets, including plant-based diets, since the mere fact of following them does not constitute evidence of orthorexia.

Important Nutritional Concepts and Recommendations at the Level of Medical School Education

PURPOSE OF REVIEW

The purpose of the review is to share experiential recommendations to improve nutrition education for medical students. The review examines the history and the current state of nutrition education in order to identify opportunities to strengthen medical provider nutrition knowledge. Methods currently in use by medical school educators are highlighted to promote wellness and prevent development of chronic disease. Lastly, strategies and resources are described to integrate fundamental nutrition concepts into medical school education.

RECENT FINDINGS

Several surveys reveal that most U.S. medical students and residents feel underprepared to address patient nutrition and lifestyle concerns. Innovative programs such as culinary medicine, hands-on cooking electives, and modules on motivational interviewing show promise in improving students' competence and confidence. There is a lack of guidance from nutrition experts on how to improve medical school education by incorporating nutrition. A growing number of experts agree that medical school curricula should include more comprehensive nutrition content to prepare future physicians for addressing chronic diseases. Structured learning modules, enrichment electives, real-world community involvement, and interdisciplinary approaches can enhance evidence-based dietary counseling skills in medical trainees.

Planetary health diet, mediterranean diet and micronutrient intake adequacy in the Seguimiento Universidad de Navarra (SUN) cohort

PURPOSE

Our study aimed to investigate and compare the association between adherence to a priori Planetary Health Diet Index and two well-known Mediterranean indices, the Mediterranean Diet Score (MDS) and the Mediterranean Adherence Screener (MEDAS), and micronutrient intake adequacy.

METHODS

We assessed 18,259 Spanish university graduates at baseline who participated in the SUN cohort using a validated semi-quantitative food frequency questionnaire. Inadequate intake of Zn, I, Se, Fe, Ca, P, Mg, Cr, K, vitamins B1, B2, B3, B6, B12, C, A, D, E, and folic acid was evaluated using the estimated average requirement (EAR) cut-point approach and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either ≥ 3 or ≥ 6 micronutrients.

RESULTS

Participants with higher adherence to the Planetary Health Diet had a lower risk of overall inadequacy, while the Mediterranean Diet (MedDiet) showed even greater nutritional adequacy. The adjusted Odds Ratio (OR) for failing to meet ≥ 3 EAR was 0·24 (95% CI 0·21 - 0·27) for the Planetary Health Diet Index, whereas it was substantially lower for MEDAS with OR = 0·12, 95% CI 0·11 - 0·13, and for MDS with OR = 0·09, 95% CI 0·08 - 0·10, always for the comparison of the fourth v. first quartile and using the probabilistic approach method.

CONCLUSION

In this Mediterranean cohort, better adherence to both the Planetary Health Diet and the MedDiet (with a stronger inverse association) showed lower risk of micronutrient inadequacy.

Energy and Macronutrient Dietary Intakes of Vegetarian and Semi-Vegetarian Serbian Adults: Data from the EFSA EU Menu Food Consumption Survey (2017-2022)

This study is the first to examine the diet and nutritional status of the adult vegetarian and semi-vegetarian population in Serbia, using data from the EFSA EU Menu Food Consumption Survey 2017-2022. The survey included 314 participants (63 vegans, 192 lacto-ovo vegetarians, 50 pescatarians, and 9 flexitarians), aged 18-74 years (166 women and 148 men, with no gender differences in dietary patterns) across all regions of Serbia. Collected data included anthropometrics (BMI) and intake of energy, macronutrients, and specific food groups (assessed through two 24 h dietary recalls). The study revealed multiple nutritional shortcomings across all three dietary patterns. The most significant was an insufficient protein intake (especially among vegans, but also among non-vegans), connected with an unsatisfactory protein quantity, quality, and availability in plant sources. There was also a high fat intake (particularly from omega-6 and trans-fats-rich sources), especially among non-vegans (but also among vegans), while the intake of omega-3 sources was low. Non-vegans consumed less carbohydrates, fiber, vegetables, and fruit, but more sweets, beverages, and alcohol. Our findings highlight the need for improved nutritional education of vegetarians/semi-vegetarians in Serbia and the development of national food system-based guidelines for this population.

Higher Consumption of Ultra-Processed Foods Is Associated with Lower Plant-Based Diet Quality in Australian Adults

Background/Objectives: Plant-based diets are associated with human and planetary health. However, the overall quality of these diets may depend on the proportion of ultra-processed foods (UPFs). This study investigates the association between UPF consumption and plant-based diet quality in Australian adults. Methods: Analysis was conducted on 9111 participants (aged ≥ 19 years) from the National Nutrition and Physical Activity Survey 2011-2012. Food items reported from a 24 h recall were classified using the NOVA system, and the contribution of UPFs to total energy intake was calculated. Plant-based diet quality was examined using the overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). Multiple linear regression models were used to examine the association between the UPF intake and PDI, hPDI, uPDI, and their score components. Results: The proportion of energy from UPFs was positively associated with the uPDI (β = 0.80; 95% CI 0.72, 0.89) and negatively associated with the PDI (β = -0.13; 95% CI: -0.22, -0.04) and the hPDI (β = -0.65; 95% CI: -0.73, -0.57). All score components of the PDI, hPDI and uPDI, except whole grains, legumes and fruit juices, significantly contributed to these associations. The sugars and syrups group contributed most to the positive association between UPFs and the uPDI (β = 6.47; 95% CI: 6.07, 6.87) and the negative association of UPFs and the hPDI (β = -6.47; 95% CI: -6.07, -6.87). Conclusions: Higher consumption of UPFs was associated with a lower plant-based diet quality. These findings have implications for the design of dietary interventions that encourage the consumption of minimally processed plant-based foods.

Preventive Role of Cocoa-Enriched Extract Against Neuroinflammation in Mice

BACKGROUND

Chronic aberrant inflammation is a crucial step in mediating cerebrovascular and neurodegenerative pathologies, including Alzheimer's and Parkinson's disease. Due to their exceptional antioxidant properties and ability to alter imbalance metabolism and reactive inflammation response, cocoa-derived flavanols are being investigated as potential bioactive substances to modulate and reverse these inflammation-associated disorders.

OBJECTIVE

The present study will focus on the possible beneficial effects of cocoa-derived extract, enhanced with other bioactive phytochemicals such as spirulina and pineapple, on selected biomarkers of the inflammatory, metabolic, and neurodegenerative processes.

METHODS

A mice model of inflammation was treated with cocoa-derived extract cocktail, and biomolecular data was obtained by performing immunohistochemical and biochemical analysis.

RESULTS

Results show that the cocoa-derived extract mitigates the neuroinflammatory processes triggered (decreased expression of macrophage CD11b) and prevents the escalade of subsequent neurodegeneration pathologies.

CONCLUSIONS

The results based on hypo-vitaminosis, neuroinflammation, and inmunoreactive analysis suggest that cocoa-derived extract is a powerful bioproduct for ameliorating neuroinflammatory processes that mediate metabolic and cerebrovascular diseases.

The Two Dimensions of Nutrition for the Planet: Environment and Health

PURPOSE OF REVIEW

Protecting the planet is protecting the future. Food production systems are among the most important human activities threatening planetary health. Diet, food systems, the environment, and health are interconnected. Accordingly, this review aims to assess the effects of nutrition on the planet and the relationship between some types of diets defined as sustainable and the planet and human health.

RECENT FINDINGS

Many diets have been proposed to protect the planet and human health, but there is no consensus on which diet is best. It should not be forgotten that planetary health diets, plant-based diets, and vegetarian/vegan diets can reduce environmental pressure. Still, they cannot have the same effect in every country, and these diets may have different effects depending on the differences in the countries' income level, nutritional culture, and food systems. Moreover, it should not be overlooked that these diets may cause difficulties in terms of adaptation, cause deficiencies in some nutrients, and may not be suitable for all segments of society. Sustainable diets such as the Mediterranean and New Nordic, as well as Dietary Approaches to Stop Hypertension, are more flexible and acceptable. Instead of a globally recommended reference diet to protect the planet and human health, each country can analyze its food systems and choose the most appropriate food production methods and sustainable diet style to reduce environmental burden, improve health, and create policies accordingly, which can help achieve sustainable goals faster.

Adopting vegetarian and vegan eating patterns: Associations with disordered eating behaviors among young adult college students

INTRODUCTION

Vegan and vegetarian diets are increasingly popular, though there is concern that disordered eating can drive, emerge, or intensify from the choice to adopt dietary restrictions.

OBJECTIVE

We sought to ascertain whether disordered eating or weight-control behaviors are associated with newly adopting a vegetarian/vegan diet during college and to assess symptom awareness and treatment utilization.

METHODS

Data came from 11,503 students in the Healthy Minds Study spanning 2015-2021. We examined associations between (i) the SCOFF eating disorder screener and (ii) symptom-specific items from the Eating Disorder Examination Questionnaire, and recent adoption of a vegan/vegetarian diet. Participants' knowledge of eating disorder symptoms and experiences with treatment utilization were also assessed.

RESULTS

Five-hundred thirty-two participants (∼5 %) reported adopting a vegan/vegetarian diet. Compared to students who did not change eating patterns, those who adopted vegetarianism/veganism had higher past-month prevalence of binge eating (25 % vs, 16 %), compulsive exercise (18 % vs. 9 %), and fasting (12 % vs. 8 %). Each behavior was significantly associated with greater odds of having recently adopted a vegetarian/vegan diet. A positive SCOFF screen (2+ items) was associated with 1.79-times (95 % CI: 1.48, 2.16) greater odds of newly adopting a vegetarian/vegan diet. There were no observed differences between groups with respect to knowledge of eating disorder symptoms or treatment-seeking attitudes and behaviors.

DISCUSSION

Disordered eating or weight-control behaviors were prevalent in this population of young adults and were associated with adopting a vegetarian/vegan diet, though awareness and help-seeking were not elevated among those with higher eating disorder risk.

Supplementation Behavior and Expenditures in Healthy German Vegans, Lacto-Ovo-Vegetarians and Omnivores: A Cross-Sectional Study

Purpose: Dietary supplements may ensure an adequate intake of nutrients of concern in all diets. Supplementation behavior and expenditures in vegetarians and vegans, however, have been rarely discussed in the literature. Methods: We reviewed supplementation expenditures in a cohort of 115 healthy adult German vegans, lacto-ovo-vegetarians and omnivores, characterized by comparable sociodemographic data. Supplementation behavior (excluding protein supplements) was re-analyzed to estimate yearly supplementation expenditures by dietary group. Results: The number of total supplements and multivitamin supplements taken differed significantly between the 3 groups (P = .016 and .026, respectively). Median number (interquartile range) of reported supplements in vegans was n = 2.5 (3), n = 2 (1) in lacto-ovo-vegetarians and n = 1 (2) in omnivores. Yearly supplementation expenses in supplementing participants ranged from .66€ to 1566.50€. They were highest in vegans (53.81€), followed by omnivores (29.30€) and lacto-ovo-vegetarians (12.05€) (P = .013). Approximately 40% of participants spent more than 50 Euros per year on supplements. A strong association between supplement expenses and the number of reported supplements was found (Spearman's rho: .65, P < .001). The most frequent supplements were vitamin D (vegetarians/omnivores) and vitamin B12 (vegans). Conclusions: Supplements were widely used in our study population, with substantial differences in expenditures and risk for over-supplementation across the examined diet groups.

Analyzing dietary exposure to critical nutrients on a plant-based diet using the food- and total nutrient index

BACKGROUND

Unfortified plant-based diets are devoid of vitamin B12, and supply low intakes of iodine, zinc, selenium, and calcium. To disentangle the complex interplay between nutritional adequacy and nutrient intakes from supplements and foods in plant-based diets, data from a Germany-based cross-sectional study examining the nutritional status of omnivores, lacto-ovo-vegetarians and vegans was re-analyzed. Special emphasis was put on potentially under-consumed nutrients in plant-based diets, including vitamin A and choline.

METHODS

A novel tool focusing on under-consumed micronutrients was employed to shed a new light on nutrient supply and dietary exposure to critical nutrients in plant-based diets: The Total Nutrient Index (TNI). The TNI extends existing measures of diet quality by considering nutrient intake data from both foods and supplements. The TNI covers calcium, magnesium, potassium, choline and vitamins A, C, D, and E. The TNI was compared between omnivores, vegetarians and vegans, with a special focus on its micronutrient component scores and with regard to dietary supplement contributions.

RESULTS

Data from 108 participants was analyzed. The vegan and the omnivorous diet resulted in similar TNI scores (73.70 ± 19.68 and 72.77 ± 17.88), whereas lacto-ovo-vegetarians scored lower (68.50 ± 17.10). The contribution of supplements to the TNI was higher in vegans and omnivores (median contribution: 12.50 (16.80) and 10.81 (18.23) score points, respectively) as compared to lacto-ovo-vegetarians (3.42 (12.50) score points). High micronutrient component score contributions to the TNI were found for vitamin D supplements (all dietary groups), vitamin C supplements (omnivores and vegans) and magnesium supplements (all groups).

CONCLUSIONS

Supplementation has a profound impact on nutrient supplies in individuals on a plant-based diet. This study reiterates the need to quantitatively assess nutrient intakes from supplements to assess diet quality of plant-based dietary patterns. We posit that defining diet-specific TNI scores is important for a precise evaluation of diet quality, whether in omnivore or in the spectrum of plant-based diets.

Plant-Based vs. Animal-Based Diets: Appetitive Traits and Dietary Patterns in Adults Based on Cross-Sectional Surveys

BACKGROUND

Dietary patterns play a crucial role in shaping eating behaviours and influencing health outcomes, such as body weight. Understanding how appetitive traits differ between plant-based and animal-based diets can provide insights into dietary strategies for weight management and improved health.

OBJECTIVES

The aim of this study was to analyse the relationships between appetitive traits, as measured by the Adult Eating Behaviour Questionnaire (AEBQ), and dietary patterns in adults consuming plant-based or animal-based diets. It examined how these dietary patterns influence body mass index (BMI) and explored the differences in appetite-related traits between groups with different levels of plant and animal product consumption.

METHODS

A cross-sectional survey of 553 Polish adults was conducted using validated questionnaires, including the AEBQ and a food frequency questionnaire (FFQ). The participants were categorised into four dietary groups: high intake of both plant and animal products, low intake of both, plant-based diet, and animal-based diet. The data were analysed using SPSS version 14.0 software.

RESULTS

The participants on a plant-based diet had significantly lower BMIs and slower eating rates than those on an animal-based diet. Positive correlations were observed between 'food approach' traits (e.g., food responsiveness, emotional overeating) and BMI, particularly in individuals with higher animal product consumption. Conversely, 'food avoidance' traits (e.g., food fussiness, slowness in eating) were more prevalent among those on a plant-based diet.

CONCLUSIONS

The results suggest that plant-based diets are associated with favourable appetitive traits and a lower BMI. These findings highlight the potential of plant-based diets to support weight control and improve eating behaviours. Further research is warranted to investigate the causal mechanisms underlying these associations.

Experiencing transformation: Emerging adults, food, and mood-A phenomenological analysis

Mental health concerns have become increasingly prevalent among young adults. A growing body of literature indicates that increasing plant intake shows benefits for mental health. An existential-phenomenological study was conducted with 11 emerging adults with symptoms of anxiety and/or depression who had adopted a whole-food, plant-based diet (WFPB) diet to understand their lived experiences. Adoption of a WFPB diet was about Experiencing Transformation: An "Internal Calling." The context of transformation was the experience of Going Against the Grain of Society. Six figural themes were identified: (a) Embracing Food as Medicine: "Healthy from the inside out," (b) Benefiting from a Holistic Approach: "Feeding your body is feeding your soul and is feeding your mind," (c) Adopting a Lifestyle Change and Its Evolution Over Time: "Getting older and realizing what you need," (d) Finding Time for "The Joy of Cooking," versus Time Constraints, (e) Fostering Community: The "Community-Building Power of Food," and (f) Following the Call: "I'm motivated by my moral compass." For nurses, primary care nurse practitioners, and psychiatric mental health nurse practitioners, a holistic approach, including an anti-inflammatory diet, could be key for managing symptoms of anxiety and depression among emerging adults.

Vegetarian Diets During Complementary Feeding: An Overview of Nutritional and Health Features

Nowadays, vegetarian diets are present in a solid way in Western countries' lifestyles. Some families opt for this dietetic pattern for their infants too, during the period of introduction of complementary foods. Many releases have been issued about this subject, with different and often contradictory advice and conclusions. The aim of this work is to provide a comprehensive overview through the analysis of recently published opinions of the implementation of a vegetarian or vegan diet over the course of complementary feeding. The literature agrees about some key points to consider, that is the necessity for the diet to be well-planned, in order to meet energy, macro- and micronutrients requirements, as well as the need to follow the child longitudinally. Also, there is a substantial agreement on the need for fortified foods and/or supplements to be included in the diet. Following these suggestions, most (but not all) of the papers agree that normal growth and development may be achieved. Final considerations, however, are not straightforward to make and more research with better definition of the features of the diet adopted and of supplementation used and long-term follow-up studies are highly warranted.

Food groups, macronutrient intake and objective measures of total carotenoids and fatty acids in 16-to-24-year-olds following different plant-based diets compared to an omnivorous diet

BACKGROUND

Knowledge about the diet quality among youth who follow different types of plant-based diets is essential to understand whether support is required to ensure a well-planned diet that meets their nutritional needs. This study aimed to investigate how food groups, macronutrient intake, and objective blood measures varied between Norwegian youth following different plant-based diets compared to omnivorous diet.

METHODS

Cross-sectional design, with healthy 16-to-24-year-olds (n = 165) recruited from the Agder area in Norway, following a vegan, lacto-ovo-vegetarian, pescatarian, flexitarian or omnivore diet. Participants completed an electronic questionnaire, a dietary screener, 24-hour dietary recalls and provided dried blood samples for analysis of carotenoids and fatty acids.

RESULTS

Vegans reported the highest mean intake (g/d, g/MJ) of vegetables, legumes, nuts and seeds and substitutes to dairy and meat (compared to all, p<0.001), fruit and berries (compared to omnivores, p = 0.004 and pescatarians, p = 0.007), and vegetable oil (compared to omnivores, p<0.001, pescatarians, p = 0.003 and flexitarians, p = 0.004) and vegetable products (compared to omnivores, p = 0.007). No difference was found between groups in mean intake (g/d, g/MJ) of any of the confectionary foods or sweet pastries, beverages (sugar-sweetened, non-sugary, alcoholic), or salted snacks, neither in g/MJ of convenience foods. The energy percentage (E%) of protein, carbohydrates and total fat were within the Nordic Nutrition Recommendations 2023 across groups. However, all groups, except vegans, exceeded the E% for saturated fatty acids. All groups exceeded recommendations for added and free sugar. Furthermore, all groups consumed <25g/d of dietary fibre, except vegans and pescatarians. For omega-3, lacto-ovo-vegetarians had intakes below recommendations. Blood marker of total carotenoids did not differ between groups, neither did the reported mean intake (g/MJ) of carotenoid-rich foods. Vegans showed the lowest blood level of palmitic acid compared to all (p<0.001), but highest level of linoleic acid (compared to flexitarians, p = 0.022, and omnivores, p<0.001). The lowest blood levels of eicosapentaenoic acid and docosahexaenoic acid were found in vegans and lacto-ovo-vegetarians.

CONCLUSIONS

Our findings suggest that all groups had risk of dietary shortcomings. However, vegans consumed the most favorable diet. All groups should increase their consumption of vegetables, fruits and berries, and reduce their total sugar intake.

Planetary Health Diet and Cardiovascular Disease Risk in the Seguimiento Universidad de Navarra (SUN) Cohort

BACKGROUND/OBJECTIVES

Noncommunicable diseases, particularly cardiovascular disease (CVD), represent a significant global public health challenge, with unhealthy diets as a major risk factor. This study investigates the association between adherence to the Planetary Health Diet proposed by the EAT-Lancet Commission and CVD risk.

METHODS

Utilizing data from the Seguimiento Universidad de Navarra (SUN) cohort, which included 18,656 participants (mean age 38 years; 61% women), we assessed dietary intake using a validated food frequency questionnaire and the Planetary Health Diet Index to evaluate adherence (range 0-42). CVD was defined as new-onset stroke, myocardial infarction, or CVD death.

RESULTS

After a median follow-up time of 11.5 years, 220 cases of CVD were identified. Higher adherence to the Planetary Health Diet revealed no statistically significant reduction in CVD risk associated with the diet. Cox proportional hazard models indicated a trend towards lower CVD risk in the highest adherence quartile, but this did not reach significance (HR 0.77, 95% CI 0.51-1.18, p-trend = 0.127). Sensitivity analyses corroborated these results. Discrepancies in previous studies highlight the complexity of dietary assessments and underscore the need for standardized scoring systems.

CONCLUSIONS

In a large Spanish cohort, adherence to the Planetary Health Diet showed no significant reduction in CVD risk. Further research is needed to reach a consensus on the operational definition of the Planetary Health Diet and to clarify the relationship between diet and CVD risk.

A systematic review and meta-analysis of functional vitamin B12 status among adult vegans

The dietary intake of vitamin B12 among unsupplemented vegans is notably lower compared to both vegetarians and omnivores. Prolonged low intakes of vitamin B12, such as seen in those adhering to a vegan diet, lead to physiological deficiency of vitamin B12 and an elevated risk of B12-related morbidity. However, while serum B12 serves as a conventional biomarker for assessing B12 status, its utility is limited given its sensitivity and specificity in ascribing physiological deficiency of B12 and the functional vitamin B12 status of those adhering to vegan diets is unclear. We conducted a systematic review and meta-analysis using data based on the full panel of biomarkers of vitamin B12 status to test whether adherence to a vegan diet is associated with an elevated risk of functional vitamin B12 deficiency compared to vegetarian or omnivorous diets. In addition, subgroup analysis was carried out to look at the effect of vitamin B12 supplement use on B12 status among vegans. Our search identified 4002 records, of which 19 studies met the inclusion criteria for the systematic review and 17 studies were taken forward for the meta-analysis. Meta-analysis results revealed significantly lower serum B12, pmol/ (-0.72 [-1.26, -0.18]; p = 0.01) and elevated total homocysteine, μmol/L (tHcy) (0.57 [0.26, 0.89]; p < 0.001) concentrations, alongside elevated methylmalonic acid, nmol/L (MMA) (0.28 [-0.01, 0.57]; p = 0.06) and lower holotranscobalamin, pmol/ (HoloTC) (-0.42 [-0.91, 0.07]; p = 0.09) levels among vegan adults compared to omnivores, indicating increased functional B12 deficiency in addition to low vitamin B12 status in vegan adults. There were no differences between vegans and vegetarians in HoloTC (0.04 [-0.28, 0.35]; p = 0.814) or MMA (-0.05 [-0.29, 0.20]; p = 0.708), but differences were found in serum B12 (-0.25 [-0.40, -0.10]; p = 0.001) and for tHcy (0.24 [0.09, 0.39]; p = 0.002) concentrations. Subgroup analyses indicated that the use of vitamin B12 supplements among vegans contributes to significant improvements in all biomarker concentrations compared to their unsupplemented counterparts. Our findings underscore the need for improved strategies to redress poor vitamin B12 status with appropriate B12 supplementation use among those adhering to vegetarian and vegan diets.

Association between provegetarian food patterns and micronutrient adequacy in preschoolers: the SENDO project

This study aims to examine the association between different versions of a provegetarian food pattern and micronutrient adequacy in a population of children from the SENDO Project. Children aged 4-5 years old were recruited and baseline information on diet, lifestyle and socio-demographic characteristics was collected through self-administered online questionnaires completed by their parents. Scores were calculated for overall, healthful, and unhealthful provegetarian food patterns (FP) using an a priori approach. Participants were categorized into tertiles according to their scores. Micronutrient adequacy was assessed using the Estimated Average Requirement (EAR) cut-off point. Multivariate analyses were performed to evaluate the relationship between tertiles of each provegetarian FP and the risk of inadequate micronutrient intake (failing to meet ≥ 3 requirements). Despite lower intakes of certain micronutrients, children with higher scores in the healthful provegetarian FP did not exhibit a higher prevalence of inadequacy. Children in the highest tertile of this index had 0.47-fold lower odds (95%CI 0.23-0.95) of having ≥ 3 inadequate micronutrient intakes than their peers in the lowest tertile, after adjusting for potential confounders. In contrast, children in the highest tertile of the unhealthful provegetarian FP had 20.06-fold higher odds (95%CI 9.19-43.79) of having ≥ 3 inadequate micronutrient intakes compared to children in the lowest tertile.

CONCLUSIONS

Adherence to a healthful provegetarian food pattern is associated with improved nutritional adequacy in preschoolers, while following an unhealthful pattern is detrimental to micronutrient adequacy. These results suggest that moderate reductions in animal food consumption within a healthy diet may not compromise micronutrient adequacy in young children. Further research is needed to explore the impact of diets reduced in animal food intake on the health of children.

WHAT IS KNOWN

• There's a notable trend towards plant-based diets due to health and sustainability concerns. • Research links plant-based diets in adults with lower risks of obesity, cardiovascular disease, and cancer.

WHAT IS NEW

• A new study examines how different versions of a provegetarian food pattern affect micronutrient adequacy in children, using a moderate and stepwise approach. • Following a healthful provegetarian food pattern enhances nutritional adequacy in preschoolers, whereas an unhealthful pattern negatively impacts micronutrient adequacy.

Knowledge, attitude and practices of health professionals with regard to plant-based diets in pregnancy: a scoping review

OBJECTIVE

This scoping review aimed to systematically map and describe the existing evidence regarding the knowledge, attitudes and practices of health professionals with regard to plant-based diets during pregnancy and to highlight areas for further research.

DESIGN

Following a pre-registered protocol, online databases were searched using a comprehensive search string, in addition to selected grey literature sources, and reference lists of included studies. The studies were independently screened for eligibility by two authors, SM and JM. Data from all eligible studies were charted by the first author, and a narrative summary was performed.

SETTING

Maternal health care services.

RESULTS

Ten studies were included for review, from New Zealand (n 2), Australia (n 2), Germany, Netherlands, United Kingdom, France, Italy and Peru. Most of these studies were observational, employed various validated and non-validated survey instruments, interviews and one education intervention. Knowledge was the most frequently assessed outcome in the reviewed studies. Health professionals' knowledge of plant-based nutrition in pregnancy was reported to be limited and frequently attributed to a lack of nutrition training. Participants' personal dietary patterns and work specialisation appear to be closely associated with their knowledge, attitudes and practices regarding plant-based diets.

CONCLUSION

This review identified a significant research gap regarding health professionals' practices in relation to plant-based diets during pregnancy. Additionally, this review has demonstrated the need for further research, awareness and practice protocols to promote high-quality care and education or professional development to address the prevalent lack of knowledge among this group.

Combined mediterranean diet-based sustainable healthy diet and multicomponent training intervention impact on plasma biomarkers and metabolome in older adults

BACKGROUND AND AIMS

Healthy dietary patterns and exercise practices have been associated with improved metabolic and inflammatory profiles. However, studies regarding the combined effect of these interventions on plasma biomarkers and metabolome in older adults are sparser. The primary aim of this study was to investigate the impact of a combined Mediterranean Diet-based Sustainable Healthy Diet (SHD) and Multicomponent Training (MT) intervention on the plasma biomarkers and metabolome and how dietary intake and exercise could modulate these effects.

METHODS

SHD intervention included a weekly supply of Mediterranean Diet-based SHD food and four nutrition sessions involving a Mediterranean-Diet culinary workshop, and the exercise program included 50-min MT group sessions, held three times a week, lasting both 12 weeks. Plasma biomarkers were obtained through standard biochemical analysis. A proton (1H) nuclear magnetic resonance (NMR) spectroscopy-based metabolomics approach was used to study the metabolome in blood plasma. Repeated measures ANOVA were performed and adjusted for confounders.

RESULTS

SHD + MT intervention significantly decreased HDL-C and calcium. SHD + MT showed some changes in common with the SHD and MT group, namely a significant decrease in citrate levels (p = 0.009 for SHD + MT; p = 0.037 for SHDT) and an increase in pyruvate (p < 0.001 for MT and SHD + MT). The SHD + MT group also revealed specific changes in the levels of some amino acids (decrease in alanine, glutamine and lysine: p = 0.026; p < 0.001; p = 0.038, respectively). Increases in formate (p = 0.025) and unsaturated lipids (p = 0.011) are consistent with changes in energy and lipoprotein metabolism.

CONCLUSION

Our data show that a combined lifestyle intervention program, including a Mediterranean Diet-based SHD and MT, could modulate biomarker and metabolome and there seems to be a metabolic path associated to these interventions in older adults. Due to its wide-ranging relevance, it is pertinent to assess to what extent combined SHD and MT can contribute to better clinical profiles.

Adherence to the EAT-Lancet diet reduces the risk of head and neck cancers in 101,755 American adults: a prospective cohort study

OBJECTIVES

The aim of this study was to explore the relationship between the EAT-Lancet diet (ELD) and head and neck cancers (HNCs) in 101,755 Americans enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

STUDY DESIGN

Prospective cohort study.

METHODS

ELD score was calculated to assess participant's adherence to ELD. Cox hazard regression models were utilised to evaluate the association of ELD and dietary components with HNC risk. Restricted cubic spline (RCS) plots were employed to explore the linearity of the relationships. Predefined subgroup analyses and sensitivity analyses were performed to identify potential effect modifiers and to assess the stability of the findings, respectively.

RESULTS

After a mean follow-up of 8.84 years, 279 cases of HNCs, including 169 cases of oral cavity and pharyngeal cancers and 110 cases of laryngeal cancer were recorded. This study observed a dose-response negative correlation between ELD and HNCs (hazard ratio [HR]Q4 vs Q1: 0.52; 95% confidence interval [CI]: 0.34, 0.80; P-trend = 0.003; HRper SD increment: 0.80; 95% CI: 0.71, 0.91), and oral cavity and pharyngeal cancers (HRQ4 vs Q1: 0.52; 95% CI: 0.31, 0.88; P-trend = 0.008; HRper SD increment: 0.78; 95% CI: 0.66, 0.92). Analysis using RCS plots indicated a significant linear association between adherence to the ELD and reduced risk of HNCs and oral cavity and pharyngeal cancers (P-nonlinearity > 0.05). Subgroup analysis did not reveal significant interaction factors (P-interaction > 0.05), and sensitivity analysis confirmed the robustness of this study. Additionally, negative correlations were found between the consumption of fruits and whole grains and HNCs (fruits: HRQ4 vs Q1: 0.58; 95% CI: 0.40, 0.84; P-trend = 0.010; whole grains: HRQ4 vs Q1: 0.51; 95% CI: 0.26, 0.97; P-trend = 0.004).

CONCLUSION

Adherence to ELD contributes to the prevention of HNCs.

Health Benefits of a Plant-Based Dietary Pattern and Implementation in Healthcare and Clinical Practice

The American College of Lifestyle Medicine recommends eating a predominantly plant-based diet with a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds. At any level, adoption of a plant-based diet can improve one's health through a variety of mechanisms. Increasing intake of plant-based foods often results in increases in fiber intake, decreases in saturated fat intake, and increased intake of essential vitamins and minerals, among other healthful benefits. Despite such potential benefits, many individuals are reluctant or resistant to change their usual dietary behaviors or unable to sustain diet changes over time. This is largely because an individual's decision to adopt a plant-based diet is influenced by a diverse array of motivating factors, priorities, and/or misconceptions about nutrient adequacy of plant-based diets. Here, we discuss key points from a session at the American College of Lifestyle Medicine's annual conference LM2023. Specifically, we review common preconceptions about plant-based diets, provide guidance on removing the barriers to adopting and adhering to plant-based diets, and highlight key literature findings supporting the health benefits of plant-based diets. Last, we discuss how plant-based diets are increasingly being implemented within health care and clinical practice to support Food is/as Medicine approaches.

Trends in Plant-Based Diets and the Associated Health Characteristics among Canadians

In Canada, unhealthy dietary patterns comprise diets with poor nutrient density and are associated with chronic conditions. Plant-based diets have gained popularity due to their ability to provide a nutritionally adequate healthy diet. This study aims to compare sociodemographic, socioeconomic, and health characteristics, and diet quality between Canadian adults following plant-based and omnivore diets as well as assess the extent to which key nutrient intakes are of public health concern among Canadians following plant-based diets. The study used nationally representative nutritional data from the 2015 Canadian Community Health Survey and descriptive statistics were computed. The analysis determined that Canadians following strict plant-based diets (1% of total population) were significantly more likely to be an immigrant to Canada, less likely to meet national physical activity guidelines, and less likely to be overweight, compared to Canadians following omnivore diets. Compared to omnivore diets, plant-based diets were nutritionally superior according to the Nutrient-Rich Food index. Continued knowledge translation on what comprises healthy plant-based diets, public guidance on the intersection between diet and health, and the completion of prospective cohort studies are needed. To conclude, the research suggests well-planned plant-based diets, in comparison to omnivore diets, offer a nutrient-dense diet.

Association of plant-based diet indexes with the metabolomic profile

Plant-based diets have gained attention for their potential benefits on both human health and environmental sustainability. The objective of this study was to investigate the association of plant-based dietary patterns with the endogenous metabolites of healthy individuals and identify metabolites that may act as mediators of the associations between dietary intake and modifiable disease risk factors. Adherence to plant-based dietary patterns was assessed for 170 healthy adults using plant-based diet indexes (PDI). Individuals with higher healthful PDI had lower BMI and fasting glucose and higher HDL-C, while those with higher unhealthful PDI had higher BMI, triacylglycerol and fasting glucose and lower HDL-C. Unhealthful PDI was associated with higher levels of several amino acids and biogenic amines previously associated with cardiometabolic diseases and an opposite pattern was observed for healthful PDI. Furthermore, healthful PDI was associated with higher levels of glycerophosphocholines containing very long-chain fatty acids. Glutamate, isoleucine, proline, tyrosine, α-aminoadipate and kynurenine had a statistically significant mediation effect on the associations between PDI scores and LDL-C, HDL-C and fasting glucose. These findings contribute to the growing evidence supporting the role of plant-based diets in promoting metabolic health and shed light on the potential mechanisms explaining their beneficial health effects.

Plant-Based Meat Analogs and Their Effects on Cardiometabolic Health: An 8-Week Randomized Controlled Trial Comparing Plant-Based Meat Analogs With Their Corresponding Animal-Based Foods

BACKGROUND

With the growing popularity of plant-based meat analogs (PBMAs), an investigation of their effects on health is warranted in an Asian population.

OBJECTIVES

This research investigated the impact of consuming an omnivorous animal-based meat diet (ABMD) compared with a PBMAs diet (PBMD) on cardiometabolic health among adults with elevated risk of diabetes in Singapore.

METHODS

In an 8-wk parallel design randomized controlled trial, participants (n = 89) were instructed to substitute habitual protein-rich foods with fixed quantities of either PBMAs (n = 44) or their corresponding animal-based meats (n = 45; 2.5 servings/d), maintaining intake of other dietary components. Low-density lipoprotein (LDL) cholesterol served as primary outcome, whereas secondary outcomes included other cardiometabolic disease-related risk factors (e.g. glucose and fructosamine), dietary data, and within a subpopulation, ambulatory blood pressure measurements (n = 40) at baseline and postintervention, as well as a 14-d continuous glucose monitor (glucose homeostasis-related outcomes; n = 37).

RESULTS

Data from 82 participants (ABMD: 42 and PBMD: 40) were examined. Using linear mixed-effects model, there were significant interaction (time × treatment) effects for dietary trans-fat (increased in ABMD), dietary fiber, sodium, and potassium (all increased in PBMD; P-interaction <0.001). There were no significant effects on the lipid-lipoprotein profile, including LDL cholesterol. Diastolic blood pressure (DBP) was lower in the PBMD group (P-interaction=0.041), although the nocturnal DBP dip markedly increased in ABMD (+3.2% mean) and was reduced in PBMD (-2.6%; P-interaction=0.017). Fructosamine (P time=0.035) and homeostatic model assessment for β-cell function were improved at week 8 (P time=0.006) in both groups. Glycemic homeostasis was better regulated in the ABMD than PBMD groups as evidenced by interstitial glucose time in range (ABMD median: 94.1% (Q1:87.2%, Q3:96.7%); PBMD: 86.5% (81.7%, 89.4%); P = 0.041). The intervention had no significant effect on the other outcomes examined.

CONCLUSIONS

An 8-wk PBMA diet did not show widespread cardiometabolic health benefits compared with a corresponding meat based diet. Nutritional quality is a key factor to be considered for next generation PBMAs. This trial was registered at https://clinicaltrials.gov/as NCT05446753.

Dietary Habits and Race Day Strategies among Flexitarian, Vegetarian, and Vegan Recreational Endurance Runners: A Cross-Sectional Investigation from The NURMI Study (Step 2)

Many of today's recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.

The Future of Plant-Based Diets: Aligning Healthy Marketplace Choices with Equitable, Resilient, and Sustainable Food Systems

The future of plant-based diets is a complex public health issue inextricably linked to planetary health. Shifting the world's population to consume nutrient-rich, plant-based diets is among the most impactful strategies to transition to sustainable food systems to feed 10 billion people by 2050. This review summarizes how international expert bodies define sustainable diets and food systems and describes types of sustainable dietary patterns. It also explores how the type and proportion of plant- versus animal-source foods and alternative proteins relate to sustainable diets to reduce diet-related morbidity and mortality. Thereafter, we synthesize evidence for current challenges and actions needed to achieve plant-based sustainable dietary patterns using a conceptual framework with principles to promote human health, ecological health, social equity, and economic prosperity. We recommend strategies for governments, businesses, and civil society to encourage marketplace choices that lead to plant-rich sustainable diets within healthy, equitable, and resilient agroecological food systems.

A Narrative Review of the Significance of Popular Diets in Diabetes Mellitus Management

Diabetes mellitus is a collection of metabolic disorders marked by elevated levels of glucose in the blood due to irregularities in the generation or functioning of insulin. Medical nutrition therapy and weight loss are crucial elements in the management of diabetes and the prevention of complications. Several diets have become popular over time for the goal of achieving weight loss, but their popularity has declined due to a lack of reliable scientific evidence. This study classifies popular diets into three categories: diets that manage the composition of macronutrients, diets that restrict specific foods or food groups, and diets that manipulate meal timing. The review includes research studies that investigated the effects of popular diets on the prevention, management, and complications of diabetes. It is clear that different popular diets can have positive effects on both preventing and treating diabetes and preventing and treating complications related to diabetes. However, it is not practical to determine which diet is the most effective option for preventing or controlling diabetes. Thus, the main focus should be on common underlying factors that support well-being, such as decreasing the intake of refined grains and added sugar, choosing non-starchy vegetables, and giving priority to whole foods over processed foods whenever possible, until there is stronger evidence supporting the specific benefits of different dietary patterns.

Piloting a brief assessment to capture consumption of whole plant food and water: version 1.0 of the American College of Lifestyle Medicine Diet Screener (ACLM Diet Screener)

Background

Despite the availability of various dietary assessment tools, there is a need for a tool aligned with the needs of lifestyle medicine (LM) physicians. Such a tool would be brief, aimed at use in a clinical setting, and focused on a "food as medicine" approach consistent with recommendations for a diet based predominately on whole plant foods. The objective of this study is to describe the development and initial pilot testing of a brief, dietary screener to assess the proportion of whole, unrefined plant foods and water relative to total food and beverage intake.

Methods

A multidisciplinary study team led the screener development, providing input on the design and food/beverage items included, and existing published dietary assessment tools were reviewed for relevance. Feedback was solicited from LM practitioners in the form of a cross-sectional survey that captured information on medical practice, barriers, and needs in assessing patients' diets, in addition to an opportunity to complete the screener and provide feedback on its utility. The study team assessed feedback and revised the screener accordingly, which included seeking and incorporating feedback on additional food items to be included from subject matter experts in specific cultural and ethnic groups in the United States. The final screener was submitted for professional design, and scoring was developed.

Results

Of 539 total participants, the majority reported assessing diet either informally (62%) or formally (26%) during patient encounters, and 73% reported discussing diet with all or most of their patients. Participants also reported facing barriers (80%) to assessing diet. Eighty-eight percent believed the screener was quick enough to use in a clinical setting, and 68% reported they would use it.

Conclusion

The ACLM Diet Screener was developed through iterative review and pilot testing. The screener is a brief, 27-item diet assessment tool that can be successfully used in clinical settings to track patient dietary intakes, guide clinical conversations, and support nutrition prescriptions. Pilot testing of the screener found strong alignment with clinician needs for assessing a patient's intake of whole plant food and water relative to the overall diet. Future research will involve pilot testing the screener in clinical interventions and conducting a validation study to establish construct validity.

Nutrient composition of plant-based fast-food meals and their omnivore counterparts: A cross-sectional analysis of e-menus

OBJECTIVES

Fast food chains have introduced many plant-based meals to their menus. We aimed to compare the nutrient composition and allergenic content of plant-based (vegan or vegetarian) meals in fast food chains with their animal-based equivalents.

METHODS

E-menus from 50 fast food chains across 5 countries (Australia, Canada, Poland, the UK, and the US) were analyzed. Data on meal type, weight, calories, macronutrients, sodium, fiber, and allergen presence were gathered. Plant-based meals were matched with meat counterparts, where the latter shared the same meal type, originated from the same country and chain, and showed a weight difference of less than 10%. Multivariate logistic regression analysis was performed.

RESULTS

From n = 2455 records, n = 1868 unique meals were matched. Plant-based meals showed lower odds ratios (OR) for protein (OR, 0.10; 95% confidence interval [CI], 0.08-0.14) and sodium (OR, 0.70; 95% CI, 0.55-0.90) and higher odds for carbohydrates (OR, 1.87; 95% CI, 1.41-2.49), sugar (OR, 1.43; 95% CI, 1.12-1.82), and fiber (OR, 4.87; 95% CI, 3.60-6.63) compared with omnivorous meals, adjusted for country, meal type, and meal weight. Notably, plant-based and omnivorous meals were not associated with total caloric content. Separate analyses of vegetarian and vegan meals yielded similar results. Omnivorous meals more frequently contained allergens such as dairy, eggs, fish, shellfish, and mustard, whereas plant-based meals more likely contained allergens such as sesame, seeds, and nuts.

CONCLUSIONS

Plant-based fast food meals were more likely to contain more carbohydrates, sugar, and fiber and less protein and sodium than their animal-based counterparts. These findings emphasize the importance of informed food choices in the fast food context.

Impact of consuming an environmentally protective diet on micronutrients: a systematic literature review

BACKGROUND

A global move toward consumption of diets from sustainable sources is required to protect planetary health. As this dietary transition will result in greater reliance on plant-based protein sources, the impact on micronutrient (MN) intakes and status is unknown.

OBJECTIVE

Evaluate the evidence of effects on intakes and status of selected MNs resulting from changes in dietary intakes to reduce environmental impact. Selected MNs of public health concern were vitamins A, D, and B12, folate, calcium, iron, iodine, and zinc.

METHODS

We systematically searched 7 databases from January 2011 to October 2022 and followed the PRISMA guidelines. Eligible studies had to report individual MN intake and/or status data collected in free-living individuals from the year 2000 onward and environmental outcomes.

RESULTS

From the 10,965 studies identified, 56 studies were included, mostly from high-income countries (n = 49). Iron (all 56) and iodine (n = 20) were the most and least reported MNs, respectively. There was one randomized controlled trial (RCT) that also provided the only biomarker data, 10 dietary intake studies, and 45 dietary modeling studies, including 29 diet optimization studies. Most studies sought to reduce greenhouse gas emissions or intake of animal-sourced foods. Most results suggested that intakes of zinc, calcium, iodine, and vitamins B12, A, and D would decrease, and total iron and folate would increase in a dietary transition to reduce environmental impacts. Risk of inadequate intakes of zinc, calcium, vitamins A, B12 and D were more likely to increase in the 10 studies that reported nutrient adequacy. Diet optimization (n = 29) demonstrated that meeting nutritional and environmental targets is technically feasible, although acceptability is not guaranteed.

CONCLUSIONS

Lower intakes and status of MNs of public health concern are a potential outcome of dietary changes to reduce environmental impacts. Adequate consideration of context and nutritional requirements is required to develop evidence-based recommendations. This study was registered prospectively with PROSPERO (CRD42021239713).

Modelling the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity in a cohort of Australian adults

Dietary guidelines are increasingly promoting mostly plant-based diets, limits on red meat consumption, and plant-based sources of protein for health and environmental reasons. It is unclear how the resulting food substitutions associate with insulin resistance, a risk factor for type 2 diabetes. We modelled the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity. We included 783 participants (55 % female) from the Childhood Determinants of Adult Health study, a population-based cohort of Australians. In adulthood, diet was assessed at three time points using FFQ: 2004–2006, 2009–2011 and 2017–2019. We calculated the average daily intake of each food group in standard serves. Insulin sensitivity was estimated from fasting glucose and insulin concentrations in 2017–2019 (aged 39–49 years) using homoeostasis model assessment. Replacing red meat with a combination of plant-based alternatives was associated with higher insulin sensitivity (β = 10·5 percentage points, 95 % CI (4·1, 17·4)). Adjustment for waist circumference attenuated this association by 61·7 %. Replacing red meat with either legumes, nuts/seeds or wholegrains was likewise associated with higher insulin sensitivity. Point estimates were similar but less precise when replacing processed meat with plant-based alternatives. Our modelling suggests that regularly replacing red meat, and possibly processed meat, with plant-based alternatives may associate with higher insulin sensitivity. Further, abdominal adiposity may be an important mediator in this relationship. Our findings support advice to prioritise plant-based sources of protein at the expense of red meat consumption.

Efficacy of vitamin D2 in maintaining serum total vitamin D concentrations and bone mineralisation in adult dogs fed a plant-based (vegan) diet in a 3-month randomised trial

Dogs are considered omnivores based on their evolution consuming diets including animal tissue. Few feeding trials evaluating the nutritional suitability of exclusively plant-based (vegan) diets in dogs have been published, and the efficacy of vitamin D2 in maintaining canine serum vitamin D levels has not been clearly determined. A blinded dietary trial included sixty-one healthy desexed adult dogs: thirty-one fed an experimental extruded vegan diet (PLANT) and thirty fed a commercial extruded meat-based diet (MEAT) for 3 months. Dogs were screened via veterinary examination and routine laboratory analyses prior to enrolment, at baseline and exit timepoints. Body composition was measured by dual-energy X-ray absorptiometry and blood was collected for vitamin D profiling. All dogs maintained health parameters, body weight and composition throughout the study. Dogs maintained on PLANT demonstrated a significant reduction in platelet count, creatinine, blood urea nitrogen and cholesterol, though values remained within normal reference ranges. Dogs fed PLANT also demonstrated a shift from vitamin D3 to vitamin D2 metabolites, though total vitamin D analogue levels were unchanged, with the exception of 24,25-dihydroxyvitamin D. Bone mineral content and density did not differ from baseline values. Health status was maintained in dogs fed PLANT and vitamin D2 appeared efficacious in maintaining serum total vitamin D concentrations and bone mineralisation. Findings support the hypothesis that PLANT was comparable to MEAT for maintenance of healthy adult dogs for at least 3 months and identified areas where further research is warranted to elucidate the potential risks and benefits of plant-based (vegan) diets.

Experiences of Vegans with General Practitioners in the Austrian Health Care System: A Qualitative Study

This article explores the factors influencing the choice of general practitioners (GPs) and their role in the health care of vegans in Austria. The number of people identifying as vegan is on the rise, and GPs are increasingly confronted with vegan patients. A qualitative method was chosen for this study, and 14 semi-structured interviews with vegans were conducted between April 2022 and July 2022. Participants were recruited primarily through vegan social media groups. In their experiences with health care, vegans felt treated unequally or sometimes incorrectly. The experiences described highlight that participants felt that most GPs were biased against their veganism. Information exchange among vegans primarily takes place online and through publications of vegan associations, while GPs play a minor role in information provision. As the number of vegans grows, an appreciative way of communicating between GPs and vegan patients ought to be promoted. Voluntary interdisciplinary nutritional training, collaboration of the medical field with support organizations, provision of evidence-based information, and collaboration with dietitians and nutritionists could enrich the care of patients with a vegan diet.

Plant-Based Diets and Metabolic Syndrome Components: The Questions That Still Need to Be Answered-A Narrative Review

Metabolic syndrome (MetS) is defined as the co-occurrence of at least three of the following metabolic disorders: abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), high blood glucose, and hypertension. The treatment of MetS involves lifestyle changes, including following an appropriate diet. In addition to weight reduction, it is crucial to search for optimal nutritional patterns that are highly effective in optimizing other MetS markers, such as glucose and lipid metabolism, and reducing blood pressure. To date, the effects of a Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diet on MetS have been extensively evaluated. Recent epidemiological studies suggest that plant-based diets (PBDs) may be effective in treating MetS; however, there is still a lack of experimental data. This review aims to analyze the potential benefits of different PBDs on MetS determinants based on the available studies. The findings may help personalize dietary interventions and improve patient care for those with MetS.

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.

Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease?

Plant-based diets are growing in popularity worldwide due to the importance of reducing the population's ecological footprint as well as an emerging role in the prevention and treatment of chronic human diseases. In adults, plant-based diets have been shown to be beneficial for preventing and controlling conditions that are common in patients with chronic kidney disease (CKD), such as obesity, hypertension, type 2 diabetes, dyslipidemia, and metabolic acidosis. Emerging evidence suggests that the higher fiber content of plant-based diets may help to modulate production of uremic toxins through beneficial shifts in the gut microbiome. The effects of the plant-based diet on progression of CKD remain controversial, and there are no data to support this in children. However, knowledge that the bioavailability of potassium and phosphorus from plant-based foods is reduced has led to recent changes in international kidney-friendly diet recommendations for children with CKD. The new guidelines advise that high potassium fruits and vegetables should no longer be automatically excluded from the kidney-friendly diet. In fact, a plant-based diet can be safely implemented in children with CKD through building the diet around whole, high fiber foods, avoiding processed foods and using recommended cooking methods to control potassium. The health benefits of the plant-based diet compared to omnivorous diets in children with CKD need investigation.

A cross-sectional study of nutritional status in healthy, young, physically-active German omnivores, vegetarians and vegans reveals adequate vitamin B12 status in supplemented vegans

BACKGROUND/OBJECTIVE

Plant-based diets reduce the risk of cardiovascular disease but also increase the risk of certain micronutrient deficiencies, particularly, of vitamin B12 (B12). The extent to which the unsupervised use of oral nutrient supplements is sufficient to prevent these deficiencies is not well established. We analyzed nutrient intake, laboratory biomarkers, supplementation behavior, and B12 status adequacy amongst young, healthy, physically active omnivores, lacto-ovo-vegetarians and vegans from Germany.

METHODS

We recruited 115 participants (n = 40 omnivores; n = 37 lacto-ovo-vegetarians, and n = 38 vegans) with comparable age, sex, marital status, physical activity and educational levels through online advertisements and local newspapers in Freiburg, Germany.

RESULTS

Energy intake and macronutrient distribution were comparable across diets. Major differences included intake of fiber, cholesterol, and several vitamins. Vegans had the lowest intake of B12 from foods (0.43 (0.58) µg/d), compared to omnivores (2.14 (2.29) µg/d) and lacto-ovo-vegetarians (0.98 (1.34) µg/day). Multivariate analysis of 36 blood biomarkers revealed that three major classes of biomarkers contributed the most to the clustering of individuals by dietary group, namely, biomarkers of B12 status (B12, holoTC, Hcy), iron (iron, ferritin, transferrin) and lipid metabolism (vitamin A, HDL, LDL, total cholesterol, TAG). This suggests that nutrients that modify the metabolic pathways represented by these biomarkers have the most penetrating effect on health status across diets. Analysis of B12 status (including 4cB12) revealed adequacy in omnivores and vegans, and a poorer B12 status amongst lacto-ovo-vegetarians. Fewer lacto-ovo-vegetarians used B12 supplements compared to vegans (51% versus 90%).

CONCLUSIONS

Even amongst homogeneously healthy Germans, each diet manifested with measurable differences in dietary intakes and biomarkers of health. Plant-based diets, in particular the vegan diet, exhibited the most favorable patterns of lipid metabolism and glycemic control, but the lowest food intake of B12. Supplementation of healthy vegans with B12 (median 250 µg B12/day, over 2 years) secured an adequate B12 status that was comparable to that of healthy omnivores.Clinical Trial Registry: German Clinical Trial register number: DRKS00027425.

Ultraprocessed plant-based foods: Designing the next generation of healthy and sustainable alternatives to animal-based foods

Numerous examples of next-generation plant-based foods, such as meat, seafood, egg, and dairy analogs, are commercially available. These products are usually designed to have physicochemical properties, sensory attributes, and functional behaviors that match those of the animal-sourced products they are designed to replace. However, there has been concern about the potential negative impacts of these foods on human nutrition and health. In particular, many of these products have been criticized for being ultraprocessed foods that contain numerous ingredients and are manufactured using harsh processing operations. In this article, the concept of ultraprocessed foods is introduced and its relevance to describe the properties of next-generation plant-based foods is discussed. Most commercial plant-based meat, seafood, egg, and dairy analogs currently available do fall into this category, and so can be classified as ultraprocessed plant-based (UPB) foods. The nutrient content, digestibility, bioavailability, and gut microbiome effects of UPB foods are compared to those of animal-based foods, and the potential consequences of any differences on human health are discussed. Some commercial UPB foods would not be considered healthy based on their nutrient profiles, especially those plant-based cheeses that contain low levels of protein and high levels of fat, starch, and salt. However, it is argued that UPB foods can be designed to have good nutritional profiles and beneficial health effects. Finally, areas where further research are still needed to create a more healthy and sustainable food supply are discussed.

A qualitative study of young peoples' thoughts and attitudes to follow a more plant-based diet

Plant-based diets (PBDs) refer to dietary habits that reduce the consumption of animal-based products and increase the consumption of nutritionally rich plant foods. PBD's have been shown to provide significant health benefits, such as reducing obesity and improving psychological wellbeing, and are environmentally friendly. However, few studies have investigated factors that influence young people's thoughts and attitudes toward following a PBD in western societies, particularly in the United Kingdom. Understanding these factors may benefit public health interventions that encourage the consumption of more fruit and vegetables. The aim of this study was to explore the factors that affect young people's intentions toward following a PBD. Twenty-one young people (18-24 years) participated in this qualitative study. Participants were asked about their views of PBDs in a semi-structured interview. Thematic analysis was utilized to explore views and the barriers and facilitators to following a PBD. The Theory of Planned Behavior (TPB) was used as a framework to organise the findings. Within attitudes, the sub-themes identified were an awareness of a healthy diet, environmental concerns, health concerns and distrust, perceptions of PBDs and associated stereotypes, perceived restriction and lack of enjoyment, and need for education. Within subjective norms, the sub-themes identified were cultural and familial norms, peer influence, and exposure through social media. Within perceived behavioral control (PBC), the sub-themes identified were a lack of independence and parental control, lack of knowledge and perceived difficulty, lack of inclusiveness and accessibility, and inconvenience. Overall, the findings suggest that increased provision of education and knowledge about PBDs to young people, and widening access to PBDs, could encourage and help improve their understanding and intention to follow this dietary style. Tailored health promotion strategies, which also consider additional barriers and facilitators found within this study, could motivate young people to consume a more PBD.

Beneficial Effects of Plant-Based Diets on Skin Health and Inflammatory Skin Diseases

The human skin is a crucial organ that protects the organism from the outer environment. Skin integrity and health depend on both extrinsic and intrinsic factors. Intrinsic factors such as aging and genetic background contribute to weakened skin and disease susceptibility. Meanwhile, extrinsic factors including UV radiation, pollution, smoking, humidity, and poor diet also affect skin health and disease. On the other hand, healthy dietary patterns such as plant-based diets have gained popularity as a complementary therapy for skin health. A plant-based diet is defined as all diets based on plant foods, including an abundance of vegetables, fruits, beans, lentils, legumes, nuts, seeds, fungi, and whole grains, with limited or no animal products or processed foods. However, some authors also exclude or limit processed foods in the definition. Recent research has shown that these diets have beneficial effects on inflammatory skin diseases. This review explored the beneficial effects of plant-based diets on inflammatory skin diseases and plant-based functional foods on healthy skin. In conclusion, plant-based diets and plant-based functional foods may have beneficial effects on skin health through the gut microbiome.

The Role of Diet and Specific Nutrients during the COVID-19 Pandemic: What Have We Learned over the Last Three Years?

Nutrients and diets have an important impact on our immune system and infection risk and a huge number of papers have been published dealing with various aspects of nutrition in relation to SARS-CoV-2 infection risk or COVID-19 severity. This narrative review aims to give an update on this association and tries to summarize some of the most important findings after three years of pandemic. The analysis of major studies and systematic reviews leads to the conclusion that a healthy plant-based diet reduces the risks for SARS-CoV-2 infection and especially COVID-19 severity. Regarding micronutrients, vitamin D is to the fore, but also zinc, vitamin C and, to some extent, selenium may play a role in COVID-19. Furthermore, omega-3-fatty acids with their anti-inflammatory effects also deserve attention. Therefore, a major aim of societal nutritional efforts in future should be to foster a high quality plant-based diet, which not only exerts beneficial effects on the immune system but also reduces the risk for non-communicable diseases such as type 2 diabetes or obesity which are also primary risk factors for worse COVID-19 outcomes. Another aim should be to focus on a good supply of critical immune-effective nutrients, such as vitamin D and zinc.

A scoping review of approaches used to develop plant-based diet quality indices

Plant-based dietary patterns are comprised of a range of foods, and increasingly, diet quality indices are used to assess them and their associations with health outcomes. As the design of these indices varies, a review of existing indices is necessary to identify common features, strengths, and considerations. This scoping review aimed to synthesize the literature on plant-based diet quality indices by examining their 1) basis for development, 2) scoring methodology, and 3) validation approaches. MEDLINE, CINAHL, and Global Health databases were systematically searched from 1980 to 2022. Observational studies were included if they assessed plant-based diets in adults, using an a priori methodology with food-based components. Studies conducted among pregnant/lactating people were excluded. Thirty-five unique plant-based diet quality indices were identified in 137 included articles published between 2007 and 2022. Indices were developed to reflect epidemiological evidence for associations between foods and health outcomes (n = 16 indices), previous diet quality indices (n = 16), country-specific dietary guidelines (n = 9), or foods from traditional dietary patterns (n = 6). Indices included 4 to 33 food groups, with fruits (n = 32), vegetables (n = 32), and grains (n = 30) the most common. Index scoring comprised of population-specific percentile cutoffs (n = 18) and normative cutoffs (n = 13). Twenty indices differentiated between healthy and less healthy plant-based foods when scoring intakes. Validation methods included construct validity (n = 26), reliability (n = 20), and criterion validity (n = 5). This review highlights that most plant-based diet quality indices were derived from epidemiological research, the majority of indices differentially scored healthy and unhealthy plant and animal foods, and indices were most often evaluated for construct validity and reliability. To ensure best practice use and reporting of plant-based dietary patterns, researchers should consider the basis for development, methodology, and validation when identifying appropriate plant-based diet quality indices for use in research contexts.

A healthful plant-based eating pattern is longitudinally associated with higher insulin sensitivity in Australian adults

BACKGROUND

A healthful plant-based eating pattern is associated with lower type 2 diabetes risk; however, the association with its preceding state, compromised insulin sensitivity, is less well-established, particularly in younger populations with repeated measures of diet over time.

OBJECTIVE

We aimed to examine the longitudinal relationship between a healthful plant-based eating pattern and insulin sensitivity in young to middle-aged adults.

METHODS

We included 667 participants from the Childhood Determinants of Adult Health (CDAH) study, a population-based cohort in Australia. Healthful plant-based diet index (hPDI) scores were derived from food frequency questionnaire data. Plant foods considered 'healthful' were scored positively (e.g., whole grains, fruit, vegetables), with all remaining foods scored reversely (e.g., refined grains, soft drinks, meat). Updated homeostatic model assessment (HOMA2) estimated insulin sensitivity from fasting insulin and glucose concentrations. We used linear mixed-effects regression to analyse data from two time points: CDAH-1 (2004-06, aged 26-36 years) and CDAH-3 (2017-19, aged 36-49 years). hPDI scores were modelled as between- and within-person effects (i.e., a participant's overall mean and their deviation from said mean at each time point, respectively).

RESULTS

The median follow-up duration was 13 years. In our primary analysis, each 10-unit difference in hPDI score was associated with higher log-HOMA2 insulin sensitivity [95% confidence interval], with between-person (β = 0.11 [0.05, 0.17], P < .001) and within-person effects (β = 0.10 [0.04, 0.16], P = .001). The within-person effect persisted despite accounting for compliance with dietary guidelines. Adjustment for waist circumference attenuated the between-person effect by 70% (P = .26) and the within-person effect by 40% (P = .04).

CONCLUSIONS

In young to middle-aged Australian adults, a healthful plant-based eating pattern (determined using hPDI scores) was longitudinally associated with higher insulin sensitivity, and therefore, potentially lower type 2 diabetes risk later in life.

Comparison of Intake of Food Groups Based on Dietary Inflammatory Index (DII) and Cardiovascular Risk Factors in the Middle-Age Population of Lower Silesia: Results of the PURE Poland Study

Chronic inflammation is involved in the pathogenesis of many non-infectious diseases, including cardiovascular diseases (CVD), a leading cause of death in Europe. The aim of the study was to assess the inflammatory potential of the diets of participants enrolled in the Polish arm of the Prospective Urban and Rural Epidemiological (PURE) study, evaluate the association between the dietary inflammatory index (DII) score with the dietary content, and to determine the correlation of DII score with selected anthropometric parameters and biochemical risk factors for CVD. Diets were assessed with the Food Frequency Questionnaire (FFQ). Among participants with pro-inflammatory diets, we reported higher mean values of triglycerides (TG), fasting glucose (FG), atherogenic index of plasma (AIP), and the Castelli's risk index (CRI) in the group of men and women, and higher waist circumference (WC) and waist-to-hip ratio (WHR) in the group of women. Pro-inflammatory diets were associated with higher intake of refined grains, sweets, juices, red meat, high-fat cheese and cream, alcohol, fats except for vegetable oils, potatoes, sugar and honey, French fries, fried fish, and processed/high-fat poultry. Moreover, study participants with pro-inflammatory diets consumed more milk, low-fat dairy, and eggs associated with unhealthy dietary habits, but this should not be considered as an independent CVD risk factor. Anthropometric and biochemical outcomes were more favorable among study participants who consumed more vegetables, fruits, nuts, seeds, raisins, pulses, low-fat poultry, and tea. However, association of beverage consumption with dietary inflammatory potential requires further study.

Mediterranean Diet and Parkinson's Disease

Parkinson's disease (PD) is an age-related neurodegenerative disorder, diagnosed on the basis of typical motor disturbances, but also characterized by the presence of non-motor symptoms, such as rapid eye movement (REM)-sleep behavior disorders, olfactory impairment, and constipation, which are often prodromal to the onset of the disease. PD is often associated with the presence of oxidative brain injury and chronic neuroinflammation, with infiltration and accumulation of peripheral immune cells that have been found in affected brain regions of PD patients. Recently, the role of the gut-brain axis in the pathogenesis of PD is getting more and more attention, and several pieces of evidence indicate alterations in the gut microbiota of PD-affected patients. Diet exerts a central role in defining the microbiota composition and different dietetic patterns can result in a higher or lower abundance of specific bacteria that, in turn, can affect gut permeability and express anti- or pro-inflammatory metabolites. In the present review, the effects of the Mediterranean diet in modulating both PD onset and its progression will be considered with a special focus on the antioxidant and anti-inflammatory properties of this dietetic regimen as well as on its effects on the microbiota composition.

Self-Reported Purchasing Behaviour, Sociodemographic Predictors of Plant-Based Protein Purchasing and Knowledge about Protein in Scotland and England

Plant-based diets are seen as a food-based strategy to address both the impact of dietary patterns on the environment, to reduce climate change impact, and also to reduce rates of diet-related disease. This study investigated self-reported consumer purchasing behaviour of plant-based alternative foods (PBAF) and wholefood plant protein foods (legumes) with a cross-sectional online survey. We identified the sociodemographic factors associated with purchasing behaviour and examined knowledge about protein and plant-based diets. We recruited and obtained consent from n = 1177 adults aged >18 from England and Scotland (mean age (± standard deviation (SD)) 44 (16.4) years), across different areas of social deprivation, based on postcode. Descriptive statistics were conducted, and sociodemographic factors were examined by computing covariate-adjusted models with binary logistic regression analysis. A total of 47.4% (n = 561) consumers purchased PBAF and 88.2% (n = 1038) wholefood plant-proteins. The most frequently purchased PBAF were plant-based burgers, sausages, and mince/meatballs. Individuals from low deprivation areas were significantly more likely than individuals from high deprivation areas to purchase wholefood plant-proteins (odds ratio (OR) 3.46, p = 0.001). People from low deprivation areas were also more likely to recognise lentils as good source of protein (OR 1.94, p = 0.003) and more likely to recognise plant-based diets as healthy (OR 1.79, p = 0.004) than those from high deprived areas. These results support current trends of increasing popularity of PBAF, which is positive for the environment, but also highlights these products as being ultra-processed, which may negatively impact on health. The study also re-enforces the link between deprivation, reduced purchasing of wholefood plant-proteins and knowledge of plant-based protein and diets. Further research is needed to examine healthfulness of PBAF and how sociodemographic factors, especially deprivation, affect both food choice and consumption of wholefood plant-proteins.

A Global Analysis of National Dietary Guidelines on Plant-Based Diets and Substitutions for Animal-Based Foods

Discussing plant-based diets and substitutions for animal-based foods in food-based dietary guidelines (FBDGs) can be a key step in making dietary recommendations more sustainable and healthy as well as more inclusive. The existing large-scale evaluations of FBDGs do not assess whether and to what extent countries cover the broad spectrum of plant-based diets and have policy positions on vegetarian diets, including vegan diets, and whether they mention specific plant-based alternatives to milk, dairy products, and meat. The main aim of this state-of-the-art review was to determine whether and how FBDGs provide such information. An overall 95 guidelines and 100 corresponding countries were assessed via an exploratory sequential mixed method. This involved qualitative explorative content analysis of the guidelines, followed by hierarchical cluster analysis. Furthermore, the Balanced Food Choice Index (BFCI) was constructed, which measures the extent to which FBDGs provide recommendations that cover the broad spectrum of plant-based diets, with some or no animal-based products. To explore the correlations between FBDGs' recommendations and ecological and economic country characteristics, ordinary least squares regression was used. It was found that most countries do not provide information to their citizens that cover the broad spectrum of plant-based diets, as indicated by the mean score of the BFCI (33.58 of 100 points). A total of 38 guidelines (40%) contain a position on vegetarian diets. Nearly half (45%) of all FBDGs already mention plant-based alternatives to meat or animal milk. The regressions showed that the BFCI correlates positively with countries' ecological efforts and negatively with the importance of animal-based products in their economies. This study demonstrates considerable information insufficiency in current FBDGs worldwide. FBDGs should provide recommendations for the broad spectrum of plant-based diets and balance the ethical, ecological, religious, and economic aspects that play a role in people's food choice.

Plant-Based Innovations for the Transition to Sustainability: A Bibliometric and in-Depth Content Analysis

Plants maintain the ecological equilibrium of the earth and stabilize the ecosystem. Today, traditional commodities and new value-added markets can be served simultaneously. There is significant biosource and bioprocess innovation for biobased industrial products. Furthermore, plant-based innovation is associated with the transition to sustainability. This study performed a bibliometric and in-depth content analysis to review plant-based innovations in the research field between 1995 and 2022. A set of 313 articles was identified from the Scopus and Web of Science databases. Different analytical scientometric tools (topic mapping and overlay visualization networks) were used to analyze 124 articles; the most influential countries, institutions, authors, journals and articles were identified. Through in-depth studies, based on the grounded theory approach, five leading research areas related to plant-based innovation were determined: (1) agricultural/environmental innovation, (2) plant-based food or feed innovation, (3) innovation within the medical/pharmaceutical research area, (4) technology-related innovation and (5) economic/business aspects of plant-based innovations. Future research directions include exploring less examined and new topics, such as the sustainability implications of incorporating various plant-based foods and Industry 4.0 in plant-based innovation, and linking and developing findings from different research areas.