Flexitarian Diets and Health: A Review of the Evidence-Based Literature

Detailed characterization of plant-based burgers

Flexitarians have reduced their meat consumption showing a rising interest in plant-based meat alternatives with 'meaty' characteristics, and we are witnessing an unprecedented growth of meat substitutes in the Western market. However, to our knowledge, no information regarding the 'simulated beef burgers' nutritional profile compared to similar meat products has been published yet. Here we show that, whilst both plant-based and meat-based burgers have similar protein profile and saturated fat content, the former are richer in minerals and polyunsaturated fatty acids. We found that the most abundant minerals in both categories were Na, K, P, S, Ca, and Mg; being Na and S content similar between groups. Only six amino acids differed between categories, being hydroxyproline exclusively in meat-based burgers. Plant-based burgers revealed fourfold greater content of n-6 than meat-based burgers, and greater short-chain fatty acids proportion. Our results demonstrate how 'simulated beef' products may be authenticated based on some specific nutrients and are a good source of minerals. We believe that there is a need to provide complete and unbiased nutritional information on these 'new' vegan products so that consumers can adjust their diet to nutritional needs.

Young adults' experiences with flexitarianism: The 4Cs

Meat reduction has important implications for public health and the environment. With people more likely to reduce their meat consumption than eliminate it completely, there is increased interest in flexitarian (reduced meat) diets. Young adults in particular are transitioning towards a flexitarian diet, yet there is very little research on this crucial sub-set of the population. In this research, 23 interviews are conducted with young adults aged 18-35 in New Zealand to explore their lived experiences (i.e., motivations, strategies and barriers) towards flexitarianism. The research finds young adults are encouraged to transition towards flexitarianism due to increased control, through a transition away from home which is enabled through cooking strategies, social support and experimentation. Young flexitarians are motivated to reduce meat consumption due to concern about various individual (health, variety, price, reduce social unease) and altruistic (environment and ethics) motivations. Continued meat consumption is mainly driven by a need to compromise at social gatherings, and due to positive associations with variety, nutrients and fullness as well as taste due to cravings. The findings have several implications for social marketing and public health, particularly around supportive social settings, seeing flexitarianism as a 'not all or nothing approach' (one does not have to be a full vegetarian or a meat eater, but can instead be something in between), positive emotions such as pride associated with meat reduction, and that documentaries and social networks are key triggers for meat reduction.

In Vitro Protein Digestibility and Fatty Acid Profile of Commercial Plant-Based Milk Alternatives

Plant-based milk alternatives (PBMA) are a new popular food trend among consumers in Europe and North America. The forecast shows that PBMA will double their value by 2023. The objective of this study was to analyze the nutritional value of commercial products in terms of their fatty acid profile and protein digestibility from commercial PBMA. Eight commercially available PBMA were selected for fatty acid analysis, performed with gas chromatography of methylated fatty acids (GC-FAME), and, from these, four commercial products (almond drink, hemp drink, oat drink, and soy drink) were selected for a short-term in vitro protein digestibility (IVPD) analysis. The fatty acid analysis results showed that most of the products predominantly contained oleic acid (C18:1 ω-9) and linoleic acid (C18:2 ω-6). Hemp drink contained the highest omega-6/omega-3 (ω6/ω3) ratio among all tested products (3.43). Oat drink and almond drink were the PBMA with the highest short-term protein digestibility, non-significantly different from cow's milk, while soy drink showed the lowest value of protein digestibility. In conclusion, PBMA showed a significant variability depending on the plant source, both in terms of fatty acid composition and protein digestibility. These results provide more in-depth nutritional information, for future product development, and for consumer's choice.

Nutrient Profiling of Romanian Traditional Dishes—Prerequisite for Supporting the Flexitarian Eating Style

Currently, most countries have to deal with multiple discrepancies that have arisen between the constraints of sustainable development and the return to traditions, involving food producers, as well as consumers, aspects that are also easily noticed in Romania. Thus, the main purpose of this study was to assess the nutritional quality of the Romanian traditional diet using a nutrient profiling method based on the Nutri-Score algorithm, applied to several representative Romanian traditional dishes. Because this algorithm has the capacity to highlight the amount (%) of fruits, vegetables, and nuts from a certain dish, it might be considered an indicator of the sustainable valences of the selected meals. The results showed that the traditional menus do not correspond to a balanced and sustainable eating behavior; thus, it is recommended to improve the Romanian pattern of food consumption and to ensure its sustainable basis. In order to achieve this goal, we propose the development of a new paradigm of the contemporary Romanian food style incorporating three main directions of action: acceptance, adaptation, and transformation.

Evaluating Animal-Based Foods and Plant-Based Alternatives Using Multi-Criteria and SWOT Analyses

Global diets have transitioned in recent decades with animal and processed products increasing. Promoting a reversal in these trends towards plant-based diets could reduce the environmental impacts of food systems and reduce the prevalence of non-communicable diseases and malnutrition. In Spain, a reference point for the Mediterranean diet (predominantly plant-source based), plant-based alternatives to traditional animal-based products are receiving increased attention. However, limited focus has been given to the opinions of stakeholder groups on the potential of these novel products. We evaluate the opinions of stakeholders within the Spanish agri-food sector, using multicriteria and SWOT analyses, on traditional and novel food products. Stakeholders involved in the supply chain of food products (producers, processors, and distributors) were critical of novel plant-based foods, highlighting problems with their taste, processing technology, and high prices. These results contrast with the perspectives of policymakers, researchers, environmental NGOs, and consumers who see novel products more positively - healthier, more sustainable, and highly profitable. These results illustrate the more traditional mindset seen in Spanish production systems, contrasting with the rapidly shifting tastes and demands of consumers and the potential legislative orientation of policymakers. This study calls for improved understanding and collaboration between stakeholders to better manage complex choices that affect the future of food systems during their needed transformation.

Mapping Young Adults' Concerns and Attitudes toward Food-Related Sustainability Issues in Israel: Implications for Food Policy

Identifying the concerns about and attitudes toward adopting a healthy, sustainable diet may facilitate the development of effective implementation policies targeted at changing an individual’s dietary choices toward reducing the environmental burden of food systems. This cross-sectional online study was conducted in Israel among 348 adults aged 20–45 who responded to an advertisement posted on several social media platforms. Respondents received a link for the survey after signing informed consent forms. The questionnaire included three sections: concerns regarding food-related sustainability issues, willingness to act (“self”), and expectation that leaders would act upon these issues (“leaders”). Responses were recorded on a 1–4 Likert scale. Health-related issues—healthy food and drink, food prices, food safety, and the quality of health services—were scored the highest, both in the “self” and “leaders” sections. In all items, the expectation that leaders would act was higher than the willingness to act (composite mean ± SD: 3.04 ± 3.11 vs. 2.51 ± 2.47, respectively, p < 0.001). There were significant differences among dietary patterns in all three components. Mapping young adults’ concerns about and attitudes toward food-related sustainability issues allows for the identification of leverages that can be further used as focus issues in messages and interventions such as communication, food labeling, and economic incentives.

Vegetarian and omnivorous diets: A cross-sectional study of motivation, eating disorders, and body shape perception

Vegetarianism, which is increasingly widespread in Western societies, is underpinned by various motivations (ethical, environmental, health concerns …) and the question of its association with eating disorders continues to divide the literature. This cross-sectional study aimed to explore and compare eating motives/attitudes and bodily preoccupations of vegetarian and omnivorous participants from the general population. Forty-nine vegetarians and 52 omnivores, aged between 18 and 70 years, completed a battery of questionnaires including sociodemographic characteristics, Body Mass Indexes (BMI - current, ideal, lifetime lowest, and lifetime highest), the Food Choice Questionnaire (FCQ), the Eating Attitudes Test-26 (EAT-26), and the Body Shape Questionnaire (BSQ). Compared to omnivores, vegetarians reported lower current (p = .017), ideal (p = .009), and lifetime lowest (p = .005) BMIs, more motivations related to health (p = .001) and natural content (p < .0001), but less weight control motivations (p = .015). While no differences were observed in EAT-26 scores, vegetarians had lower BSQ total scores (p = .043), and lower scores on the Body Dissatisfaction related to Lower body parts (p = .025) and Unsuited Cognitions and Behaviors (p = .015) subscales compared to omnivores. Separate gender comparisons revealed that these differences existed only among women. Hierarchical regressions revealed that the natural content motivation was the strongest positive statistical predictor of the vegetarian group (Expβ = 1.18, p = .002), while the weight control motivation was a negative statistical predictor (Expβ = .710, p = .023). Results demonstrated that vegetarians expressed motivation for a healthy and natural diet, and were less concerned about controlling their weight than the omnivores. Vegetarian women had lower BMIs but expressed fewer psychological concerns associated with eating disorders than omnivorous women. Vegetarian diets appeared to be associated with health benefits and less body and weight concerns, particularly among women in the general population.

Is There Scope for a Novel Mycelium Category of Proteins alongside Animals and Plants?

In the 21st century, we face a troubling trilemma of expanding populations, planetary and public wellbeing. Given this, shifts from animal to plant food protein are gaining momentum and are an important part of reducing carbon emissions and consumptive water use. However, as this fast-pace of change sets in and begins to firmly embed itself within food-based dietary guidelines (FBDG) and food policies we must raise an important question-is now an opportunistic time to include other novel, nutritious and sustainable proteins within FBGD? The current paper describes how food proteins are typically categorised within FBDG and discusses how these could further evolve. Presently, food proteins tend to fall under the umbrella of being 'animal-derived' or 'plant-based' whilst other valuable proteins i.e., fungal-derived appear to be comparatively overlooked. A PubMed search of systematic reviews and meta-analytical studies published over the last 5 years shows an established body of evidence for animal-derived proteins (although some findings were less favourable), plant-based proteins and an expanding body of science for mycelium/fungal-derived proteins. Given this, along with elevated demands for alternative proteins there appears to be scope to introduce a 'third' protein category when compiling FBDG. This could fall under the potential heading of 'fungal' protein, with scope to include mycelium such as mycoprotein within this, for which the evidence-base is accruing.

The Environmental Impact of the Athlete's Plate Nutrition Education Tool

Periodized nutrition is necessary to optimize training and enhance performance through the season. The Athlete's Plate (AP) is a nutrition education tool developed to teach athletes how to design their plates depending on training load (e.g., volume × intensity), from easy (E), moderate (M) to hard (H). The AP was validated, confirming its recommendations according to international sports nutrition guidelines. However, the AP had significantly higher protein content than recommended (up to 2.9 ± 0.5 g·kg-1·d-1; p < 0.001 for H male). The aim of this study was to quantify the environmental impact (EnvI) of the AP and to evaluate the influence of meal type, training load, sex and registered dietitian (RD). The nutritional contents of 216 APs created by 12 sport RDs were evaluated using Computrition Software (Hospitality Suite, v. 18.1, Chatsworth, CA, USA). The EnvI of the AP was analyzed by life cycle assessment (LCA) expressed by the total amount of food on the AP, kg, and kcal, according to the Swiss Agricultural Life Cycle Assessment (SALCA) methodology. Higher EnvI is directly associated with higher training load when the total amount of food on the plate is considered for E (5.7 ± 2.9 kg CO2 eq/day); M (6.4 ± 1.5 kg CO2 eq/day); and H (8.0 ± 2.1 kg CO2 eq/day). Global warming potential, exergy and eutrophication are driven by animal protein and mainly beef, while ecotoxicity is influenced by vegetable content on the AP. The EnvI is influenced by the amount of food, training load and sex. This study is the first to report the degree of EnvI in sports nutrition. These results not only raise the need for sustainability education in sports nutrition in general, but also the urgency to modify the AP nutrition education tool to ensure sports nutrition recommendations are met, while not compromising the environment.

How to protect both health and food system sustainability? A holistic 'global health'-based approach via the 3V rule proposal

OBJECTIVE

To define a generic diet to protect human health and food system sustainability based on three dimensions: animal:plant ratio, degree of food processing and food diversity.

DESIGN/SETTING

The percentages of maximum animal and ultra-processed energy content were evaluated from scientific papers (Web of Science database) and reports from international scientific institutions. Then, a weekly French standard diet, including these percentages and food diversity (≥42 different foods), was designed to calculate adequacy to nutritional needs.

RESULTS

Based on traditional and scientifically based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median daily animal energy content intake of 15 % was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed energy consumption with increased overweight/obesity risk, a precautionary threshold of approximately 15 % ultra-processed energy content was observed. The French diet allows addressing all nutritional needs and other nutritional indicators such as maximum salt and simple sugar consumption, α-linolenic acid:linoleic acid ratio and essential amino acids. This diet was named the '3V rule' for Végétal (plant), Vrai (real) and Varié (varied, if possible organic, local and seasonal). This generic diet can be adapted according to regional traditions and environmental characteristics. Excluding only one dimension of it would threaten both health and food system sustainability.

CONCLUSIONS

Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost).

Reshaping the Traditional Pattern of Food Consumption in Romania through the Integration of Sustainable Diet Principles. A Qualitative Study

The Romanian traditional pattern of food consumption as a whole is no longer a reference point in shaping a healthy and sustainable food behavior due to the growing discrepancies between the return to traditions and the constraints of sustainable development, so the aim of this study is to provide solutions for reshaping the food pattern by incorporating the principles of sustainable diet. The research conducted is based on qualitative data and the semi-structured interview was used as method of data collection from a sample of 21 Romanians traditional food consumers. The study led to a typology of respondents that combines two consumption orientations, “healthy” and “convenience”, with two attitudes towards traditional diet, “hedonism” and “conformism”. Although respondents do not completely reject the idea of flexitarianism, they showed the tendency for overconsumption of meat-based traditional foods and a weak concern for environmental sustainability. For these reasons, a set of recommendations for a new model of sustainable diet for Romanian population, focused on the relationship between traditionality, sustainability, and health, was put forward. The research findings show the need for supporting nutritional education programs and extensive information campaigns targeted at Romanian consumers to encourage the adoption of flexitarian style and the switch to a more sustainable diet in the near future.

Association between sustainable dietary patterns and body weight, overweight, and obesity risk in the NutriNet-Santé prospective cohort

BACKGROUND

Improving the sustainability of current food systems may prevent future public health, environmental, and social concerns.

OBJECTIVE

Our objective was to investigate the associations between sustainable dietary patterns, assessed using the Sustainable Diet Index (SDI), and the risk of obesity, overweight, and weight gain in French adults, with a prospective design.

METHODS

In 2014, the SDI was computed among 15,626 participants of the NutriNet-Santé study (of whom 76% were women) using data collected within the BioNutriNet project. The SDI ranges from 4 (lowest sustainability) to 20 points and includes 4 subindexes representing the 4 pillars of a sustainable diet. Longitudinal data of weight and height were collected yearly from 2014 to 2018. We used mixed models to estimate the associations between sex-specific quintiles (Qs) of the SDI and weight change and Cox proportional hazard models with different levels of adjustments to assess the association between sex-specific Qs of the SDI and risk of obesity and overweight (mean follow-up time: 2.8 y).

RESULTS

At baseline, a higher percentage of participants with overweight was observed in the first SDI Q, reflecting the lowest sustainable dietary patterns (Q1), than in Q5 (29.83% compared with 12.71%). Compared with Q5, a slight increase (at the population level) of almost 160 g/y was observed in Q1, whereas weight remained relatively stable among participants in other Qs. In total, 281 incident cases of obesity and 777 cases of overweight were identified during the follow-up. Participants in Q1 had a higher risk of obesity and overweight than participants in Q5 (HR comparing Q1 with Q5: 4.03; 95% CI: 2.42, 6.10; P-trend < 0.001; and HR comparing Q1 with Q5: 1.49; 95% CI: 1.13, 1.95; P-trend < 0.001, respectively).

CONCLUSIONS

The findings support a potential protective role for more sustainable diets to prevent the risk of weight gain, overweight, and obesity.This trial was registered at clinicaltrials.gov as NCT03335644.

ORAL AND ENTERAL NUTRITION THERAPY IN INFLAMMATORY BOWEL DISEASES AMONG THE PEDIATRIC POPULATION: A LITERATURE REVIEW

Objectives:

To review the literature on oral and enteral nutrition therapy and investigate the evidence of its efficacy as a treatment, as well as in preventing relapses and reducing symptoms of inflammatory bowel diseases in the pediatric population.

Data source:

We performed a bibliographic search in the PubMed, Web of Science, and Latin American and Caribbean Health Sciences Literature (Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs) databases, using the keywords “inflammatory bowel disease,” “diet,” and “diet therapy” in English and Portuguese, with filters for pediatric studies published in the previous five years.

Data summary:

We selected 16 articles for this study, nine on exclusive and/or partial enteral nutrition and seven on modified oral diets, such as the specific carbohydrate diet (SCD) and the Crohn’s Disease exclusion diet (CDED). The studies found evaluated the anthropometric profile of patients and the inflammatory profile of diseases in children before and after the introduction of each specific nutrition therapy. All interventions presented positive changes in these parameters; however, the results were inconclusive regarding the efficacy of SCD and CDED in the treatment and prevention of relapses.

Conclusions:

Exclusive enteral nutrition has proven to be effective in inducing remission of Crohn’s Disease, and the use of partial enteral nutrition for maintenance treatment has shown promising results. Other modified oral diets are inconclusive concerning their effectiveness, requiring further randomized controlled clinical trials.

A goal-systems perspective on plant-based eating: keys to successful adherence in university students

OBJECTIVE

To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems.

DESIGN

A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits.

SETTING

Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools.

PARTICIPANTS

University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents).

RESULTS

Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report 'To manage or treat a medical condition' as motivation and almost seven times more likely to report 'To align with my ethical beliefs' as motivation compared with non-adherents. However, these participants were 94 % less likely to report 'To maintain and/or improve my health' as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet.

CONCLUSIONS

Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.

Towards More Sustainable Diets-Attitudes, Opportunities and Barriers to Fostering Pulse Consumption in Polish Cities

Despite the evidence-based health benefits of pulses and their significant role in sustainable diets, consumption remains at a very low level in highly developed countries. In an attempt to fill in the knowledge gaps on factors influencing this phenomenon, a study aimed at identifying attitudes, incentives and barriers to pulse consumption was carried out in a sample of 1027 Polish urban employees aged 25-40 years. The sample (quota type) was representative in terms of age and gender. Exploratory classifications using Kohonen neural networks were performed to define profiles of participants for each analysed issue. Pearson's chi-square analysis was used to check whether the profiles depended on socio-demographic characteristics of the respondents. The results suggest that very low pulse consumption is a result of lack of habits, discomfort after eating and long preparation time. Pulses were recognized as a good source of protein (72% of the sample), especially among women (81%). Only 43% of the sample saw pulses as a substitute for meat. The majority of consumers pictured pulses as a tasty and healthy food, although they were not sure if this is true for small children. Women recognised pulses as a more environmentally friendly food but this knowledge would not impact their intake. Profiles of respondents with positive attitudes towards increased pulse consumption were identified, constituting 39% of the sample. These consumers could eat more if they were encouraged to do so. This shows that programmes aimed at fostering greater pulse consumption are crucial to activate a change towards more sustainable diets. At the same time, simple and clear guidelines should be developed to overcome the unjustified stereotypes about pulses. These would support consumers to make healthier and more sustainable choices and help professionals carry out effective promotion and education activities.

Vegetarian, pescatarian and flexitarian diets: sociodemographic determinants and association with cardiovascular risk factors in a Swiss urban population

Prevalence and trends of different vegetarian diets remain unknown, with estimates varying depending on the source. Evidence suggests that vegetarian diets are associated with a more favourable cardiovascular risk profile. The present study aimed to assess the prevalence and trends of different types of vegetarian diets in a population-based representative sample, sociodemographic characteristics of participants following such diets and the association of these diets with cardiovascular risk factors. Using repeated cross-sectional population-based surveys conducted in Geneva, Switzerland, 10 797 individuals participated in the study between 2005 and 2017. Participants were classified as vegetarians, pescatarians, flexitarians or omnivores using an FFQ. Sociodemographic and cardiovascular risk factors were evaluated through questionnaires, anthropometric measurements and blood tests. Findings show prevalence of vegetarians increased from 0·5 to 1·2 %, pescatarians from 0·3 to 1·1 % and flexitarians remained stable at 15·6 % of the population over the study period. Compared with omnivores, vegetarians were more likely to be young (OR 2·38; 95 % CI 1·01, 5·6), have higher education (OR 1·59; 95 % CI 1·01, 2·49) and lower income (OR 1·83; 95 % CI 1·04, 3·21); pescatarians and flexitarians were more likely to be women (pescatarian: OR 1·81; 95 % CI 1·10, 3·00; vegetarian: OR 1·57; 95 % CI 1·41, 1·75) and flexitarians were also more likely to have a lower income (OR 1·31; 95 % CI 1·13, 1·53). Participants who adhered to any diet excluding/reducing meat intake had lower BMI, total cholesterol and hypertension compared with omnivores. The present study shows an increase in the prevalence of vegetarians over a 13-year period and suggests that the different vegetarian diets assessed are associated with a better cardiovascular risk profile.

Usual intake of meat in Australians: secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey using the NCI method

INTRODUCTION

Global public health recommendations advise limiting the intake of red and processed meats. There is a need for more comprehensive information on meat consumption in Australia, specifically usual intake of meat from a nationally representative sample. The aim of this study was to use the National Cancer Institute (NCI) method to examine usual meat intakes in the 2011-12 National Nutrition and Physical Activity Survey (NNPAS).

METHODS

This was a secondary analysis of the cross-sectional 2011-12 NNPAS, which contains observations for 12 153 respondents (9341 adults and 2812 children/adolescents). Usual consumption of all meat, red and processed meats was calculated using the NCI method. Consumption of meat was explored by age and gender groups, as well as by household type.

RESULTS

Amongst adults and children/adolescents, consumption of all meat was significantly higher in males (adults: 187.1 g day^-1 ; children/adolescents: 125.0 g day^-1 ) than females (adults: 125.5 g day^-1 ; children/adolescents: 95.4 g day^-1 ). Similar patterns were observed for red (males: adults 85.5 g day^-1 , children/adolescents 42.9 g day^-1 ; females: adults 57.1 g day^-1 , children/adolescents 34.9 g day^-1 ) and processed meat, although intakes of processed meats in children and adolescents (males: 26.5 g day^-1 ; females: 16.8 g day^-1 ) were found to be similar to those of adults aged ≥19 years (males: 28.3 g day^-1 ; females: 15.3 g day^-1 ). Patterns of meat consumption across household types appeared to differ between genders.

CONCLUSIONS

The present study suggests that Australians are likely to be exceeding population recommendations for meat intakes, with differing patterns observed across gender and household types. These findings highlight a need for targeted dietetic and population strategies aimed at promoting a healthy consumption of meats within the Australian population.

Using Evidence Mapping to Examine Motivations for Following Plant-Based Diets

Motivations to adopt plant-based diets are of great public health interest. We used evidence mapping to identify methods that capture motivations to follow plant-based diets and summarize demographic trends in dietary motivations. We identified 56 publications that described 90 samples of plant-based diet followers and their dietary motivations. We categorized the samples by type of plant-based diet: vegan (19%), vegetarian (33%), semivegetarian (24%), and other, unspecified plant-based diet followers (23%). Of 90 studies examined, 31% administered multiple-choice questions to capture motivations, followed by rate items (23%), Food Choice Questionnaire (17%), free response (9%), and rank choices (10%). Commonly reported motivations were health, sensory/taste/disgust, animal welfare, environmental concern, and weight loss. The methodological variation highlights the importance of using a structured questionnaire to investigate dietary motivations in epidemiological studies. Motivations among plant-based diet followers appear distinct, but evidence on the association between age and motivations appears limited.

Cow Milk versus Plant-Based Milk Substitutes: A Comparison of Product Image and Motivational Structure of Consumption

Cow milk is under increased scrutiny due to its environmental impact and ethical considerations concerning animal welfare. At the same time, a rising share of consumers is switching to plant-based milk substitutes (abbreviated “plant milk”). The objective of this study was (1) to analyze the product image of plant milk and cow milk and (2) to compare the motivational structure behind the consumption of both product categories. For this purpose, a quantitative survey with Austrian consumers was carried out to analyze the product image of plant milk in comparison to cow milk (n = 1001). The product image analysis revealed that the product image of cow milk is still much better than that of plant milk. Amongst others, cow milk is considered to be healthier, more natural, and better for bones. Product image valuation was dependent on the (non-)consumption of plant milk. Plant milk consumers evaluated plant milk significantly better; they considered plant milk to be much better digestible and allergy-free. The qualitative study using means-end-chain analysis, with two sub-samples of interviewees (plant milk consumers, n = 30, and cow milk consumers, n = 30), identified different motives for the consumption of cow milk and plant milk. Motives that were only reported from cow milk consumers are the origin of milk and the support of small-scale dairy production of farmers. Motives of plant milk consumers were much more diverse and included animal welfare and sustainability aspects.

Consumer acceptance and sensory drivers of liking for high plant protein snacks

BACKGROUND

Consumers are being encouraged to increase the proportion of plant protein in their diet to tend to a sustainable food system. Solutions could include developing a food rich in plant protein. However, these new products have an interest only if they are in accordance with expectation and the liking of consumers. In this context, extruded snack balls were developed to explore the sensory drivers of liking and barriers to consumption of formulated products with a high level of plant proteins. Eight different products varying in the type of cereal flour (rice or wheat) and pea flour content (from 60% to 90%) were developed following a factorial design. Eighty omnivore and 72 flexitarian consumers were recruited to evaluate the liking of these products. In addition, their sensory properties were described by a trained panel according to a profile method.

RESULTS

The cereal type had globally more influence on liking than the percentage of pea. However, liking was inversely correlated with pea flour content, regardless of the cereal type. The main drivers of liking are texture criteria (in particular crispy and puffy), whereas flavor perception (pea, green) constitutes a barrier to acceptance. Interestingly, very few differences of liking were observed depending on the diet of consumers even though the attitudes of flexitarian'towards such type of products differed from those of omnivores. We identified three clusters of consumers based on their preferences. Pea flavor acceptance or rejection could explain these clusters. Although most consumers rejected pea flavor, approximately 40% of the participants preferred the products with highest pea content.

CONCLUSION

The results of the present study will help provide guidance for innovative plant food design and formulation. © 2019 Society of Chemical Industry.

Dietary Change Scenarios and Implications for Environmental, Nutrition, Human Health and Economic Dimensions of Food Sustainability

Demand side interventions, such as dietary change, can significantly contribute towards the achievement of 2030 national sustainable development goals. However, most previous studies analysing the consequences of dietary change focus on a single dimension of sustainability (e.g., environment) using a limited number of indicators and dietary scenarios. A multi-dimension and multi-indicator analysis can identify the potential trade-offs. Here, starting from the current food consumption data (year 2011), we first designed nine alternative dietary scenarios (healthy Swiss diet, healthy global diet, vegetarian, vegan, pescatarian, flexitarian, protein-oriented and meat-oriented diets and a food greenhouse gas tax diet). Next we calculated three nutritional quality (nutrient balance score, disqualifying nutrient score, percent population with adequate nutrition), five environmental (greenhouse gas, water, land, nitrogen and phosphorus use), one economic (daily food expenditure) and one human health indicator (DALYs) for current and alternative diets. We found that transition towards a healthy diet following the guidelines of Swiss society of nutrition is the most sustainable option and is projected to result in 36% lesser environmental footprint, 33% lesser expenditure and 2.67% lower adverse health outcome (DALYs) compared with the current diet. On the other extreme, transition towards a meat or protein oriented diet can lead to large increases in diet related adverse health outcomes, environmental footprint, daily food expenditure and a reduction in intakes of essential nutrients (for Vitamin C, Fibre, Potassium and Calcium). We found that shifting to the vegetarian and vegan diet scenarios might lead to a reduction in intakes of certain micronutrients currently supplied primarily by animal-sourced foods (Vitamin B12, Choline and Calcium). Results show that achieving a sustainable diet would entail a high reduction in the intake of meat and vegetable oils and a moderate reduction in cereals, roots and fish products and at the same time increased intake of legumes, nuts, seeds, fruits and vegetables. We identify several current data and research gaps that need to be filled in order to get more accurate results. Overall, our analysis underscores the need to consider multiple indicators while assessing the dietary sustainability and provides a template to conduct such studies in other countries and settings. Future efforts should focus on assessing the potential of different interventions and policies that can help transition the population from current to sustainable dietary patterns.

Building a Market for New Meat Alternatives

This chapter provides an overview of developments in the Netherlands on new meat alternatives with a focus on plant-based meat substitutes and lab-grown meat. It devotes attention to both the supply side of the market (business activity) and the demand side (consumer appetite). The first concerns developments in the meat substitutes' innovation system since the 1990s until now. It concludes that the Netherlands has become a major player. The latter concerns the supportive purchasing power of consumers regarding the building of a viable and strong market for new meat alternatives. It is concluded that available consumer studies provide evidence for being cautiously optimistic. The closing parts of this chapter, however, bring to the fore that a transition from the current high-meat diets to more sustainable and healthier diets with more non-meat sources of proteins is anything but self-evident. However encouraging and energetic modern developments in the Netherlands are, much progress is needed as it comes to consumer acceptance of new meat alternatives, producer capacity to innovate, concentrate strengths, and capture market share, as well as governmental support for reducing the adverse effects of today's meat consumption and production levels in accordance with Sustainable Development Goal 12 concerning responsible consumption and production.

Perspective: Reductionist Nutrition Research Has Meaning Only within the Framework of Holistic and Ethical Thinking

Today, it seems that nutrition is in a state of great confusion, especially for the general public. For decades, some nutrients (e.g., cholesterol, saturated fats, sugars, gluten, salt) and food groups (e.g., dairy, cereals, meats) have been regularly denigrated. In this position paper, we hypothesize that such a state of confusion is mainly the result of the reductionist paradigm applied to nutrition research for more than a century, and by being pushed to its extreme, this perspective has led to accusations about some nutrients and foods. However, the real issue is about foods taken as a whole and therefore about their degree of processing, which affects both the food matrix and composition. Indeed, we eat whole foods, not nutrients. Therefore, the objectives of this article are to emphasize the need for more holistic approaches in nutrition to preserve our health, animal welfare, and planet. We propose to first redefine the food health potential on a holistic basis and then to show that reductionism and holism are interconnected approaches that should coexist. Then, we try to explain how extreme reductionism has been disconnected from reality and ethical considerations and has ultimately led to environmental degradation and loss of biodiversity, notably through very specific crops, and to an increased prevalence of chronic diseases. Furthermore, to address the confusion of the general public and to simplify nutritional messages, we propose 3 holistic golden rules based on scientific evidence to protect human health, animal welfare, and the environment (climate and biodiversity). Finally, we try to show how these 3 rules can be easily applied worldwide while respecting the environment, cultural traditions, and heritage.

Flexitarian Diet and Weight Control: Healthy or Risky Eating Behavior?

A carefully planned vegetarian diet meets nutrition recommendations by providing essential nutrients and lowering levels of saturated fat and cholesterol. Because balanced diets that limit or exclude meat tend to be lower in calories than omnivorous diets, it has been suggested that vegetarian eating patterns may be motivated by weight control. This view has been supported by findings demonstrating that vegetarians have a higher rate of disordered and restrained eating than non-vegetarians. Other findings suggest that weight control is a primary reason identified by adolescents and young adults for eliminating items such as meat and other animal products from their diet. Thus, it has been suggested that vegetarianism may provide a socially acceptable means to control body weight. However, this may be an over-generalization. Vegetarians are a heterogeneous group of individuals with radically different eating habits. Moreover, they are often compared to omnivores who eat meat on a regular basis. These omnivorous eating habits do not represent a growing subset of the population, many of whom are adopting a flexitarian diet that involves only the occasional consumption of meat. The goal of the current paper will be to demonstrate that semi-vegetarians and flexitarians are categorically different from vegans, lacto-ovo-vegetarians, and omnivores and describe the motivations as well as the positive and negative health implications that are associated with dietary patterns that limit the intake of meat. It is important for us to understand the motivations and behaviors that are characteristic of flexitarians in order to develop effective evidence-based strategies to address unhealthy eating behaviors.

Global Provisioning of Red Meat for Flexitarian Diets

Although not always labeled as such, flexitarianism is the default lifestyle for much of the world, whereby meals based on plant materials provide the bulk of people's calories. The rich nutrition of meat and animal products is often the lynchpin of these diets, even when only consumed occasionally. It provides forms and concentrations of essential proteins, lipids, and micronutrients that are otherwise scarce. However, the production of this meat is resource intensive. It requires large quantities of arable land and water, and typically has lower conversion efficiency of farm inputs to edible outputs compared with crops, poultry, aquaculture, dairy, and eggs. An additional complication is that the quantity of ancillary products produced during slaughterhouse operations is large and underutilized. Each year, approximately 190 million metric tons (MMT) of red meat, including pork, lamb, sheep, veal, beef, and goats are produced globally, half of which will be consumed by less than 25% of the population living in developed countries. With demand for meat expected to exceed 376 MMT by 2030, an increase in the adoption of plant-based diets presents an opportunity for the world to re-evaluate how meat can be sustainably produced, with greater emphasis on animal welfare, nutritional value, product safety, better utilization, and distribution channels. In this article we consider the role meat plays in the modern diet, its production and consumption, opportunities to improve utilization of the animal, the benefits of incorporating a diverse range of red meat into diets, and the strategies that the meat industry should consider in response to flexitarianism.

Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable?

In the past, different types of diet with a generally low-carbohydrate content (< 50–< 20 g/day) have been promoted, for weight loss and diabetes, and the effectiveness of a very low dietary carbohydrate content has always been a matter of debate. A significant reduction in the amount of carbohydrates in the diet is usually accompanied by an increase in the amount of fat and to a lesser extent, also protein. Accordingly, using the term “low carb–high fat” (LCHF) diet is most appropriate. Low/very low intakes of carbohydrate food sources may impact on overall diet quality and long-term effects of such drastic diet changes remain at present unknown. This narrative review highlights recent metabolic and clinical outcomes of studies as well as practical feasibility of low LCHF diets. A few relevant observations are as follows: (1) any diet type resulting in reduced energy intake will result in weight loss and related favorable metabolic and functional changes; (2) short-term LCHF studies show both favorable and less desirable effects; (3) sustained adherence to a ketogenic LCHF diet appears to be difficult. A non-ketogenic diet supplying 100–150 g carbohydrate/day, under good control, may be more practical. (4) There is lack of data supporting long-term efficacy, safety and health benefits of LCHF diets. Any recommendation should be judged in this light. (5) Lifestyle intervention in people at high risk of developing type 2 diabetes, while maintaining a relative carbohydrate-rich diet, results in long-term prevention of progression to type 2 diabetes and is generally seen as safe.

Patterns of Protein Food Intake Are Associated with Nutrient Adequacy in the General French Adult Population

Protein food intake appears to partially structure dietary patterns, as most current emergent diets (e.g., vegetarian and flexitarian) can be described according to their levels of specific protein sources. However, few data are available on dietary protein patterns in the general population and their association with nutrient adequacy. Based on protein food intake data concerning 1678 adults from a representative French national dietary survey, and non-negative-matrix factorization followed by cluster analysis, we were able to identify distinctive dietary protein patterns and compare their nutrient adequacy (using PANDiet probabilistic scoring). The findings revealed eight patterns that clearly discriminate protein intakes and were characterized by the intakes of one or more specific protein foods: ‘Processed meat’, ‘Poultry’, ‘Pork’, ‘Traditional’, ‘Milk’, ‘Take-away’, ‘Beef’ and ‘Fish’. ‘Fish eaters’ and ‘Milk drinkers’ had the highest overall nutrient adequacy, whereas that of ‘Pork’ and ‘Take-away eaters’ was the lowest. Nutrient adequacy could often be accounted for by the characteristics of the food contributing to protein intake: ‘Meat eaters’ had high probability of adequacy for iron and zinc, for example. We concluded that protein patterns constitute strong elements in the background structure of the dietary intake and are associated with the nutrient profile that they convey.

Nutritional Quality of School Meals in France: Impact of Guidelines and the Role of Protein Dishes

In France, school meals must comply with 15 frequency criteria (FC) expressed as nutritional requirements (e.g., “starters containing more than 15% fat served no more than four times out of 20”) in a series of 20 consecutive meals. The objective was to assess, for the first time, the nutritional impact of complying with French school food FC. Based on 40 series of meals actually served in primary schools (“observed series”), several scenarios (1600 series per scenario) of compliance or non-compliance with FC were simulated, and nutritional quality was assessed via the mean adequacy ratio (MAR/2000 kcal). In the observed series, only 9.7 FC on average (range 4–14) were fulfilled. In the simulated series: (i) MAR was positively associated with FC compliance level, with the highest MAR obtained with complete compliance; (ii) MAR decreased when meat or fish-based dishes were replaced by dishes without meat or fish; and (iii) removing the protein dish without replacement led to the lowest MAR. This study demonstrates that French school food guidelines ensure good nutritional quality of food services. It also shows that generalizing the service of meals without meat or fish would deteriorate overall nutritional quality, highlighting the need to define the composition of vegetarian dishes and their frequency of service to children.

A New Approach to Assess Lifetime Dietary Patterns Finds Lower Consumption of Animal Foods with Aging in a Longitudinal Analysis of a Health-Oriented Adventist Population

Life-course diet patterns may impact risk of disease, but little is known about dietary trends with aging. In a retrospective longitudinal analysis we estimated lifetime intake of animal products and adherence to vegetarian dietary patterns among 51,082 Adventist Health Study-2 (AHS-2) subjects using data from a reliable life-course dietary (meats, dairy, eggs) questionnaire. Results showed a marked tendency to consume fewer animal products (in total) in older years and to reduce consumption of meat, poultry and fish, but not eggs or dairy. Among the 29% of elderly subjects who during their lifetime kept the same dietary pattern (LTS) were: LTS-vegans (1.1%), LTS-lacto-ovo vegetarians (31.2%), LTS-pesco vegetarians (0.49%), LTS-semi vegetarians (3.7%), and LTS-non-vegetarians (63.5%). Among the 71% of switchers were “Converters” (59.7%) who moved towards and “Reverters” (9.1%) who moved away from vegetarian diets, and Multiverters (31.2%), who had moved in both directions. LTS-non-vegetarians, and also reverters, were more overweight and showed a less healthy lifestyle than others. We conclude that the dietary patterns are dynamic with strong trends to reduce animal foods and to adopt more vegetarian patterns with aging. The disease experience of subjects with different lifetime dietary patterns can be compared.