Vegetarian, vegan, or plant-based? Comparing how different labels influence consumer evaluations of plant-based foods

Market actors have a role to play in enabling sustainable food transitions. One challenge for these actors is how to promote plant-based foods in ways that appeal to a growing number of consumers. Here we test how different plant-based related labels affect consumer appraisals of a range of foods (cookies, sausages, cheese, chocolate, pasta). In two studies (pre-registered; NUSA = 1148, NGermany = 491), we examined the effects of a 'vegetarian', 'vegan', or 'plant-based' label (compared to no label) on five attributes (healthy, tasty, ethical, pure, environmentally friendly) related to the products. We also measured self-reported likelihood to purchase the products. Overall, the results indicated that the 'plant-based' label was slightly more appealing to participants than the 'vegetarian' and 'vegan' labels. However, contrary to our expectations, neither consumers' information-seeking tendencies nor their pre-existing attitudes toward plant-based foods influenced (i.e., moderated) the effects of the labels. Anticipated taste was a strong and consistent predictor of purchase likelihood for all labeled products, but the ethical and pure attributes also accounted for unique variance in this outcome variable. Taken together, our findings and discussion provide insights into the role of labels and label terminology on consumer appraisals of plant-based foods.

Differences in dietary acceptability, restraint, disinhibition, and hunger among African American participants randomized to either a vegan or omnivorous soul food diet

The Nutritious Eating with Soul study was a 24-month, randomized behavioral nutrition intervention among African American adults. This present study, which is a secondary analysis of the NEW Soul study, examined changes in dietary acceptability, restraint, disinhibition, and hunger. Participants (n = 159; 79% female, 74% with ≥ college degree, mean age 48.4 y) were randomized to either a soul food vegan (n = 77) or soul food omnivorous (n = 82) diet and participated in a two-year behavioral nutrition intervention. Questionnaires assessing dietary acceptability (Food Acceptability Questionnaire; FAQ) and dietary restraint, disinhibition, and hunger (Three-Factor Eating Questionnaire; TFEQ) were completed at baseline, 3, 6, 12, and 24 months. Mixed models were specified with main effects (group and time) and interaction effects (group by time) to estimate mean differences in FAQ and TFEQ scores using intent-to-treat analysis. After adjusting for employment, education, food security status, sex, and age, there were no differences in any of the FAQ items, total FAQ score, dietary restraint, disinhibition, and hunger at any timepoint except for one item of the FAQ at 12 months. Participants in the vegan group reported a greater increase in satisfaction after eating a meal than the omnivorous group (mean difference 0.80 ± 0.32, 95% CI 0.18, 1.42; P = 0.01). This is one of the first studies to examine differences in dietary acceptability, hunger, and other eating factors among African American adults randomized to either a vegan or omnivorous soul food diet. The findings highlight that plant-based eating styles are equally acceptable to omnivorous eating patterns and have similar changes in hunger, restraint, and disinhibition. These results suggest that plant-based eating styles can be an acceptable dietary pattern to recommend for cardiovascular disease prevention and may result in greater post-meal satisfaction.

Fruit-based vegan ice cream-type frozen dessert with aquafaba: effect of fruit types on quality parameters

"Aquafaba", defined as legume cooking water, has a feature that can be used in various formulations as an egg and milk alternative in vegan products and improves functional properties such as foaming, emulsifying and gelling. In this study, it was aimed to investigate the usability of aquafaba in ice cream type frozen desserts containing different fruit purees (strawberry, nectarine and banana) by using its foaming capacity. Rheological properties, microstructure, overrun, melting characteristics, color measurement, dry matter, and sensory properties were investigated in different fruit-based frozen dessert samples. The brix value, density, protein content, foaming capacity (FC) and foaming stability (FS), flow behavior index, consistency coefficient, and overrun of aquafaba were determined as 7.1 ± 0°Bx, 1.022 ± 0.011 g/ml, 1.51 ± 0.41%, 85 ± 0% FC and 81 ± 0.23% FS, between 0.28 and 0.64, between 8.68 and 41.30 Pa·sn, between 116.75 and 395.93%, respectively. The dry matter content of the strawberry, nectarine, and banana-based dessert samples ranged between 17 and 48%, 20-49%, 25-50%, and the first dropping times were determined between 348 and 1538 s, 369-1689 s and 435-1985 s, respectively. As a result, cooking liquid leftover aquafaba can be used as a suitable raw material in the production of an alternative ice cream type frozen dessert for individuals with milk allergy, lactose intolerance or who prefer a vegan diet.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-023-05885-y.

Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis

Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle-Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α-linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets.

Similarities and differences between vegetarians and vegans in motives for meat-free and plant-based diets

Plant-based diets are quickly gaining popularity for their benefits to animal welfare, the environment, and public health. Compared to meat-eaters, meat-abstainers such as vegetarians and vegans are especially motivated by animal rights and the environment. However, little is known about the motivational and psychological factors that distinguish vegetarians from vegans, and what prevents vegetarians to shift towards a fully plant-based diet. In a sample of vegans (n = 335) and vegetarians (n = 182), we investigated a) motives for reducing or quitting meat consumption and b) motives for reducing or quitting animal product (dairy and egg products) consumption, as well as moral psychological and social-contextual factors that may explain potential differences. Results demonstrate that vegetarians and vegans tend to be similar in their motives to abstain from meat consumption and are most strongly motivated by animal rights. However, vegetarians are less motivated by health, environmental, and especially animal rights for dairy/egg reduction compared to meat reduction and compared to vegans. Lower moral concern for animals, stronger beliefs in human supremacy over animals, and heightened veganism threat among vegetarians (vs. vegans) partly explained why vegetarians were less strongly motivated by animal rights for dairy/egg reduction. Human supremacy beliefs also explained differences between vegetarians and vegans in health and environmental motives for dairy/egg reduction. Furthermore, vegetarians reported significantly less social support for plant-based diets and perceived more practical barriers to plant-based diets than vegans. These findings reveal meaningful differences in the motivational and psychological profiles of vegetarians and vegans and highlight the value of distinguishing between motives for meat-free diets and motives for plant-based diets.

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.

Plant-based diets benefit aerobic performance and do not compromise strength/power performance: a systematic review and meta-analysis

Plant-based diets have emerged as athletic performance enhancers for various types of exercise. Therefore, the present study evaluated the effectiveness of plant-based diets on aerobic and strength/power performances, as well as on BMI of physically active individuals. This systematic review and meta-analysis was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search of electronic databases, including PubMed, Web of Science and SPORTDiscus, was performed. On the basis of the search and inclusion criteria, four and six studies evaluating the effects of plant-based diets on aerobic and strength/power performances in humans were, respectively, included in the systematic review and meta-analysis. Plant-based diets had a moderate but positive effect on aerobic performance (0·55; 95 % CI 0·29, 0·81) and no effect on strength/power performance (-0·30; 95 % CI -0·67, 0·07). The altogether analyses of both aerobic and strength/power exercises revealed that athletic performance was unchanged (0·01; 95 % CI -0·21, 0·22) in athletes who adopted plant-based diets. However, a small negative effect on BMI (-0·27; 95 % CI -0·40, -0·15) was induced by these diets. The results indicate that plant-based diets have the potential to exclusively assist aerobic performance. On the other hand, these diets do not jeopardise strength/power performance. Overall, the predicted effects of plant-based diets on physical performance are impactless, even though the BMI of their adherents is reduced.

The perceived experience of adhering to vegan diet: a descriptive phenomenological study

BACKGROUND

Today, raw vegetarianism is considered one of the most important socio-cultural developments in contemporary societies. In this regard, the present study was conducted to describe the perceived experience of people adhering to a vegan diet through a phenomenological perspective.

METHODS

This qualitative study explores the perceived experiences of individuals who follow a vegan diet and are part of the self-care campaign in Kermanshah, Iran. sampling was purposeful and face-to-face interviews were conducted with 12 individuals who follow a vegan lifestyle. The data were analyzed after being collected using the seven steps of Collizi. MAXQUDA software (version 12) was used for data management.

RESULTS

After qualitative data analysis, we identified 567 codes, which were categorized into 15 sub-themes. From these sub-themes, we derived 4 main themes. The main themes include: In pursuit of redemption (Meaningful framework, In awareness path, Unequaled Disappointment, Chronic and complex conditions), Seeking the New World (Starting with doubt and hesitation, The temptation to return, Constant criticism, Unfamiliar appearance), On the path of overcoming difficulties (Associate problems, Matching the new way, Perceived recommendations), and attaining the expected outcomes (Healthy lifestyle, Therapeutic feedback, Enhancing emotional wellbeing, Feeling of youth).

CONCLUSION

Based on the participants' experience, despite the challenging journey, the people with a vegetarian diet experienced partial and complete improvement of all the symptoms of the diseases. They had a healthy lifestyle and felt young and energetic. Likewise, this method had a positive effect on people's mental state and mood.

Contribution of plant-based dairy and fish alternatives to iodine nutrition in the Swiss diet: a Swiss Market Survey

PURPOSE

With dairy products and fish being major sources of iodine in Switzerland, the growing popularity of plant-based alternatives may impact iodine nutrition. This study aimed to assess the iodine content in plant-based dairy and fish alternatives available in the Swiss market and compare them with conventional products.

METHODS

In 2022, a market survey was conducted in Zurich, Switzerland, to identify the plant-based dairy and fish alternatives available and assess their iodine content. To evaluate the impact of plant-based alternatives on iodine consumption in Switzerland, we modeled dietary scenarios by substituting the intake of dairy and fish items with plant-based alternatives. In addition, we investigated fortification with calcium, vitamins B2, B12, and D.

RESULTS

Out of 477 identified products, only four milk-alternative products were iodine fortified (median iodine concentration: 22.5 μg/100 ml). The median iodine concentration in unfortified plant-based alternatives was negligible compared to conventional dairy and fish products (milk: 0.21 vs 9.5 μg/100 ml; yogurt 0.36 vs 6.1 μg/100 g; cheese: 0.10 vs 20 μg/100 g; fish 0.50 vs 44 μg/100 g). Three portions of dairy per day as recommended by the Swiss Food Pyramid provide 25% of the RDA for iodine (150 μg/day), whereas substituting those with unfortified alternatives provides only 0.7% of the RDA.

CONCLUSION

Only four out of 477 plant-based alternative products are iodine fortified in the Swiss market. Thus, the risk for consumers to miss out on the ca. 25% of the RDA for iodine by consuming plant-based alternatives is high, placing them at a risk for inadequate iodine intake.

Eating vegan due to cancer: A different social experience than other vegan dieters?

Many diagnosed with cancer change their diet in response to the diagnosis, with a vegan diet being a common choice. There may be health benefits to this, but research has demonstrated that following a vegan diet can have negative social ramifications. These social ramifications seem to be experienced to a lesser extent by those who following a vegan diet for health versus moral reasons, but this is a heterogeneous group; people may choose the diet for a myriad of different health reasons. In two pre-reregistered studies, we examined the social experience of those who adopt a vegan diet following a cancer diagnosis. Study 1, an experimental study, demonstrated that omnivores responded more positively to a friend who was vegan for cancer reasons than animal or general health reasons, which was explained by increased empathy. In Study 2, a cross-sectional survey study, those who adopted a vegan diet due to cancer reported (overall) less negative social experiences than those following a vegan diet more generally. These participants reported that cancer represented a greater social challenge than their diet. Taken together, these findings suggest that "vegan due to cancer" is a unique social identity and a unique social experience, relative to that of those motivated by other reasons, including general health reasons.

Analysis of ingredient list and nutrient composition of plant-based burgers available in the global market

The nutrient composition of plant-based burgers is a key factor when making their purchase/consumption decision to maintain a balanced diet. For this reason, ingredient list and nutritional information of burgers launched in the global market were retrieved from their labels. Products were classified based on the technology development, market position and region of the manufacturer. From the ingredient analysis, we observed a high heterogeneity in the ingredients used, a predominance of soy and wheat as main sources of proteins, and the increasing use of new protein sources (e.g. peas, other types of beans and pseudo-cereals). Oil was the most cited ingredient followed by salt. Nutritional composition varied mainly depending on the region with no clear pattern among countries. To less extent, technology development resulted in traditional products with lower amounts of protein and higher amounts of carbohydrates. Vegan and vegetarian products showed limited differences due to the high intra-heterogenicity.

Plant-based recovery from restrictive eating disorder: A qualitative enquiry

OBJECTIVES

Plant-based/vegan diets are growing in popularity. There are growing numbers of individuals adopting plant-based diets and there are legitimate concerns from professionals that this can enable food restriction or mask disordered eating. The aim of this study was to examine the role a plant-based diet can play for those in recovery from restrictive eating disorders (anorexia and bulimia nervosa).

METHODS

Interviews conducted with fourteen individuals who identified as having a restrictive eating disorder for which a plant-based diet played/plays an important part in their recovery. Semi-structured interviews explored the individual's lived experiences and motivations of adopting a plant-based diet, and perceptions of the role it played in recovery. Data was transcribed verbatim and analyzed using thematic analysis (Braun & Clarke, 2006).

RESULTS

Three key themes with six contributory subthemes were identified. Key themes were plant-based as a gateway to recovery, the changing value of food, and the function of control. Theme content highlighted an evolving role of identity and community, with a shift in meaning and value of food described, and for some, the development of a new relationship with their body. This facilitated a de-coupling of anxieties about food and promoted positive experiences of eating, esteem and empowerment.

CONCLUSIONS

These findings present a unique insight into the role that plant-based eating may play in recovery for some restrictive eating disorders. The data demonstrated that motivations to control food intake may contribute to the decision to eat plant-based. However, for these individuals it provided a "gateway" to a new more meaningful relationship with food. These findings highlight some of the risks and benefits of eating plant-based in recovery and an important role for health professionals in understanding/supporting individuals during recovery. w/c 280.

A microalgae docosahexaenoic acid supplement does not modify the influence of sex and diet on iron status in Spanish vegetarians or omnivores: A randomized placebo-controlled crossover study

OBJECTIVE

Plant-based diets are accepted as healthy, provided that are well-planned and include supplements. In this context, iron deficiency is a threat, and data from Spanish vegetarians are scarce. The aim of this study was to determine if a microalgae ω-3 supplement rich in docosahexaenoic acid (DHA) affected iron status in this population.

METHODS

Iron biomarkers and nutrient intake (72-h dietary records) were analyzed in 204 usual consumers of lacto-ovo vegetarian (LOV), vegan (VEG), or omnivorous (OMN) diets. A randomized double-blind, placebo-controlled crossover trial was performed in a subgroup (n = 98) to test if a microalgae DHA supplement (250 mg/d for 5 wk) changed iron status.

RESULTS

Iron intake was higher in vegetarians than omnivores (P= 0.002), fiber intake was highest in vegans followed by lacto-ovo vegetarians and omnivores, whereas calcium intake was lower in vegans than both lacto-ovo vegetarians and omnivores (all P < 0.001). Women, regardless of diet type, showed lower iron status than men. Erythrocytes, hemoglobin, hematocrit, and serum ferritin were lower in lacto-ovo vegetarians and vegans than omnivores. The prevalence of iron deficiency anemia was low (<10%), but iron depletion (ferritin <15 ng/mL) was higher in lacto-ovo vegetarians than omnivores (P = 0.003). Iron biomarkers were similar in lacto-ovo vegetarians and vegans. The DHA supplementation did not change iron status compared with placebo.

CONCLUSIONS

Spanish vegetarians had lower iron status than omnivores. Consumption of eggs and dairy products increased the risk for iron deficiency, but a microalgae DHA supplement had no effect. Dietary strategies to increase iron bioavailability in vegetarians, particularly in lacto-ovo vegetarians and women, are recommended.

Dietary supplement use among lactating mothers following different dietary patterns - an online survey

BACKGROUND

Breastfeeding is important for the healthy growth and development of newborns, and the nutrient composition of human milk can be affected by maternal nutrition and supplementation. In Germany, iodine supplementation is recommended for all lactating mothers, and docosahexaenoic acid (DHA) supplementation is recommended for mothers with inadequate or no fish intake. Vitamin B12 supplementation is required for strict vegans during lactation, and other nutrient supplementation may be necessary depending on the individual's nutritional status. To address the lack of data on dietary supplements used by lactating mothers following a vegetarian or vegan diet, an online survey was conducted in Germany, with a focus on iodine, DHA, and vitamin B12.

METHODS

Study participants were asked to report whether they followed specific dietary patterns (omnivorous [OM], vegetarian [VT], vegan [VN]) as well as their use of dietary supplements. Relationships between diets and supplement use were analyzed using chi-square tests.

RESULTS

2054 lactating women were included (1240 OM, 410 VT, and 404 VN) in this analysis. Within OM, VT and VN, at least one dietary supplement was taken by 67.3%, 84.9% and 98.0% respectively (p < 0.001). Overall, 53.2% OM, 66.8% VT, 88.4% VN reported taking at least one supplement containing iodine (p < 0.001). 54.6% OM, 61.7% VT and 58.2% VN reported supplements containing vitamin B12, while 34.1% OM, 40.2% VT and 38.6% VN mentioned supplements containing DHA (p < 0.05).

CONCLUSION

More than half of the participants reported the use of supplements during lactation with the highest proportion in vegans. However, over one third of the mothers did not report supplementing with iodine, regardless of their dietary pattern and most participants also did not report DHA supplements. It is worrisome that a high number of vegans did not report vitamin B12 supplementation, but this could be partly due to issues with reporting. It is crucial to provide further education to breastfeeding mothers about the importance of taking micronutrient supplements, especially for those following a vegetarian or vegan diet. This will help ensure that mothers and their breastfed infants receive optimal nutrition for a healthy development.

Iodine and plant-based diets: a narrative review and calculation of iodine content

An increasing number of food-based recommendations promote a plant-based diet to address health concerns and environmental sustainability in global food systems. As the main sources of iodine in many countries are fish, eggs and dairy products, it is unclear whether plant-based diets, such as the EAT-Lancet reference diet, would provide sufficient iodine. This is important as iodine, through the thyroid hormones, is required for growth and brain development; adequate iodine intake is especially important before, and during, pregnancy. In this narrative review, we evaluated the current literature and estimated iodine provision from the EAT-Lancet reference diet. There is evidence that those following a strict plant-based diet, such as vegans, cannot reach the recommended iodine intake from food alone and are reliant on iodine supplements. Using the EAT-Lancet reference diet intake recommendations in combination with iodine values from UK food tables, we calculated that the diet would provide 128 μg/d (85 % of the adult recommendation of 150 μg/d and 51–64 % of the pregnancy recommendation of 200–250 μg/d). However, if milk is replaced with unfortified plant-based alternatives, total iodine provision would be just 54 μg/d (34 % and 22–27 % of the recommendations for adults and pregnancy, respectively). Plant-based dietary recommendations might place consumers at risk of iodine deficiency in countries without a fortification programme and where animal products provide the majority of iodine intake, such as the UK and Norway. It is essential that those following a predominantly plant-based diet are given appropriate dietary advice to ensure adequate iodine intake.

Preliminary identification of clinical cut-off of the vegetarian vegan eating disorder screener (V-EDS) in a community and self-reported clinical sample of vegetarians and vegans

BACKGROUND

The vegetarian vegan eating disorder screener (V-EDS) is an 18-item self-report screening tool designed to assess the unique elements of eating disorder symptomology in vegetarians and vegans. Previous results have suggested strong initial psychometric properties in non-clinical community samples of vegetarians and vegans. The present study sought to identify a preliminary threshold cut-off score to discriminate eating disorder pathology in a self-reported clinical and community sample.

METHODS

This study involved secondary analysis using data collected in McLean et al. (Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS, 2023), comprising 599 non-clinical participants and 51 self-reported clinical participants. Receiver operating characteristic (ROC) curve analysis was used to compute possible cut-off values for the V-EDS.

RESULTS

ROC analysis indicated good performance of the V-EDS (area under the curve = 0.87), with integration of the Youden index demonstrating a global score of ≥ 18 to be optimal in predicting clinical caseness with good sensitivity (0.804) and specificity (0.843).

CONCLUSIONS

The present study fills an important gap as the first to investigate an optimal V-EDS score to discriminate level of impairment from eating disorder pathology in a sample of vegetarian and vegan community and self-reported clinical participants. We extend the utility of the V-EDS in discovering good discrimination power in classifying clinical caseness with a cut-off score of 18 shown to optimise the trade-off between sensitivity and specificity. Future research should focus on expanding the psychometric properties of the V-EDS in larger and more diverse participant groups, including gender, age, cultural identity, and eating disorder history.

Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS

BACKGROUND

Eating disorders have one of the highest mortality of all mental illnesses but are associated with low rates of screening and early intervention. In addition, there remains considerable uncertainty regarding the use of current standardised screening tools in measuring eating pathology in vegetarians and vegans. With these groups presenting as potential at-risk groups for disordered eating development, the present study aimed to develop and preliminary validate a novel eating disorder screening tool, the Vegetarian Vegan Eating Disorder Screener (V-EDS).

METHODS

We utilised a mixed-methods approach, comprising four phases.

RESULTS

A conceptual framework was developed from 25 community, clinician, and lived experience interviews and used to derive a preliminary set of 163 items (Phase 1). Phase 2 piloted the items to establish face and content validity through cognitive debriefing interviews of 18 additional community, clinician, and lived experience participants, resulting in a reduced, revised questionnaire of 53 items. Phase 3 involved scale purification using Item Response Theory in analysis of 230 vegetarians and 230 vegans resulting in a further reduced 18-item questionnaire. Phase 4 validated the screening tool in a large community sample of 245 vegetarians and 405 vegans using traditional psychometric analysis, finding the V-EDS supports a unidimensional factor structure with excellent internal consistency (α = 0.95-0.96) and convergent validity (0.87-0.88), and moderate discriminate validity (0.45-0.55).

CONCLUSIONS

This study provided strong initial support for the psychometric validity and theoretical assumptions of the novel V-EDS screening tool. The V-EDS has the potential to increase early intervention rates for vegetarians and vegans experiencing eating disorder symptoms, further supporting advocacy and treatment approaches for these expanding dietary groups.

The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults

OBJECTIVE

This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns.

DESIGN

The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet.

SETTING

New Zealand.

PARTICIPANTS

Adults, aged ≥ 15 years (n 23 292).

RESULTS

The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian.

CONCLUSIONS

Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

The nutrient profile and cost of specialty dietary patterns: a hypothetical case study

OBJECTIVE

Ketogenic and vegan diets have become increasingly popular. The rising popularity of these dietary trends has been met in kind by the food industry producing a variety of specialty ultra-processed foods (UPF). Despite increasing popularity, the cost and nutrient profile of vegan and ketogenic diets (KD) that rely on UPF specialty products is poorly understood. We aimed to assess the cost and nutrient profile of vegan and KD that relied primarily on UPF and compare this to those that relied primarily on whole foods.

DESIGN

We designed and calculated the cost of four 1-d meal plans for a hypothetical weight-stable adult female. Two meal plans were created for the vegan-style and ketogenic-style diets, respectively, with one of each being predominantly whole food based and the other constituting primarily of UPF. Carbohydrates were limited to ≤50 g, protein was set at 15-20 % and fat ≥75 % for the ketogenic meal plans. Carbohydrates were set between 45 and 65 %, protein 15 and 25 % and fat 20 and 35 % for the vegan meal plans. FoodWorks dietary analysis software was used to assess data against the national Australian/New Zealand nutrient reference value for adult females and cost was calculated using Countdown online shopping (a local New Zealand supermarket).

SETTING

New Zealand.

PARTICIPANTS

None.

RESULTS

The whole food-based meal plans met a greater proportion of the macro and micronutrient thresholds and were less costly when compared with the specialty-based meal plans.

CONCLUSIONS

This study demonstrates that well-planned, predominantly whole food diets (regardless of dietary trend) are nutritionally superior and more cost-effective than those that rely on UPF.

Food literacy and diet quality in young vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores

OBJECTIVE

To investigate whether food literacy competencies and diet quality vary between 16-to-24-year-olds vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores and to assess whether food literacy is associated with diet quality.

DESIGN

Cross-sectional study. Food literacy (general nutrition knowledge, critical nutrition literacy and food skills) and diet quality were measured using an electronic questionnaire.

SETTING

Southern Norway, September 2021 - March 2022.

PARTICIPANTS

Healthy 16-24-year-olds (n 165).

RESULTS

Overall, the mean general nutrition knowledge score was moderate (48·0 out of 67·0); the lowest mean score was found in omnivores and the highest in flexitarians (45·6 v. 51·5) (P = 0·034). The mean score of critical nutrition literacy was also moderate (3·7 out of 5·0); vegans showed higher scores compared to other dietary practices (P = 0·018). No difference was observed in food skills between the different dietary practices. The overall median diet quality score was 46·0 out of 80·0, lowest in omnivores and highest in vegans (42·0 v. 56·0) (P =< 0·001). In multivariate regression analyses, general nutrition knowledge, food skills and vegan dietary practice were significantly associated with higher diet quality.

CONCLUSIONS

We found moderate levels of food literacy across all dietary practices. The food literacy competencies, general nutrition knowledge and food skills were associated with higher diet quality in our sample. Omnivores showed both the lowest general nutrition knowledge level and lowest diet quality scores. In contrast, both flexitarians and vegans scored highest on general nutrition knowledge and diet quality scores, despite being one of the less restrictive and one of the strictest plant-based dietary practices, respectively.

A dietary intervention for postmenopausal hot flashes: A potential role of gut microbiome. An exploratory analysis

OBJECTIVE

This study examined the role of gut microbiome changes in mediating the effects of a dietary intervention on the frequency and severity of postmenopausal vasomotor symptoms METHODS: Postmenopausal women (n = 84) reporting ≥2 moderate-to-severe hot flashes daily were randomly assigned, in 2 successive cohorts, to an intervention including a low-fat, vegan diet and cooked soybeans (½ cup [86 g] daily) or to stay on their usual diet. Over a 12-week period, frequency and severity of hot flashes were recorded with a mobile application. In a subset of 11 women, gut microbiome was analyzed at baseline and after 12 weeks of the dietary intervention (low-fat vegan diet with soybeans), using deep shotgun metagenomic sequencing. Differences in the microbiome between baseline and 12 weeks were assessed by comparing alpha diversity with Wilcoxon signed rank tests, beta diversity with permanovaFL, and taxon abundance with Wilcoxon signed rank tests. Pearson correlations were used to assess the association between changes in hot flashes and gut bacteria.

RESULTS

In the subset for which microbiome testing was done, total hot flashes decreased by 95 % during the dietary intervention (p = 0.007); severe hot flashes disappeared (from 0.6 to 0.0/day; p = 0.06); and moderate-to-severe hot flashes decreased by 96 % (p = 0.01). Daytime and nighttime hot flashes were reduced by 96 % (p = 0.01) and 94 % (p = 0.004), respectively. Alpha and beta diversity did not significantly differ in the intervention group between baseline and 12 weeks. Two families (Enterobacteriaceae and Veillonellaceae), 5 genera (Erysipelatoclostridium, Fusicatenibacter, Holdemanella, Intestinimonas, and Porphyromonas), and 6 species (Clostridium asparagiforme, Clostridium innocuum, Bacteroides thetaiotaomicron, Fusicatenibacter saccharivorans, Intestinimonas butyriciproducens, Prevotella corporis, and Streptococcus sp.) were differentially abundant, but after correction for multiple comparisons, these differences were no longer significant. Changes in the relative abundance of Porphyromonas and Prevotella corporis were associated with the reduction in severe day hot flashes both unadjusted (r = 0.61; p = 0.047; and r = 0.69; p = 0.02), respectively), and after adjustment for changes in body mass index (r = 0.63; p = 0.049; and r = 0.73; p = 0.02), respectively). Changes in relative abundance of Clostridium asparagiforme were associated with the reduction in total severe hot flashes (r = 0.69; p = 0.019) and severe night hot flashes (r = 0.82; p = 0.002) and the latter association remained significant after adjustment for changes in body mass index (r = 0.75; p = 0.01).

CONCLUSIONS

This exploratory analysis revealed potential associations between changes in vasomotor symptoms in response to a diet change and changes in the gut microbiome. Larger randomized clinical trials are needed to investigate these findings.

Vegetarian diets and risk of all-cause mortality in a population-based prospective study in the United States

The popularity of vegetarian diets has increased the need for studies on long-term health outcomes. A limited number of studies, including only one study from a non-vegetarian population, investigated the risk of mortality with self-identified vegetarianism and reported inconsistent results. This study evaluated prospective associations between vegetarian diets and all-cause mortality among 117,673 participants from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial cohort study. Vegetarian diet status was self-identified on the questionnaire. Deaths were ascertained from follow-up questionnaires and the National Death Index database. Multivariable Cox regression models were used to estimate the risk of all-cause mortality in hazard ratio (HR) and 95% confidence intervals (CI). By diet group, there were 116,894 omnivores (whose diet does not exclude animal products), 329 lacto- and/or ovo-vegetarians (whose diet excludes meat, but includes dairy and/or eggs), 310 pesco-vegetarians (whose diet excludes meat except for fish and seafood) and 140 vegans (whose diet excludes all animal products). After an average follow-up of 18 years, 39,763 participants were deceased. The risk of all-cause mortality did not statistically significantly differ among the four diet groups. Comparing with the omnivore group, the HR (95% CI) were 0.81 (0.64-1.03) for pesco-vegetarian group, 0.99 (0.80-1.22) for lacto- and/or ovo-vegetarian group and 1.27 (0.99-1.63) for vegan group, respectively. Similarly, mortality risk did not differ when comparing lacto- and/or ovo-vegetarians plus vegans with meat/fish eaters (omnivores and pesco-vegetarians) (HR [95% CI] = 1.09 [0.93-1.28]). As this study is one of the two studies of vegetarianism and mortality in non-vegetarian populations, further investigation is warranted.

Protein content and amino acid composition in the diet of Danish vegans: a cross-sectional study

BACKGROUND

A growing proportion of the population are replacing their dietary animal protein with plant protein. A particular example of this trend is the vegan diet, which excludes all food items of animal origin. However, the DIAAS score for individual plant proteins is generally lower than that of animal proteins due to an unbalanced amino acid composition and lower bioavailability. Care must therefore be taken to meet the nutritional recommendations in the daily food intake.

METHODS

A three-day dietary food record was carried out by 40 Danish vegans in a cross-sectional study. The data were analysed, with particular emphasis on protein requirements and the essential amino acid composition of the diet.

RESULTS

The protein recommendations were met on all three days by 60% of the participants. In contrast, 18% did not meet the protein recommendations on any of the three days and 7% met the recommendations on only one of the days. Lysine was the most limiting amino acid (only 50% met the recommendations every day) followed by the sulphur-containing amino acids (recommendations met by 67.5%), leucine and valine (recommendations met by 70%). Combining both the amount of protein and the intake of the essential amino acids showed that less than half of the participants met the recommendations on all three days (47.5%) and 35% did not meet the recommendations on any days or on one day only.

CONCLUSION

In conclusion, our study showed that many of the participants in the present study failed to meet the daily protein intake requirements, both on single days and on all three days. Furthermore, the food intake was found to have an inadequate amino acid composition and was particularly limited by the essential amino acids lysine, the sulphur-containing amino acids, and leucine and valine. This could be ascribed to the fact that only a limited number of protein sources were consumed during a day.

Systematic review and meta-analysis of iodine nutrition in modern vegan and vegetarian diets

Vegan and vegetarian diets are widely supported and adopted, but individuals following such diets remain at greater risk of iodine deficiency. This systematic review and meta-analysis was conducted to assess the iodine intake and status in adults following a vegan or vegetarian diet in the modern day. A systematic review and quality assessment were conducted from October 2020 to December 2022 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidance. Studies were identified in Ovid MEDLINE, Web of Science, PubMed, and Scopus. Eleven articles were eligible for review containing 4421 adults (aged ≥ 18 years). Vegan groups had the lowest median urinary iodine concentration (mUIC) (12·2/l). None of the dietary groups had mUIC within the optimal range for iodine status (100-200 µg/l) (WHO). Vegan diets had the poorest iodine intake (17·3 µg/d) and were strongly associated with lower iodine intake (P = < 0·001) compared with omnivorous diets. Lower intake in vegan diets was influenced by sex (P = 0·007), the presence of voluntary or absence of Universal Salt Iodisation (USI) programmes (P = 0·01 & P = < 0·001), and living in a country with adequate iodine nutrition (P = < 0·001). Vegetarians and particularly vegans living in countries with no current USI programme continue to have increased risk of low iodine status, iodine deficiency and inadequate iodine intake. Further research into the usefulness of mandatory fortification of vegan appropriate foods is required.

Feeling morally troubled about meat, dairy, egg, and fish consumption: Dissonance reduction strategies among different dietary groups

A largescale shift towards plant-based diets is considered a critical requirement for tackling ethical, environmental, and global health issues associated with animal food production and consumption. Although previous research has identified psychological strategies that enable meat-eaters to justify and continue meat consumption and feel less morally conflicted about it, research on the psychological strategies that enable consumers to continue dairy, egg, and fish consumption is scarce. We conducted an online survey study using an adjusted version of the Meat-Eating Justification Scale to investigate the use of psychological strategies to cope with cognitive dissonance related to meat, dairy, egg, and fish consumption in omnivores (n = 186), pescatarians (n = 106), vegetarians (n = 143), vegans (n = 203), and flexitarians (n = 63). Results indicated greater use of meat-related dissonance reduction strategies among omnivores as compared to other dietary groups, greater use of fish-related dissonance reduction strategies among fish consumers (omnivores, flexitarians and pescatarians) compared to vegetarians and vegans, and greater use of dairy and egg-related dissonance reduction strategies among dairy and egg consumers (omnivores, flexitarians, pescatarians, and vegetarians) as compared to vegans. This pattern was particularly clear for justifications used to defend animal product consumption, denial of animal suffering, and use of dichotomization when considering meat and fish consumption. These findings highlight the importance of extending the research on dissonance reduction strategies beyond meat consumption and studying the consumption of a range of animal products. This can help in identifying the psychological barriers to adopting a plant-based diet and informing interventions for behaviour change.

A glimpse into plant-based fermented products alternative to animal based products: Formulation, processing, health benefits

Fermented foods and beverages are increasingly being included in the diets of people around the world, as they significantly contribute to flavor and interest in nutrition and food consumption. Plant sources, like cereals and pulses, are employed to produce vegan fermented foods that are either commercially available or the subject of ongoing scientific investigation. In addition, the inclination towards nutritionally healthy, natural, and clean-label products amongst consumers has encouraged the development of vegan fermented products alternative to animal-based products for industrial-scale production. However, as the vegan diet is more restrictive than the vegetarian diet, manufacturing food products for vegans presents a significant problem due to the limited availability of many raw materials. So further research is required on this topic. This paper aims to review the formulation, quality, microbial resources, health benefits, and safety of foods that can be categorised as vegan fermented foods and beverages.

Veganism and body weight: An N of 1 self-experiment

The causal effect that veganism has on body weight has not been scientifically examined. An N of 1 self-experiment was conducted in which blinded body weight and additional behavioural and psychological measures were assessed during two phases of vegan vs. non-vegan lifestyle adherence. In study phase 1, body weight change was -0.8 kg over 1 month of veganism (vs. +0.5 kg non-vegan month). In study phase 2, weight change was -1.2 kg over two veganism months (vs. +1.6 kg non-vegan months). Behavioural and psychological measures were similar during vegan vs. non-vegan periods. Veganism appeared to reduce body weight in this N of 1 self-experiment.

Meta-analysis of personality trait differences between omnivores, vegetarians, and vegans

Vegetarian and vegan diets have been increasing in the Western world. Recent research has focused on personality trait differences between dietary groups, in part because personality traits are broad characteristics that can integrate findings about different factors that motivate vegetarian or vegan diets. Previous research on personality predictors of vegetarian and vegan (veg*n) diet, however, has yielded inconsistent results. The goal of this study was to integrate the existing results of Big Five personality differences between veg*ns and omnivores as well as between vegetarians and vegans. To this end, we meta-analyzed data from 15 studies and N = 69,576 individuals from several countries. Results indicated that veg*ns were significantly higher in Openness (d = 0.40) and Agreeableness (d = 0.17) than omnivores, while vegans were significantly higher in Openness (d = 0.14) than vegetarians. This work isolates Openness and Agreeableness as important trait predictors of plant-based diets and sets the stage for future work on the factors that motivate vegetarian or vegan diet. Personality traits can provide an integrative framework for conceptualizing dietary preferences, be used to make predictions about the sources, course and correlates of dietary choices, and potentially be useful for advocates and policymakers seeking to tailor meat-reduction interventions.

Vegetarian and vegan diets: benefits and drawbacks

Plant-based diets have become increasingly popular thanks to their purported health benefits and more recently for their positive environmental impact. Prospective studies suggest that consuming vegetarian diets is associated with a reduced risk of developing cardiovascular disease (CVD), diabetes, hypertension, dementia, and cancer. Data from randomized clinical trials have confirmed a protective effect of vegetarian diets for the prevention of diabetes and reductions in weight, blood pressure, glycosylated haemoglobin and low-density lipoprotein cholesterol, but to date, no data are available for cardiovascular event rates and cognitive impairment, and there are very limited data for cancer. Moreover, not all plant-based foods are equally healthy. Unhealthy vegetarian diets poor in specific nutrients (vitamin B12, iron, zinc, and calcium) and/or rich in highly processed and refined foods increase morbidity and mortality. Further mechanistic studies are desirable to understand whether the advantages of healthy, minimally processed vegetarian diets represent an all-or-nothing phenomenon and whether consuming primarily plant-based diets containing small quantities of animal products (e.g. pesco-vegetarian or Mediterranean diets) has beneficial, detrimental, or neutral effects on cardiometabolic health outcomes. Further, mechanistic studies are warranted to enhance our understanding about healthy plant-based food patterns and the biological mechanisms linking dietary factors, CVD, and other metabolic diseases.

Effect of a pescetarian and vegan diet on fatty acid composition in blood and spermatozoa in young healthy men

INTRODUCTION

There is a growing interest in vegetarian and vegan diets, but both can potentially affect tissue fatty acids (FA) composition. We aimed to evaluate the effect of vegetarian diets on plasma, erythrocytes, and sperm n-3 polyunsaturated fatty acids (n-3 PUFA) status in healthy young men.

METHODS

Four groups were studied: i) men consuming a regular omnivore diet (OMV-1, n = 35); ii) men consuming an omnivore diet but excluding fish and seafood (OMV-2, n = 34); iii) men consuming a pescetarian diet (including dairy, eggs, fish, and seafood) (PESC, n = 36); and iv) men following a strict vegan diet (VEG, n = 35). Participants in each group should follow their diet for at least the previous 12 months. Diet evaluation used a structured validated food frequency questionnaire. FA composition was measured in plasma, erythrocyte phospho-lipids, and spermatozoa by gas-liquid chromatography, expressed as a mole percentage of the total FA content.

RESULTS

Main findings showed higher alpha-linolenic fatty acid (ALA) and total n-3 PUFA dietary intake in the VEG group. In plasma, arachidonic and eicosapentaenoic acids were higher in OMV and PESC groups, whereas docosahexaenoic acid (DHA) level was lower in VEG. Higher ALA, but reduced DHA and total n-3 PUFA levels were found in erythrocytes and spermatozoa in the VEG group.

CONCLUSION

Higher dietary ALA intake was found in pescetarians and vegan men. However, the higher ALA intake was not reflected in higher DHA content in the evaluated tissues. PUFA assessment, with particular emphasis in DHA, are necessary to improve PUFA status in vegan men.

"Vegan" and "plant-based" claims: risk implications for milk- and egg-allergic consumers in Canada

The market share of foods carrying labels suggesting absence of animal ingredients has significantly increased in recent years. The purpose of this study was to document the purchasing behaviour of egg- or milk-allergic consumers vis-à-vis food marketed as "vegan" and "plant-based", and to evaluate the associated allergenic risk. A survey was conducted among egg- and milk-allergic consumers and revealed that 86% (margin of error 5.4%; confidence level 95%) would buy "vegan" products, indicating this label may be perceived as a substitute for "free from milk and eggs". To assess the risk posed by these products, 87 prepackaged foods with "vegan" and/or "plant-based" claims purchased in Quebec were tested for milk proteins, and 64 for egg proteins. Overall, 5.7% and 0% occurrence of milk and egg proteins, respectively, were observed, suggesting that the analysed prepackaged foods carrying "vegan" and/or "plant-based" labels pose little risk to egg- or milk-allergic consumers. However, this is likely due to allergen management practices applied by the Canadian manufacturers of the products tested, and should not be attributed to the use of "vegan" or similar labels. Enhanced regulatory requirements for the use of these labels, and an education campaign on their meaning with respect to allergy-related risks, are necessary to better inform and protect egg- and milk-allergic consumers.

Fruits as nutraceuticals: A review of the main fruits included in nutraceutical patents

Fruits have relevant usefulness in the elaboration of nutraceutical compositions and, as it is considered a "natural medicine", its market has been growing exponentially each year. Fruits, in general, contain a large source of phytochemicals, carbohydrates, vitamins, amino acids, peptides and antioxidants that are of interest to be prepared as nutraceuticals. The biological properties of its nutraceuticals can range from antioxidant, antidiabetic, antihypertensive, anti-Alzheimer, antiproliferative, antimicrobial, antibacterial, anti-inflammatory, among others. Furthermore, the need for innovative extraction methods and products reveals the importance of developing new nutraceutical compositions. This review was developed by searching patents of nutraceuticals from January 2015 until January 2022 in Espacenet, the search database of the European Patent Office (EPO). Of 215 patents related to nutraceuticals, 43% (92 patents) were including fruits, mainly berries. A great number of patents were focused on the treatment of metabolic diseases, representing 45% of the total patents. The principal patent applicant was the United States of America (US), with 52%. The patents were applied by researchers, industries, research centers and institutes. It is important to highlight that from 92 fruit nutraceutical patent applications reviewed, 13 already have their products available on the market.

The cheese paradox: How do vegetarians justify consuming non-meat animal products?

Researchers interested in animal ethics have proposed the 'meat paradox' - psychological discomfort arising from people's affinity for animals and conflicting desire to consume their flesh. Yet what can be said about the psychology of consuming an animal's non-meat products, in an age where most beings in these industries are harmed, and ultimately killed? Non-meat animal products (NMAPs) such as eggs and dairy entail the same, and perhaps even worse ethical issues as meat yet receive disproportionately less critical attention. Therefore, unlike meat, very little is known about the psychology of egg and dairy consumption. This study looks at vegetarians to address this gap, because they are more likely to show empathetic concern for animals than meat-eaters, yet actively choose to include these products in their diet, a conflict ripe for exploration. Interview data were analysed via thematic analysis, finding that vegetarians perceive robust ethical issues with NMAPs but give various justifications pertaining to personal benefits and social norms. Cognitive dissonance was evident and participants used various strategies to resolve it. This paper expands research on food psychology and animal ethics and may also be used to inform NMAP reduction strategies, an important pursuit in the quest for a more sustainable and compassionate world.

Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials

AIMS

Due to growing environmental focus, plant-based diets are increasing steadily in popularity. Uncovering the effect on well-established risk factors for cardiovascular diseases, the leading cause of death worldwide, is thus highly relevant. Therefore, a systematic review and meta-analysis were conducted to estimate the effect of vegetarian and vegan diets on blood levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B.

METHODS AND RESULTS

Studies published between 1980 and October 2022 were searched for using PubMed, Embase, and references of previous reviews. Included studies were randomized controlled trials that quantified the effect of vegetarian or vegan diets vs. an omnivorous diet on blood lipids and lipoprotein levels in adults over 18 years. Estimates were calculated using a random-effects model. Thirty trials were included in the study. Compared with the omnivorous group, the plant-based diets reduced total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B levels with mean differences of -0.34 mmol/L (95% confidence interval, -0.44, -0.23; P = 1 × 10-9), -0.30 mmol/L (-0.40, -0.19; P = 4 × 10-8), and -12.92 mg/dL (-22.63, -3.20; P = 0.01), respectively. The effect sizes were similar across age, continent, duration of study, health status, intervention diet, intervention program, and study design. No significant difference was observed for triglyceride levels.

CONCLUSION

Vegetarian and vegan diets were associated with reduced concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-effects that were consistent across various study and participant characteristics. Plant-based diets have the potential to lessen the atherosclerotic burden from atherogenic lipoproteins and thereby reduce the risk of cardiovascular disease.

Iodine in plant-based dairy products is not sufficient in the UK: A market survey

BACKGROUND

Following a well-balanced diet ensures that a person gets all the essential elements for health sustenance. However, in the United Kingdom an increasing proportion of people are transiting to become vegans who exclude animal-based products in their diets. Consequently, people may have a deficit of essential elements such as iodine which is not present in most plant-based meals, additionally iodide fortified table salt is not commonly used in the UK. Without iodine people consuming a vegan diet risk developing iodine deficiency and diseases like goiter.

METHODS

The objective of this study is to determine the difference in iodine content and iodine speciation between plant-based and dairy products. More than 100 market samples of plant-based and dairy milk products were collected in Scotland, UK.

RESULTS

Iodine concentrations in dairy milk is ten times higher compared to plant-based milks. Similar differences were also apparent for butter, yogurt and cheese. A total of 20% of plant-based milk products were fortified with iodine, however these products had lower iodine concentrations compare to the equivalent dairy products. In this study we calculated that people with average diet have an iodine intake of 226 + /- 103 μg day^-1 from dairy products which satisfies the WHO recommended intake of adults and 90% of the recommend intake for pregnant and breast-feeding women. A diet from substituted dairy products gives only 21.8 µg day^-1 for the respective WHO guideline intake values, which accounts only 15% of the iodine intake for adults and 9% for pregnant and lactating women. Iodine fortified diet could increase the iodine intake to 55% or 33% of the WHO recommended daily intake respectively.

CONCLUSION

Plant-based dairy consumers are encouraged to use iodine fortified dairy products or use of iodized salt in the UK for home cooking, otherwise there are at risk to get iodine deficient.

Various ways towards animal product limiting - Practical and social engagements in initial phase of dietary change

Reducing one's consumption of foods containing animal products, or avoiding such foods altogether, has become part of everyday life for many people in the Western world. People's motivations for such "animal product limiting" are well-established, but the ways in which individuals enact and experience dietary change in the initial phase are not well understood. Nor is it clear whether, and how, these people present their dietary changes to others. Through the analysis of interviews with 28 people residing in Denmark who had recently (<9 months) embarked on flexitarian, vegetarian or vegan diets, this paper explores how people, in the initial phase of trying to consume fewer, or no, foods with animal products, (i) engage in the practicalities of daily food activities and (ii) communicate their experiences with, and opinions about, the dietary changes they are making in interpersonal interactions. The findings reveal two very different ways of organising the daily food activities: Foodism and Convenience. They also disclose three different ways of communicating in interpersonal interactions: Ethical advocacy, Plant food demonstration and Anonymisation of diet. The paper offers insights into the variation in practices underlying animal product limiting. It suggests that the plant food sector should cater for people relying on convenient food practices as well as those engaged in more advanced ("foodie") practices. Further, in discussing interpersonal communication in the light of community-based social marketing, we argue that the findings highlight how animal product limiters, in everyday social life, may be able to encourage more people to embark on animal product limiting.

Assessment of Nutritional Status in the Diagnostic Evaluation of the Child with Growth Failure

Current clinical guidelines provide information about the diagnostic workup of children with growth failure. This mini-review focuses on the nutritional assessment, which has received relatively little attention in such guidelines. The past medical history, in particular a low birth size and early feeding problems, can provide information that can increase the likelihood of nutritional deficits or several genetic causes. The current medical history should include a dietary history and can thereby reveal a poorly planned or severely restricted diet, which can be associated with nutritional deficiencies. Children on a vegan diet should receive various nutritional supplements, but insufficient compliance has been reported in one-third of cases. While proper use of nutritional supplements in children consuming a vegan diet appears to be associated with normal growth and development, insufficient intake of supplements may impede growth and bone formation. Physical examination and analysis of height and weight over time can help differentiating between endocrine causes, gastrointestinal disorders, psychosocial problems, or underlying genetic conditions that prevent adequate nutritional intake. Laboratory screening should be part of the workup in every child with short stature, and further laboratory tests can be indicated if warranted by the dietary history, especially in children on a poorly planned vegan diet.

Knowledge, attitudes, and factors associated with vegetarianism in the Saudi Population

BACKGROUND

In recent years, there has been great interest in the dietary practices of vegetarians in addition to an increasing awareness of the potential benefits of vegetarian diets. However, there are insufficient data on the spread of vegetarianism in Arab countries. The aim of this study was to investigate knowledge and attitudes about vegetarianism and associated factors in the Saudi population and to understand the reasons for its growing prevalence.

METHOD

This is a cross-sectional study began in May 2020 and ended in September 2020. Researchers distributed the questionnaire electronically through social media. Data were collected electronically and exported to Excel by the researchers .The electronic questionnaire comprised three sections: sociodemographic questions, reasons for following a vegetarian diet, and beliefs and knowledge about vegetarianism.

RESULTS

There were 3,035 responses, of which 80.2% of respondents were female and 19.8% were male. Participant were aged 18-65. Vegetarians represented 37.5% (15.7% semivegetarians, 8.1% pescovegetarians, 64.3% lacto-ovo-vegetarians, and 11.3% vegans), and the rest were nonvegetarians. The majority of the vegetarian participants (92.9%) had a low vegetarianism knowledge level. Health issues, followed by ethical and environmental concerns, were the most common motivators for adopting a vegetarian diet; these reasons were cited by 72.5%, 59.3%, and 47.9% of participants, respectively. Factors associated with increased vegetarianism were engaging in exercise for half an hour to two hours, while factors associated with decreased vegetarianism were male, aged 51-64 years, being married, having a higher education, working in the health sector, being a housewife, and having an income between 5,000 and 10,000 SR/month.

CONCLUSION

Vegetarianism appears to be a growing phenomenon among the Saudi population. Increased awareness of health issues and the desire to live a healthy lifestyle might be the strongest motives. This study offers an opportunity to better understand vegetarianism in Saudi Arabia along with the possibility of expanding vegetarian food choices for the general public.

Moral emotions and justifying beliefs about meat, fish, dairy and egg consumption: A comparative study of dietary groups

Meat eaters and meat abstainers differ in their beliefs and moral emotions related to meat consumption alongside gender differences. Few studies have investigated beliefs and moral emotions in pescatarians and vegans. Little is known about differences in moral emotions and beliefs regarding dairy, eggs, and fish or about speciesist beliefs within and between specific dietary groups. To address this gap, we investigated moral emotions (consumption-related disgust and guilt), attitudes towards animals (Animal Attitudes Scale) and justifying beliefs related to meat (Carnism Inventory), dairy, egg, and fish consumption in omnivores (n = 167), pescatarians (n = 110), vegetarians (n = 116), and vegans (n = 149). Results showed that people who consumed animal-derived products reported lower disgust and guilt and held stronger justifying beliefs about consumption of these products than those who did not consume animal products. All dietary groups significantly differed from each other in their attitudes about using animals for human benefit, with omnivores showing the least positive attitudes towards animals, followed by pescatarians and vegetarians, and with vegans showing the most positive attitudes towards animals. Women experienced greater moral emotions and held fewer justifying beliefs than men within groups where animal products were consumed and related to the animal-based products they consume (i.e., fish for pescatarians and eggs/dairy for vegetarians). These findings emphasise the importance of considering a wider range of animal products, such as eggs, dairy and fish, and dietary groups in order to obtain a comprehensive understanding of the psychological underpinnings of animal product consumption. The results highlight differences between dietary groups in attitudes and moral concern towards animals, which may be important to consider when designing interventions to reduce animal product consumption.

Popular fad diets: An evidence-based perspective

Despite the emergence of stronger nutritional science over the past two decades, fad diets remain highly popular. However, growing medical evidence has led to the endorsement of healthy eating patterns by medical societies. This thus allows fad diets to be compared to the emerging scientific evidence as to which diets promote or damage health. In this narrative review, the most popular current fad diets are critically analyzed, including low-fat diets, vegan and vegetarian diets, low-carbohydrate diets, ketogenic diets, Paleolithic diets, and intermittent fasting. Each of these diets has some scientific merit, but each has potential deficiencies relative to the findings of nutritional science. This article also presents the common themes that emerge among the dietary guidance of leading health organizations, such as the American Heart Association and the American College of Lifestyle Medicine. While there are important distinctions between dietary recommendations emanating from various medical societies, each recommends eating more unrefined, plant-based foods, while eating fewer highly processed foods and added sugars, and avoiding excessive calorie consumption as an important nutritional strategy for the prevention and management of chronic conditions and promotion of overall health.

Same strategies - different categories: An explorative card-sort study of plant-based proteins comparing omnivores, flexitarians, vegetarians and vegans

Replacing animal-derived proteins with plant-based proteins has environmental and health benefits. Despite increasing consumer acceptance of plant-based proteins, most individuals do not frequently consume them. Understanding how different consumer groups perceive and categorise plant-based proteins in comparison to animal-derived proteins can support the protein transition, as it might provide insights into both consumer acceptance and how to position plant-based proteins. Based on categorisation theory, we investigated how different consumers - omnivores, flexitarians, vegetarians and vegans - categorise various sources of proteins and to what extent they use taxonomic, goal-derived or cross-categorisation approaches. 121 Dutch participants free-sorted 80 product cards (30 plant-based proteins, 20 animal-derived proteins, 5 hybrids (animal-plant) and 25 non-protein products). Forty participants elaborated on their categorisations in follow-up interviews. Our findings show that similar strategies can result in different categories depending on consumer group. Taxonomic categorisation strategies are dominantly applied by all consumer groups, but specific categories differ. With decreasing animal protein consumption, omnivores, flexitarians, vegetarians and vegans become increasingly strict in their categorisations. Omnivores do not separate proteins as strictly as flexitarians, vegetarians and vegans. All groups separate animal-derived meat from plant-based meat alternatives, but hybrid meat is ambiguous for omnivores and flexitarians. Variations in categorisations of plant-based proteins between groups give directions to marketers on how to tailor positioning of these products in a way that consumers identify and adopt plant-based proteins, to guide and accelerate the protein transition.

Experiences of initiating and maintaining a vegan diet among young adults: A qualitative study

A vegan diet, which excludes all animal-derived products, has been associated with some improvements in health, while also conferring environmental benefits. Understanding the psychological determinants of successfully switching to a vegan diet will help to inform the design of interventions supporting long-term dietary change. Studies to date have tended to focus on reasoned motives underlying the decision to initiate such a dietary shift. Yet, focusing on reasons for switching may overlook the importance of a broader range of psychological factors that may help or hinder attempts to maintain a vegan diet. This qualitative interview study, the timing of which coincided with UK Covid-19 lockdowns, documented experiences of 20 young adults (17 female; mean age 22y) who attempted to adopt a vegan diet in the past nine months and had or had not successfully maintained this change. Reflexive Thematic Analysis identified five themes surrounding initiation and maintenance. A theme of 'motives, expectations and cues to switching' showed that switching was motivated by ethical or health concerns, and cued by Veganuary, lockdown or health issues. 'The effortfulness of switching' captured experiences of the perceived burden imposed by adhering to the diet due to, for example, a perceived lack of accessible vegan options. The 'flexibility of dietary rules' theme showed that many found the 'no animal products' rule clear but restrictive, so allowed themselves occasional non-meat animal products. 'Social acceptability concerns' captured the importance of acceptance from vegan and non-vegan family and friends, and 'satisfaction with the switch' described the perceived benefits that sustained maintenance for many. Our findings suggest that interventions should seek to support people to overcome potentially unforeseen practical and social challenges to adhering to a vegan diet.

Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies

PURPOSE

Vegetarian diets have been associated with reduced risk of ischemic heart disease (IHD). However, results regarding cardiovascular disease (CVD) overall and stroke are less clear. We conducted a systematic review and meta-analysis of prospective cohort studies on CVD, IHD and stroke risk among vegetarians or vegans versus nonvegetarians to clarify these associations.

METHODS

PubMed and Ovid Embase databases were searched through August 12, 2021. Prospective cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for incidence or mortality from CVD, IHD and stroke, comparing vegetarians and vegans to nonvegetarians were included. Risk of bias (RoB) was assessed using ROBINS-I and the strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria. Summary RRs (95% CIs) were estimated using a random effects model.

RESULTS

Thirteen cohort studies (844,175 participants, 115,392 CVD, 30,377 IHD, and 14,419 stroke cases) were included. The summary RR for vegetarians vs. nonvegetarians was 0.85 (95% CI: 0.79-0.92, I² = 68%, n = 8) for CVD, 0.79 (95% CI: 0.71-0.88, I² = 67%, n = 8) for IHD, 0.90 (95% CI: 0.77-1.05, I² = 61%, n = 12) for total stroke, and for vegans vs. nonvegetarians was 0.82 (95% CI: 0.68-1.00, I² = 0%, n = 6) for IHD. RoB was moderate (n = 8) to serious (n = 5). The associations between vegetarian diets and CVD and IHD were considered probably causal using WCRF criteria.

CONCLUSIONS

Vegetarian diets are associated with reduced risk of CVD and IHD, but not stroke, but further studies are needed on stroke. These findings should be considered in dietary guidelines.

REVIEW REGISTRATION

No review protocol registered.

Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors

PURPOSE OF REVIEW

There is strong evidence that poor dietary intake of certain micro- and macro-nutrients can negatively affect bone health. It is unclear if diet is the primary culprit for poor bone health in the vegan population.

RECENT FINDINGS

Plant-based diets are gaining public interest since they may improve metabolic health. Studies that examine vegetarians and vegans together show a lower bone mineral density (BMD), but not always increased fracture risk compared to omnivores. However, vegans consistently have higher risk of fracture at multiple bone sites, especially at the hip. There is higher fracture risk in vegans which may be due to calcium and vitamin D intake, as well as amount of dietary protein and quality. Other nutrients (B vitamins, Se, Zn, Fe, iodine) or physiological factors (lower body mass index, microbiome, or endocrine profile) may also play a role but have not been examined and require further study.

Identity processes and food choice: predictors of dietary lapses among ethical and health vegans

An interesting finding in the literature on vegetarianism and veganism finds that vegetarians and vegans often report that they deviate from their diets from time to time. Work examining this phenomenon finds that these dietary lapses relate to many factors; however, little research examines how these factors collectively influence dietary lapses while also controlling for the relationships that may exist among factors. Here, I fill this gap by drawing from the unified model of vegetarian identity (UMVI) and identity theory (IT) to propose an inclusive model of dietary lapses. Structural equation model results from a sample of 488 vegans reveal differences in how identity and interactional processes relate to dietary lapses across ethical and health motivations. This work is important because it highlights how identities relate to dietary behaviors differently for ethical and health vegans; it also provides fruitful avenues for future work in this area.

Vegan labeling for what is already vegan: Product perceptions and consumption intentions

Given the increasing popularity of vegan labels, our study examines the effect of vegan labeling on product perceptions and consumption intentions. We focus on randomly-vegan products which are products that have neither undergone any special reformulation to be vegan nor explicitly aim to serve the market segment of vegans and vegetarians. Food marketers are often tempted to add a vegan label to their randomly-vegan products to capitalize on the growing popularity of vegan food. Our results show that labeling randomly-vegan products biases the perceived healthiness, expected taste, and perceived sustainability, but only if consumers do not expect such randomly-vegan products to be vegan by default. This translates into altered consumption intentions for these unexpected-vegan products with a vegan label (vs. no label). Importantly, this applies to both utilitarian and hedonic products. No effects attributed to the vegan label (vs. no label) were found for randomly-vegan products that consumers expected to be vegan by default.

Nutritional management of immediate hypersensitivity to legumes in vegetarians

Vegetarianism is becoming a common practice among people. Products of vegetable origin are also on the rise, such as vegetable "milk" and legume-based snacks, which may lead to legume sensitivity and allergies in vegetarian diet followers. Furthermore, products derived from legumes, such as lupin flour or fenugreek powder, are often used as food additives. They function as hidden allergens, not always evident on the precautionary labeling, favoring allergic reactions. As dietary allergen restriction is the fundamental pillar in managing patients with food allergies, this review aims to reflect on practical aspects-diagnosis and nutritional management-in managing legume allergies in vegetarians, aiming to reduce the negative nutritional impact of an even more restrictive diet.

Characteristics and clinical implications of the relationship between veganism and pathological eating behaviours

OBJECTIVE

Veganism may serve as a socially acceptable means to restrict food intake and disguise pathological eating behaviours. Studies that include vegan participants typically group them with other meat avoiders (e.g., vegetarians), potentially masking risk factors unique to veganism.

METHOD

We addressed this issue by recruiting two Amazon Mechanical Turk samples of 110 vegan and 118 omnivore participants, with comparable gender composition. We aimed to examine whether vegans showed higher disordered eating than omnivores, and if motives for pursuing a vegan diet impacted disordered eating. We assessed disordered eating using the Eating Attitudes Test, the Eating Disorder Examination-Questionnaire, and the Eating Pathology Symptom Inventory.

RESULTS

Vegans displayed more pathological eating behaviours than omnivores, which was significantly predicted by cognitive restraint. However, body dissatisfaction levels were higher in omnivores than vegans. Diet motives did not influence vegans' disordered eating.

CONCLUSION

We propose vegans have high levels of cognitive restraint, possibly due to their intention to avoid animal products. In turn, cognitive restraint subscales in eating disorder measures might be over-pathologising rates of eating disorders in vegans. Future research should monitor the progression of people's eating-related attitudes and behaviours before and after they transition to veganism to establish whether veganism increases the risk of disordered eating, or vice versa.

LEVEL OF EVIDENCE

IV, cross-sectional study.

Plant-based diets and long-term health: findings from the EPIC-Oxford study

The concept of plant-based diets has become popular due to the purported benefits for both human health and environmental impact. Although 'plant-based' is sometimes used to indicate omnivorous diets with a relatively small component of animal foods, here we take it to mean either vegetarian (plant-based plus dairy products and/or eggs) or vegan (100% plant-based). Important characteristics of plant-based diets which would be expected to be beneficial for long-term health are low intakes of saturated fat and high intakes of dietary fibre, whereas potentially deleterious characteristics are the risk of low intakes of some micronutrients such as vitamin B12, vitamin D, calcium and iodine, particularly in vegans. Vegetarians and vegans typically have lower BMI, serum LDL cholesterol and blood pressure than comparable regular meat-eaters, as well as lower bone mineral density. Vegetarians in the EPIC-Oxford study have a relatively low risk of IHD, diabetes, diverticular disease, kidney stones, cataracts and possibly some cancers, but a relatively high risk of stroke (principally haemorrhagic stroke) and bone fractures, in comparison with meat-eaters. Vegans in EPIC-Oxford have a lower risk of diabetes, diverticular disease and cataracts and a higher risk of fractures, but there are insufficient data for other conditions to draw conclusions. Overall, the health of people following plant-based diets appears to be generally good, with advantages but also some risks, and the extent to which the risks may be mitigated by optimal food choices, fortification and supplementation is not yet known.

A new real-time PCR assay to specifically detect crustaceans in vegan raw materials and vegan shrimps

Contamination of vegan products and vegan shrimps with real shrimps and crustaceans must be avoided to comply with vegan claims, even more for preventing strong allergenic reactions. Therefore, the detection of crustaceans must be reliable and sensitive enough for authenticity, traceability, and food safety purposes. A new real-time PCR assay was developed targeting the mitochondrial 16S rRNA gene of crustaceans and was optimised to avoid critical mismatches with primers and probe. By testing several crustacean species and common food ingredients, the method was demonstrated to be specific to crustaceans only. To comply with the limit of non-vegan contamination established at 0.1% (w/w) by the European Vegetarian Union, dedicated cut-off C_T values were determined on vegan raw materials and on vegan shrimps spiked with crustacean materials. The method reached a sensitivity ≤ 0.0005% (w/w), which was further confirmed on reference materials containing a similar amount of crustacean.