Development of a Food Guide for the Vegetarians of Spain

Development and validation of a novel food exchange system for Chinese pregnant women

BACKGROUND

The dietary nutritional status of pregnant women is critical for maintaining the health of both mothers and infants. Food exchange systems have been employed in the nutritional guidance of patients in China, although their application in the dietary guidance of healthy pregnant women is quite limited. This study aimed to develop a novel food exchange system for Chinese pregnant women (NFES-CPW) and evaluate the relative validation of its application.

METHODS

NFES-CPW covers approximately 500 types of food from ten categories and has more elaborate food portion sizes. It established a recommendation index for guiding food selection and used energy, water content, and protein as the exchange basis to balance the supply of energy and important nutrients throughout pregnancy. Furthermore, dietitians used the NFES-CPW and traditional food exchange system to generate new recipes based on the sample recipe. There were 40 derived recipes for each of the two food exchange methods. The food consumption, energy, and key nutrients of each recipe were calculated, and the differences between the two food exchange systems were compared using the Wilcoxon rank sum test or the Chi-square test.

RESULTS

The results revealed that compared to those derived from traditional food exchange system, the NFES-CPW derived recipes had a better dietary structure, as evidenced by the intakes of whole-grain cereals, beans excluding soybeans, potatoes, fruits, fish, shrimp and shellfish, as well as eggs (P < 0.05), which were more conducive to reaching the recommended range of balanced dietary pagoda. After calculating energy and nutrients, although these two food exchange systems have similar effects on the dietary energy and macronutrient intake of pregnant women, the intake of micronutrients in NFES-CPW derived recipes was significantly higher than that from the traditional food exchange system, which was more conducive to meeting the dietary requirements of pregnant women. The outstanding improvement are primarily vitamin A, vitamin B2, folic acid, vitamin B12, vitamin C, calcium, iron, and iodine (P < 0.05). Moreover, when compared to recipes obtained from the traditional food exchange system, the error ranges of energy and most nutrients were significantly reduced after employing the NFES-CPW.

CONCLUSIONS

Therefore, NFES-CPW is an appropriate tool that adheres to Chinese dietary characteristics and can provide suitable dietary guidance to pregnant women.

Vegetarian diets and diets which restrict animal-source foods during childhood in high-income countries

Increasing numbers of populations in the West are restricting their intake of meat and other animal products for reasons relating to health or ethics; in many countries, these restrictions are already common for cultural, religious, or socio-economic reasons. By following their parent's diet, children are exposed in parallel. This narrative review aims at assessing current data regarding vegetarian diets in children from birth to 18 years of age, which include, by increasing degree of restriction, flexitarian, lacto-ovo-vegetarian, lacto-vegetarian, pescatarian, vegan and macrobiotic diets. The 202 references include 45 studies in children. The more restrictive the diet and the younger the child, the greater the risk of nutritional deficiency. Of particular concern are vitamin B12, iron, zinc, calcium, n-3 long-chain polyunsaturated fatty acids, and protein and energy intake, especially in pregnant and nursing women, infants and young children. Providing an adequate lacto-ovo-vegetarian diet is relatively easy, whereas the maintenance of more restrictive diets may be challenging. The benefits and risks of vegetarian diets in adults are relatively well documented, but data for children are scarce. Vegan and macrobiotic diets should be discouraged in pregnant and lactating mothers as well as in young children, who, otherwise, should pay careful attention to ensuring nutritional adequacy, blood testing and appropriate supplementation. The health consequences of a chosen diet should be discussed with parents and adolescents to ensure the best possible adherence to advice and prescriptions. There is a need for well conducted studies in children but also for better knowledge of nutrition in healthcare professionals.Abbreviations: ALA: α-linolenic acid; ARA: arachidonic acid; ASF: animal source foods; BMC: bone mineral content; BMD: bone mineral density; DHA: docosahexaenoic acid; DRV: dietary reference value; EPA: eicosapentaenoic acid; FLD: flexitarian diet; LA: linoleic acid; LC-PUFA: long-chain polyunsaturated fatty acids; LOVD: lacto-ovo-vegetarian diet; LVD: lacto-vegetarian diet; MAD: macrobiotic diet; OMD: omnivorous diet; PSF: plant-source foods; SFA: saturated fatty acids; VGD: vegetarian diets; VND: vegan diet.

Risk Assessment of Micronutrients Deficiency in Vegetarian or Vegan Children: Not So Obvious

Vegetarian diets have gained in popularity worldwide and therefore an increasing number of children may be exposed to the resulting nutritional consequences. Among them, the risk of micronutrient shortfall is particularly of concern. This narrative review aims to assess and discuss the relevance of micronutrient deficiency risk based on the available data. It mainly draws attention to iron, zinc, iodine, and vitamins B12 and D intake. Diets that are more restrictive in animal source foods, such as vegan diets, have a greater likelihood of nutritional deficiencies. However, the actual risk of micronutrient deficiency in vegetarian children is relatively difficult to assert based on the limitations of evidence due to the lack of well-designed studies. The risk of vitamin B12 deficiency must be considered in newborns from vegan or macrobiotic mothers and children with the most restrictive diet, as well as the risk of iron, zinc, and iodine deficiency, possibly by performing the appropriate tests. A lacto-ovo-vegetarian diet exposes a low risk if it uses a very varied diet with a sufficient intake of dairy products. Vegan and macrobiotic diets should be avoided during pregnancy and childhood. There is a need for education and nutrition guidance and the need for supplementation should be assessed individually.

The Effect of a Vegan Diet on the Cardiovascular System

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.

Development of a Tool for Determining the Equivalence of Nutritional Supplements to Diabetic Food Exchanges

Malnutrition is a prevalent issue in hospitals, nursing homes and the community setting. Nutritional products can be used by dietitians to supplement people's diet by adding energy, macronutrients and other constituents. The aim of the present work was (i) to create a database of nutritional products with information on their energy and macronutrient content, (ii) to estimate the food exchanges of each product and assist in diet plan development for malnourished persons and (iii) to provide a tool for calculation of food exchanges of newly developed products not included in the database. We searched the web for nutritional supplements, and an electronic database with 461 products was generated with data regarding the contained energy and macronutrients of each entry. The following companies were included: Abbott Nutrition, Nestle Nutrition, Nutricia North America, Nutricia Global, Nutricia Europe & Middle East, Axcan Pharma Inc., Kate Farms, Global Health, High Protein, NutriMedical BV, Hormel Health Labs, Hormel Health Labs/Diamond Crystal Brands, Lyons Magnus, Mead Johnson, Medical Nutrition USA Inc., Medtrition, Nutritional Designs Inc., Nutrisens, Humana (Germany), and Vitaflo USA. The created database facilitates product comparisons and categorization into several groups according to energy and protein content. In addition, a tool was created to determine food exchanges for each supplement per serving and/or food exchanges for newly developed products by simply inserting their macronutrient content. The developed tool can facilitate dietitians in comparing products and incorporating them into diet plans, if needed. Such tools may thus serve clinical practice, may be used in dietary or other smart applications and can familiarize dietitians with the digital epoch.

Household Food Metabolism: Losses, Waste and Environmental Pressures of Food Consumption at the Regional Level in Spain

Dealing with an increasing population is challenging the global food system not only in productive terms, but also through the associated environmental pressures. A growing diagnostic effort is being made by global and national agencies. Innovative approaches are needed to support effective policy efforts. This study aims to illustrate the potentialities of the household metabolism approach in the diagnosis of the environmental pressures derived from household food consumption, using the Spanish regions and the effects of the 2008 crisis as case studies. The direct information concerning food consumption in physical terms provided by the Spanish household budget survey is used to estimate some relevant environmental pressures (food losses and waste along the food chain, as well as water and carbon footprint) for the Spanish food system at a sub-national level. These data are directly translated into differences in environmental pressures and compared with other dietary profiles. Furthermore, the physical information of environmental pressures is related to household socio-economic status, showing the potentialities of the association with household socio-economic information. Finally, our data illustrate with some examples how the economic crisis has acted as a driver of change in food consumption, promoting a better environmental performance at the cost of poorer diets.

Development of a Sport Food Exchange List for Dietetic Practice in Sport Nutrition

Food exchange lists have been widely used in dietary practice in health and disease situations, but there are still no exchange lists for sports foods. The aim of this study was to apply a previous published methodology to design food exchange lists to the development of a sports food exchange list, with sport products available in Spain. A cross-sectional study of the nutritional composition of sports foods, regarding macronutrients and energy, was carried out. A total of 322 sports foods from 18 companies were selected, taking into account their interest in sports practice and with nutritional data provided by companies. Sports foods were divided into seven groups: sports drinks; sports gels; sports bars; sports confectionery; protein powders; protein bars; and liquid meals. A sports food composition database based on portion size usually consumed by athletes and/or recommended in commercial packaging was created. Within each sports foods group, different subgroups were defined due to differences in the main and/or secondary macronutrient. The definition of each exchange list with the amounts—in grams—of each sports food within each group and subgroup, was done using statistical criteria such as mean, standard deviation, coefficient of variation, and Z value. Final exchange values for energy and macronutrient have been established for each group and subgroup using a methodology to design food exchange lists previously published by the authors. In addition, those products with high Z values that can provide greater variability in dietary planning were included. The usefulness of sport foods lists as well as the use of an exchange system in the dietary practice of sports nutrition is discussed, and examples of how to use them with athletes are presented. This first sport foods exchange list showed in this study, with commercial sports products available in Spain, can be a novel tool for dietetic practice and also can allow sport nutrition professionals to develop another sport food list using the methodology described in this paper. Its management would allow dietitians to adapt dietary plans more precisely to the training and/or competition of the athlete.

[Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association]

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used. There are few data on the medium and long-term health outcomes when removing all animal foods from the child's diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies. In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B₁₂ supplements at all ages, as well as other nutrients (iodine, iron, vitaminD₃, poly-unsaturated fatty acid n-3), when required. A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet.

Theoretical Food and Nutrient Composition of Whole-Food Plant-Based and Vegan Diets Compared to Current Dietary Recommendations

Public interest in popular diets is increasing, in particular whole-food plant-based (WFPB) and vegan diets. Whether these diets, as theoretically implemented, meet current food-based and nutrient-based recommendations has not been evaluated in detail. Self-identified WFPB and vegan diet followers in the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey reported their most frequently used sources of information on nutrition and cooking. Thirty representative days of meal plans were created for each diet. Weighted mean food group and nutrient levels were calculated using the Nutrition Data System for Research (NDSR) and data were compared to DRIs and/or USDA Dietary Guidelines/MyPlate meal plan recommendations. The calculated HEI-2015 scores were 88 out of 100 for both WFPB and vegan meal plans. Because of similar nutrient composition, only WFPB results are presented. In comparison to MyPlate, WFPB meal plans provide more total vegetables (180%), green leafy vegetables (238%), legumes (460%), whole fruit (100%), whole grains (132%), and less refined grains (−74%). Fiber level exceeds the adequate intakes (AI) across all age groups. WFPB meal plans failed to meet the Recommended Dietary Allowances (RDA)s for vitamin B12 and D without supplementation, as well as the RDA for calcium for women aged 51–70. Individuals who adhere to WFBP meal plans would have higher overall dietary quality as defined by the HEI-2015 score as compared to typical US intakes with the exceptions of calcium for older women and vitamins B12 and D without supplementation. Future research should compare actual self-reported dietary intakes to theoretical targets.

Vitamin B12 and folate status in Spanish lacto-ovo vegetarians and vegans

Studies on the nutritional status of vegetarians in Spain are lacking. Prevention of vitamin B₁₂ deficiency is the main concern, as dietary sources are of animal origin. The present study aimed to evaluate vitamin B₁₂ and folate status of Spanish vegetarians using classical markers and functional markers. Participants were adult and healthy lacto-ovo vegetarians (forty-nine subjects) and vegans (fifty-four subjects) who underwent blood analyses and completed a FFQ. Serum vitamin B₁₂, homocysteine (Hcy), methylmalonic acid (MMA), erythrocyte folate and haematological parameters were determined. The effects of the type of plant-based diet, and the intake of supplements and foods were studied by a FFQ. Mean erythrocyte folate was 1704 (sd 609) nmol/l. Clinical or subclinical vitamin B₁₂ deficiency was detected in 11 % of the subjects (MMA>271 nmol/l) and 33 % of the participants showed hyperhomocysteinaemia (Hcy>15 µmol/l). Regarding plant-based diet type, significantly higher Hcy was observed in lacto-ovo vegetarians compared with vegans (P = 0·019). Moreover, use of vitamin B₁₂ supplements involved an improvement of vitamin B₁₂ status but further increase in erythrocyte folate (P = 0·024). Consumption of yoghurts was weakly associated with serum vitamin B₁₂ adequacy (P = 0·049) and that of eggs with lower Hcy (P = 0·030). In conclusion, Spanish vegetarians present high folate status but vitamin B₁₂ subclinical deficiency was demonstrated using functional markers. The lack of influence of dietary sources on functional markers and the strong effect of vitamin B₁₂ supplement intake emphasise the need of cobalamin supplementation in both lacto-ovo vegetarians and vegans.

Developing a Food Exchange System for Meal Planning in Vegan Children and Adolescents

Vegan diets in children need to be adequately planned so they can safely meet children’s requirements for growth and development. Adequate and realistic meal planning guidelines should not be difficult to achieve, thanks to the increasing number and availability of natural and fortified vegan foods, which can help children to meet all their nutrients requirements. In order to ensure an adequate supply of key nutrients, families and health professionals need accurate, reliable, and easy-to-use meal planning tools. The aim of this article is to provide a practical approach system to meal planning, based on the same food exchange methodology that has been already published in adults. Daily portions of each food exchange group have been calculated so the resulting menu provides at least 90% of the Dietary Reference Intakes (DRIs) of protein, iron, zinc, calcium, and n-3 fatty acids for each age group, sex, and physical activity level. These diets do not provide enough vitamin B-12 and vitamin D. Although fortified plant drinks, breakfast cereals or plant protein-rich products could provide variable amounts of these two vitamins, B12 supplementation is always recommended and vitamin D supplementation should be considered whenever sun exposure is limited. This tool can be used to plan healthful and balanced vegan diets for children and adolescents.

Methylmalonic Acid Levels and their Relation with Cobalamin Supplementation in Spanish Vegetarians

Cobalamin deficiency represents a health issue for vegetarians, especially vegans, if supplements are not consumed. Vitamin B12 serum levels, traditionally used to assess the vitamin B12 status, can be normal under functional deficiency conditions. In this regard, methylmalonic acid (MMA) has proven to be a more specific marker to detect subclinical vitamin B12 deficiency. In this study, we present for the first time the cobalamin status of Spanish vegetarians using both vitamin B12 and MMA markers, and the effects of the plant-based diet and the intake of vitamin B12 supplements. Healthy adults were recruited (n = 103, 52% vegans). Dietary preferences and use of supplements were assessed by questionnaires and serum samples were collected and stored. Vitamin B12 was measured by chemiluminiscence and MMA by liquid chromatography tandem mass spectrometry (LC-MS/MS) using solid phase extraction for sample preparation. Obtained values, median (IQR), were: vitamin B12, 278.9 (160.2) pmol/l and MMA, 140.2 (78.9) nmol/l. No significant differences between lacto-ovo vegetarians and vegans were observed. Considering these two markers, 10% of the participants were mild vitamin B12 deficient. Supplementation (75% of the participants) was associated with higher vitamin B12 (p < 0.001) and lower MMA (p = 0.012). In conclusion, Spanish vegetarians have low risk of vitamin B12 deficiency due to vitamin B12 supplementation and the MMA determination is useful to detect mild deficiency.