Perspective: Identifying Ultra-Processed Plant-Based Milk Alternatives in the USDA Branded Food Products Database

Defining the role of processing in food classification systems-the IUFoST formulation & processing approach

The Task Force on Food Processing for Nutrition, Diet and Health established by the International Union of Food Science and Technology (IUFoST) has developed a rational approach to determine the impact of food processing on the nutritional value of processed foods, called the IUFoST Formulation and Processing Classification (IF&PC) scheme which is comprehensively reported here. The purpose of developing this scheme is (A) to address the current confusion between formulation and processing and thereby offer assistance to improve and refine the controversial NOVA classification system, and (B) to explore the potential for considering other relevant essential food attributes, such as (a) safety, (b) sustainability, (c) palatability, (d) affordability, and (e) convenience in food product classification. The authors recommend that this IUFoST initiative be further investigated and complemented based on concerted R&D interactions of food scientists, food engineers, and nutritionists.

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.

Ultra-Processed Foods Marketed in Türkiye: An Analysis of Nutritional Quality and Packaging Sustainability

This study aimed to evaluate the nutritional profile and packaging recycling status of ultra-processed foods (UPFs) sold in chain markets across Türkiye. In this regard, the nutritional quality and recyclability status of the packages of UPFs, as defined by NOVA, sold in five major supermarket chains across Türkiye were examined. The energy and nutrient content displayed on UPF labels were analysed, and their nutritional profiles considered using the Nutri-Score algorithm. The study also documented the frequency of recycling symbols on the packaging. Of the 1365 UPFs examined across 13 categories, 61.6% were identified as having an unhealthy nutritional profile (Nutri-Score Grades D and E), whereas only 16% were classified as healthy (Grades A and B). Categories predominantly containing unhealthy products included milk and dairy, sauces and dressings, frozen and dehydrated meals, processed meats, along with various snacks and desserts like salty and sweet snacks, candies, chocolates and ice cream. Notably, candies, chocolates, and salty and sweet snacks were identified as the most energy-dense UPF categories. In terms of packaging, 84.4% of UPFs used at least one recycling symbol, 55.3% of these used plastic material and 38.2% used the Green Dot symbol. The results of the study may guide UPF nutrient profile reformulations and contribute to epidemiological studies analysing the relationship between UPF consumption and public health. Furthermore, these results highlight the necessity for more defined national regulations on the recycling of food packaging within the context of food system sustainability.

Parent and physician beliefs, perceptions and knowledge of plant milks for children

Background: Parent and physician perceptions of plant milk are unclear. Aim: To explore parent and physician perceptions of plant milk for children and to gain a better understanding of why parents and physicians might choose plant milk for children. Methods: A mixed methods study was conducted using a questionnaire and interviews with parents and physicians participating in the TARGet Kids! cohort study. Questionnaire data were analyzed using descriptive statistics. Interview transcripts were analyzed using thematic analysis. Results: Parents reported a variety of reasons for choosing plant milk for their children including concerns around allergies, the environment, animal welfare, plant-based diet, health benefits, taste and hormones in cow's milk. Parents gave their children various types of plant milks and physicians provided various recommendations to parents of children not consuming cow's milk. Our study identified that 79% of parents and 51% of physicians were unaware that soy milk is the recommended cow's milk substitute for children. Additionally, 26% of parents did not know some plant milks are not fortified and can contain added sugar. Three main themes were identified from interviews about why parents and physicians may choose plant milk for children: (i) healthiness of plant milk; (ii) concerns about hormones; and (iii) environmental impacts. Conclusions: Parents and physicians choose the milk that they believe is healthiest for their child or patient. However, a lack of clarity on the effects of plant milk consumption on children's health resulted in conflicting views on whether plant milk or cow's milk is healthier for children.

Overview: the food matrix and its role in the diet

The food matrix which includes the physiochemical structure and interaction with chemical constituents is a focus of investigation that is revealing potentially important influences on diet and health. This paper, the first in an article collection titled, The Important Role of the Dairy Matrix in Diet and Health, serves as an introduction to the food matrix to put into context the subsequent articles specific to the matrix effects of dairy milk, cheese and yogurt on human health. This introductory article describes the effects of processing on the food matrix and implications for diet and health, examines the contribution of nutrients compared to whole foods and food patterns, and characterizes examples of the complexity of the food matrix including current controversies of dairy fat and ultra-processed foods. The gaps in knowledge and research identified in this overview may help guide researchers and funding entities moving forward. Current knowledge indicates that translating research on the food matrix to the consumer through recommendations for the intake of whole foods and food patterns is prudent at this time.

Nova fails to appreciate the value of plant-based meat and dairy alternatives in the diet

Processed foods play an important role in achieving both food and nutrition security. However, in recent years, there has been increased concern about the health effects of food processing, in large part because of the emergence of the Nova food classification system. Nova classifies all foods into one of four groups purportedly based entirely on the extent to which they have been processed. Recommendations to limit intake of ultra-processed foods (UPF) (group 4) are based primarily on observational studies showing that their intake is associated with a range of adverse outcomes. Nearly all plant milks and the entire new generation of plant-based meat alternatives (PBMAs), which are made using concentrated sources of plant protein, are classified as UPFs. This classification may deter the public from consuming and health professionals from recommending these products even though they represent a convenient way to increase plant protein intake in high-income countries, which is recommended by health authorities. However, although total UPF intake is associated with adverse health outcomes, this is not the case for many subcategories of UPFs. Furthermore, in many instances, clinical research shows that PBMAs and plant milks have beneficial effects relative to their animal-based counterparts (Group 1). Collectively, the evidence leads to two conclusions. First, PBMAs represent a viable approach for lowering the dietary animal to plant protein ratio. Second, Nova paints with too broad a brush and is insufficiently nuanced to serve as a public guide for food purchasing decisions and may distract consumers from focusing on the importance of nutrient content.

A comparison of the effects of dairy products with their plant-based alternatives on metabolic responses in healthy young Canadian adults: a randomized crossover study

Plant-based food demand is rapidly increasing. However, the metabolic responses of plant proteins within their commercially available form remain unclear. Two randomized crossover experiments compared plant-based alternatives to dairy on postprandial glycemia, metabolic hormones, and appetite before and after a fixed-size (12 kcal/kg body weight) pasta meal in sixteen healthy young adults (eight males and eight females). In experiment 1, participants (22.8 ± 2.3 year) consumed one serving of Greek yogurt (175 g), cheddar cheese (30 g), plant-based cheese (30 g), or plant-based yogurt (175 g). In experiment 2, participants (22.3 ± 2.4 year) consumed one serving (250 mL) of cow's milk, vanilla soy beverage or vanilla almond beverage, and (30 g) of cheddar cheese or plant-based cheese. Blood glucose, insulin, and appetite were measured at baseline, post-treatment, and following a fixed-size pasta meal (post-meal) within 15-30 min. In experiment 2, C-peptide, glucagon-like peptide-1 (GLP-1), and ghrelin were measured. Greek yogurt and cheddar cheese lowered post-meal blood glucose more than their plant-based alternatives (p < 0.01) and post-treatment blood glucose was higher following almond beverage than cheddar cheese and plant-based cheese (p < 0.01). In experiment 1, post-treatment insulin was higher after Greek yogurt than cheddar cheese and plant-based cheese and all treatments post-meal (p < 0.02). Post-meal appetite was lower after plant-based yogurt than cheddar cheese and plant-based cheese (p < 0.01). In experiment 2, post-treatment insulin was higher after almond beverage compared to all treatments (p < 0.01), and post-meal GLP-1 was higher after milk than almond beverage (p = 0.03). We conclude that the physiological functionality of plant-based alternatives as measured by blood glucose, insulin, C-peptide, and GLP-1 did not replicate the metabolic functions of dairy products. Clinical trial registry number: http://clinicaltrials.gov (NCT04600128 and NCT05919667).

Achieving High Protein Quality Is a Challenge in Vegan Diets: A Narrative Review

The transition toward plant-based (PB) diets has gained attention as a plausible step toward achieving sustainable and healthy dietary goals. However, the complete elimination of all animal-sourced foods from the diet (ie, a vegan diet) may have nutritional ramifications that warrant close examination. Two such concerns are the adequacy and bioavailability of amino acids (AAs) from plant-sourced foods and the consequences for older vegan populations who have elevated AA requirements. This narrative review describes the challenges of achieving high protein quality from vegan diets. Data were synthesized from peer-reviewed research articles and reviews. Plant-sourced proteins provide poorer distribution of indispensable AAs (IAAs) and have poorer digestibility, partly due to their inherent structural components within the food matrix. The review addresses complexities of combinations of varied plant protein sources and why the inclusion of novel PB alternatives adds uncertainty to the achievement of adequate protein adequacy. Meal distribution patterns of protein and the ensuing physiological impacts deserve further research and are outlined in this review. Particular attention is given to describing the challenges of achieving sufficient protein and IAA intakes by aging populations who choose to follow a vegan diet. This review contributes to the emerging discussions of nutritional risks associated with vegan diets and adds perspective to the current dietary shifts toward PB diets.

Dairy milk: There are alternatives but no equivalents

Dairy milk is a core food in many food-based guides to healthy eating. However, plant-based milk alternatives are becoming increasingly available as substitutes. While these products serve a subset of the population unable or unwilling to consume milk, plant-based milk alternatives can be perceived by consumers as direct equivalents, or even more healthful alternatives to dairy milk. This commentary addresses the significant differences in nutrient content that may have implications for the intake of key nutrients in the case of direct substitutions. Furthermore, while there is a significant body of knowledge demonstrating the significant health benefits associated with dairy milk consumption and a small number of potentially negative associations, there is a paucity of data on the health benefits of plant-based milk alternatives directly. A "health halo" may exist based on matching individual nutrients through fortification, lower energy levels, and the health properties of the unprocessed raw characterizing ingredients of plant-based milk alternatives. This may mislead consumers regarding healthfulness. Similarly, environmental attributes based on volumes of production, without considering contribution to nutrients, may also skew consumer perception. Positioning of plant-based milk alternatives in food-based dietary guidelines, marketing, and personal recommendations should acknowledge the differences in nutritional, bioactive, and health properties between plant-based milk alternatives and dairy milk to ensure appropriate adaptations are made to account for shortfalls in nutrients.

Comparing Nutrient Profiles of Meat and Fish with Plant-Based Alternatives: Analysis of Nutrients, Ingredients, and Fortification Patterns

Nutrient quality of plant-based meat and fish alternative (MFA) products has been reported as variable. The present objective was to compare the nutrient density of raw meat and fish with MFA products and to examine MFA ingredients and fortification patterns. Nutrient composition data for raw beef, pork, and chicken (n = 450) came from the USDA Standard Reference Legacy Reselase (SR28) nutrient composition database (n = 450). Data for plant-based meat alternatives (n = 118) came from the USDA Branded Food Products Database (BFPDB). Data for fish and seafood (n = 68) and alternatives (n = 12) came from the Danish Frida Database and Mintel (n = 503). Analyses compared macronutrient content and selected micronutrients per 100 g and percentage of US Daily Values. Nutrient density scores were based on the NRF5.3 algorithm. NRF5.3 scores were significantly lower for MFA products as compared to meat or fish. Saturated fat content was lower, but the mean MFA sodium content was 660 mg/100 g compared to 60 mg/100 g for beef. Mean protein content (17 g) was lower than for beef and pork (20 g). A search of ingredient lists found that fortification with most nutrients associated with animal source proteins (such as B vitamins, vitamin D, iodine, zinc, and omega-3 EPA and DHA) was minimal. Plant-based MFA products would benefit from nutrient standards and fortification guidelines to ensure that these products are not nutritionally inferior to the originals.

From Palm to Plate: Unveiling the Potential of Coconut as a Plant-Based Food Alternative

This review investigates coconut as a sustainable and nutrient-rich plant-based alternative to traditional animal-based food sources. We have explored the nutritional profile, culinary versatility, particularly focusing on the use of coconut meat, milk, cream, and oil in diverse dietary contexts when consumed in balance. Comparative analysis with animal-derived products reveals the high content of medium-chain triglycerides (MCTs), essential vitamins, and minerals in coconut, contrasted with its lower protein content. Researchers have underscored the environmental sustainability of coconut, advocating for its role in eco-friendly food production chains. We have also addressed challenges like potential allergies, nutritional balance, sensory attributes, and consumer motivations for coconut-based products, in terms of understanding the market dynamics. In conclusion, this review positions coconut as a promising candidate within sustainable diet frameworks, advocating for further research to augment its nutritional value, sensory characteristics, and product stability, thereby facilitating its integration into health-conscious and eco-centric dietary practices.

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.

Sensory characteristics of plant-based milk alternatives: Product characterisation by consumers and drivers of liking

Like other plant-based (PB) product categories, PB milk alternatives (PBMA) are in ascendency as part of the green consumer transition and a greater focus on personal health. However, consumption remains far below that for cow's milk, and among multiple barriers to uptake, inferior sensory properties is one problem, nutritional inadequacies another. While exceptions exist in both instances, a general need for improved products remains. The present research is situated in this nexus, and its primary aim was to contribute new consumer-centric insight regarding the sensory drivers of liking/disliking in the PBMA category. This was achieved through a central location study with adult New Zealanders (n = 143, not regular PBMA consumers) who tasted 18 different PBMA samples spanning a broad range of PB ingredients (soy, oat, coconut, almond, rice, cashew, peanut, macadamia, lentil, hemp, sesame) in different product types (single PB source, blends, barista style) with varying nutritional profiles. The most liked sample (6.5/9), which was made from soy, had the nutritional profile that most approximated cow's milk (3 g/100 mL protein), as well as a milky appearance and taste. Its mouthfeel was smooth, and this sensory characteristic was also paramount for barista-style PBMAs being well-liked (>5.9/9) regardless of their constituent PB ingredient (oat, almond, coconut). Opportunities for product innovation within this type of PBMA was identified including for using barista-style beyond hot beverages, as these samples received positive liking scores on average. The same applied to blends as multiple-source PBMAs can facilitate improved nutritional composition, and significant scope seemed to exist to identify more liked vs less liked PB ingredient combinations (e.g., almond/rice vs coconut/sesame). By identifying, through penalty/lift analysis that positive sensory drivers of PBMA liking span all sensory modalities (appearance, taste, flavour, texture and mouthfeel), it becomes easier to appreciate that products in this category are complex and challenging to optimise. A second minor research aim was focused on the modulating influence of PBMA consumption frequency on product liking and the sensory drivers of liking. The key result was a positive association between liking and higher consumption frequency, and greater appreciation of sweet, coconut, nutty and cereal/oaty characteristics of PBMAs.

Plant-Based Dairy Alternatives Contribute to a Healthy and Sustainable Diet

Plant-based foods are increasing in popularity as more and more people are concerned about personal and planetary health. The consumption of plant-based dairy alternatives (PBDAs) has assumed a more significant dietary role in populations shifting to more sustainable eating habits. Plant-based drinks (PBDs) made from soya and other legumes have ample protein levels. PBDs that are appropriately fortified have adequate levels of important vitamins and minerals comparable to dairy milk. For the PBDs examined, the greenhouse gas emissions were diminished by 59-71% per 250 mL, and the land use and eutrophication impact was markedly less than the levels displayed by dairy milk. The water usage for the oat and soya drinks, but not rice drinks, was substantially lower compared to dairy milk. When one substitutes the 250 mL serving of dairy milk allowed within the EAT Lancet Planetary Health Diet for a fortified plant-based drink, we found that the nutritional status is not compromised but the environmental footprint is reduced. Combining a nutrient density score with an environmental index can easily lead to a misclassification of food when the full nutrition profile is not utilized or only a selection of environmental factors is used. Many PBDAs have been categorized as ultra-processed foods (UPFs). Such a classification, with the implied adverse nutritional and health associations, is inconsistent with current findings regarding the nutritional quality of such products and may discourage people from transitioning to a plant-based diet with its health and environmental advantages.

A Little Bird Told Me… Nutri-Score Panoramas from a Flight over Europe, Connecting Science and Society

Within the Farm to Fork Strategy, the European Commission ask for a unified Front Of Pack nutritional label for food to be used at the European level. The scientific debate identified the Nutri-Score (NS) as the most promising candidate, but within the political discussion, some Member States brought to attention several issues related to its introduction. This misalignment led to a postponement of the final decision. With the aim to shed some light on the current stances and contribute to the forthcoming debate, the objective of the present work is to understand to what extent scientific research addresses the issues raised by the general public. We applied a structural topic model to tweets from four European countries (France, Germany, Italy, Spain) and to abstracts of scientific papers, all dealing with the NS topic. Different aspects of the NS debate are discussed in different countries, but scientific research, while addressing some of them (e.g., the comparison between NS and other labels), disregards others (e.g., relations between NS and traditional products). It is advisable, therefore, to widen the scope of NS research to properly address the concerns of European society and to provide policymakers with robust evidence to support their decisions.

Can the Substitution of Milk with Plant-Based Drinks Affect Health-Related Markers? A Systematic Review of Human Intervention Studies in Adults

The consumption of plant-based drinks (PBDs) in substitution for cow's milk (CM) is increasing due to concerns for human and planet health and animal welfare. The present review aims to analyze the main findings from intervention trials investigating the effect of PBDs in comparison with CM on markers of human health. Suitable articles published up to July 2022 were sourced from PubMed and Scopus databases. A total of 29 papers were collected, with 27 focusing on soy drinks (1 of which also evaluated the effects of an almond drink), while only 2 focused on rice drinks. Among studies focused on soy drinks, the most investigated factors were anthropometric parameters (n = 13), the lipid profile (n = 8), markers of inflammation and/or oxidative stress (n = 7), glucose and insulin responses (n = 6) and blood pressure (n = 4). Despite some evidence of a beneficial effect of PBDs, especially for the lipid profile, it was not possible to draw any overall conclusions due to some conflicting results. As well as the low number of studies, a wide heterogeneity was found in terms of the characteristics of subjects, duration and markers, which reduces the strength of the available results. In conclusion, further studies are needed to better elucidate the effects of substituting CM with PBDs, especially in the long term.

A comparison of the nutritional profile and nutrient density of commercially available plant-based and dairy yogurts in the United States

Introduction

Plant-based yogurts are sustainable alternatives to dairy yogurts, but a nutritional comparison of plant-based yogurts within the context of dairy yogurts has not yet been applied to commercially available products in the United States. Dairy yogurts provide significant dietary nutrients, and substituting plant-based yogurts may have unintended nutritional consequences. The objective of this study was to compare the macronutrient and micronutrient values of commercially available plant-based and dairy yogurts launched between 2016 and 2021.

Methods

Nutritional information for yogurts were collected through Mintel Global New Products Database, and products were categorized according to their primary ingredient. Regular-style yogurts (n = 612) were included in this study: full-fat dairy (n = 159), low and nonfat dairy (n = 303), coconut (n = 61), almond (n = 44), cashew (n = 30), and oat (n = 15). We utilized the Nutrient Rich Foods (NRF) Index, a comprehensive food guidance system that assigns a score based on the nutrient density of individual foods. This allowed us to compare the nutritional density of the yogurts based on nutrients to encourage (protein, fiber, calcium, iron, potassium, vitamin D) and nutrients to limit (saturated fat, total sugar, sodium).

Results

Compared to dairy yogurts, plant-based yogurts contained significantly less total sugar, less sodium, and more fiber. However, plant-based yogurts contained significantly less protein, calcium, and potassium than dairy yogurts. The yogurts were ranked from the highest to lowest nutrient density based on the NRF Index as follows: almond, oat, low and nonfat dairy, full-fat dairy, cashew, and coconut. Almond yogurts scored significantly higher than all other yogurts, indicating the highest nutrient density.

Discussion

The highest NRF scores were awarded to almond and oat yogurts, likely a result of their low levels of total sugar, sodium, and saturated fat. By applying the NRF model to plant-based and dairy yogurts, we have identified opportunities for the food industry to improve the formulation and nutritional composition of plant-based yogurts. In particular, fortification is an opportunity to improve plant-based yogurt nutritional properties.

Ultra-Processed Foods in the Mediterranean Diet according to the NOVA Classification System; A Food Level Analysis of Branded Foods in Greece

While the Mediterranean diet (MD) is championed as a healthy and sustainable dietary pattern, the NOVA classification is discussed as a tool to identify ultra-processed foods and further specify healthy food choices. We tested whether the NOVA System aligns with the MD recommendations as presented in the MD pyramids. Foods from the Greek branded food composition database, HelTH, (n = 4581) were scored according to NOVA and assigned to the tiers of the traditional and/or sustainable MD pyramids. Nutritional quality was measured as nutrient content and Nutri-Score grades. NOVA identified 70.2% of all foods as UPFs, and 58.7% or 41.0% of foods included in the sustainable and the traditional MD, respectively. Although foods at the top of the pyramids were mostly (>80%) UPFs, NOVA identified > 50% of foods in the MD base as UPFs. Only 22-39% of foods in the MD base were not UPFs and of high nutritional quality (Nutri-Score A-B). NOVA has low discriminatory capacity across the MD tiers, and it restricts food choices to <30% of foods currently available in supermarkets and <60% within the recommended MD tiers. Therefore, the NOVA classification cannot always identify suitable food choices under the MD pyramid in the modern packaged food environment.

“Got Milk Alternatives?” Understanding Key Factors Determining U.S. Consumers’ Willingness to Pay for Plant-Based Milk Alternatives

Milk is an important dairy product in U.S. food retail. Lifestyle changes toward climate-conscious consumption, animal welfare, and food safety concerns have increased the popularity of plant-based milk alternatives. This study is focused on such beverages and provides insights and best practice recommendations for marketing managers in the U.S. food retail sector. An online survey was distributed to explore factors explaining the intentions of U.S. consumers to purchase and pay a premium for plant-based milk alternatives. Food curiosity and food price inflation were identified as relevant for both willingness to buy and willingness to pay a price premium. In addition, animal welfare concerns and the green and clean product image of plant-based alternatives were relevant to the willingness to pay a premium for plant-based milk.

Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? YES

The recommendation to prefer unprocessed/minimally processed foods and freshly made meals instead of ultra-processed foods (following the Nova food classification system) is being increasingly adopted in new official dietary guidelines issued by national governments and international health associations. This recommendation is supported by systematic reviews and meta-analyses of nationally representative dietary surveys and long-term cohort studies. These data show that increased intake of ultra-processed foods is associated with poor-quality diets and with increased morbidity and mortality from several chronic diseases. Various attributes of ultra-processed foods acting through known, plausible, or suggested physiologic and behavioral mechanisms relate them to ill health, and it is likely that different combinations of attributes and mechanisms affect different health outcomes. Although more research should be done to identify these mechanisms, existing evidence is sufficient to recommend the avoidance of ultra-processed foods to optimize health and policies to support and make feasible this recommendation.

Does the concept of "ultra-processed foods" help inform dietary guidelines, beyond conventional classification systems? NO

The Nova classification of ultra-processed foods (UPFs) rests on poorly defined food processes and the presence of food additives from a chemically heterogeneous group, easily leading to misclassification. UPFs are claimed to promote overconsumption of energy and obesity due to high palatability, but little evidence supports effects beyond those that can be accounted for by nutrient composition, energy density, and food matrices. Observational studies link dietary intake of UPFs with obesity, but none have demonstrated independent associations after controlling for likely confounders. A highly cited randomized controlled feeding study that compared a UPF diet with an unprocessed diet showed a rapidly weaning effect on energy intake that can be entirely explained by more conventional and quantifiable dietary factors, including energy density, intrinsic fiber, glycemic load, and added sugar. Clearly, many aspects of food processing can affect health outcomes, but conflating them into the notion of ultra-processing is unnecessary, because the main determinants of chronic disease risk are already captured by existing nutrient profiling systems. In conclusion, the Nova classification adds little to existing nutrient profiling systems; characterizes several healthy, nutrient-dense foods as unhealthy; and is counterproductive to solve the major global food production challenges.

Most Plant-Based Milk Alternatives in the USDA Branded Food Products Database Do Not Meet Proposed Nutrient Standards or Score Well on Nutrient Density Metrics

Plant-based milk alternatives and plant-based waters are of variable nutritional value. The present objective was to assess nutrient density of all plant-based beverages in the US Department of Agriculture Branded Food Products Database and determine whether plant-based milk alternatives met the proposed nutrient standards. Plant-based milk alternatives (n = 1042) were identified as almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and oat, quinoa, and rice products. Plant-based waters (n = 550) were coconut, aloe, tree, fruit, and plain. Machine searches of ingredient lists identified products with added sugars, salt, vitamins, and minerals. Plant-based milk alternatives were tested for compliance with previously developed nutrient standards. The Nutrient Rich Food Index (NRF5.3), two versions of Nutri-Score, and Choices International were the nutrient density metrics. Plant-based milk alternatives had mean energy density of 49 kcal/100 g, were low in protein (~1.1 g/100 g), often contained added sugars and salt, and tended to be fortified with calcium, vitamin A, vitamin D, and vitamin B12. Only 117 milk alternatives (11.2%) met nutrient standards and only 80 (7.7%) met the more stringent “best of class” standards for ≥2.8 g/100 g protein and <3.1 g/100 g added sugars. The latter were mostly soy milks. Nutri-Score grades varied depending on whether the beverages were treated as beverages or as solid foods, as is currently required. The highest NRF5.3 scores were given to soy, almond, and tree nut milk alternatives. Plant-based waters had low energy density (~23 kcal/100 g), contained added sugars (4.6 g/100 g), and some had added vitamin C. Applying nutrient standards to plant-based milk alternatives can aid new product development, promote more transparent labeling, and inform potential regulatory actions. Guidance on minimum protein content, maximum recommended amounts of fat, added sugars, and sodium, and consistent fortification patterns would be of value to regulatory agencies and to the food industry.

Nutritional assessment of plant-based beverages in comparison to bovine milk

Plant-based beverages (PBB) are often marketed and used by consumers as alternatives to ruminant milks, particularly bovine milk (hereafter referred to as milk). However, much research has established that there is variation in nutritional composition among these products, as well as demonstrating that they are largely not nutritional replacements for milk. A survey of the prices and nutrition labels of PBB available in New Zealand supermarkets was undertaken. Selected almond, coconut, oat, rice, and soy PBB products were then analyzed for nutritional content, including energy, fat, protein, amino acid, bioavailable amino acid, and trace element contents. Finally, the protein and calcium contents of well-mixed and unshaken products were analyzed to ascertain the impact of colloidal stability on nutrient content. All PBB groups were more expensive than milk on average, while their declared nutrient contents on package labels was highly variable within and between groups. Analyses of selected PBB revealed that soy products had the most similar proximate composition to milk, while all other PBB groups contained less than 1.1 g protein per 100 mL on average. Many PBB were fortified with calcium to a similar concentration as that in milk. Shaken and unshaken samples showed divergent protein and calcium content for several PBB products but had no effect on the composition of milk, indicating that the nutrient content of PBB at the point of consumption will be dependent on whether the product has been shaken. Only the soy PBB had comparable amino acid content and bioavailability to milk. Overall, our results demonstrate the diversity in composition and nutritional properties of PBB available in New Zealand. While the existent environmental footprint data on PBB shows that they generally have lower carbon emissions than milk, milk currently accounts for approximately 1% of the average New Zealand resident’s consumption-based emissions. Except for calcium-fortified soy PBB, none of the commercially available PBB had nutritional compositions that were broadly comparable to milk.

National Food Intake Assessment: Technologies to Advance Traditional Methods

National dietary surveillance produces dietary intake data used for various purposes including development and evaluation of national policies in food and nutrition. Since 2000, What We Eat in America, the dietary component of the National Health and Nutrition Examination Survey, has collected dietary data and reported on the dietary intake of the US population. Continual innovations are required to improve methods of data collection, quality, and relevance. This review article evaluates the strengths and limitations of current and newer methods in national dietary data collection, underscoring the use of technology and emerging technology applications. We offer four objectives for national dietary surveillance that serve as guiding principles in the evaluation. Moving forward, national dietary surveillance must take advantage of new technologies for their potential in enhanced efficiency and objectivity in data operations while continuing to collect accurate dietary information that is standardized, validated, and publicly transparent.

A Comparative Analysis of Plant-Based Milk Alternatives Part 1: Composition, Sensory, and Nutritional Value

Consumers are becoming increasingly interested in reducing the consumption of animal-based foods for health, sustainability, and ethical reasons. The food industry is developing products from plant-based ingredients that mimic animal-based foods’ nutritional and sensory characteristics. In this study, the focus is on plant-based milk alternatives (PBMAs). A potential problem with plant-based diets is the deficiency of important micronutrients, such as vitamin B12, B2, and calcium. Therefore, an analysis of micronutrients in PBMAs was conducted to assess their nutritional value. The second main focus was on the sensory description of the PBMAs, done by a trained panel, and instrumental assessment to characterize the sensory attributes. Almond drinks met the daily micronutrient requirements the least, while soy drinks came closest to cow’s milk in macro- and micronutrients. The experimentally determined electronic tongue and volatile compound results confirmed the sensory panel’s evaluations and could therefore be used as a method for easy and effective assessments of PBMAs. The PBMAs evaluated in this study could not completely replace cow’s milk’s nutritional and sensory properties. They are products in their own product group and must be evaluated accordingly. Given the variety of products, consumers should experiment and make their decisions regarding the substitution of cow’s milk.

Perspective: Soy-based Meat and Dairy Alternatives, Despite Classification as Ultra-processed Foods, Deliver High-quality Nutrition on Par with Unprocessed or Minimally Processed Animal-based Counterparts

In many non-Asian countries, soy is consumed via soy-based meat and dairy alternatives, in addition to the traditional Asian soyfoods, such as tofu and miso. Meat alternatives are typically made using concentrated sources of soy protein, such as soy protein isolate (SPI) and soy protein concentrate (SPC). Therefore, these products are classified as ultra-processed foods (UPFs; group 4) according to NOVA, an increasingly widely used food-classification system that classifies all foods into 1 of 4 groups according to the processing they undergo. Furthermore, most soymilks, even those made from whole soybeans, are also classified as UPFs because of the addition of sugars and emulsifiers. Increasingly, recommendations are being made to restrict the consumption of UPFs because their intake is associated with a variety of adverse health outcomes. Critics of UPFs argue these foods are unhealthful for a wide assortment of reasons. Explanations for the proposed adverse effects of UPFs include their high energy density, high glycemic index (GI), hyper-palatability, and low satiety potential. Claims have also been made that UPFs are not sustainably produced. However, this perspective argues that none of the criticisms of UPFs apply to soy-based meat and dairy alternatives when compared with their animal-based counterparts, beef and cow milk, which are classified as unprocessed or minimally processed foods (group 1). Classifying soy-based meat and dairy alternatives as UPFs may hinder their public acceptance, which could detrimentally affect personal and planetary health. In conclusion, the NOVA classification system is simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soy.

Nutrition research challenges for processed food and health

Existing highly processed food (HPF) classification systems show large differences in the impact of these foods on biochemical risk factors for disease. If public health nutrition is to consider the degree of food processing as an important element of the link between food and health, certain gaps in research must be acknowledged. Quantifying the food additive exposure derived from HPFs is a task made challenging by the lack of data available on the occurrence and concentration of additives in food and the degree to which the natural occurrence of additives in unprocessed foods confounds exposure estimates. The proposed role of HPFs in health outcomes could also be associated with altered nutrient profiles. Differences exist within and between HPF classification systems in this regard and there are conflicting data on the impact of controlling for nutrient intake. Furthermore, research is needed on how the sensory aspects of HPFs contribute to energy intake. Current data suggest that high energy intake rate may be the mechanism linking HPFs and increased energy intake. A high priority now is to clarify the basis of definitions used to categorize foods as highly processed and, in a constructive sense, to distinguish between the contributions of nutrients, additives and sensory properties to health.

Sensory-Related Industrial Additives in the US Packaged Food Supply

Background: Increasing evidence suggests that ultra-processed foods (UPFs) lead to elevated risk of obesity-related conditions, but UPF measurement has been criticized for its subjectivity and lack of clarity on biological mechanism. Sensory-related industrial additives (SRIAs) are a defining feature of UPFs and may encourage overconsumption by enhancing the sensory quality of foods. However, practical challenges have prevented systematic incorporation of SRIAs into UPF measurement.

Objective: The objectives of this work were to describe a new, open-source ingredient list search method and to apply this method to describe the presence of SRIAs in US packaged foods.

Methods: We developed computer coding to search for 64 common SRIAs related to sweetness, flavor, appearance, and texture in 241,688 foods in the US Branded Food Products Database (BFPD). The BFPD includes manufacturer-provided ingredient lists for ~300,000 branded and private label food items. We determined the total number of SRIAs (0–64) and the number of different types of SRIAs (sweetness, flavor, appearance, texture, 0–4) in each food, then calculated the percent of all foods with SRIAs. This was done for all foods, and by food group for 224,098 items with food group data.

Results: Most (64.9%) foods in the BFPD contained at least one SRIA, and more than a third had at least three. Sweets (89.5%), beverages (84.9%), and ready-to-eat (RTE) foods (82.0%) were the most likely to contain SRIAs. With respect to SRIA types, 25.7% of all food items had at least three of the four types of SRIAs examined, with texture-related additives being the most common. Among sweets, 20% had all four types of SRIAs.

Discussion: This work confirms the high prevalence of SRIAs in US packaged foods. They are ubiquitous in sweets, beverages, and RTE foods, but also present in substantial proportions of other food groups. Quantifying the presence of SRIAs in ingredient lists offers a novel way to identify UPFs for research; to distinguish more vs. less ultra-processed foods; and to test whether UPFs increase risk for obesity-related conditions through additives that enhance the product's sensory qualities.

A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead

Ultra-processed foods (UPFs) are negatively perceived by part of the scientific community, the public, and policymakers alike, to the extent they are sometimes referred to as not "real food". Many observational surveys have linked consumption of UPFs to adverse health outcomes. This narrative synthesis and scientific reappraisal of available evidence aims to: (i) critically evaluate UPF-related scientific literature on diet and disease and identify possible research gaps or biases in the interpretation of data; (ii) emphasize the innovative potential of various processing technologies that can lead to modifications of the food matrix with beneficial health effects; (iii) highlight the possible links between processing, sustainability and circular economy through the valorisation of by-products; and (iv) delineate the conceptual parameters of new paradigms in food evaluation and classification systems. Although greater consumption of UPFs has been associated with obesity, unfavorable cardiometabolic risk factor profiles, and increased risk for non-communicable diseases, whether specific food processing techniques leading to ultra-processed formulations are responsible for the observed links between UPFs and various health outcomes remains elusive and far from being understood. Evolving technologies can be used in the context of sustainable valorisation of food processing by-products to create novel, low-cost UPFs with improved nutritional value and health potential. New paradigms of food evaluation and assessment should be funded and developed on several novel pillars-enginomics, signalling, and precision nutrition-taking advantage of available digital technologies and artificial intelligence. Research is needed to generate required scientific knowledge to either expand the current or create new food evaluation and classification systems, incorporating processing aspects that may have a significant impact on health and wellness, together with factors related to the personalization of foods and diets, while not neglecting recycling and sustainability aspects. The complexity and the predicted immense size of these tasks calls for open innovation mentality and a new mindset promoting multidisciplinary collaborations and partnerships between academia and industry.

Proposed Nutrient Standards for Plant-Based Beverages Intended as Milk Alternatives

Background: Plant-based beverages (PBB) that are marketed as alternatives to cow milk are gaining in popularity worldwide. Nutrient quality of PBB can be highly variable. Objective: To develop a set of voluntary or mandatory nutrient standards for the PBB product category in order to assist innovation and guide product development and reformulation. Methods: The present goal was to develop standards for PBB energy content, minimum protein content and quality, maximum content for added fat, sugar, and salt, and to suggest fortification levels for selected vitamins and minerals. The standards were based on dietary recommendations and guidelines and current practices of federal agencies in the US. Results: The proposed energy and nutrient content for PBB milk alternatives are maximum 85-100 kcal energy per 100 g; a minimum for 2.2/100 g of high-quality protein, low content of saturated fat (<0.75/100 g) and added sugar (5.3-6.25/100 g) and consistent fortification with calcium, vitamins A, D, B-2, and B-12 at levels comparable to those found in cow milk (1%). Ideally, the protein content ought to be increased (2.8/100 g) and added sugar content reduced even further (2.7-3.1/100 g) for "best of class" products. These proposed standards were applied to the 641 existing PBB products listed in the 2018 version of the USDA Branded Food Products Database (BFPDB). The standards were met by <5% of the PBB on the US market. Conclusion: Often viewed as equivalent to milk in nutritional value, many PBB are often low in protein and are fortified with varying amounts of calcium, and vitamins A and D. Nutrient standards for this category should be adopted by the food industry, by public health regulatory authorities, and by standardization bodies such as the Codex Alimentarius.