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Baroni L, Bonetto C, Rizzo G, Galchenko A, Guidi G, Visaggi P, Savarino E, Zavoli M, de Bortoli N. Nutrient Composition of Four Dietary Patterns in Italy: Results from an Online Survey (the INVITA Study). Foods 2024; 13:2103. [PMID: 38998609 PMCID: PMC11240948 DOI: 10.3390/foods13132103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Though Italy is a native land of Mediterranean diet, its adherence in the Italian population is low, witnessed by the high rates of overweight in its inhabitants. Vegetarian dietary patterns (i.e., lacto-ovo-vegetarian and vegan) are increasing in western countries, and also in Italy, where 9.5% of the population self-declared as vegetarian in 2023. Though the vegetarian diet has been associated with beneficial health effects, speculation on its alleged nutrient inadequacy exists. For this reason, we assessed the nutrient composition of the diet of 470 participants enrolled in an online survey (the INVITA study), who completed a weighted food questionnaire on three different days. Participants were divided into four dietary groups obtained according to their self-declared dietary intakes: 116 Meat Eaters (MEs), 49 Fish Eaters (FEs), 116 Lacto-Ovo-Vegetarians (LOVs), and 189 VegaNs (VNs). The mean intake of most of the main nutrients was similar among all groups and within the normal range expected for the Italian population, supporting the adequacy of diets within our Italian sample, especially the LOV and VN diet. Since the Mediterranean diet is a plant-based diet, some of its components still persist in the current Italian diet, representing a staple also for people adopting a vegetarian diet.
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Affiliation(s)
- Luciana Baroni
- Scientific Society for Vegetarian Nutrition-SSNV, 30171 Venice, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | | | - Alexey Galchenko
- Scientific Society for Vegetarian Nutrition-SSNV, 30171 Venice, Italy
- Earth Philosophical Society "Melodia Vitae", International, Toronto, CA, Canada
| | - Giada Guidi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Pierfrancesco Visaggi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy
- Gastroenterology Unit, University Hospital of Padua, 35124 Padua, Italy
| | - Martina Zavoli
- Scientific Society for Vegetarian Nutrition-SSNV, 30171 Venice, Italy
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
- NUTRAFOOD, Interdepartmental Center for Nutraceutical Research and Nutrition for Health, University of Pisa, 56126 Pisa, Italy
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Bogataj Jontez N, Šik Novak K, Jenko Pražnikar Z, Petelin A, Kenig S, Mohorko N. Does Dietary Supplement Use Increase Micronutrient Intake Adequacy in Healthy Adults with Habitual Omnivorous, Vegetarian, Vegan, and Low-Carbohydrate High-Fat Diets? Nutrients 2024; 16:1832. [PMID: 38931187 PMCID: PMC11206289 DOI: 10.3390/nu16121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Diets omitting whole food groups pose a risk for micronutrient insufficiencies, but there are no data as to whether those are suitably attenuated with dietary supplements (DS). Micronutrient intakes with food and DSs were analyzed in 130 healthy adults: 32 vegans, 37 vegetarians, 24 following low-carbohydrate high-fat diet (LCHF), and 37 omnivores. A total of 63% used DS (84% of vegans, 75% of LCHF, 54% of vegetarians, and 46% of omnivores); however, a DS did not always tackle dietary insufficiencies. Vitamin B12 was often supplemented in vegans in doses substantially higher than recommended, but it was supplemented less often in vegetarians, despite the low prevalence of sufficient intake. Only 43% of participants supplemented vitamin D in wintertime, 23% of them with an insufficient dose. Supplementation of potassium, calcium, and iodine was rare, despite low intake adequacy with food alone in all groups. Some micronutrients were supplemented unnecessarily, such as vitamin K, riboflavin, biotin, and iron. Multimicronutrient DSs were used often; they increased intake adequacy of group B vitamins but failed to sufficiently supplement vitamin D, potassium, calcium, and iodine. Although DS use increased micronutrient intake sufficiency when used properly, the knowledge on micronutrient inadequacy in all dietary patterns should be increased and the public should be educated on the proper use of DSs. Multimicronutrient DSs should be reformulated to tackle the insufficiencies.
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Affiliation(s)
| | | | | | | | | | - Nina Mohorko
- University of Primorska, Faculty of Health Sciences, 6310 Izola, Slovenia; (N.B.J.); (K.Š.N.); (Z.J.P.); (A.P.); (S.K.)
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Galchenko A, Rizzo G, Sidorova E, Skliar E, Baroni L, Visaggi P, Guidi G, de Bortoli N. Bone mineral density parameters and related nutritional factors in vegans, lacto-ovo-vegetarians, and omnivores: a cross-sectional study. Front Nutr 2024; 11:1390773. [PMID: 38919395 PMCID: PMC11196821 DOI: 10.3389/fnut.2024.1390773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction The growing prevalence of vegetarianism determines the need for comprehensive study of the impact of these diets on health and particularly on bone metabolism. We hypothesized that significant dietary differences between vegans, lacto-ovo-vegetarians, and omnivores also cause significant differences in their nutrient status, which may affect bone health. Methods The study assessed dual-energy X-ray absorptiometry parameters in lumbar spine and femoral neck, average nutrient intake, serum nutrient concentrations, serum PTH levels, and urinary pH among 46 vegans, 38 lacto-ovo-vegetarians, and 44 omnivores. Results There were no differences in bone mineral density (BMD) between the groups. However, the parathyroid hormone (PTH) levels were still higher in vegans compared to omnivores, despite the same prevalence of hyperparathyroidism in all groups. These findings may probably be explained by the fact that each group had its own "strengths and weaknesses." Thus, vegans and, to a lesser extent, lacto-ovo-vegetarians consumed much more potassium, magnesium, copper, manganese, and vitamins B6, B9, and C. At the same time, the diet of omnivores contained more protein and vitamins D and B12. All the subjects consumed less vitamin D than recommended. More than half of vegans and omnivores had insufficiency or even deficiency of vitamin D in the blood. Low serum concentrations of manganese with its quite adequate intake are also noteworthy: its deficiency was observed in 57% of vegans, 79% of lacto-ovo-vegetarians, and 63% of omnivores. Discussion Currently, it is no longer possible to conclude that lacto-ovo-vegetarians have lower BMD than omnivores, as our research supported. Vegans in our study also did not demonstrate lower BMD values, only higher PTH blood concentrations, compared to omnivores, however, a large number of studies, including recent, show the opposite view. In this regard, further large-scale research is required. Vegans and lacto-ovo-vegetarians now have a variety of foods fortified with vitamins D and B12, as well as calcium. There is also a great diversity of ethically sourced dietary supplements. The found low concentrations of manganese require further investigation.
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Affiliation(s)
- Alexey Galchenko
- Scientific Society for Vegetarian Nutrition, Venice, Italy
- Earth Philosophical Society “Melodia Vitae”, International, Toronto, CA, Canada
| | | | | | - Elena Skliar
- Earth Philosophical Society “Melodia Vitae”, International, Toronto, CA, Canada
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Luciana Baroni
- Scientific Society for Vegetarian Nutrition, Venice, Italy
| | - Pierfrancesco Visaggi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giada Guidi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- NUTRAFOOD, Interdepartmental Center for Nutraceutical Research and Nutrition for Health, University of Pisa, Pisa, Italy
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Hannibal L, Lederer AK, Storz MA, Huber R, Jacobsen DW. Vitamin B 12 Status and Supplementation in Plant-Based Diets. Food Nutr Bull 2024; 45:S58-S66. [PMID: 38987876 DOI: 10.1177/03795721241227233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Plant-based diets are increasingly popular worldwide. A well-planned plant-based diet lowers the risk of cardiovascular disease, type 2 diabetes and certain cancers. In contrast, a poorly planned plant-based diet increases the risk of certain micronutrient deficiencies, chiefly, vitamin B12 (B12). Because B12 is not present in plants or in unfortified plant-based foodstuffs, the safest way to prevent its deficiency in plant-based diets is to take an oral B12 supplement. Studies determining the dose and frequency of B12 to be taken by healthy individuals on a plant-based diet to support an adequate B12 status are scarce. Here, we summarize the natural sources, metabolic requirements, biomarker findings with and without supplementation with B12, and current recommendations to help prevent vitamin B12 deficiency in healthy individuals adhering or transitioning to plant-based diets. This review focuses on the prevention of vitamin B12 deficiency in healthy individuals adhering to plant-based diets. The information covered in this review does not apply to individuals suffering from autoimmune-based malabsorption of vitamin B12 resulting from pernicious anemia due to atrophic gastritis, other acquired causes of B12 malabsorption or to those with genetic disorders that impair vitamin B12 absorption, transport and utilization.
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Affiliation(s)
- Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Ann-Kathrin Lederer
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Department of General, Visceral and Transplant Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maximilian A Storz
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Donald W Jacobsen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Knecht KT, Chiriac G, Guan HD. The potential impact of a vegetarian diet on glaucoma. Surv Ophthalmol 2024:S0039-6257(24)00048-1. [PMID: 38768761 DOI: 10.1016/j.survophthal.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
Treatment of primary open-angle glaucoma has centered on the lowering of intraocular pressure that damages the optic nerve; however, this strategy is not uniformly successful, especially in normal tension glaucoma, and there is interest in antioxidant, anti-inflammatory, and other neuroprotective strategies. Vegetarian diets are known to be rich in antioxidant and anti-inflammatory components and have a number of established health benefits. Thus, it would be reasonable to assume that vegetarian diets would be beneficial in glaucoma, but this approach has not been well studied. We examine the possible role of vegetarian diets and their components in the incidence and progression of glaucoma.
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Affiliation(s)
- Kathryn T Knecht
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Gabriela Chiriac
- Loma Linda University School of Public Health, Loma Linda, California, USA
| | - Howard D Guan
- Loma Linda University Eye Institute, Loma Linda, California, USA.
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Fernandes S, Oliveira L, Pereira A, Costa MDC, Raposo A, Saraiva A, Magalhães B. Exploring Vitamin B12 Supplementation in the Vegan Population: A Scoping Review of the Evidence. Nutrients 2024; 16:1442. [PMID: 38794680 PMCID: PMC11124153 DOI: 10.3390/nu16101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
With a significant portion of the population adopting veganism and conflicting views among nutrition professionals regarding the necessity of vitamin B12 supplementation, this review aims to explore existing studies evaluating interventions through food supplementation. It focuses on the impact of vitamin B12 deficiency across different demographics. The present study seeks to understand how research has addressed the relationship between the rise in veganism and vitamin B12 deficiency over the past decade. A scoping review was conducted following the PRISMA flow diagram. Studies from 2010 to 2023 were identified using Boolean operators and key terms in electronic databases such as PubMed/MEDLINE, Web of Science, and EBSCO (Library, Information Science & Technology Abstracts, and Academic Search Complete). Out of 217 articles identified, 70 studies were included. The topical analysis categorized the studies into three groups: those associating vitamin B12 deficiency with diseases (n = 14), those analyzing the dietary habits of vegetarian individuals (vegan or not) without a specific focus on vitamin B12 (n = 49), and those addressing food guides and nutrition institution positions (n = 7). The authors concluded that vitamin B12 deficiency is prevalent among vegans due to limited consumption of animal products. For vegetarians, supplementation is an efficient means of treating and preventing deficiency; a daily dose of 50 to 100 micrograms is advised. There are still significant gaps in the research, nevertheless, such as the absence of randomized controlled trials evaluating various forms or dosages of vitamin B12 among vegetarians and the requirement for more information and awareness of the vitamin's significance in vegan diets.
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Affiliation(s)
- Sávio Fernandes
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (S.F.); (L.O.)
| | - Leandro Oliveira
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (S.F.); (L.O.)
- Coimbra Health School, Polytechnic Institute of Coimbra, Rua 5 de Outubro—S. Martinho do Bispo, Apartado 7006, 3046-854 Coimbra, Portugal
| | - Alda Pereira
- Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisboa, Portugal;
- University Clinic of General and Family Medicine, Ecogenetics and Human Health Unity, Institute for Environmental Health, Instituto de Saúde Ambiental (ISAMB), 1649-028 Lisboa, Portugal
| | - Maria do Céu Costa
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (S.F.); (L.O.)
- Núcleo de Investigação em Ciências e Tecnologias da Saúde (NICiTeS), Polytechnic Institute of Lusophony, ERISA—Escola Superior de Saúde Ribeiro Sanches, 1900-693 Lisboa, Portugal
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (S.F.); (L.O.)
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - Bruno Magalhães
- School of Health, University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal;
- RISE—Health Research Network, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- Clinical Academic Centre of Trás-os-Montes and Alto Douro (CACTMAD), 5000-801 Vila Real, Portugal
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Khalil ZA, Herter-Aeberli I. Contribution of plant-based dairy and fish alternatives to iodine nutrition in the Swiss diet: a Swiss Market Survey. Eur J Nutr 2024:10.1007/s00394-024-03339-5. [PMID: 38451284 DOI: 10.1007/s00394-024-03339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/20/2024] [Indexed: 03/08/2024]
Abstract
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.
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Affiliation(s)
- Zulekha Abbas Khalil
- Institute of Food, Nutrition and Health, Laboratory of Nutrition and Metabolic Epigenetics, ETH Zürich, 8092, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Institute of Food, Nutrition and Health, Laboratory of Nutrition and Metabolic Epigenetics, ETH Zürich, 8092, Zurich, Switzerland.
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Fischer L, Andersson M, Braegger C, Herter-Aeberli I. Iodine intake in the Swiss population 100 years after the introduction of iodised salt: a cross-sectional national study in children and pregnant women. Eur J Nutr 2024; 63:573-587. [PMID: 38141138 PMCID: PMC10899291 DOI: 10.1007/s00394-023-03287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. METHODS We conducted a nationwide cross-sectional study in children (6-12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. RESULTS The median UIC was 127 μg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 μg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 μg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 μg/day). Compared to non-users, users had higher median UIC (129 vs. 81 μg/L, P < 0.001), lower prevalence of inadequacy (< 160 μg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 μg/L, P < 0.001). All women were euthyroid. CONCLUSIONS The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013.
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Affiliation(s)
- Lena Fischer
- Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.
| | - Maria Andersson
- Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Christian Braegger
- Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
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García-Maldonado E, Gallego-Narbón A, Zapatera B, Alcorta A, Martínez-Suárez M, Vaquero MP. Bone Remodelling, Vitamin D Status, and Lifestyle Factors in Spanish Vegans, Lacto-Ovo Vegetarians, and Omnivores. Nutrients 2024; 16:448. [PMID: 38337732 PMCID: PMC10857037 DOI: 10.3390/nu16030448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Sustainable healthy diets are promoted, and consequently vegetarian diets are currently increasing. However, scientific information on their effects on bone health is scarce. A cross-sectional study was performed in adults (66% women) classified into three groups: omnivores (n = 93), lacto-ovo vegetarians (n = 96), and vegans (n = 112). Nutrient intake, body composition, physical activity, vitamin D status (25-hydroxycholecalciferol, 25-OHD), parathormone (PTH), and bone formation (bone alkaline phosphatase, BAP) and resorption (N-telopeptides of type I collagen, NTx) markers were determined. Lacto-ovo vegetarians and especially vegans showed lower protein, fat, calcium, phosphorous, vitamin D, retinol, iodine, and zinc intakes, and higher carbohydrate, fibre, carotenes, magnesium, and vitamin K intakes compared to omnivores. Body composition was similar in the three groups that performed vigorous physical activity regularly. Body bone mass and muscle mass were positively correlated with BAP, and time performing physical activity with 25-OHD. The prevalence of vitamin D deficiency or insufficiency (25-OHD < 75 nmol/L) was 93.7% in the studied population, and vitamin D deficiency (25-OHD < 25 nmol/L) was significantly higher in vegans. Vegetarians of both groups had increased PTH and NTx with vegans showing significantly higher PTH and NTx than omnivores. Conclusion: Adult vegetarians, especially vegans, should reduce the risk of bone loss by appropriate diet planning and vitamin D supplementation.
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Affiliation(s)
- Elena García-Maldonado
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C. José Antonio Novais 10, 28040 Madrid, Spain; (E.G.-M.); (A.G.-N.); (B.Z.); (A.A.); (M.M.-S.)
| | - Angélica Gallego-Narbón
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C. José Antonio Novais 10, 28040 Madrid, Spain; (E.G.-M.); (A.G.-N.); (B.Z.); (A.A.); (M.M.-S.)
- Biology Department, Universidad Autónoma de Madrid, Darwin, 2, 28049 Madrid, Spain
| | - Belén Zapatera
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C. José Antonio Novais 10, 28040 Madrid, Spain; (E.G.-M.); (A.G.-N.); (B.Z.); (A.A.); (M.M.-S.)
| | - Alexandra Alcorta
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C. José Antonio Novais 10, 28040 Madrid, Spain; (E.G.-M.); (A.G.-N.); (B.Z.); (A.A.); (M.M.-S.)
| | - Miriam Martínez-Suárez
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C. José Antonio Novais 10, 28040 Madrid, Spain; (E.G.-M.); (A.G.-N.); (B.Z.); (A.A.); (M.M.-S.)
| | - M. Pilar Vaquero
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C. José Antonio Novais 10, 28040 Madrid, Spain; (E.G.-M.); (A.G.-N.); (B.Z.); (A.A.); (M.M.-S.)
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Insua A, Galindo-Moreno P, Miron RJ, Wang HL, Monje A. Emerging factors affecting peri-implant bone metabolism. Periodontol 2000 2024; 94:27-78. [PMID: 37904311 DOI: 10.1111/prd.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.
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Affiliation(s)
- Angel Insua
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Bez NS, Haddad J, Tedde GS, Rose K, Ivanov AV, Milazzo M, Wickart J, Casale G, D'Ascanio M, Van der Horst K, Herter-Aeberli I, Bogl LH. Development of a diet quality score and adherence to the Swiss dietary recommendations for vegans. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:17. [PMID: 38291526 PMCID: PMC10829326 DOI: 10.1186/s41043-024-00498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Vegan diets have recently gained popularity in Switzerland as well as globally. The aim of the present study was to develop a diet quality score for vegans (DQS-V) based on the Swiss dietary recommendations for vegans. METHODS The dataset included 52 healthy vegan adults. Dietary intake data were assessed by three-day weighed food records. Body weight and height were measured, and a venous blood sample for the analysis of vitamin and mineral status was collected. Spearman rank correlation coefficients were used due to not-normally distributed data. Dietary patterns were identified using principal component analysis (PCA). RESULTS The DQS-V score (mean ± SD) was 48.9 ± 14.7. Most vegans adhered to the recommended portions of vegetables, vitamin C-rich vegetables, fruits, omega-3-rich nuts, fats and oils, and iodized salt. However, the intake of green leafy vegetables, vitamin C-rich fruits, wholegrains, legumes, nuts and seeds, selenium-rich nuts, zero caloric liquid, and calcium-fortified foods was suboptimal. The sample overconsumed sweet-, salty-, fried foods, and alcohol. The DQS-V had a significantly positive correlation with intakes of fibre, polyunsaturated fatty acids, potassium, zinc, and phosphorus intakes (p's < 0.05) but was negatively correlated with vitamin B12 and niacin intakes (p's < 0.05). Two dietary patterns were derived from PCA: 1) refined grains and sweets and 2) wholegrains and nuts. The correlation between the DQS-V and the first dietary pattern was negative (- 0.41, p = 0.004) and positive for the second dietary pattern (0.37, p = 0.01). The refined grains and sweets dietary pattern was inversely correlated with beta-carotene status (- 0.41, p = 0.004) and vitamin C status (r = - 0.51, p = 0.0002). CONCLUSION The newly developed DQS-V provides a single score for estimating diet quality among vegan adults. Further validation studies examining the DQS-V in relation to an independent dietary assessment method and to biomarkers of nutritional intake and status are still needed before the general application of the DQS-V.
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Affiliation(s)
- Natalie S Bez
- Department Nutrition and Dietetics, Faculty of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Joyce Haddad
- Department Nutrition and Dietetics, Faculty of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Giulia S Tedde
- Department Nutrition and Dietetics, Faculty of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Karolin Rose
- Swiss Working Group for Vegetarian Diets, Swiss Association of Registered Dietitians (SVDE), Altenbergstrasse 29, 3000, Bern, Switzerland
| | - Aljoscha V Ivanov
- Swiss Working Group for Vegetarian Diets, Swiss Association of Registered Dietitians (SVDE), Altenbergstrasse 29, 3000, Bern, Switzerland
| | - Marina Milazzo
- Swiss Working Group for Vegetarian Diets, Swiss Association of Registered Dietitians (SVDE), Altenbergstrasse 29, 3000, Bern, Switzerland
| | - Joëlle Wickart
- Swiss Working Group for Vegetarian Diets, Swiss Association of Registered Dietitians (SVDE), Altenbergstrasse 29, 3000, Bern, Switzerland
| | - Giulia Casale
- Swiss Working Group for Vegetarian Diets, Swiss Association of Registered Dietitians (SVDE), Altenbergstrasse 29, 3000, Bern, Switzerland
| | - Michele D'Ascanio
- Swiss Working Group for Vegetarian Diets, Swiss Association of Registered Dietitians (SVDE), Altenbergstrasse 29, 3000, Bern, Switzerland
| | - Klazine Van der Horst
- Department Nutrition and Dietetics, Faculty of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | | | - Leonie H Bogl
- Department Nutrition and Dietetics, Faculty of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
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Clotet-Vidal S, Saez Prieto ME, Duch Llorach P, Gutiérrez ÁS, Casademont Pou J, Torres Bonafonte OH. Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia. Nutrients 2023; 16:11. [PMID: 38201841 PMCID: PMC10780721 DOI: 10.3390/nu16010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIMS Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. METHODS This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30-60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. RESULTS In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09-1.26), previous institutionalization (29.1; 3.7-224.7), BI (1.09; 1.05-1.14), CCI (1.5; 1.1-2.1), and length of stay (1.1, 1.02-1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93-0.99) and length of stay (1.06; 1.00-1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20-51.21), BI (0.95; 0.92-0.98), and length of stay (1.12; 1.04-1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. CONCLUSIONS After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.
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Affiliation(s)
- Sandra Clotet-Vidal
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
| | - M. Encarna Saez Prieto
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
| | - Pol Duch Llorach
- Infectious Diseases Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Álvaro Santos Gutiérrez
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
| | - Jordi Casademont Pou
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Olga H. Torres Bonafonte
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
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13
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Nolte S, Krüger K, Lenz C, Zentgraf K. Optimizing the Gut Microbiota for Individualized Performance Development in Elite Athletes. BIOLOGY 2023; 12:1491. [PMID: 38132317 PMCID: PMC10740793 DOI: 10.3390/biology12121491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
The human gut microbiota can be compared to a fingerprint due to its uniqueness, hosting trillions of living organisms. Taking a sport-centric perspective, the gut microbiota might represent a physiological system that relates to health aspects as well as individualized performance in athletes. The athletes' physiology has adapted to their exceptional lifestyle over the years, including the diversity and taxonomy of the microbiota. The gut microbiota is influenced by several physiological parameters and requires a highly individual and complex approach to unravel the linkage between performance and the microbial community. This approach has been taken in this review, highlighting the functions that the microbial community performs in sports, naming gut-centered targets, and aiming for both a healthy and sustainable athlete and performance development. With this article, we try to consider whether initiating a microbiota analysis is practicable and could add value in elite sport, and what possibilities it holds when influenced through a variety of interventions. The aim is to support enabling a well-rounded and sustainable athlete and establish a new methodology in elite sport.
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Affiliation(s)
- Svenja Nolte
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, University of Giessen, 35394 Giessen, Germany; (K.K.); (C.L.)
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, University of Giessen, 35394 Giessen, Germany; (K.K.); (C.L.)
| | - Claudia Lenz
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, University of Giessen, 35394 Giessen, Germany; (K.K.); (C.L.)
| | - Karen Zentgraf
- Department 5: Psychology & Sports Sciences, Institute for Sports Sciences, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany;
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Campana M, Löhrs L, Strauß J, Münz S, Oviedo-Salcedo T, Fernando P, Maurus I, Raabe F, Moussiopoulou J, Eichhorn P, Falkai P, Hasan A, Wagner E. Blood-brain barrier dysfunction and folate and vitamin B12 levels in first-episode schizophrenia-spectrum psychosis: a retrospective chart review. Eur Arch Psychiatry Clin Neurosci 2023; 273:1693-1701. [PMID: 36869234 PMCID: PMC10713685 DOI: 10.1007/s00406-023-01572-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
Vitamin deficiency syndromes and blood-brain barrier (BBB) dysfunction are frequent phenomena in psychiatric conditions. We analysed the largest available first-episode schizophrenia-spectrum psychosis (FEP) cohort to date regarding routine cerebrospinal fluid (CSF) and blood parameters to investigate the association between vitamin deficiencies (vitamin B12 and folate) and BBB impairments in FEP. We report a retrospective analysis of clinical data from all inpatients that were admitted to our tertiary care hospital with an ICD-10 diagnosis of a first-episode F2x (schizophrenia-spectrum) between January 1, 2008 and August 1, 2018 and underwent a lumbar puncture, blood-based vitamin status diagnostics and neuroimaging within the clinical routine. 222 FEP patients were included in our analyses. We report an increased CSF/serum albumin quotient (Qalb) as a sign of BBB dysfunction in 17.1% (38/222) of patients. White matter lesions (WML) were present in 29.3% of patients (62/212). 17.6% of patients (39/222) showed either decreased vitamin B12 levels or decreased folate levels. No statistically significant association was found between vitamin deficiencies and altered Qalb. This retrospective analysis contributes to the discussion on the impact of vitamin deficiency syndromes in FEP. Although decreased vitamin B12 or folate levels were found in approximately 17% of our cohort, we found no evidence for significant associations between BBB dysfunction and vitamin deficiencies. To strengthen the evidence regarding the clinical implications of vitamin deficiencies in FEP, prospective studies with standardized measurements of vitamin levels together with follow-up measurements and assessment of symptom severity in addition to CSF diagnostics are needed.
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Affiliation(s)
- Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
| | - Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Johanna Strauß
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Susanne Münz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Tatiana Oviedo-Salcedo
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Piyumi Fernando
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Florian Raabe
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Peter Eichhorn
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
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Eveleigh E, Coneyworth L, Craigon J, Welham S. Adoption of a Short-Term (4-Week) Vegan Diet as Part of 'Veganuary' Significantly Reduces Saturated Fatty Acid (SFA), Cholesterol, B12, and Iodine Intake in Omnivorous Individuals-An Observational Study. Nutrients 2023; 15:4967. [PMID: 38068825 PMCID: PMC10708059 DOI: 10.3390/nu15234967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Global veganism campaigns like 'Veganuary' have gained popularity. We conducted an observational study to assess the impact of a 4-week vegan diet during 'Veganuary' on nutrient intake, status, knowledge, and motivations for veganism. Data were collected before and after 'Veganuary', using Food Frequency Questionnaires (FFQs) to estimate dietary intake. Micronutrient knowledge and motivation were assessed through questionnaires. A total of 154 UK adults aged 18-60 years (2019: n81; 2020: n73) participated. Groups were vegetarians and omnivores committed to a 4-week vegan diet during 'Veganuary'. Control groups were vegans and omnivores who did not transition. Short-term vegan diets significantly decreased intake of iodine, B12, cholesterol, and saturated fatty acids (SFAs) in omnivores. Micronutrient knowledge was low, and motivation for veganism varied. Short-term vegan diets reduce macro- and micronutrient intake in omnivores. Veganuary participants could benefit from nutritional guidance or supplementation. Attention is required for UK micronutrient intake and knowledge. Motivations for vegan pledges may influence diets, warranting further research.
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Affiliation(s)
- Elizabeth Eveleigh
- Division of Food, Nutrition and Dietetics, School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK; (E.E.); (L.C.)
| | - Lisa Coneyworth
- Division of Food, Nutrition and Dietetics, School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK; (E.E.); (L.C.)
| | - Jim Craigon
- School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK;
| | - Simon Welham
- Division of Food, Nutrition and Dietetics, School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK; (E.E.); (L.C.)
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16
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Bruns A, Nebl J, Jonas W, Hahn A, Schuchardt JP. Nutritional status of flexitarians compared to vegans and omnivores - a cross-sectional pilot study. BMC Nutr 2023; 9:140. [PMID: 38017527 PMCID: PMC10685640 DOI: 10.1186/s40795-023-00799-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND In the Western world, there has been a notable rise in the popularity of plant-based, meat-reduced flexitarian diets. Nevertheless, there is insufficient data on the nutritional status of individuals following this dietary pattern. The aim of this study was to investigate the intake and endogenous status of various nutrients in a healthy German adult study population consisting of flexitarians (FXs), vegans (Vs) and omnivores (OMNs). METHODS In this cross-sectional study, dietary intake of 94 non-smoking adults (32 FXs, 33 Vs, 29 OMNs) between 25 and 45 years of age was assessed using 3-day dietary records. In addition, blood samples were collected to determine different endogenous nutrient status markers. RESULTS 32%, 82% and 24% of the FXs, Vs, and OMNs respectively reported using dietary supplements. In the FXs, intake of total energy as well as macronutrients and most micronutrients were within the reference range. FXs had higher intakes of fiber, retinol-equ., ascorbic acid, folate-equ., tocopherol-equ., calcium, and magnesium compared to OMNs. However, cobalamin intake in FXs (2.12 µg/d) was below the reference (4 µg/d). Based on 4cB12, 13% of FXs showed a cobalamin undersupply [< -0.5 to -2.5] compared to 10% of OMNs, and 9% of Vs. The median 25(OH)D serum concentrations in FXs, Vs and OMNs were 46.6, 55.6, and 59.6 nmol/L. The prevalence of an insufficient/deficient vitamin-D status [< 49.9 nmol 25(OH)D/L] was highest in FXs (53%), followed by Vs (34%) and OMNs (27%). In FXs and Vs, the supplement takers had better cobalamin and vitamin-D status than non-supplement takers. Anemia and depleted iron stores were found only occasionally in all groups. In women, the prevalence of pre-latent iron deficiency and iron deficiency was highest in FXs (67%) compared to Vs (61%) and OMNs (54%). CONCLUSION Our findings indicated that all three diets delivered sufficient amounts of most macro- and micronutrients. However, deficiencies in cobalamin, vitamin-D, and iron status were common across all diets. Further studies are needed to investigate the nutrient supply status and health consequences of meat-reduced plant-based diets. The study was registered in the German Clinical Trial Register (number: DRKS 00019887, data: 08.01.2020).
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Affiliation(s)
- Anja Bruns
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, 30167, Germany
| | - Josefine Nebl
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, 30167, Germany
| | - Wiebke Jonas
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, 30167, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, 30167, Germany
| | - Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, 30167, Germany.
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Světnička M, Heniková M, Selinger E, Ouřadová A, Potočková J, Kuhn T, Gojda J, El-Lababidi E. Prevalence of iodine deficiency among vegan compared to vegetarian and omnivore children in the Czech Republic: cross-sectional study. Eur J Clin Nutr 2023; 77:1061-1070. [PMID: 37488261 PMCID: PMC10630131 DOI: 10.1038/s41430-023-01312-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The intake and homeostasis of iodine, an essential micronutrient that plays a vital role in thyroid physiology, is of particular concern with the increasing popularity of vegetarian (VG) and vegan (VN) diets. Children on these restrictive diets may be at risk of possible adverse effects on growth and development, but there is currently a lack of recent epidemiological studies on this topic. METHODS We gathered clinical, anthropometric, and blood/urine data on iodine status and thyroid function from children aged 0-18 years who followed either a VG diet (n = 91), VN diet (n = 75), or omnivore diet (OM, n = 52). Cross-sectional comparison of the groups and linear regression was used. Stratified analyses were performed based on age (according to WHO): 0-5 years and 6-18 years. RESULTS Our study revealed no significant differences in levels of thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroglobulin (TG) or anti-thyroid peroxidase antibody (ATPOc) between the VG, VN, and OM groups. However, thyroxine (fT4) levels were found to be higher in the VN group compared to the OM group (15.00 ± 1.73 vs. 16.17 ± 1.82 pmol/l, p < 0.001). The presence of anti-thyroglobulin antibodies (AhTGc) was notably more common in the VG (18.2%)/VN (35.0%) groups than in the OM group (2.1%) (p < 0.001). Regarding iodine status, the concentration of iodine in spot urine (UIC) was found to be highest in the OM group (197.28 ± 105.35 vs. VG: 177.95 ± 155.88 vs. VN: 162.97 ± 164.51 µg/l, p < 0.001). Notably, the lowest (5.99 µg/l) and highest (991.80 µg/l) levels were measured in the VN group. Of the participants, 31 VN, 31 VG and 10 OM children met the criteria for iodine deficiency (i.e., UIC < 100 µg/l). We found that children with regular iodine supplementation had higher UIC (p < 0.001). Importantly, the median UIC was above 100 µg/l in all three groups, through the recommended intake (RDI) of iodine was rarely met throughout the groups. CONCLUSION We have observed a trend to lower UIC values in VN as compared to OM. This trend is also reflected in the median UIC values, even though the median UIC values were above the WHO cut-off (e.g., 100 µg/l) for iodine deficiency in all dietary groups. These results suggest that VN and VG children may be more at higher risk of iodine deficiency, this theory is also supported by higher prevalence of AhTGc positivity. Further research is needed to investigate the long-term impact of these dietary patterns on iodine status and thyroid function in children. Given our findings, it may also be necessary to consider new guidelines for supplementing children following VG and VN diets to ensure their iodine needs are met.
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Affiliation(s)
- Martin Světnička
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Paediatrics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Marina Heniková
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eliška Selinger
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
- The National Institute of Public Health, Centre for Public Health Promotion, Prague, Czech Republic
| | - Anna Ouřadová
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Potočková
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tilman Kuhn
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg, Germany
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Medical University of Vienna, Centre for Public Health, Vienna, Austria
| | - Jan Gojda
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva El-Lababidi
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Paediatrics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Alsaeedi A, Welham S, Rose P. Impact of lifestyle factors on dietary vitamin B 6 intake and plasma pyridoxal 5'-phosphate level in UK adults: National Diet and Nutrition Survey Rolling Programme (NDNS) (2008-2017). Br J Nutr 2023; 130:1403-1415. [PMID: 36789783 PMCID: PMC10511679 DOI: 10.1017/s0007114523000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
Reduction in dietary vitamin B6 intake is associated with an increased relative risk of diseases such as cancer, atherosclerosis and cognitive dysfunction. The current research has assessed vitamin B6 intakes and PLP concentrations as a marker of vitamin B6 status among the UK adult (≥ 19 years) population. This study was carried out using a cross-sectional analysis of the National Diet and Nutrition Survey Rolling Programme (NDNS) (2008-2017). The impacts of lifestyle factors, including type of diet, smoking, alcohol consumption, and commonly used medications grouped by therapeutic usage, were determined, and data were analysed using IBM SPSS®. Results are expressed as medians (25th-75th percentiles), with P values ≤ 0·05 considered statistically significant. Among UK adults, the median intakes of total population of dietary vitamin B6 met the reference nutrient intake and median plasma PLP concentrations were above the cut-off of vitamin B6 deficiency; however, we found an association between reduction in vitamin B6 intake and plasma PLP concentration and age group (P < 0·001). Smokers had significantly lower plasma PLP concentrations than non-smokers (P < 0·001). Moreover, regression analysis showed some commonly used medications were associated with plasma PLP levels reduction (P < 0·05). Taken together, we report on a tendency for dietary vitamin B6 intake and plasma PLP concentrations to decrease with age and lifestyle factors such as smoking and medication usage. This information could have important implications for smokers and in the elderly population using multiple medications (polypharmacy).
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Affiliation(s)
- Asrar Alsaeedi
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, LeicestershireLE12 5RD, UK
| | - Simon Welham
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, LeicestershireLE12 5RD, UK
| | - Peter Rose
- Division of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, LeicestershireLE12 5RD, UK
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Storz MA, Müller A, Niederreiter L, Zimmermann-Klemd AM, Suarez-Alvarez M, Kowarschik S, Strittmatter M, Schlachter E, Pasluosta C, Huber R, Hannibal L. A cross-sectional study of nutritional status in healthy, young, physically-active German omnivores, vegetarians and vegans reveals adequate vitamin B 12 status in supplemented vegans. Ann Med 2023; 55:2269969. [PMID: 37851870 PMCID: PMC10586079 DOI: 10.1080/07853890.2023.2269969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND/OBJECTIVE Plant-based diets reduce the risk of cardiovascular disease but also increase the risk of certain micronutrient deficiencies, particularly, of vitamin B12 (B12). The extent to which the unsupervised use of oral nutrient supplements is sufficient to prevent these deficiencies is not well established. We analyzed nutrient intake, laboratory biomarkers, supplementation behavior, and B12 status adequacy amongst young, healthy, physically active omnivores, lacto-ovo-vegetarians and vegans from Germany. METHODS We recruited 115 participants (n = 40 omnivores; n = 37 lacto-ovo-vegetarians, and n = 38 vegans) with comparable age, sex, marital status, physical activity and educational levels through online advertisements and local newspapers in Freiburg, Germany. RESULTS Energy intake and macronutrient distribution were comparable across diets. Major differences included intake of fiber, cholesterol, and several vitamins. Vegans had the lowest intake of B12 from foods (0.43 (0.58) µg/d), compared to omnivores (2.14 (2.29) µg/d) and lacto-ovo-vegetarians (0.98 (1.34) µg/day). Multivariate analysis of 36 blood biomarkers revealed that three major classes of biomarkers contributed the most to the clustering of individuals by dietary group, namely, biomarkers of B12 status (B12, holoTC, Hcy), iron (iron, ferritin, transferrin) and lipid metabolism (vitamin A, HDL, LDL, total cholesterol, TAG). This suggests that nutrients that modify the metabolic pathways represented by these biomarkers have the most penetrating effect on health status across diets. Analysis of B12 status (including 4cB12) revealed adequacy in omnivores and vegans, and a poorer B12 status amongst lacto-ovo-vegetarians. Fewer lacto-ovo-vegetarians used B12 supplements compared to vegans (51% versus 90%). CONCLUSIONS Even amongst homogeneously healthy Germans, each diet manifested with measurable differences in dietary intakes and biomarkers of health. Plant-based diets, in particular the vegan diet, exhibited the most favorable patterns of lipid metabolism and glycemic control, but the lowest food intake of B12. Supplementation of healthy vegans with B12 (median 250 µg B12/day, over 2 years) secured an adequate B12 status that was comparable to that of healthy omnivores.Clinical Trial Registry: German Clinical Trial register number: DRKS00027425.
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Affiliation(s)
- Maximilian Andreas Storz
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexander Müller
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lisa Niederreiter
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Amy M. Zimmermann-Klemd
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
- Translational Complementary Medicine, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Martin Suarez-Alvarez
- Faculty of Medicine, Medical Center, Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, University of Freiburg, , Freiburg, Germany
| | - Stefanie Kowarschik
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Monique Strittmatter
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Evelyn Schlachter
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Cristian Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Luciana Hannibal
- Faculty of Medicine, Medical Center, Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, University of Freiburg, , Freiburg, Germany
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20
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Klein L, Dawczynski C, Schwarz M, Maares M, Kipp K, Haase H, Kipp AP. Selenium, Zinc, and Copper Status of Vegetarians and Vegans in Comparison to Omnivores in the Nutritional Evaluation (NuEva) Study. Nutrients 2023; 15:3538. [PMID: 37630729 PMCID: PMC10459941 DOI: 10.3390/nu15163538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Plant-based diets usually contain more nutrient-dense foods such as vegetables, legumes, whole grains, and fruits than a standard Western diet. Yet, the amount and especially the bioavailability of several nutrients, such as trace elements, is supposed to be lower in comparison to diets with consumption of animal-derived foods. Based on this, the Nutritional Evaluation (NuEva) study (172 participants) was initiated to compare the trace element status of omnivores, flexitarians, vegetarians, and vegans. Serum selenium, zinc, and copper concentrations and biomarkers were evaluated at baseline and during a 12-month intervention with energy- and nutrient-optimized menu plans. The implementation of optimized menu plans did not substantially influence the status of trace elements. At baseline, serum selenium biomarkers were lower in vegetarians and vegans compared to omnivores and flexitarians. The zinc intake of vegetarians and vegans was significantly lower compared to omnivores, whereas the Phytate Diet Score was increased. Accordingly, total serum zinc concentrations were reduced in vegans which was, however, only significant in women and was further supported by the analysis of free zinc. Regarding copper status, no differences were observed for total serum copper. Overall, we identified selenium and zinc as critical nutrients especially when maintaining a vegan diet.
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Affiliation(s)
- Lea Klein
- Institute of Nutritional Sciences, Friedrich Schiller University, 07743 Jena, Germany; (L.K.); (M.S.)
- Junior Research Group Nutritional Concepts, 07743 Jena, Germany
| | - Christine Dawczynski
- Institute of Nutritional Sciences, Friedrich Schiller University, 07743 Jena, Germany; (L.K.); (M.S.)
- Junior Research Group Nutritional Concepts, 07743 Jena, Germany
| | - Maria Schwarz
- Institute of Nutritional Sciences, Friedrich Schiller University, 07743 Jena, Germany; (L.K.); (M.S.)
- TraceAge—DFG Research Unit 2558, 07743 Potsdam-Berlin-Jena-Wuppertal, Germany; (M.M.); (H.H.)
| | - Maria Maares
- TraceAge—DFG Research Unit 2558, 07743 Potsdam-Berlin-Jena-Wuppertal, Germany; (M.M.); (H.H.)
- Department of Food Chemistry and Toxicology, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Kristin Kipp
- Department for Pediatrics, Sophien- and Hufeland Klinikum, Hospital Weimar, 99425 Weimar, Germany;
| | - Hajo Haase
- TraceAge—DFG Research Unit 2558, 07743 Potsdam-Berlin-Jena-Wuppertal, Germany; (M.M.); (H.H.)
- Department of Food Chemistry and Toxicology, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Anna P. Kipp
- Institute of Nutritional Sciences, Friedrich Schiller University, 07743 Jena, Germany; (L.K.); (M.S.)
- TraceAge—DFG Research Unit 2558, 07743 Potsdam-Berlin-Jena-Wuppertal, Germany; (M.M.); (H.H.)
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Jedut P, Glibowski P, Skrzypek M. Comparison of the Health Status of Vegetarians and Omnivores Based on Biochemical Blood Tests, Body Composition Analysis and Quality of Nutrition. Nutrients 2023; 15:3038. [PMID: 37447364 DOI: 10.3390/nu15133038] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Many vegetarians are motivated by the health aspect of starting a plant-based diet. This diet can offer many health benefits. The study aimed to check whether people on a vegetarian diet are in good health, have a good nutritional intake, and follow the principles of healthy eating compared with omnivores. Twenty-two vegetarians on a vegetarian diet for more than five years and 22 omnivores aged 18-45 were interviewed. Each of them was given a food questionnaire, body composition analysis (BIA), and biochemical blood analysis, and their 7-day diet was analyzed. Polish vegetarians exhibit similar health statuses and tend towards better health than omnivores. They have an adequate body composition. Biochemical blood analysis showed no significant differences in blood parameters between vegetarians and omnivores, despite specific deficiencies such as vitamin B12, vitamin D and elevated homocysteine levels in vegetarians. They have a better nutritional status and follow good dietary principles. However, they were more likely to consume alcohol, add salt to their meals and sweeten hot drinks. In addition, the lifestyle of vegetarians can be described as healthier, as they are more likely to engage in leisure-time physical activity and get enough sleep.
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Affiliation(s)
- Paulina Jedut
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, 8 Skromna St., 20-704 Lublin, Poland
| | - Paweł Glibowski
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, 8 Skromna St., 20-704 Lublin, Poland
| | - Michał Skrzypek
- Faculty of Health Sciences, Vincent Pol University in Lublin, 20-816 Lublin, Poland
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22
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West S, Monteyne AJ, van der Heijden I, Stephens FB, Wall BT. Nutritional Considerations for the Vegan Athlete. Adv Nutr 2023; 14:774-795. [PMID: 37127187 PMCID: PMC10334161 DOI: 10.1016/j.advnut.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023] Open
Abstract
Accepting a continued rise in the prevalence of vegan-type diets in the general population is also likely to occur in athletic populations, it is of importance to assess the potential impact on athletic performance, adaptation, and recovery. Nutritional consideration for the athlete requires optimization of energy, macronutrient, and micronutrient intakes, and potentially the judicious selection of dietary supplements, all specified to meet the individual athlete's training and performance goals. The purpose of this review is to assess whether adopting a vegan diet is likely to impinge on such optimal nutrition and, where so, consider evidence based yet practical and pragmatic nutritional recommendations. Current evidence does not support that a vegan-type diet will enhance performance, adaptation, or recovery in athletes, but equally suggests that an athlete can follow a (more) vegan diet without detriment. A clear caveat, however, is that vegan diets consumed spontaneously may induce suboptimal intakes of key nutrients, most notably quantity and/or quality of dietary protein and specific micronutrients (eg, iron, calcium, vitamin B12, and vitamin D). As such, optimal vegan sports nutrition requires (more) careful consideration, evaluation, and planning. Individual/seasonal goals, training modalities, athlete type, and sensory/cultural/ethical preferences, among other factors, should all be considered when planning and adopting a vegan diet.
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Affiliation(s)
- Sam West
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Alistair J Monteyne
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Ino van der Heijden
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Francis B Stephens
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Benjamin T Wall
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
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23
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Grasso AC, Besselink JJF, Tyszler M, Bruins MJ. The Potential of Food Fortification as an Enabler of More Environmentally Sustainable, Nutritionally Adequate Diets. Nutrients 2023; 15:nu15112473. [PMID: 37299436 DOI: 10.3390/nu15112473] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Policies encouraging shifts towards more plant-based diets can lead to shortfalls in micronutrients typically present in animal products (B-vitamins, vitamin D, calcium, iodine, iron, selenium, zinc, and long-chain omega-3 fatty acids). We modelled the effect of fortifying foods with these critical micronutrients, with the aim of achieving nutrition and sustainability goals, using food consumption data from Dutch adults (19-30 years). Three dietary scenarios were optimized for nutritional adequacy and 2030 greenhouse gas emissions (GHGE-2030) targets, respectively, with the fewest deviations from the baseline diet: (i) the current diet (mainly vitamin A- and D-fortified margarine, iodized bread, and some calcium- and vitamin D-fortified dairy alternatives and iron- and vitamin B12-fortified meat alternatives); (ii) all plant-based alternatives fortified with critical micronutrients; and (iii) fortified bread and oils. Optimizing the current diet for nutrition and GHGE-2030 targets reduced animal-to-plant protein ratios from ~65:35, to 33:67 (women) and 20:80 (men), but required major increases in legumes and plant-based alternatives. When fortifying all plant-based alternatives and, subsequently, bread and oil, smaller dietary changes were needed to achieve nutrition and GHGE-2030 targets. Fortifying food products with critical micronutrients, ideally with complementary education on plant-based foods, can facilitate the transition to healthier and more sustainable diets.
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Affiliation(s)
| | | | | | - Maaike J Bruins
- dsm-firmenich, Taste, Texture and Health, 2613 AX Delft, The Netherlands
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24
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Equey A, Berger MM, Gonseth-Nusslé S, Augsburger M, Rezzi S, Hodgson ACC, Estoppey S, Pantaleo G, Pellaton C, Perrais M, Lenglet S, Rousson V, D'Acremont V, Bochud M. Association of plasma zinc levels with anti-SARS-CoV-2 IgG and IgA seropositivity in the general population: A case-control study. Clin Nutr 2023; 42:972-986. [PMID: 37130500 PMCID: PMC10110932 DOI: 10.1016/j.clnu.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Some micronutrients have key roles in immune defence, including mucosal defence mechanisms and immunoglobulin production. Altered micronutrient status has been linked with COVID-19 infection and disease severity. We assessed the associations of selected circulating micronutrients with anti-SARS-CoV-2 IgG and IgA seropositivity in the Swiss community using early pandemic data. METHODS Case-control study comparing the first PCR-confirmed COVID-19 symptomatic cases in the Vaud Canton (May to June 2020, n = 199) and controls (random population sample, n = 447), seronegative for IgG and IgA. The replication analysis included seropositive (n = 134) and seronegative (n = 152) close contacts from confirmed COVID-19 cases. Anti-SARS-CoV-2 IgG and IgA levels against the native trimeric spike protein were measured using the Luminex immunoassay. We measured plasma Zn, Se and Cu concentrations by ICP-MS, and 25-hydroxy-vitamin D3 (25(OH)D3) with LC-MS/MS and explored associations using multiple logistic regression. RESULTS The 932 participants (54.1% women) were aged 48.6 ± 20.2 years (±SD), BMI 25.0 ± 4.7 kg/m2 with median C-Reactive Protein 1 mg/l. In logistic regressions, log2(Zn) plasma levels were negatively associated with IgG seropositivity (OR [95% CI]: 0.196 [0.0831; 0.465], P < 0.001; replication analyses: 0.294 [0.0893; 0.968], P < 0.05). Results were similar for IgA. We found no association of Cu, Se, and 25(OH)D3 with anti-SARS-CoV-2 IgG or IgA seropositivity. CONCLUSION Low plasma Zn levels were associated with higher anti-SARS-CoV-2 IgG and IgA seropositivity in a Swiss population when the initial viral variant was circulating, and no vaccination available. These results suggest that adequate Zn status may play an important role in protecting the general population against SARS-CoV-2 infection. REGISTRY CORONA IMMUNITAS:: ISRCTN18181860.
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Affiliation(s)
- Antoine Equey
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Semira Gonseth-Nusslé
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Marc Augsburger
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Lausanne-Geneva, Lausanne University Hospital and University of Lausanne - Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Épalinges, Switzerland
| | | | - Sandrine Estoppey
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline Pellaton
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maïwenn Perrais
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Lausanne-Geneva, Lausanne University Hospital and University of Lausanne - Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland
| | - Sébastien Lenglet
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Lausanne-Geneva, Lausanne University Hospital and University of Lausanne - Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Valérie D'Acremont
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
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Abraham K, Penczynski K, Monien BH, Bergau N, Knüppel S, Weikert C. Risks of misinterpretation of biomarker measurements in spot urine adjusted for creatinine - A problem especially for studies comparing plant based with omnivorous diets. Int J Hyg Environ Health 2023; 249:114142. [PMID: 36842230 DOI: 10.1016/j.ijheh.2023.114142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
Biomarker measurements in spot urine are often adjusted for creatinine to control for dilution resulting from individual hydration. We here report on results of a study involving age- and sex-matched vegans and omnivores (n = 36 each). The daily urinary excretion of 2,3-dihydroxypropylmercapturic acid (DHPMA, a diet-independent endogenous C3-metabolite used as an example compound) was found not to be different in vegans and omnivores (median 433 μg/24 h each), however, creatinine-adjusted levels were 26% lower in omnivores (median 285 μg/g creatinine) than in vegans (median 383 μg/g creatinine, p = 0.003). This difference results from the higher urinary excretion of creatinine in the omnivores compared to vegans (median 1.51 vs. 1.21 g/24 h, p = 0.009). Linear regression showed - besides the fat-free mass - a significant impact of the factor diet (vegans vs. omnivores). This may be due to the consumption of meat and fish as exogenous sources of creatinine. A literature search revealed broad evidence for this interpretation, as creatinine is formed from creatine during heating of meat and fish. Accordingly, consumption leads to temporary increase of serum/plasma creatinine and urinary creatinine excretion, resulting in higher levels in omnivores compared to vegans/vegetarians. An adjustment of the urinary DHPMA concentrations using specific gravity revealed 13% lower values in omnivores (median 225 μg/L) than in vegans (median 260 μg/L, p = 0.07). Compared to creatinine-adjustment, adjustment for specific gravity introduces a smaller but still obvious difference between omnivores and vegans. Especially with respect to future studies comparing vegans, vegetarians and omnivores, researchers should be aware of the risks of severe misinterpretations if biomarker measurements in spot urine are adjusted for creatinine.
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Affiliation(s)
- Klaus Abraham
- German Federal Institute for Risk Assessment, Department Food Safety, Max-Dohrn-Str. 8-10, 10589, Berlin, Germany.
| | - Katharina Penczynski
- German Federal Institute for Risk Assessment, Department Food Safety, Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
| | - Bernhard H Monien
- German Federal Institute for Risk Assessment, Department Food Safety, Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
| | - Nick Bergau
- German Federal Institute for Risk Assessment, Department Food Safety, Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
| | - Sven Knüppel
- German Federal Institute for Risk Assessment, Department Food Safety, Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
| | - Cornelia Weikert
- German Federal Institute for Risk Assessment, Department Food Safety, Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
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Plotnikoff GA, Dobberstein L, Raatz S. Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions. Nutrients 2023; 15:1387. [PMID: 36986117 PMCID: PMC10056340 DOI: 10.3390/nu15061387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.
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Affiliation(s)
| | | | - Susan Raatz
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
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Assessment of Oxidant and Antioxidant Status in Prepubertal Children following Vegetarian and Omnivorous Diets. Antioxidants (Basel) 2023; 12:antiox12030682. [PMID: 36978931 PMCID: PMC10044729 DOI: 10.3390/antiox12030682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Oxidant-antioxidant balance is crucial for maintaining one’s health, and the diet is possibly one of the most important factors affecting this balance. Therefore, the aim of this study was to determine the oxidant-antioxidant balance in children on a lacto-ovo-vegetarian diet. The study was conducted between January 2020 and December 2021. The concentrations of total oxidant capacity (TOC), total antioxidant capacity (TAC), reduced (GSH), and oxidized (GSSG) glutathione, as well as C-reactive protein (CRP) and calprotectin were measured in serum samples of 72 healthy prepubertal children (32 vegetarians and 40 omnivores). The oxidative stress index (OSI) and the GSH/GSSG ratio (R-index) were calculated. Children on a vegetarian diet had significantly lower median values of TOC, GSH, and GSSG, and higher TAC compared with the omnivores. OSI was significantly lower in vegetarians, while R-index, as well as median values of CRP and calprotectin did not differ between both groups of children. Significant negative correlations were observed between TOC and TAC levels in the whole group of children and in vegetarians. GSH and GSSG levels correlated positively in the groups of vegetarians, omnivores, and in all the children. There were significant positive correlations between TOC and GSH, as well as GSSG levels in all the studied groups of children. Our study results suggest that the vegetarian model of nutrition allows to maintain the oxidant-antioxidant balance in the serum of prepubertal children.
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The Effect of a Vegan Diet on the Cardiovascular System. J Cardiovasc Dev Dis 2023; 10:jcdd10030094. [PMID: 36975858 PMCID: PMC10052889 DOI: 10.3390/jcdd10030094] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
The vegan diet, often known as a plant-rich diet, consists primarily of plant-based meals. This dietary approach may be beneficial to one’s health and the environment and is valuable to the immune system. Plants provide vitamins, minerals, phytochemicals, and antioxidants, components that promote cell survival and immune function, allowing its defensive mechanisms to work effectively. The term “vegan diet” comprises a range of eating patterns that prioritize nutrient-rich foods such as fruits and vegetables, legumes, whole grains, nuts, and seeds. In comparison to omnivorous diets, which are often lower in such products, the vegan diet has been favorably connected with changes in cardiovascular disease (CVD) risk markers such as reduced body mass index (BMI) values, total serum cholesterol, serum glucose, inflammation, and blood pressure. Reduced intake of low-density lipoprotein (LDL), saturated fat, processed meat, and greater consumption of fiber and phytonutrients may improve cardiovascular health. However, vegans have much smaller amounts of nutrients such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), selenium, zinc, iodine, and vitamin B12, compared to non-vegans, which may lead to detrimental cardiovascular effects. This review aims to present the effect of plant-based diets (PBDs), specifically vegan diets, on the cardiovascular system.
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29
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Nedić O. Iodine: Physiological importance and food sources. EFOOD 2023. [DOI: 10.1002/efd2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- Olgica Nedić
- Department of Metabolism, Institute for the Application of Nuclear Energy (INEP) University of Belgrade Belgrade Republic of Serbia
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Hoy MK, Murayi T, Moshfegh AJ. Effect of Animal Protein Intake on Meeting Recommendations for Nutrient Intake among US Adults, What We Eat in America, NHANES 2015-2018. Curr Dev Nutr 2023; 7:100027. [PMID: 37180090 PMCID: PMC10111582 DOI: 10.1016/j.cdnut.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Background Replacing some animal sources of protein with plant foods is encouraged. Nutrient intake may reflect changes in the protein source. The adequacy of habitual nutrient intake among US adults has not been evaluated by the level of animal protein (AP) intake. Objectives The objective of this study was to compare food consumption and nutrient intake and adequacy among quintiles of percent AP intake. Methods Dietary intake data of adults 19+ y (N = 9706) from What We Eat in America, National Health and Nutrition Examination Survey 2015-2018 were used. Proportions of protein from animal and plant sources were estimated from ingredients in the Food and Nutrient Database for Dietary Studies 2015-2018, and then applied to dietary intakes. Intakes were classified by Q of percent AP. Food intake was described using the United States Department of Agriculture Food Patterns components. Usual nutrient intakes were estimated using the National Cancer Institute Method and compared with age and gender-specific Dietary Reference Intakes (DRIs). Comparisons between quintiles were made using t-tests. Results were considered significant at P < 0.01. Results Total protein intake was higher as the Q of AP intake increased. Among the higher quintiles of percent AP, <1% did not meet their DRIs for protein than 17% in Q1 and 5% in Q2 (P < 0.01). In quintiles with lower compared with higher percent AP, there were significantly higher percentages not meeting DRIs for vitamins A, B12, choline, zinc, and calcium but meeting recommendations for folate, vitamin C, saturated fat, cholesterol, and fiber (P < 0.01). Among all quintiles, over one-third did not meet DRIs for fiber, vitamins A, C, D, E, K, choline, calcium, and potassium. Conclusions Replacing protein from animal sources with plant foods may result in lower intakes of protein and some nutrients but a better intake of dietary components associated with reducing chronic disease risk. The current intake of US adults indicates dietary improvements are needed, regardless of protein source.
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Affiliation(s)
- M Katherine Hoy
- Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, Maryland, USA
| | - Theophile Murayi
- Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, Maryland, USA
| | - Alanna J. Moshfegh
- Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, Maryland, USA
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Dietary Antioxidants, Quality of Nutrition and Cardiovascular Characteristics among Omnivores, Flexitarians and Vegetarians in Poland-The Results of Multicenter National Representative Survey WOBASZ. Antioxidants (Basel) 2023; 12:antiox12020222. [PMID: 36829779 PMCID: PMC9952668 DOI: 10.3390/antiox12020222] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Several reports have shown that more plant-based dietary patterns provide a higher intake of antioxidants compared to diets rich in meat and animal products. Data on the intake of key nutrients in cardiovascular disease (CVD) prevention in relation to particular diets in countries of Central and Eastern Europe are scarce. The aim of this study was to assess quality of nutrition and CVD characteristics in a representative sample of Polish adults following different dietary patterns. Special regard was paid to the intake of natural antioxidants. The study comprised 13,318 (7159 females) randomly selected adults aged ≥ 20 years participating in the National Multicentre Health Surveys WOBASZ and WOBASZ II. The subjects were categorized into groups of omnivores (92.4%), flexitarians (7.4%) and vegetarians (0.16%) according to type of diet using the Food Frequency Questionnaire and 24 h dietary recall. The obtained results showed that neither flexitarians nor vegetarians represented better dietary habits or lifestyle behaviors compared to omnivores. Flexitarians had significantly lower daily energy intake than omnivores, but their diet was rich in total fat (above 30% of daily energy consumption) and low in fiber. Omnivores declared a higher consumption of fresh vegetables (p < 0.001), fresh fruit (p < 0.01), coffee (p < 0.01) and tea (p < 0.05, in women only) than flexitarians. Omnivores had significantly higher intake of natural antioxidants (vitamin C, E, zinc in both genders and vitamin A in men) as compared with flexitarians. Among women, the highest adherence to the intake of recommended amounts of antioxidant nutrients was noted among omnivores. Among men, vegetarians had the highest proportion of meeting the guidelines for vitamin A (77.8%), E (66.7%) and C (66.7%), while the lowest proportions were found in flexitarians (69.9%, 39.5% and 32.4%, respectively). The groups did not differ in terms of smoking and physical activity level. There were no significant differences in the analyzed CVD characteristics between omnivores and flexitarians. In women, vegetarians had substantially lower BMI than omnivores (p < 0.05) and flexitarians (p < 0.05) and a lower mean serum glucose compared with omnivores (p < 0.01) and flexitarians (p < 0.05). Vegetarians had lower prevalence of hypertension and obesity than meat eaters. In conclusion, the results of the current research showed an inappropriate intake of several nutrients, including highly potent antioxidants, irrespective of the dietary regimen. Flexitarians did not have a more favorable CVD profile than omnivores. Taking into account the growing popularity of diets with reduced animal products, there is a need to elaborate strategies providing Polish adults with guidance regarding properly balanced nutrition.
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Bogataj Jontez N, Kenig S, Šik Novak K, Petelin A, Jenko Pražnikar Z, Mohorko N. Habitual low carbohydrate high fat diet compared with omnivorous, vegan, and vegetarian diets. Front Nutr 2023; 10:1106153. [PMID: 37125046 PMCID: PMC10133707 DOI: 10.3389/fnut.2023.1106153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background Dietary patterns which exclude whole food groups, such as vegetarian, vegan and low carbohydrate high fat diet (LCHF), are increasingly popular in general public. When carefully planned, all these diets have some known benefits for health, but concerns are also raised in particular for LCHF. The quality of LCHF diet which individuals follow in real life without supervision is not known. Methods One hundred thirty healthy individuals with stable body mass following LCHF, vegan, vegetarian and omnivorous diet for at least six months, were compared in a cross-sectional study. Diet was analyzed through 3-day food records and FFQ, anthropometric measurements were performed and serum metabolic biomarkers determined from fasting blood. Results Participants on LCHF diet had the intakes of micronutrients comparable to other groups, while the intakes of macronutrients differed in line with the definition of each diet. The intakes of saturated fats, cholesterol and animal proteins were significantly higher and the intakes of sugars and dietary fibers were lower compared to other groups. Healthy eating index 2015 in this group was the lowest. There were no differences in the levels of glucose, triacylglycerols and CRP among groups. Total and LDL cholesterol levels were significantly higher in LCHF group, in particular in participants with higher ketogenic ratio. Fatty acids intakes and intakes of cholesterol, dietary fibers and animal proteins explained 40% of variance in total cholesterol level, with saturated fatty acids being the strongest positive predictor and monounsaturated fatty acids a negative predictor. Conclusion None of the self-advised diets provided all the necessary nutrients in optimal levels. Due to the detected increased levels of serum cholesterols, selection of healthy fat sources, higher intake of dietary fibers and partial replacing of animal sources with plant sources of foods should be recommended to the individuals selecting LCFH dietary pattern.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04347213.
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Branković M, Budžak A, Tulić N, Janković J. Effects of experimentally induced self-affirmation on the openness to meat reduction and alternative protein sources. Front Psychol 2023; 14:1021891. [PMID: 37151312 PMCID: PMC10160641 DOI: 10.3389/fpsyg.2023.1021891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Consumption of animals entails disregarding the pain of sentient beings, and acknowledging this can threaten an individual's image of oneself as a moral person. Also, abstaining from meat in a meat-eating culture can threaten an individual's valued group identity. Previous research on inter-group relations suggests that self-affirmation, affirmation of personally or collectively important values, can help individuals alleviate self-threats since it enhances one's global self-image and decreases threat perceptions. Methods We tested for potential effects of self-affirmation on openness toward reducing meat consumption in an experimental study. Participants (N = 277) were randomized into an individual affirmation, group affirmation, or a control condition. Individual affirmation participants ranked a list of values and then wrote a short paragraph about their first-ranked value. Group affirmation participants did a similar task, focusing on the values of their ethnic group, while participants in the control condition had an unrelated task of ranking their color preferences. Participants then read a persuasive message presenting health risks related to meat consumption and the health benefits of reducing meat. Finally, they indicated their openness toward reducing meat consumption and acceptability of plant-based alternatives and lab-grown meat. Results and Discussion Results show that affirmed participants expressed more readiness to reconsider their meat consumption habits, reduced perceptions of vegetarianism as a threat to the local culture, and more positive perceptions of the idea of lab-grown meat. However, self-esteem and frequency of meat consumption pose important limitations to the experimental effects. We discuss the findings from the perspective of self-and collective identity threats and the potential of self-affirmations to create a more open debate about animal product consumption.
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Affiliation(s)
- Marija Branković
- Insitute for Philosophy and Social Theory, University of Belgrade, Belgrade, Serbia
- Faculty of Media and Communications, Singidunum University, Belgrade, Serbia
- *Correspondence: Marija Branković,
| | - Anastasija Budžak
- Faculty of Media and Communications, Singidunum University, Belgrade, Serbia
| | - Nađa Tulić
- Faculty of Media and Communications, Singidunum University, Belgrade, Serbia
| | - Jovana Janković
- Faculty of Media and Communications, Singidunum University, Belgrade, Serbia
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Pawlak R, Judd N, Donati GL, Perrin MT. Prevalence and Predictors of Low Breast Milk Iodine Concentration in Women Following Vegan, Vegetarian, and Omnivore Diets. Breastfeed Med 2023; 18:37-42. [PMID: 36450113 DOI: 10.1089/bfm.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Purpose: Breast milk iodine concentration (BMIC) from vegan and vegetarian lactating mothers has not previously been evaluated. The goal of this study was to assess BMIC from vegans, vegetarians, and omnivores and to assess intake of iodine by breastfed infants. Materials and Methods: Breast milk samples from vegans (n = 12), vegetarians (n = 6), and omnivores (n = 12) living in the United States were analyzed. BMIC was determined at the mass-to-charge ratio (m/z) 127 by inductively coupled plasma mass spectrometry (ICP-MS) using an Agilent 8800 ICP-MS/MS (Agilent Technologies). Results: There was a significant difference in mean BMIC between participants following a plant-based diet (vegan and vegetarian, n = 18) compared with omnivores [4.42 versus 5.02 Ln(BMIC), respectively; p = 0.0405]. In linear regression to predict BMIC, vegan diet was a negative predictor (standardized β = -0.409) and use of multi- or prenatal supplements was a positive predictor (standardized β = 0.319). There were differences in the percentage of inadequate BMIC per maternal diet (75% vegan, 67% vegetarian, omnivore 58%) but this did not reach statistical significance. In 67% of the samples (20/30) BMIC was lower than the National Academy of Medicine's adequate intake (AI), assuming infant milk consumption of 0.78 L/day. Conclusions: Most samples from vegans and vegetarians contained a lower BMIC than AI for infants 0-6 months. Counseling of pregnant vegans and vegetarians should highlight importance of iodine supplementation during lactation. The findings are based on a small number of samples, especially for vegetarians, and thus, they need to be confirmed by larger studies.
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Affiliation(s)
- Roman Pawlak
- Department of Nutrition Science, East Carolina University, Greenville, North Carolina, USA
| | - Nicholas Judd
- Department of Chemistry, Wake Forest University, Wake Forest, North Carolina, USA
| | - George L Donati
- Department of Chemistry, Wake Forest University, Wake Forest, North Carolina, USA
| | - Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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Razavi R, Xue G. Predicting Unreported Micronutrients from Food Labels: A Machine Learning Approach (Preprint). J Med Internet Res 2022; 25:e45332. [PMID: 37043261 PMCID: PMC10134025 DOI: 10.2196/45332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/11/2023] [Accepted: 03/12/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Micronutrient deficiencies represent a major global health issue, with over 2 billion individuals experiencing deficiencies in essential vitamins and minerals. Food labels provide consumers with information regarding the nutritional content of food items and have been identified as a potential tool for improving diets. However, due to governmental regulations and the physical limitations of the labels, food labels often lack comprehensive information about the vitamins and minerals present in foods. As a result, information about most of the micronutrients is absent from existing food labels. OBJECTIVE This paper aims to examine the possibility of using machine learning algorithms to predict unreported micronutrients such as vitamin A (retinol), vitamin C, vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6, vitamin B12, vitamin E (alpha-tocopherol), vitamin K, and minerals such as magnesium, zinc, phosphorus, selenium, manganese, and copper from nutrition information provided on existing food labels. If unreported micronutrients can be predicted with acceptable accuracies from existing food labels using machine learning predictive models, such models can be integrated into mobile apps to provide consumers with additional micronutrient information about foods and help them make more informed diet decisions. METHODS Data from the Food and Nutrient Database for Dietary Studies (FNDDS) data set, representing a total of 5624 foods, were used to train a diverse set of machine learning classification and regression algorithms to predict unreported vitamins and minerals from existing food label data. For each model, hyperparameters were adjusted, and the models were evaluated using repeated cross-validation to ensure that the reported results were not subject to overfitting. RESULTS According to the results, while predicting the exact quantity of vitamins and minerals is shown to be challenging, with regression R2 varying in a wide range from 0.28 (for magnesium) to 0.92 (for manganese), the classification models can accurately predict the category ("low," "medium," or "high") level of all minerals and vitamins with accuracies exceeding 0.80. The highest classification accuracies for specific micronutrients are achieved for vitamin B12 (0.94) and phosphorus (0.94), while the lowest are for vitamin E (0.81) and selenium (0.83). CONCLUSIONS This study demonstrates the feasibility of predicting unreported micronutrients from existing food labels using machine learning algorithms. The results show that the approach has the potential to significantly improve consumer knowledge about the micronutrient content of the foods they consume. Integrating these predictive models into mobile apps can enhance their accessibility and engagement with consumers. The implications of this research for public health are noteworthy, underscoring the potential of technology to augment consumers' understanding of the micronutrient content of their diets while also facilitating the tracking of food intake and providing personalized recommendations based on the micronutrient content and individual preferences.
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Affiliation(s)
- Rouzbeh Razavi
- Department of Management and Information Systems, Kent State University, Kent, OH, United States
| | - Guisen Xue
- Department of Management and Information Systems, Kent State University, Kent, OH, United States
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How Does Selenium Intake Differ among Children (1-3 Years) on Vegetarian, Vegan, and Omnivorous Diets? Results of the VeChi Diet Study. Nutrients 2022; 15:nu15010034. [PMID: 36615692 PMCID: PMC9824336 DOI: 10.3390/nu15010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
In regions with low selenium soil concentrations, selenium can be considered a critical nutrient for vegetarians and vegans. While the number of vegetarians and vegans is increasing in many countries, a large research gap remains in this field. For example, to date, no study seems to have assessed selenium intake in vegetarian and vegan children. Therefore, the selenium intake of 1- to 3-year-old vegetarian, vegan, and omnivorous children who participated in the cross-sectional VeChi Diet study was determined. Selenium intake was assessed based on 3-day food diaries (not including supplements) and food selenium concentrations provided by the European Food Safety Authority (EFSA). Between-group differences were assessed with analysis of covariance (ANCOVA). The median daily selenium intake was 17 µg, 19 µg, and 22 µg in vegetarian, vegan, and omnivorous children, respectively. However, only the difference between the vegan and omnivorous children was statistically significant. On average, all three groups met the harmonized average requirement (H-AR) for selenium of 17 µg/day. Nevertheless, the hypothesis that vegetarian and vegan children generally consume less selenium than omnivorous children could be confirmed, and 39% of vegetarians, 36% of vegans, and 16% of omnivores fell below the adequate intake for selenium (provided by EFSA) of 15 µg/day.
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Chen G, Tan W, Ran N, Zhang J, Yan B. Do urban tourists prefer vegetarianism? An urban-rural comparison of vegetarian consumption in China. Front Nutr 2022; 9:996158. [PMID: 36570159 PMCID: PMC9773143 DOI: 10.3389/fnut.2022.996158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
The adoption of a vegetarian diet might have public health and environmental benefits. However, little is known about urban and rural Generation Z tourists' attitudes toward vegetarianism or vegetarian consumption within the Chinese urban and rural settings. Hence, to address this gap, the present study adopted a sequential and mixed research approach based on a survey (n = 212) and laddering interviews (n = 20) to validate post-millennial tourists' motives for adopting a vegetarian diet. The results identified the top four motives as environmental protection and resource conservation, ethical consideration, personal taste and choice, and personal healthcare issues. The top four barriers to vegetarianism were unavailability and limited choice, peer pressure, traditional prejudice/habit, and the inability to change. The results also demonstrated that both rural and urban tourists adopt vegetarianism mainly for environmental protection and ethical consideration, a subtle difference between them is that urban vegetarians emphasized ethical considerations more but rural ones emphasized food and variety. Urban consumers considered unavailability and limited choice as the topmost barriers to being vegetarian, while rural vegetarians found traditional prejudice to be restricting. Due to traditional dietary habits and peer influence, rural tourists face many more challenges when adopting a vegetarian diet. Understanding the perceived benefits and barriers to being vegetarian in different regions will not only enrich the theory of food nutrition but also expand Generation Z tourists' consumption behavior and practices.
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Affiliation(s)
- Guoyi Chen
- Department of Business Management, Chongqing Three Gorges University, Chongqing, China,*Correspondence: Guoyi Chen
| | - Wei Tan
- Department of Public Administration, Chongqing Three Gorges University, Chongqing, China
| | - Ning Ran
- Department of Business Management, Chongqing Three Gorges University, Chongqing, China
| | - Jiansheng Zhang
- Department of Financial Management, Chongqing Three Gorges University, Chongqing, China
| | - Bangquan Yan
- Department of Business Management, Chongqing Three Gorges University, Chongqing, China
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Ogilvie AR, McGuire BD, Meng L, Shapses SA. Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors. Curr Osteoporos Rep 2022; 20:442-452. [PMID: 36129610 DOI: 10.1007/s11914-022-00754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Anna R Ogilvie
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
- Institute of Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
| | - Brandon D McGuire
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
- Institute of Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
| | - Lingqiong Meng
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
- Institute of Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA.
- Institute of Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA.
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Effect of a Vegan Diet on Alzheimer's Disease. Int J Mol Sci 2022; 23:ijms232314924. [PMID: 36499257 PMCID: PMC9738978 DOI: 10.3390/ijms232314924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
There is evidence indicating that a vegan diet could be beneficial in the prevention of neurodegenerative disorders, including Alzheimer's disease (AD). The purpose of this review is to summarize the current knowledge on the positive and negative aspects of a vegan diet regarding the risk of AD. Regarding AD prevention, a vegan diet includes low levels of saturated fats and cholesterol, contributing to a healthy blood lipid profile. Furthermore, it is rich in phytonutrients, such as vitamins, antioxidants, and dietary fiber, that may help prevent cognitive decline. Moreover, a vegan diet contributes to the assumption of quercetin, a natural inhibitor of monoamine oxidase (MAO), which can contribute to maintaining mental health and reducing AD risk. Nonetheless, the data available do not allow an assessment of whether strict veganism is beneficial for AD prevention compared with vegetarianism or other diets. A vegan diet lacks specific vitamins and micronutrients and may result in nutritional deficiencies. Vegans not supplementing micronutrients are more prone to vitamin B12, vitamin D, and DHA deficiencies, which have been linked to AD. Thus, an evaluation of the net effect of a vegan diet on AD prevention and/or progression should be ascertained by taking into account all the positive and negative effects described here.
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Wirnitzer KC, Motevalli M, Tanous DR, Wirnitzer G, Wagner KH, Cocca A, Schätzer M, Kirschner W, Drenowatz C, Ruedl G. Study Protocol of "Sustainably Healthy-From Science 2 Highschool & University"-Prevalence of Mixed, Vegetarian, and Vegan Diets Linked to Sports & Exercise among Austrian Tertiary Students and Lecturers/Academic Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15313. [PMID: 36430039 PMCID: PMC9690980 DOI: 10.3390/ijerph192215313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Healthy lifestyle is the major indicator of individual and public health especially in target populations (e.g., during emerging adulthood). Evidence indicates that unhealthy lifestyle behaviors are strongly associated with the increasing prevalence of chronic diseases. The dual approach of sustainable health (i.e., physical exercise tied to a healthy diet) is an effective lifestyle strategy to control and manage health-related disorders, including overweight/obesity. Based on the evidence on plant-based diets regarding health and considering the growing prevalence of vegans and vegetarians worldwide, limited data exist on the health-related behaviors of those who follow plant-based vs. mixed diets in young adulthood. This multidisciplinary study is the first to examine the association between diet type (mixed, vegetarian, and vegan diets) and various health-related behaviors (primarily physical activity, sport, & exercise) among college/university students and lecturers/academic staff in Austria nationwide. Following a cross-sectional study design and using online questionnaires, 4510 tertiary students and 1043 lecturers/academic staff provided data on sociodemographic characteristics, dietary patterns, physical exercise habits, and other lifestyle behaviors (sleep, alcohol intake, smoking, etc.) along with information on health status and quality of life. While the data will be analyzed based on differentiated sociodemographic and health-related categories, the influence of the COVID-19 pandemic on lifestyle behaviors will also be evaluated. As a study protocol, this article represents comprehensive details of the design, purposes, and associated analytical measures of the present study within the tertiary educational context.
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Affiliation(s)
- Katharina C. Wirnitzer
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
| | - Mohamad Motevalli
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Derrick R. Tanous
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Karl-Heinz Wagner
- Department of Nutritional Sciences and Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria
| | - Armando Cocca
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Manuel Schätzer
- Special Institute for Preventive Cardiology and Nutrition—SIPCAN, 5061 Elsbethen, Austria
| | - Werner Kirschner
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University of Teacher Education Upper Austria, 4020 Linz, Austria
| | - Gerhard Ruedl
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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Characterisation of meat consumption across socio-demographic, lifestyle and anthropometric groups in Switzerland: results from the National Nutrition Survey menuCH. Public Health Nutr 2022; 25:3096-3106. [PMID: 35466905 PMCID: PMC9991843 DOI: 10.1017/s136898002200101x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Characterising meat consumption in Switzerland across socio-demographic, lifestyle and anthropometric groups. DESIGN Representative national data from the menuCH survey (two 24-hour dietary recalls, anthropometric measurements and a lifestyle questionnaire) were used to analyse the total average daily intake of meat and main meat categories. Energy-standardised average intake (g/1000 kcal) was calculated and its association with 12 socio-demographic, lifestyle and anthropometric variables was investigated using multivariable linear regression. SETTING Switzerland. PARTICIPANTS Totally, 2057 participants aged 18-75 years. RESULTS Average total meat intake was 109 g/d, which included 43 g/d of processed meat, 37 g/d of red meat and 27 g/d of white meat. Energy-standardised meat intake was highest for men, the Italian-language region and the youngest age group (18-29 years). Regression results showed significantly lower total meat and red meat consumption (g/1000 kcal) for women than men. However, there were no sex-specific differences for white meat. Total meat and white meat consumption were positively associated with the 18-29 age group, compared with 30-44 years, non-Swiss compared with Swiss participants and one-parent families with children compared with couples without children. Consumption of all categories of meat showed positive associations for BMI > 25 kg/m2 compared with BMI 18·5-25 kg/m2 and for French- and Italian-language regions compared with German-language region. CONCLUSION The current study reveals that there are significant differences in the amounts and types of meat consumed in Switzerland, suggesting that evidence-based risks and benefits of these categories need to be emphasised more in meat consumption recommendations.
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Wirnitzer KC, Tanous DR, Motevalli M, Göbel G, Wirnitzer G, Drenowatz C, Ruedl G, Cocca A, Kirschner W. Study protocol of "From Science 2 School"-prevalence of sports and physical exercise linked to omnivorous, vegetarian and vegan, diets among Austrian secondary schools. Front Sports Act Living 2022; 4:967915. [PMID: 36249320 PMCID: PMC9554638 DOI: 10.3389/fspor.2022.967915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
The increasing prevalence of unhealthy lifestyle choices contribute to almost all chronic conditions negatively affecting individual and public health. As the most beneficial preventative solution, a healthy lifestyle focusing on the dual approach of physical activity (PA) and a healthful diet is highly recommended. Considering the growing number of people interested in sustainable, plant-based diets, it seems crucial to analyze lifestyle behaviors with a special focus on diet type to delve deeper into the unenthusiastic health status among young populations. Therefore, this multidisciplinary study aims to survey and scale health behaviors with a special focus on the prevalence of traditional and vegetarian diets in connection with PA levels among Austrian pupils (10-19 years), teachers and principals in secondary education levels I and II. Following a cross-sectional design, sociodemographic and school-related data along with a complete profile of lifestyle behaviors, including detailed information regarding diet, PA, sports & exercise, and other health-related behaviors, were collected using online-based questionnaires. A total number of 8,845 children/adolescents (~1.2% of the eligible 771,525 Austrian secondary school pupils) and 1,350 adults (~1.5% of total eligible 89,243 Austrian teachers/principals) participated in the study. As this is the first investigation to explore the prevalence of veganism/vegetarianism amongst a large group of pupils, the present study will add an important contribution to overcome the lack of knowledge on PA, sports & exercise linked to healthy alternative diets. With a sustainable healthy lifestyle, a healthy transition from childhood to adulthood occurs, which can result in growing healthier functioning generations at all social levels. As a study protocol, the present article is intended to present comprehensive details of the study design, objectives, and the associated analytical procedures of the "From Science 2 School" study.
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Affiliation(s)
- Katharina C. Wirnitzer
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, Innsbruck, Austria
- Department of Sport Science, Leopold-Franzens University Innsbruck, Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University Innsbruck, Innsbruck, Austria
| | - Derrick R. Tanous
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, Innsbruck, Austria
- Department of Sport Science, Leopold-Franzens University Innsbruck, Innsbruck, Austria
| | - Mohamad Motevalli
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, Innsbruck, Austria
- Department of Sport Science, Leopold-Franzens University Innsbruck, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University of Teacher Education Upper Austria, Linz, Austria
| | - Gerhard Ruedl
- Department of Sport Science, Leopold-Franzens University Innsbruck, Innsbruck, Austria
| | - Armando Cocca
- Department of Sport Science, Leopold-Franzens University Innsbruck, Innsbruck, Austria
| | - Werner Kirschner
- Department of Sport Science, Leopold-Franzens University Innsbruck, Innsbruck, Austria
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Bartholomae E, Knurick J, Johnston CS. Serum creatinine as an indicator of lean body mass in vegetarians and omnivores. Front Nutr 2022; 9:996541. [PMID: 36185683 PMCID: PMC9525150 DOI: 10.3389/fnut.2022.996541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
Growing numbers of Americans are adopting vegetarian or vegan diets. While risk for some chronic conditions may be lower when following these diets, concern remains over the ability to consume adequate amounts of various nutrients, notably, protein. Knowing that serum creatinine is a reliable marker of muscle mass, this study examined the relationships between serum creatinine, lean body mass (LBM), handgrip strength, and protein intake in healthy vegetarian (n = 55) and omnivorous (n = 27) adults. Significantly higher protein intakes (+31%), LBM (+7%), serum creatinine (+12%) and handgrip strength (+14%) were observed for the omnivore participants compared to vegetarian participants. Positive correlations (p < 0.001) were noted between creatinine and LBM (R2 = 0.42), creatinine and handgrip strength (R2 = 0.41), protein intake and LBM (R2 = 0.29), and handgrip strength and LBM (R2 = 0.69). These data show that serum creatinine concentrations were lower in vegetarian women and men in comparison to their omnivorous counterparts and that serum creatinine concentrations correlate with LBM and strength in healthy adults, regardless of diet.
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Kailainathan A, Ludriksone L, Uwyse A, Elsner P. [Dermatitis in sun-exposed skin areas, forgetfulness and chronic alcohol abuse]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:747-749. [PMID: 35146545 DOI: 10.1007/s00105-022-04952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Anushan Kailainathan
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland.
- Department of Dermatology, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - Laine Ludriksone
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
| | - Ahamed Uwyse
- Department of Dermatology, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
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45
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Koeder C, Perez-Cueto FJA. Vegan nutrition: a preliminary guide for health professionals. Crit Rev Food Sci Nutr 2022; 64:670-707. [PMID: 35959711 DOI: 10.1080/10408398.2022.2107997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since the beginning of the 21st century, interest in vegan diets has been rapidly increasing in most countries. Misconceptions about vegan diets are widespread among the general population and health professionals. Vegan diets can be health-promoting and may offer certain important advantages compared to typical Western (and other mainstream) eating patterns. However, adequate dietary sources/supplements of nutrients of focus specific to vegan diets should be identified and communicated. Without supplements/fortified foods, severe vitamin B12 deficiency may occur. Other potential nutrients of focus are calcium, vitamin D, iodine, omega-3 fatty acids, iron, zinc, selenium, vitamin A, and protein. Ensuring adequate nutrient status is particularly important during pregnancy, lactation, infancy, and childhood. Health professionals are often expected to be able to provide advice on the topic of vegan nutrition, but a precise and practical vegan nutrition guide for health professionals is lacking. Consequently, it is important and urgent to provide such a set of dietary recommendations. It is the aim of this article to provide vegan nutrition guidelines, based on current evidence, which can easily be communicated to vegan patients/clients, with the goal of ensuring adequate nutrient status in vegans.
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Affiliation(s)
- Christian Koeder
- Institute of Food Science and Human Nutrition, Leibniz University Hanover, Hanover, Germany
- Department of Nutrition, University of Applied Sciences Münster, Münster, Germany
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Leshem M, Shaul S. Vegans, vegetarians and omnivores differ in nutrient hedonics, salt and sweet preference and flavouring. Physiol Behav 2022; 255:113936. [PMID: 35931195 DOI: 10.1016/j.physbeh.2022.113936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dietary content can influence taste responses. Therefore, we compared nutrient hedonics (liking foods by nutrient content), and seasoning, including taste responses to the prime flavours salt and sweet in 30 vegan, 37 vegetarian and 56 omnivore men and women. METHODOLOGY Questionnaires and taste tests examined macronutrient and electrolyte intake and hedonics, seasoning, salt and sweet preferences and psychophysical taste responses. RESULTS Compared to omnivores, vegans had lower protein, Ca++, Na+ intake, and increased carbohydrate (CHO) intake. Independently of intake, hedonics for protein Ca++ and Na+ were reduced and increased for CHO. Psychophysical responses to NaCl and sucrose also differed slightly, vegans and vegetarians scoring high concentrations of sucrose as more intense, Vegans reported more sweetening and less salting of food, added more sucrose to a test tea, less salt to a test soup, but did not differ in seasoning with oil or hot spice. PRINCIPAL CONCLUSIONS Habitual vegan, vegetarian and omnivore diets may alter taste responses to nutrient content and salt and sweet, the latter more pronounced in vegan and vegetarian women. Recognising diet-dependent changes in taste hedonics can inform diets and products.
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Affiliation(s)
- Micah Leshem
- School of Psychological Sciences, The University of Haifa, Israel.
| | - Smadar Shaul
- School of Psychological Sciences, The University of Haifa, Israel
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Menzel J, Longree A, Abraham K, Schulze MB, Weikert C. Dietary and Plasma Phospholipid Profiles in Vegans and Omnivores-Results from the RBVD Study. Nutrients 2022; 14:nu14142900. [PMID: 35889855 PMCID: PMC9320578 DOI: 10.3390/nu14142900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Over the last few years, the vegan diet has become increasingly popular in Germany. It has been proposed that this diet is generally lower in fat, but less is known about the impact on fatty acid (FA) profiles. Therefore, the cross-sectional “Risks and Benefits of a Vegan Diet” (RBVD) study (n = 72) was used to investigate dietary FA intake as well as plasma phospholipid FA in vegans (n = 36) compared to omnivores (n = 36). Vegans had a significantly lower dietary intake of total fat (median 86 g/day, IQR 64−111) in comparison to omnivores (median 104 g/day, IQR 88−143, p = 0.004). Further, vegans had a lower intake of saturated fatty acids (SFA) (p < 0.0001) and monounsaturated fatty acids (MUFA) (p = 0.001) compared to omnivores. Vegans had a higher intake in total polyunsaturated fatty acids (PUFA), omega-3 and omega-6 PUFA compared to omnivores, but without statistical significance after Bonferroni correction. According to plasma phospholipid profiles, relatively lower proportions of SFA (p < 0.0001), total trans fatty acids (TFA) (p = 0.0004) and omega-3-FA (p < 0.0001), but higher proportions of omega-6-FA (p < 0.0001) were observed in vegans. With the exception of omega-3 PUFA, a vegan diet is associated with a more favorable dietary fat intake and more favorable plasma FA profiles and therefore may reduce cardiovascular risk.
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Affiliation(s)
- Juliane Menzel
- Department of Food Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.L.); (K.A.); (C.W.)
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-18412-55001
| | - Alessa Longree
- Department of Food Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.L.); (K.A.); (C.W.)
| | - Klaus Abraham
- Department of Food Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.L.); (K.A.); (C.W.)
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam–Rehbruecke, 14558 Nuthetal, Germany;
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Cornelia Weikert
- Department of Food Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.L.); (K.A.); (C.W.)
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48
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Dawczynski C, Weidauer T, Richert C, Schlattmann P, Dawczynski K, Kiehntopf M. Nutrient Intake and Nutrition Status in Vegetarians and Vegans in Comparison to Omnivores - the Nutritional Evaluation (NuEva) Study. Front Nutr 2022; 9:819106. [PMID: 35651513 PMCID: PMC9149309 DOI: 10.3389/fnut.2022.819106] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction In recent years, vegetarian and vegan diets became increasingly important as they are associated with beneficial health outcomes. Therefore, the NuEva study compares the impact of flexitarian, vegetarian, or vegan diets with omnivorous nutritional habits on nutrient intake and risk factors for non-communicable diseases. Methods A dietary protocol was kept over five days and blood and 24h urine samples were collected to examine the impact of dietary habits [omnivores, n = 65 (Median/Interquartile range: 33/17 yrs.), flexitarians, n = 70 (30/17 yrs.), ovo-lacto vegetarians, n = 65 (28/14 yrs.), vegans, n = 58 (25/10 yrs.)] on nutrient intake, nutrient concentrations in plasma, serum or 24h urine, body composition, and blood lipids. Results The increased exclusion of animal based foods in the diet (omnivores < flexitarians < vegetarians < vegans) is associated with a decreased intake of energy, saturated fat, cholesterol, disaccharides, and total sugar as well an increased intake of dietary fibers, beta carotene, vitamin E and K. The combined index of the B12 status (4cB12 score) in vegetarians (0.02/0.75) was lower compared to omnivores (0.34/0.58; p ≤ 0.05) and flexitarians (0.24/0.52; p ≤ 0.05). In omnivores vitamin A, vitamin E, ferritin, and the urinary excretion of selenium, iodine, and zinc were higher than in vegans (p ≤ 0.05). In contrast, vegans had the highest concentrations of biotin, folate, and vitamin C. Flexitarians, vegetarians, and vegans had a lower body weight, BMI, and body fat percentage in comparison to omnivores (p ≤ 0.05). In omnivores the concentrations on total cholesterol, total cholesterol/HDL cholesterol ratio, LDL cholesterol, LDL cholesterol/HDL cholesterol ratio, apolipoprotein B, and apolipoprotein B/ apolipoprotein A1 ratio were higher than in vegetarians and vegans (p ≤ 0.05). Conclusion The NuEva study confirms the position of the Academy of Nutrition and Dietetics that adequately planned vegetarian diets are healthy, nutritionally adequate, and may provide health benefits in the prevention and treatment of non-communicable diseases. Nevertheless, critical nutrients were identified for all groups studied. This highlights the need to develop individual nutritional concepts to ensure an adequate nutrient intake.
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Affiliation(s)
- Christine Dawczynski
- Junior Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University, Jena, Germany.,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Leipzig, Germany
| | - Thomas Weidauer
- Junior Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University, Jena, Germany.,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Leipzig, Germany
| | - Cora Richert
- Institute of Clinical Chemistry and Laboratory Diagnostics, University Hospital, Jena, Germany
| | - Peter Schlattmann
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Leipzig, Germany.,Department of Medical Statistics, Informatics and Data Science, University Hospital, Jena, Germany
| | - Kristin Dawczynski
- Department for Pediatrics and Adolescent Medicine, Sophien- and Hufeland Hospital, Weimar, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics, University Hospital, Jena, Germany
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49
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Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Cuerda C. ESPEN micronutrient guideline. Clin Nutr 2022; 41:1357-1424. [PMID: 35365361 DOI: 10.1016/j.clnu.2022.02.015] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. OBJECTIVE This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". METHODS The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. CONCLUSION This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.
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Affiliation(s)
- Mette M Berger
- Department of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland.
| | | | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | | | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli (Federico II), Naples, Italy; United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair for Health Education and Sustainable Development, Federico II, University, Naples, Italy.
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
| | - Loris Pironi
- Alma Mater Studiorum - University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation (SNHf), Epalinges, Switzerland.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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50
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Voelkle M, Gregoriano C, Neyer P, Koch D, Kutz A, Bernasconi L, Conen A, Mueller B, Schuetz P. Prevalence of Micronutrient Deficiencies in Patients Hospitalized with COVID-19: An Observational Cohort Study. Nutrients 2022; 14:nu14091862. [PMID: 35565831 PMCID: PMC9101904 DOI: 10.3390/nu14091862] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022] Open
Abstract
Background: A higher risk for severe clinical courses of coronavirus disease 2019 (COVID-19) has been linked to deficiencies of several micronutrients. We therefore studied the prevalence of deficiencies of eight different micronutrients in a cohort of hospitalized COVID-19-patients. Methods: We measured admission serum/plasma levels of vitamins A, B12, D, and E, as well as folic acid, zinc, selenium, and copper in 57 consecutively admitted adult patients with confirmed COVID-19 and analyzed prevalence of micronutrient deficiencies and correlations among micronutrient levels. Further, we studied associations of micronutrient levels with severe disease progression, a composite endpoint consisting of in-hospital mortality and/or need for intensive care unit (ICU) treatment with logistic regression. Results: Median age was 67.0 years (IQR 60.0, 74.2) and 60% (n = 34) were male. Overall, 79% (n = 45) of patients had at least one deficient micronutrient level and 33% (n = 19) had ≥3 deficiencies. Most prevalent deficiencies were found for selenium, vitamin D, vitamin A, and zinc (51%, 40%, 39%, and 39%, respectively). We found several correlations among micronutrients with correlation coefficients ranging from r = 0.27 to r = 0.42. The strongest associations with lower risk for severe COVID-19 disease progression (adjusted odds ratios) were found for higher levels of vitamin A (0.18, 95% CI 0.05–0.69, p = 0.01), zinc (0.73, 95% CI 0.55–0.98, p = 0.03), and folic acid (0.88, 95% CI 0.78–0.98, p = 0.02). Conclusions: We found a high prevalence of micronutrient deficiencies in mostly older patients hospitalized for COVID-19, particularly regarding selenium, vitamin D, vitamin A, and zinc. Several deficiencies were associated with a higher risk for more severe COVID-19 courses. Whether supplementation of micronutrients is useful for prevention of severe clinical courses or treatment of COVID-19 warrants further research.
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Affiliation(s)
- Manyola Voelkle
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (M.V.); (C.G.); (D.K.); (A.K.); (B.M.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Claudia Gregoriano
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (M.V.); (C.G.); (D.K.); (A.K.); (B.M.)
| | - Peter Neyer
- Institute of Laboratory Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (P.N.); (L.B.)
| | - Daniel Koch
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (M.V.); (C.G.); (D.K.); (A.K.); (B.M.)
| | - Alexander Kutz
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (M.V.); (C.G.); (D.K.); (A.K.); (B.M.)
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (P.N.); (L.B.)
| | - Anna Conen
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
- Department of Infectious Diseases and Infection Prevention, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Beat Mueller
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (M.V.); (C.G.); (D.K.); (A.K.); (B.M.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Philipp Schuetz
- Medical University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland; (M.V.); (C.G.); (D.K.); (A.K.); (B.M.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
- Correspondence: ; Tel.: +41-62-838-9524
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