Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans

Cause-specific and all-cause mortalities in vegetarian compared with those in nonvegetarian participants from the Adventist Health Study-2 cohort

BACKGROUND

There have been mixed results reported internationally when associating vegetarian dietary patterns with all-cause and cause-specific mortalities.

OBJECTIVES

This study aimed to extend our previous results by evaluating, with a larger number of deaths (N = 12,515), cause-specific mortalities comparing different vegetarian types with nonvegetarians.

METHODS

This prospective study used data from the Adventist Health Study-2 cohort. Mortality was ascertained between study baseline, 2002-2007, and follow-up through 2015. Dietary data were collected at baseline using a validated quantitative food frequency questionnaire and then categorized into 5 dietary patterns: nonvegetarian, semivegetarian, pescovegetarian, lacto-ovovegetarian, and vegan. Main outcomes and measures include all-cause and cause-specific mortalities using Cox proportional hazards regression models and competing risk methods.

RESULTS

The analytic sample included 88,400 participants who provided 971,424 person-years of follow-up. We report results pairwise as estimated at ages 65 and 85 y owing to age dependence of many hazard ratios (HRs). Compared with nonvegetarians, vegetarians had lower risks of mortality, overall (HR: 0.89; 95% confidence interval [CI]: 0.83, 0.95; HR: 0.98; 95% CI: 0.91, 1.04), from renal failure (HR: 0.52; 95% CI: 0.38, 0.70; HR: 0.65; 95% CI: 0.55, 0.76), infectious disease (HR: 0.57; 95% CI: 0.40, 0.82; HR: 0.90; 95% CI: 0.70, 1.17), diabetes (HR: 0.51; 95% CI: 0.33, 0.78; HR: 0.69; 95% CI: 0.53, 0.88), select cardiac (HR: 0.75; 95% CI: 0.65, 0.87; HR: 0.89; 95% CI: 0.83, 0.95), and ischemic heart disease causes (HR: 0.73; 95% CI: 0.59, 0.90; HR: 0.84; 95% CI: 0.75,0.94). Vegans, lacto-ovovegetarians, and pescovegetarians were also observed to have lower risks of total mortality and several similar cause-specific mortalities. However, higher cause-specified neurologic mortalities were observed among older vegetarians (estimated at age 85 y), specifically stroke (HR: 1.17; 95% CI: 1.02, 1.33), dementia (HR: 1.13; 95% CI: 1.00, 1.27), and Parkinson's disease (HR: 1.37; 95% CI: 0.98, 1.91). Results in Black subjects for vegetarian/nonvegetarian comparisons largely followed the same trends, but HRs were less precise owing to smaller numbers.

CONCLUSIONS

Vegetarian diets are associated with lower risk for all-cause and many cause-specific mortalities, especially among males and in younger subjects. However, higher risks are observed among older vegetarians for stroke and dementia. These results need further support and investigation.

Methods and participant characteristics in the Cancer Risk in Vegetarians Consortium: a cross-sectional analysis across 11 prospective studies

BACKGROUND

The associations of vegetarian diets with risks for site-specific cancers have not been estimated reliably due to the low number of vegetarians in previous studies. Therefore, the Cancer Risk in Vegetarians Consortium was established. The aim is to describe and compare the baseline characteristics between non-vegetarian and vegetarian diet groups and between the collaborating studies.

METHODS

We harmonised individual-level data from 11 prospective cohort studies from Western Europe, North America, South Asia and East Asia. Comparisons of food intakes, sociodemographic and lifestyle factors were made between diet groups and between cohorts using descriptive statistics.

RESULTS

2.3 million participants were included; 66% women and 34% men, with mean ages at recruitment of 57 (SD: 7.8) and 57 (8.6) years, respectively. There were 2.1 million meat eaters, 60,903 poultry eaters, 44,780 pescatarians, 81,165 vegetarians, and 14,167 vegans. Food intake differences between the diet groups varied across the cohorts; for example, fruit and vegetable intakes were generally higher in vegetarians than in meat eaters in all the cohorts except in China. BMI was generally lower in vegetarians, particularly vegans, except for the cohorts in India and China. In general, but with some exceptions, vegetarians were also more likely to be highly educated and physically active and less likely to smoke. In the available resurveys, stability of diet groups was high in all the cohorts except in China.

CONCLUSIONS

Food intakes and lifestyle factors of both non-vegetarians and vegetarians varied markedly across the individual cohorts, which may be due to differences in both culture and socioeconomic status, as well as differences in questionnaire design. Therefore, care is needed in the interpretation of the impacts of vegetarian diets on cancer risk.

Dietary Habits and Race Day Strategies among Flexitarian, Vegetarian, and Vegan Recreational Endurance Runners: A Cross-Sectional Investigation from The NURMI Study (Step 2)

Many of today's recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.

Association between plant-based diet quality and chronic kidney disease in Australian adults

OBJECTIVE

To examine associations between three different plant-based diet quality indices, chronic kidney disease (CKD) prevalence and related risk factors in a nationally representative sample of the Australian population.

DESIGN

Cross-sectional analysis. Three plant-based diet scores were calculated using data from two 24-h recalls: an overall plant-based diet index (PDI), a healthy PDI (hPDI) and an unhealthy PDI (uPDI). Consumption of plant and animal ingredients from 'core' and 'discretionary' products was also differentiated. Associations between the three PDI scores and CKD prevalence, BMI, waist circumference (WC), blood pressure (BP) measures, blood cholesterol, apo B, fasting TAG, blood glucose levels (BGL) and HbA1c were examined.

SETTING

Australian Health Survey 2011-2013.

PARTICIPANTS

n 2060 adults aged ≥ 18 years (males: n 928; females: n 1132).

RESULTS

A higher uPDI score was associated with a 3·7 % higher odds of moderate-severe CKD (OR: 1·037 (1·0057-1·0697); P = 0·021)). A higher uPDI score was also associated with increased TAG (P = 0·032) and BGL (P < 0·001), but lower total- and LDL-cholesterol (P = 0·035 and P = 0·009, respectively). In contrast, a higher overall PDI score was inversely associated with WC (P < 0·001) and systolic BP (P = 0·044), while higher scores for both the overall PDI and hPDI were inversely associated with BMI (P < 0·001 and P = 0·019, respectively).

CONCLUSIONS

A higher uPDI score reflecting greater intakes of refined grains, salty plant-based foods and added sugars were associated with increased CKD prevalence, TAG and BGL. In the Australian population, attention to diet quality remains paramount, even in those with higher intakes of plant foods and who wish to reduce the risk of CKD.

Assessing Performance of Contemporary Plant-Based Diets against the UK Dietary Guidelines: Findings from the Feeding the Future (FEED) Study

Uncertainty remains about the composition of contemporary plant-based diets and whether they provide recommended nutrient intakes. We established Feeding the Future (FEED), an up-to-date online cohort of UK adults following different plant-based diets and diets containing meat and fish. We recruited 6342 participants aged 18-99 [omnivores (1562), flexitarians (1349), pescatarians (568), vegetarians (1292), and vegans (1571)] between February 2022 and December 2023, and measured diet using a food frequency questionnaire and free text. We compared personal characteristics and dietary intakes between diet groups and assessed compliance with dietary guidelines. Most participants met UK dietary recommendations for fruit and vegetables, sodium, and protein, although protein intakes were lowest among vegetarians and vegans. Omnivores did not meet the fibre recommendation and only vegans met the saturated fat recommendation. All diet groups exceeded the free sugars recommendation. Higher proportions of vegetarians and vegans were below the estimated average requirements (EARs) for zinc, iodine, selenium, and, in vegans, vitamins A and B12, whereas calcium intakes were similar across the diet groups. People following plant-based diets showed good compliance with most dietary targets, and their risk for inadequate intakes of certain nutrients might be mitigated by improved dietary choices and/or food fortification.

Prepregnancy plant-based diets and risk of hypertensive disorders of pregnancy

BACKGROUND

Plant-based diets have been associated with a lower risk of cardiovascular disease in nonpregnant adults, but specific evidence for their effects on risk of hypertensive disorders of pregnancy is scarce.

OBJECTIVE

This study aimed to evaluate the prospective association between adherence to plant-based diets before pregnancy and the risk for hypertensive disorders of pregnancy. We hypothesized that women with higher adherence to plant-based diets would have a lower risk for hypertensive disorders of pregnancy.

STUDY DESIGN

We followed 11,459 parous women (16,780 singleton pregnancies) without chronic diseases, a history of preeclampsia, and cancers who participated in the Nurses' Health Study II (1991-2009), which was a prospective cohort study. Diet was assessed every 4 years using a validated food frequency questionnaire from which we calculated the plant-based diet index (higher score indicates higher adherence) to evaluate the health associations of plant-based diets among participants while accounting for the quality of plant-based foods. Participants self-reported hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension. We estimated the relative risk of hypertensive disorders of pregnancy in relation to plant-based diet index adherence in quintiles using generalized estimating equations log-binomial regression while adjusting for potential confounders and accounting for repeated pregnancies for the same woman.

RESULTS

The mean (standard deviation) age at first in-study pregnancy was 35 (4) years. A total of 1033 cases of hypertensive disorders of pregnancy, including 482 cases of preeclampsia (2.9%) and 551 cases of gestational hypertension (3.3%) were reported. Women in the highest quintile of plant-based diet index were significantly associated with a lower risk for hypertensive disorders of pregnancy than women in the lowest quintile (relative risk, 0.76; 95% confidence interval, 0.62-0.93). There was an inverse dose-response relationship between plant-based diet index and risk for hypertensive disorders of pregnancy. The multivariable-adjusted relative risk (95% confidence interval) of hypertensive disorders of pregnancy for women in increasing quintiles of plant-based diet index were 1 (ref), 0.93 (0.78-1.12), 0.86 (0.72-1.03), 0.84 (0.69-1.03), and 0.76 (0.62-0.93) with a significant linear trend across quintiles (P trend=.005). This association was slightly stronger for gestational hypertension (relative risk, 0.77; 95% confidence interval, 0.60-0.99) than for preeclampsia (relative risk, 0.80; 95% confidence interval, 0.61-1.04). Mediation analysis suggested that body mass index evaluation for dietary assessment and pregnancy explained 39% (95% confidence interval, 15%-70%]) of the relation between plant-based diet index and hypertensive disorders of pregnancy and 48% (95% confidence interval, 12%-86%]) of the relation between plant-based diet index and gestational hypertension.

CONCLUSION

Higher adherence to plant-based diets was associated with a lower risk of developing hypertensive disorders of pregnancy. Much of the benefit seems to be related to improved weight control.

Analysis of adherence to a healthy lifestyle among vegetarian and non-vegetarian Peruvian university students: A cross-sectional survey

BACKGROUND

Evidence shows that a healthy lifestyle can promote physical and mental well-being in the general population. However, there are few studies that assess the adherence to a healthy lifestyle in vegetarian and non-vegetarian university students. The purpose of this study was to evaluate the differences in adherence to a healthy lifestyle between vegetarian and non-vegetarian university students in Peru.

METHODS

A cross-sectional study was carried out considering data from 6,846 students selected by non-probabilistic convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used. In addition, sociodemographic and anthropometric data such as weight and height were collected. Body mass index (BMI) was also calculated.

RESULTS

Semi-vegetarian and vegetarian students had a high healthy lifestyle score compared to non-vegetarians. In addition, vegetarian diets showed a significantly higher proportion among students with a lower BMI (normal and underweight). Students with excess body weight (overweight and obesity) were less likely to report healthy lifestyle. In the overall population analyzed, it was observed that the levels of health and lifestyle behaviors, such as daily exercise and sunlight exposure, were mostly moderate and low. Additionally, sweets intake was high, while healthy food consumption such as fruits, vegetables, legumes, and whole grains was low.

CONCLUSION

The current findings show that although vegetarians had better adherence to a healthy lifestyle, interventions in the university setting are needed to improve healthy lifestyle in university students.

Bone Remodelling, Vitamin D Status, and Lifestyle Factors in Spanish Vegans, Lacto-Ovo Vegetarians, and Omnivores

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.

Development of a diet quality score and adherence to the Swiss dietary recommendations for vegans

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.

Expansion of an Australian food composition database to estimate plant and animal intakes

Despite evidence for favourable health outcomes associated with plant-based diets, a database containing the plant and animal content of all foods eaten is required to undertake a reliable assessment of plant-based diets within a population. This study aimed to expand an existing Australian food database to include the plant and animal content of all whole foods, beverages, multi-ingredient products and mixed dishes. Twenty-three plant- and animal-based food group classifications were first defined. The food servings per 100 g of each product were then systematically calculated using either a recipe-based approach, a food label-based approach, estimates based on similar products or online recipes. Overall, 4687 (83·5 %) foods and beverages were identified as plant or plant-containing products, and 3701 (65·9 %) were animal or animal-containing products. Results highlighted the versatility of plant and animal ingredients as they were found in various foods across many food categories, including savoury and sweet foods, as well as discretionary and core foods. For example, over 97 % of animal fat-containing foods were found in major food groups outside the AUSNUT 2011-2013 'fats and oils' group. Surprisingly, fruits, nuts and seeds were present in a greater percentage of discretionary products than in core foods and beverages. This article describes a systematic approach that is suitable for the development of other novel food databases. This database allows more accurate quantitative estimates of plant and animal intakes, which is significant for future epidemiological and clinical research aiming to investigate plant-based diets and their related health outcomes.

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

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

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.

Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations

The scientific discourse on vegan diets for children and adolescents primarily involves referencing position statement papers from different scientific and professional organizations, including paediatric associations. Over the past two decades, specialized associations have issued official statements and published position papers about adopting well-designed vegan diets during crucial life stages, including pregnancy and lactation, infancy, and childhood. A subset of these associations firmly supports the notion that a well-designed vegan diet can indeed be healthy and support normal growth and development during particularly delicate life stages, emphasizing careful planning, vitamin B12 supplementation, and regular supervised medical and dietetics oversight. In contrast, specific paediatric associations caution against vegan diets for children and adolescents, citing potential harm and the lack of adequate substantiation. These criticisms in position papers frequently point to lower-quality studies and/or outdated studies. Additionally, concerns extend to comparing vegan and omnivorous diets, considering public health issues such as obesity and early stages of cardiovascular disease as well as the risk of prediabetes and type 2 diabetes. Notably, some scepticism stems from studies where children's adherence to a well-designed vegan diet is incomplete. Scientific rigor suggests performing a comparable assessment of omnivorous and vegan diets. This narrative review highlights the need for a comprehensive, up-to-date literature review to inform balanced perspectives on vegan diets for children and adolescents. Researchers and decision-makers should aim to actively improve the design and consistent implementation of both diet types.

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

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

Genetics of vegetarianism: A genome-wide association study

A substantial body of evidence points to the heritability of dietary preferences. While vegetarianism has been practiced for millennia in various societies, its practitioners remain a small minority of people worldwide, and the role of genetics in choosing a vegetarian diet is not well understood. Dietary choices involve an interplay between the physiologic effects of dietary items, their metabolism, and taste perception, all of which are strongly influenced by genetics. In this study, we used a genome-wide association study (GWAS) to identify loci associated with strict vegetarianism in UK Biobank participants. Comparing 5,324 strict vegetarians to 329,455 controls, we identified one SNP on chromosome 18 that is associated with vegetarianism at the genome-wide significant level (rs72884519, β = -0.11, P = 4.997 x 10-8), and an additional 201 suggestively significant variants. Four genes are associated with rs72884519: TMEM241, RIOK3, NPC1, and RMC1. Using the Functional Mapping and Annotation (FUMA) platform and the Multi-marker Analysis of GenoMic Annotation (MAGMA) tool, we identified 34 genes with a possible role in vegetarianism, 3 of which are GWAS-significant based on gene-level analysis: RIOK3, RMC1, and NPC1. Several of the genes associated with vegetarianism, including TMEM241, NPC1, and RMC1, have important functions in lipid metabolism and brain function, raising the possibility that differences in lipid metabolism and their effects on the brain may underlie the ability to subsist on a vegetarian diet. These results support a role for genetics in choosing a vegetarian diet and open the door to future studies aimed at further elucidating the physiologic pathways involved in vegetarianism.

Novel plant-based meat alternatives: future opportunities and health considerations

Present food systems threaten population and environmental health. Evidence suggests reduced meat and increased plant-based food consumption would align with climate change and health promotion priorities. Accelerating this transition requires greater understanding of determinants of plant-based food choice. A thriving plant-based food industry has emerged to meet consumer demand and support dietary shift towards plant-based eating. 'Traditional' plant-based diets are low-energy density, nutrient dense, low in saturated fat and purportedly associated with health benefits. However, fast-paced contemporary lifestyles continue to fuel growing demand for meat-mimicking plant-based convenience foods which are typically ultra-processed. Processing can improve product safety and palatability and enable fortification and enrichment. However, deleterious health consequences have been associated with ultra-processing, though there is a paucity of equivocal evidence regarding the health value of novel plant-based meat alternatives (PBMAs) and their capacity to replicate the nutritional profile of meat-equivalents. Thus, despite the health halo often associated with plant-based eating, there is a strong rationale to improve consumer literacy of PBMAs. Understanding the impact of extensive processing on health effects may help to justify the use of innovative methods designed to maintain health benefits associated with particular foods and ingredients. Furthering knowledge regarding the nutritional value of novel PBMAs will increase consumer awareness and thus support informed choice. Finally, knowledge of factors influencing engagement of target consumer subgroups with such products may facilitate production of desirable, healthier PBMAs. Such evidence-based food manufacturing practice has the potential to positively influence future individual and planetary health.

Identifying Novel Data-Driven Dietary Patterns via Dimensionality Reduction and Associations with Socioeconomic Profile and Health Outcomes in Ireland

Dietary patterns and body mass index (BMI) play a significant role in the development of noncommunicable diseases (NCDs), which are the leading cause of mortality worldwide, including Ireland. A cross-sectional survey was conducted across Ireland to collate respondents' socioeconomic profiles, health status, and dietary patterns with a representative sample size of 957 adult respondents. Principal component analysis (PCA) and statistical analyses were subsequently employed. To the author's knowledge, this is the first study to use recent (2021) nationally representative data to characterise dietary patterns in Ireland via dimensionality reduction. Five distinct dietary patterns ("meat-focused", "dairy/ovo-focused", "vegetable-focused", "seafood-focused", and "potato-focused") were identified and statistically characterised. The "potato-focused" group exhibited the highest mean BMI (26.88 kg/m²), while the "vegetable-focused" group had the lowest (24.68 kg/m²). "Vegetable-focused" respondents were more likely to be associated with a categorically healthy BMI (OR = 1.90) and urban residency (OR = 2.03). Conversely, "meat-focused" respondents were more likely to have obesity (OR = 1.46) and rural residency (OR = 1.72) along with the "potato-focused" group (OR = 2.15). Results show that data-derived dietary patterns may better predict health outcomes than self-reported dietary patterns, and transitioning to diets focusing on vegetables, seafood, and lower meat consumption may improve health.

A glimpse of academic staff health behavior on diet type and physical activity at Austrian universities: first findings from the "Sustainably Healthy - From Science 2 Highschool & University" study

Background

The association between lifestyle and health status highlights the importance of assessing health-related behavior in different populations. This multidisciplinary study aimed to examine the health behavior of academic staff of Austrian colleges and universities, with a specific focus on diet types (vegan, vegetarian, omnivorous) and physical activity (PA) reports.

Methods

Following a cross-sectional study design incorporating an online survey, a sample of 1,041 academics from 52 institutes (mean age: 46.4 years) provided data on sociodemographic characteristics, dietary patterns, PA behavior, and other lifestyle behaviors (smoking, alcohol intake, etc.).

Results

The prevalence of vegetarian and vegan diets was 13.2 and 2.0%, respectively, and 33.2% of participants had excess body weight (BMI ≥ 25). The majority of participants (88.5%) reported regularly engaging in leisure-time PA, but 18.6% were active members of sports clubs. No difference between females and males was observed in diet type and the type of sport participation (p > 0.05). Participants with a mixed diet had a higher BMI than vegetarians and vegans (p < 0.05). Leisure-time PA participation was associated with more frequent fruit and vegetable intake (p < 0.05). The prevalence of smoking and alcohol intake was 13.1 and 73.5%, respectively, without any difference between dietary or sports participation subgroups (p > 0.05).

Conclusion

The present study provides an overview of the social trends in vegan and vegetarian diets linked to health behaviors in tertiary educational settings. Findings can be used by health scientists, decision-makers, and multipliers in health and education to improve public health.

Nutritional Considerations for the Vegan Athlete

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.

Racing Experiences of Recreational Distance Runners following Omnivorous, Vegetarian, and Vegan Diets (Part B)-Results from the NURMI Study (Step 2)

The potential running or endurance performance difference based on following different general types of diets, such as omnivorous, vegetarian, or vegan, remains questionable. Several underlying modifiable factors of long-distance running performance, especially runner training behaviors and experience, diminish the clarity of results when analyzing dietary subgroups. Based on the cross-sectional design (survey), the NURMI Study Step 2 aimed to investigate a plethora of training behaviors among recreational long-distance running athletes and the relationship of general diet types with best time race performance. The statistical analysis was based on Chi-squared and Wilcoxon tests. The final sample (n = 245) included fit recreational long-distance runners following an omnivorous diet (n = 109), a vegetarian diet (n = 45), or a vegan diet (n = 91). Significant differences were found between the dietary subgroups in body mass index (p = 0.001), sex (p = 0.004), marital status (p = 0.029), and running-related motivations for well-being (p < 0.05) but not in age (p = 0.054). No significant difference was found for best time half-marathon, marathon, and/or ultra-marathon race performance based on diet type (p > 0.05). Whether the vegan diet is associated with enhanced endurance performance remains unclear. Although, the present results are suggestive that 100% plant-based (vegan) nutrition is compatible with distance running performance at the least.

Training Behaviors and Periodization Outline of Omnivorous, Vegetarian, and Vegan Recreational Runners (Part A)-Results from the NURMI Study (Step 2)

Runners train for long-distance competitions based on underlying motivations, which may be similar to individual dietary motivations (e.g., well-being and performance). Fundamental training differences may arise in recreational runners following different diet types (omnivore, vegetarian, vegan) considering possible motive variations. Following a cross-sectional design, distance runners completed a survey (online), including a thorough assessment of training behaviors with generic training details and periodization specifics in three phases: 1. an intermediary and rebound stage, 2. a main preparatory stage, and 3. a main event stage (tapering or interim event level/s). Kruskal-Wallis and chi-squared tests were used in the statistical analysis. A total of 245 fit recreational runners following omnivore (n = 109), vegetarian (n = 45), and vegan diets (n = 91) were included. Significant differences in the initial running motivation were found across dietary subgroups (p = 0.033) as well as for current motivations (p = 0.038), with vegetarians being the least health motivated (27% and 9%, respectively). No differences in each of the specific periods were found between diet types across the outline (p > 0.05). The present evidence shows that there is a lack of fundamental training differences based on recreational runners following different generic types of diets. The results of the present investigation may be especially relevant for future studies on safety, sustainability, and performance-enhancing dietary practices among athletes.

The Impact of a Vegan Diet on Many Aspects of Health: The Overlooked Side of Veganism

Vegetarianism in any of its various forms, particularly veganism, has been increasing in popularity over the past few years, especially among the young population in the United States. While several studies have shown that a vegan diet (VD) decreases the risk of cardiometabolic diseases, such as cardiovascular disease, type 2 diabetes mellitus, obesity, and non-alcoholic fatty liver disease, veganism has been associated with adverse health outcomes, namely, nervous, skeletal, and immune system impairments, hematological disorders, as well as mental health problems due to the potential for micro and macronutrient deficits. The goal of this review article is to discuss the current literature on the impact and long-term consequences of veganism on vulnerable populations, including children, adolescents, pregnant and breastfeeding women, and fetal outcomes in strict vegan mothers. It also focuses on the many deficiencies of the vegan diet, especially vitamin B12, and the related increased risk of malignancies.

Dietary Effects on Pain Symptoms in Patients with Fibromyalgia Syndrome: Systematic Review and Future Directions

Fibromyalgia syndrome (FMS) is recognized for its difficulty to diagnose and its subjective symptomatology. There is neither a known cure nor a recommended therapeutic diet to aid in the multidisciplinary treatment. We conducted a systematic review to investigate if diets can improve pain symptoms of fibromyalgia. Through the PubMed search in March 2022, 126 abstracts were identified. We included both intervention and observational studies of diets and pain symptoms among patients with FMS. After screening titles, abstracts, and full-texts, 12 studies, including 11 intervention and one observational study, were selected. These studies included 546 participants and investigated plant-based diets (n = 3), anti-inflammatory diets (n = 1), gluten-free diets (n = 2), and elimination/restrictive diets (n = 6). These studies assessed pain symptoms through visual analogue scale for pain, fibromyalgia impact questionnaire/revised fibromyalgia impact questionnaire, tender point count, pain pressure threshold, and/or total myalgic score. Nine studies, including all three plant-based diet studies, reported statistically significant beneficial effects of their respective diets on pain symptom measurements. Given the small sample size and short intervention duration of the included studies, limited evidence currently exists to recommend any specific diet to patients with FMS. Further research is warranted to clarify specific diets to recommend and explore their potential mechanisms.

Nutritional Profile of Commercialized Plant-Based Meat: An Integrative Review with a Systematic Approach

Given the high cost of production of animal-based meats and the increase in the number of adepts of meatless diets, the need for plant-based meat substitutes is growing. In this prosperously growing market, there is a lack of knowledge about the nutritional value of these meat substitutes and their ingredients. This study aims to review the nutritional composition and ingredients of meat substitutes commercialized worldwide. An integrative review was performed with a systematic literature search in PubMed, EMBASE, Scopus, Science Direct, Web of Science, and 11 studies were selected to compose the sample of this review. Data on meat substitutes' nutritional composition and ingredients from different categories were collected and analyzed. The results showed that meat substitutes commonly present lower energy values and higher amounts of carbohydrates and dietary fiber. Protein values varied according to the meat substitute category, with some showing a higher concentration than others, more specifically in substitutes for bovine meat. Higher values were found in the Pieces category and lower in Seafood substitutes. Unlike animal meat, vegan meat has a proportion of carbohydrates higher than protein in most samples, except for chicken substitutes. Meat substitutes presented similar total and saturated fat content compared to their animal-based counterparts. Higher amounts of fat were found in the "Various" category and lower in "Pieces". Ingredients such as soy, pea, and wheat were the primary protein sources in meat substitutes, and vegetable oils were their primary fat source. Methylcellulose, various gums, and flavorings were the most used food additives. In general, meat substitutes presented high concentrations of sodium, possibly collaborating with an excessive sodium intake, highlighting the need for developing sodium-reduced or sodium-free alternatives. Most of the included samples did not describe the concentration of iron, zinc, and vitamin B12. Further studies are needed to develop meat substitutes with better nutritional composition, fulfilling the need for equivalent substitutes for animal-based meat.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Animal- and Plant-Based Protein Sources: A Scoping Review of Human Health Outcomes and Environmental Impact

Dietary proteins are indispensable to human nutrition. In addition to their tissue-building function, they affect body composition and regulate various metabolic pathways, as well as satiety and immune system activity. Protein use can be examined from a quantitative or qualitative viewpoint. In this scoping review, we compare animal- and plant-based protein sources in terms of their effects on human health and the environment. We conclude that the consumption of vegetable protein sources is associated with better health outcomes overall (namely, on the cardiovascular system) than animal-based product use. The healthier outcomes of vegetable protein sources dovetail with their lower environmental impact, which must be considered when designing an optimal diet. Indeed, the health of the planet cannot be disjointed from the health of the human being. Future research will clarify the mechanisms of action underlying the health effects of plant-based protein sources when compared with animal sources, fostering better agronomic practices and influencing public health in a direction that will benefit both the planet and its inhabitants.

School health programs of physical education and/or diet among pupils of primary and secondary school levels I and II linked to body mass index: A systematic review protocol within the project From Science 2 School

The most common causes of death in Western countries today are preventable diseases mainly attributed to daily behavior. It has been well documented that genetics are influential but not the deciding factor for developing non-communicable diseases. Ideally, the public should be educated to perform methods of optimal health and wellbeing independently, meaning that individuals should be in control of their health without relying on others. As behavior is known to be consistent over time, good or poor health behavior will track from childhood into adulthood. Physical activity and diet are permanently linked to the individual's state of health, and when properly balanced, the effects on personal health summate, resulting in greater benefits from this dual-approach for public health. The objective is to highlight the different approaches (physical intervention, nutritional intervention, and dual-approach of diet and exercise) and identify effective interventions for sustainable body weight and healthy body mass index in school children. A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The review will assess school-based diet and exercise interventions on children in primary and secondary school levels I and II. Overweight and obesity develop as a result of a prolonged imbalance in the energy balance model, with both physical activity and diet being influential in the fluctuation of body weight. A dual-approach including physical activity and diet could therefore be a very promising method to promote sustainable healthy body weight in school children.

The role of the dietary patterns in the cardiovascular disease risk prevention

Cardiovascular diseases (CVD) are a part of a wide group of diseases, which became main threat to the life and health of the population in highly developed countries. To prevent and treat CVD, in addition to implementation of pharmacological methods, there are a number of lifestyle components, including eating habits, that significantly influence the development of these diseases. The dietary patterns strongly correlate with the risk of cardiovascular disease. Modifications of the dietary habits allow to control many parameters such as: body weight, cholesterol/triglyceride levels or blood pressure. Alternative diets are frequently used to reduce the risk of developing a CVD. The main recommended dietary patterns includes Mediterranean diet (MD), the DASH diet (Dietary Approach to Stop Hypertension) and mild variants of vegetarianism. The more controversial nutritional styles includes the ketogenic or vegan diets. Due to various assumptions as well as the mechanisms of action of each diets, an attempt of its evaluation have been made. The aim of our study is to review and analyze the available data on the impact of various nutrition models regarding to cardiovascular diseases risk prevention.

Prevalence of Female and Male Vegan and Non-Vegan Endurance Runners and the Potential Associations of Diet Type and BMI with Performance-Results from the NURMI Study (Step 1)

This study aims to investigate vegetarian and mixed diet type prevalences among distance runners at running events around the world and associations with running-related patterns and performance. Following a cross-sectional approach, linear regression analyses were carried out to identify potential associations among body mass index (BMI), diet type, and average best performance times of half-marathon and marathon events for males and females. From a sample of 3835 runners who completed an online questionnaire, 2864 all-distance runners (age: 37 years; 57% females) were included in inferential analyses and categorized into dietary subgroups according to self-reports: 994 vegans (34.7%), 598 vegetarians (20.9%), and 1272 omnivores (44.4%). Significant associations were identified between kind of diet and best average time to finish (i) half-marathons in females where vegans (p = 0.001) took longer than omnivores, (ii) half-marathons in males where vegans (p < 0.001) and vegetarians (p = 0.002) took longer than omnivores, and (iii) marathons in males where vegans (p < 0.001) and vegetarians (p = 0.043) averaged slower than omnivores. Increased units of BMI (+1.0) in males influenced best runtimes: 2.75 (3.22−2.27) min slower for HM and 5.5 (5.69−4.31) min slower for M. The present study did not take detailed confounders into account such as runner motives or training behaviors; however, the results may provide valuable insight for running event organizers, nutrition experts, coaches, and trainers advising runners who adhere to a general diet type regarding the basic question of who participates in running events around the world.

Arterial Stiffness and Endothelial Function are Comparable in Young Healthy Vegetarians and Omnivores

Vegetarians (VEG) are reported to have lower body weight, blood pressure (BP), and cardiovascular disease (CVD) risk compared with omnivores (OMN), yet the mechanisms remain unclear. A vegetarian diet may protect the vascular endothelium, reducing the risk of atherosclerosis and CVD. This cross-sectional study compared vascular function between OMN and VEG. We hypothesized that VEG would have greater vascular function compared with OMN. Fifty-eight normotensive young healthy adults participated (40 women [W]/18 men [M]; 28 OMN [15W/13M] and 30 VEG [25W/5M]; 26 ± 7 years; BP: 112 ± 11/67 ± 8 mm Hg). Arterial stiffness, assessed by carotid-to-femoral pulse wave velocity (OMN: 5.6 ± 0.8 m/s, VEG: 5.3 ± 0.8 m/s; P = .17) and wave reflection assessed by aortic augmentation index (OMN: 6.9 ± 12.3%, VEG: 8.8 ± 13.5%; P = .57) were not different between groups. However, central pulse pressure (OMN: 32 ± 5; VEG: 29 ± 5 mm Hg; P = .048) and forward wave reflection were greater in omnivores (OMN: 26 ± 3; VEG: 24 ± 3 mm Hg; P = .048). Endothelial-dependent dilation measured by brachial artery flow-mediated dilation was not different between groups (OMN: 6.0 ± 2.9%, VEG: 6.9 ± 3.3%; P = .29). Percent change in femoral blood flow from baseline during passive leg movement, another assessment of nitric oxide-mediated endothelial dilation, was similar between groups (OMN: 203 ± 88 mL/min, VEG: 253 ± 192 mL/min; P = .50). These data suggest that in healthy young adults, normotensive VEG do not have significantly improved vascular function compared with OMN; however, they have a lower central pulse pressure and forward wave amplitude which may lower the risk of future CVD.

Bioactive Compounds and Therapeutics from Fish: Revisiting Their Suitability in Functional Foods to Enhance Human Wellbeing

Global public awareness about fish-based diet and its health/nutritional benefits is on the rise. Fish nutritional profile projects promising bioactive and other compounds with innumerable health benefits for human wellbeing. As various reported researches involving fish/marine-derived molecules reveal promising attributes, and as the position of fish-based nutrients as nutraceuticals continue to strengthen, health challenges still confront communities worldwide, from cardiovascular disease, diabetes, and obesity to hypertension. Thus, further understanding of fish-based nutrient impact as functional foods remains crucial given the diverse prevailing compositional/nutraceutical merits. In this review, therefore, we provide important information regarding bioactive compounds and therapeutics obtained from fish, specific to the context of their suitability in functional foods to enhance human health. This contribution is hereby constructed as follows: (a) fish nutraceutical/therapeutic components, (b) constituents of fish-based nutrients and their suitability in functional foods, (c) fish antioxidant/bioactive compounds to help alleviate health conditions, (d) common human ailments alleviated by fish-based nutrients, and (e) role of fish in mental health and immune system. As increased fish consumption should be encouraged, the potential of the quality proteins, omega-3 fatty acids, and other compounds inherent in fish should steadily be harnessed.

Dietary Choices Impact on Greenhouse Gas Emissions: Determinants and Correlates in a Sample of Adults from Eastern Germany

The present study estimated diet-related greenhouse gas emissions (GHGE) and land use (LU) in a sample of adults, examined main dietary contributors of GHGE, and evaluated socio demographic, lifestyle, and wellbeing factors as potential determinants of high environmental impact. A cross-sectional design based on data collected from the European Prospective Investigation into Cancer and Nutrition (EPIC)—Potsdam cohort (2010–2012) was used. Usual diet was assessed using food frequency questionnaires. Diet-related GHGE and LU were calculated using a European-average lifecycle analyses-food-item database (SHARP-ID). Information on potential determinants were collected using self-administered questionnaires. Men (n = 404) and women (n = 401) at an average age of 66.0 ± 8.4 years were included. Dietary-related energy-adjusted GHGE in men was 6.6 ± 0.9 and in women was 7.0 ± 1.1 kg CO2 eq per 2000 kcal. LU in men was 7.8 ± 1.2 and in women was 7.7 ± 1.2 m2/year per 2000 kcal. Food groups contributing to most GHGE included dairy, meat and non-alcoholic beverages. Among women, being single, having a job, being a smoker and having higher BMI were characteristics associated with higher GHGE, whereas for men these included being married, longer sleeping duration and higher BMI. Further studies are warranted to provide insights into population-specific determinants of sustainable dietary choices.

Plant-based dietary patterns are associated with lower body weight, BMI and waist circumference in older Australian women

OBJECTIVE

To investigate the association between plant-based diets (PBD) and overweight/obesity compared to regular meat eaters in older women.

DESIGN

Cross-sectional analysis.

SETTING

1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH). PBD were categorised as vegan, lacto-ovo vegetarian, pesco-vegetarian, semi-vegetarian and regular meat eaters. Outcomes included body weight (BW), BMI and waist circumference (WC).

PARTICIPANTS

Women who completed Survey 7 (n 9102) with complete FFQ data.

RESULTS

Compared to regular meat eaters, BW, BMI and WC were significantly lower in pesco-vegetarians (-10·2 kg (95 % CI -5·1, -15·2); -3·8 kg/m2 (95 % CI -2·0, -5·6); -8·4 cm (95 % CI -3·9, -12·9)) and BW and BMI lower in lacto-ovo vegetarians (-7·4 kg (95 % CI -1·2, -13·6); -2·9 kg/m2 (95 % CI -0·6, -5·1)). In regular meat eaters, individuals consuming meat daily or multiple times/d had significantly higher BW, BMI and WC compared to those consuming meat >2 times/week but 1 but ≤2 times/week (6·8 kg (95 % CI 1·8, 11·8); 2·1 kg/m2 (95 % CI 0·3, 4·0) and 6·0 cm (95 % CI 1·7, 10·4)). This association was dose-dependent such that for every increase in category of weekly meat intake (i.e. >1 time/week but ≤2 times/week; >2 times/week but less than daily, and daily or multiple times/d), an associated 2·6 kg (95 % CI 1·8, 3·4) increase in BW, 0·9 kg/m2 (95 % CI 0·6, 1·2) increase in BMI and 2·3 cm (95 % CI 1·6, 3·0) increase in WC was reported.

CONCLUSIONS

BW, BMI and WC are lower in women following PBD and positively associated with increasing meat consumption. Results were robust to adjustment for confounders including physical activity levels, smoking status, habitual alcohol intake, use of supplements, and hormone replacement therapy.

The effects of vegetarian diets on bone health: A literature review

In these recent years many people are adopting a vegetarian type diet due to the numerous positive health effects of this regimen such as the reduction of the incidence of many chronic disorders like diabetes, hypertension, obesity and cancer. However this diet is quite restrictive and so it could be possible to have a deficiency in some specific nutrients, increasing the risk of osteoporosis and fractures. Although there are conflicting results on the effects of the vegetarian diet on bone health and fracture incidence, it is always recommendable in vegetarian people to have an adequate intake of calcium and vitamin D, through an increased intake of supplements, natural and fortified foods, an adequate intake of protein, fruit, vegetables, as well as vitamin B12. The aim of this literature review is to revise the actual knowledge of the effect of some nutrients and vegetarian diets on bone health.

Development and Validation of a Short Questionnaire on Dietary and Physical Activity Habits for Patients Submitted to Bariatric Endoscopic Therapies

PURPOSE

Individuals with obesity frequently regain weigh after endoscopic bariatric therapies (EBT) unless they adhere to healthy habits. The objective was to create and validate a short, self-administered questionnaire (EMOVE) to assess healthy dietary and physical activity (PA) habits' adherence to be used in clinical practice.

MATERIALS AND METHODS

In this prospective, unicentric study, 463 patients completed the short, Spanish EMOVE questionnaire, to be validated following the Medical Outcome Trust Criteria. Conceptual and measurement model, reliability (internal consistency and test-retest [subgroup of 93 patients]), construct validity, responsiveness, interpretability, and burden were evaluated. Patients enrolled from January 2017 through August 2018 and auto-filled the EMOVE at baseline and at 3, 6, and 12 months.

RESULTS

Patients submitted to intragastric ballon for 6 and 12 months or POSE were 82.7% women with a mean age of 42.7 years, and a mean BMI of 37.1 kg/m2. Four factors were extracted with exploratory factor analysis related to intake frequency, portions and proportions, time and place of eating, and physical activity. EMOVE showed adequate internal consistency (α = 0.73), very good test-retest (r = 0.91, CI: 0.86-0.94; p < 0.001), moderate construct validity of dietary (r = 0.24, CI: 0.11-0.37, p < 0.001), and PA habits (r = 0.44, CI 0.30-0.58; p < 0.001). Stable responsiveness, with correlations from 0.29 to 0.39 (p < 0.001) between the EMOVE scores and the % of total weight loss at 3, 6, and 12 months. Participants categorized as having good or excellent habits (score ≥ 30 points) lost significantly more weight (p < 0.05). Finally, the administration burden was 2.96 min.

CONCLUSION

The EMOVE is a useful tool in Spanish language to easily assess the level of adherence to healthy dietary and PA habits to be used routinely in clinical practice.

Life of a vegetarian college student: Health, lifestyle, and environmental perceptions

Objective To examine health behavior and environmental perception differences among vegetarian and nonvegetarian students. Participants: First-year university students (n = 1078) from eight United States universities. Methods: Data were obtained from base 2015 and followup 2016 assessments. Vegetarians and nonvegetarians were compared for anthropometrics, lifestyle behaviors, and campus environmental perceptions (CEPS). Results: Vegetarians had smaller waist circumference, lower systolic blood pressure, higher fruit and vegetable consumption, lower percentage of energy obtained from fat, and higher perceived stress. Vegetarians expressed a lower rating of perceptions of health policies on campus. Conclusion: A clear difference in indicators of physical health does not appear, however, vegetarian students show positive dietary patterns which can promote positive health outcomes. Further, vegetarians had lower perceptions of health policies on campus. Results can be used by administrators to ensure policies are in place to support health of students as currently vegetarian students see limitations in the environmental health policies.

Perspective: Striking a Balance between Planetary and Human Health: Is There a Path Forward?

The global adoption of predominantly plant-based sustainable healthy diets will help reduce the risk of obesity- and malnutrition-related non-communicable diseases while protecting the future health of our planet. This review examines the benefits and limitations of different types of plant-based diets in terms of health and nutrition, affordability and accessibility, cultural (ethical and religious) acceptability, and the environment (i.e., the four pillars underlying sustainable healthy diets). Results suggest that, without professional supervision, traditional plant-based diets (vegan, vegetarian and pescatarian diets) can increase the risk of nutritional deficiencies among infants, children/adolescents, adult females, pregnant/lactating women and the elderly. In contrast, flexitarian diets and territorial diversified diets (TDDs, e.g., Mediterranean and New Nordic diets) that include large quantities of plant-sourced foods, low levels of red meat and moderate amounts of poultry, fish, eggs and dairy can meet the energy and nutrition needs of different populations without the need for dietary education or supplementation. Compared to vegan, vegetarian and pescatarian diets, more diverse flexitarian diets and TDDs are associated with reduced volumes of food waste and may be more acceptable and easier to maintain for people who previously followed western diets. Although flexitarian diets and TDDs have a greater impact on the environment than vegan, vegetarian and pescatarian diets, the negative effects are considerably reduced compared to western diets, especially if diets include locally-sourced seasonal foods. Further studies are required to define more precisely optimal sustainable healthy diets for different populations and to ensure that diets are affordable and accessible to people in all countries.

The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals

Plant-based diets, defined here as including both vegan and lacto-ovo-vegetarian diets, are growing in popularity throughout the Western world for various reasons, including concerns for human health and the health of the planet. Plant-based diets are more environmentally sustainable than meat-based diets and have a reduced environmental impact, including producing lower levels of greenhouse gas emissions. Dietary guidelines are normally formulated to enhance the health of society, reduce the risk of chronic diseases, and prevent nutritional deficiencies. We reviewed the scientific data on plant-based diets to summarize their preventative and therapeutic role in cardiovascular disease, cancer, diabetes, obesity, and osteoporosis. Consuming plant-based diets is safe and effective for all stages of the life cycle, from pregnancy and lactation, to childhood, to old age. Plant-based diets, which are high in fiber and polyphenolics, are also associated with a diverse gut microbiota, producing metabolites that have anti-inflammatory functions that may help manage disease processes. Concerns about the adequate intake of a number of nutrients, including vitamin B12, calcium, vitamin D, iron, zinc, and omega-3 fats, are discussed. The use of fortified foods and/or supplements as well as appropriate food choices are outlined for each nutrient. Finally, guidelines are suggested for health professionals working with clients consuming plant-based diets.

Effects of Plant-Based Diets on Weight Status in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Excessive adiposity is a major risk factor for type 2 diabetes (T2D), and dietary patterns are important determinants of weight status. Plant-based dietary patterns (PBDs) are known for their therapeutic effects on T2D. The aim is to systematically review RCTs to investigate the effects of various PBDs compared to regular meat-eating diets (RMDs), in individuals who normally consume a RMD on body weight, BMI, and waist circumference in T2D. RCTs investigating PBDs and body weight, BMI, WC for ≥6 weeks in adults with T2D since 1980 were eligible for inclusion. Seven trials (n = 269) were included in the meta-analysis using random-effects models and expressed as MD (95%Cls). Compared to RMDs, PBDs significantly lowered body weight (-2.35 kg, 95% CI: -3.51, -1.19, p < 0.001), BMI (-0.90 kg/m2, 95% CI: -1.42, -0.38, p = 0.001) and WC (-2.41 cm, 95% CI: -3.72, -1.09, p < 0.001). PBDs alone significantly reduced body weight by 5.1% (-4.95 kg, 95% CI: -7.34, -2.55, p < 0.001), BMI by 5.4% (-1.87 kg/m2, 95% CI: -2.78, -0.95, p < 0.001) and WC by 4.3%(-4.23, 95% CI: -6.38, -2.07, p < 0.001). Interventions not limiting energy intake led to a significant reduction in body weight (-2.54 kg, 95% CI: -4.16, -0.92, p < 0.005) and BMI (-0.91 kg/m2, 95% CI: -1.56, -0.25, p < 0.005). Trials ≥16 weeks had a pronounced reduction in body weight (-2.93 kg, 95% CI: -5.00, -0.87, p = 0.005) and BMI (-1.13 kg/m2, 95% CI: -1.89, -0.38, p < 0.005). These findings provide evidence for the implementation of PBDs for better management of central adiposity in individuals with T2D.

Inflammatory, oxidative and DNA damage status in vegetarians: is the future of human diet green?

The health benefit of a vegetarian diet is still under debate as it may result in a higher intake of some beneficial micronutrients, while others may be reduced, thus influencing various metabolic pathways and health-related biomarkers. This scoping review discusses inflammatory, oxidative and DNA damage status in vegetarians and vegans compared to omnivores. Most of the reviewed studies indicated favorable effects of a vegetarian diet on oxidative status compared to omnivores but did not clearly associate particular dietary habits to genome damage. The evidence on the effect of vegetarian diet on the inflammatory and immunological biomarkers is poor, which could at least partly be explained by methodological constraints such as small sample size, short duration of vegetarianism and inconsistent definitions of the omnivorous diet. The only inflammatory biomarker that seems to be associated with the vegetarian diet was inflammatory mediator C-reactive protein, which in several studies showed lower values in vegetarians as compared to omnivores. There were very few studies on immunological markers and the results on the difference between vegetarians and omnivores were inconclusive. Although several biomarkers involved in oxidative stress and inflammation showed a beneficial association with the vegetarian diet, further research in well-defined and sufficiently sized cohorts is needed to provide more evidence.

Vegan Men's Food and Health Practices: A Recipe for a More Health-Conscious Masculinity?

In the age of the Anthropocene, questions of ecological sustainability, animal ethics, and human health are intimately entangled. From a gender perspective, compared to women, men’s diets tend to be less healthy and sustainable. This is linked to worse health outcomes for men. Therefore, alternative, more ethical ways of eating that have the potential to improve men’s health and well-being and simultaneously contribute to better public health and sustainability outcomes should be encouraged. Veganism addresses issues of food, health, climate change, and animal justice simultaneously.

This article explores vegan men’s food practices in relation to health and well-being, drawing on qualitative interviews with 61 vegan men. The interview material was analyzed using the method of thematic analysis. Our findings suggest that becoming vegan encourages positive changes in men’s health behavior. This includes paying more attention to nutrition and taking better care of one’s health. Vegan men report experiencing better physical and mental well-being upon going vegan. Based on these findings, we argue that vegan men’s food and health practices contribute to the emergence of healthier masculinities, as vegan men help to challenge links between risky health behavior and masculinity.

Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes

INTRODUCTION

Exercise is one of several factors known to lower the risk of developing cancer, as well as improve outcomes in patients already diagnosed. People who exercise after cancer have lower rates of cancer complications, treatment toxicities, relapse and improved survival. This review highlights the supportive data and biochemical processes, which explain these potential benefits.

SOURCES OF DATA

PubMed, Embase, Medline and Cochrane libraries were searched for papers which addressed the effects of exercise and physical activity on cancer for this review. The search terms used were physical activity, exercise and cancer up to February 2021. We also referred to the background research required for international exercise intervention study involving men with prostate cancer (INTERVAL-GAP4) and scrutinized references within the robust papers published on this subject to ensure we did not miss any clinically studies. One hundred and eighty eight papers were included.

AREAS OF AGREEMENT

Exercise programmes mitigate many of the complications and risks associated with cancer, particularly thromboembolism, fatigue, weight gain, arthralgia, cognitive impairment and depression.

AREAS OF CONTROVERSY

Molecular and biomarker changes, resulting from exercise, suggest that exercise elicits beneficial changes in insulin-related pathways, down-regulates inflammation and serum oestrogen levels, and enhances oxidative, immune and cellular repair pathways. Nonetheless, the evidence remains preliminary.

GROWING POINTS

The timing, intensity and challenges of prehabilitation, adjunct and rehabilitation exercise programmes are being increasingly understood but their implementation remains sporadic.

AREAS FOR DEVELOPING RESEARCH

More robust clinical trial data are needed to substantiate a causal effect of exercise on overall and cancer-specific survival. These studies are ongoing. Research evaluating the most cost-efficient ways of incorporating prehabilitation, adjunct and rehabilitation programmes into routine practice would be helpful to funding bodies and health care strategists.

Iron Deficiency in Vegetarian and Omnivorous Individuals: Analysis of 1340 Individuals

The objective of this study was to evaluate the serum levels of ferritin and the prevalence of iron deficiency in vegan and omnivorous individuals by taking into account the presence of elements that cause an elevation of ferritin levels, such as increased homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), and high-sensitivity C-reactive protein (hs-CRP) values. The parameters were evaluated in 1340 individuals, i.e., 422 men and 225 women who do not menstruate and 693 women who do menstruate, based on omnivorous or vegetarian eating habits. The progressive increase in BMI, HOMA-IR, and inflammation caused an elevation in ferritin concentration, regardless of the eating habits in the groups studied. In the overall sample, omnivores had a higher prevalence of obesity, higher ferritin levels, and a lower prevalence of iron deficiency (ferritin < 30 ng/mL). However, after the exclusion of individuals with inflammation (with overweight/obesity and elevated hs-CRP levels), the actual iron deficiency was assessed and was not higher among vegetarians, except in women with regular menstrual cycles. Our data show that nutritional status and inflammation levels affect ferritin levels and may interfere with the correct diagnosis of iron deficiency in both vegetarian and omnivorous individuals. Compared to vegetarians, women who do not menstruate and men had the same prevalence of iron deficiency when following an omnivorous diet.

Managing Psoriatic Arthritis With a Whole Food Plant-Based Diet: A Case Study

A 40-year-old female teacher presented to the rheumatology clinic in 2003 with nonspecific back, knees, and right ankle pain. She was subsequently diagnosed with psoriatic arthritis and was taking methotrexate to control her disease. Over the years, her symptoms were mostly under control. However, in 2018, after adopting a whole food plant-based diet free of added salt, oil, and sugar, she was able to stop taking methotrexate. She was discharged from the rheumatology clinic and has remained symptom-free since. The available literature on managing psoriatic arthritis with diet shows that less than 2% of patients with psoriatic arthritis are able to discontinue medication as a result of disease remission. This case report adds to support and encourages further research in the field of managing inflammatory polyarthropathies with diet and lifestyle.

Impact of Christian Orthodox Church dietary recommendations in Metabolic Syndrome risk factors: a scoping review

Fasting has been a practice among followers of different religions for many years. Christian Orthodox Church (COC) fasting is a periodic vegetarian-type diet while seafood and snails are allowed on most fasting days. The present scoping review aimed to present available data regarding the benefits of COC fasting on metabolic syndrome (MetS) risk factors. Databases were searched for available studies. Twenty publications, with a total of 1226 fasting participants, provided data on the effects on different variables of the MetS, including blood pressure, blood lipids and anthropometric measurements. Fasters' diet is characterized by low saturated and trans fat intake, high complex carbohydrate and fiber consumption, due to foods allowed to consume. COC fasting has no deficiency in essential amino acids intake since seafood and snails allowed on fasting days. Fasters have healthier blood lipid profiles during and after COC fasting periods, total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, body weight and body mass index are reduced after a fasting period. Due to restricted or forbidden intake of specific foods during the COC fasting periods, one might expect that fasters may have reduced intake of macro- and micro-nutrients, but as showed in the available literature there are no deficiencies. Future research on COC fasting is needed in areas not investigated at all, like MetS, before reaching definite conclusions.

Nutritional, Cardiovascular Health and Lifestyle Status of 'Health Conscious' Adult Vegans and Non-Vegans from Slovenia: A Cross-Sectional Self-Reported Survey

The study aim was to investigate differences in nutritional, cardiovascular and lifestyle status of ‘health conscious’ subjects. In a partial ‘lock-down’ during the COVID-19 pandemic period, we performed a web-based, cross-sectional study. We compared 80 self-selected subjects (51 vegans, 67% females, and 29 non-vegans, 55% females, p = 0.344). Nutritional status was assessed by bio-electrical impedance and standardized food frequency questionnaires (i.e., contribution of nutrients from foods and supplementation, combined and separate). Serum lipid concentrations and blood pressure (BP) were assessed from annual or initial examination reports, while sociodemographic, economic, and lifestyle statuses were obtained by standardized questionnaires. Finally, a multivariate linear regression model was used to estimate the relationship between total fiber and saturated fatty acid (SFA) intake and low-density lipoprotein cholesterol (LDL cholesterol) values. The vegans had a significantly lower body mass index (22.8 ± 2.4 vs. 26.6 ± 3.6 kg/m², p < 0.001) and body fat % (19.3 ± 7.3 vs. 25.8 ± 8.2%, p < 0.001) than the non-vegans. There were significant differences between vegans and non-vegans in energy intake, and most macronutrient (10/12) and micronutrient (15/23) intakes in units/day. Both diets were well designed, with high fiber and low SFA and free sugar intake but remained insufficient in n-3 long chain polyunsaturated fatty acids (for vegans), vitamin D, calcium, sodium (for vegans) and iodine. Vegans also had a significantly lower lipid profile and BP than non-vegans, except for high-density lipoprotein cholesterol. However, both groups met targeted recommendations. Furthermore, fiber and SFA intake and age explained 47% of the variance in LDL cholesterol. In conclusion, ‘health conscious’ vegans and non-vegans with comparable lifestyle statuses had significant differences in dietary intake, body composition and cardiovascular health status.

A plant-based diet in overweight adults in a 16-week randomized clinical trial: The role of dietary acid load

BACKGROUND

Evidence suggests that changes in dietary acid load may influence body weight, body composition, and insulin sensitivity.

METHODS

Participants (n = 244) were randomly assigned to an intervention (vegan) (n = 122) or control group (n = 122) for 16 weeks. Before and after the intervention period, body composition was measured by dual X-ray absorptiometry. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index and predicted insulin sensitivity index (PREDIM). Repeated measure ANOVA was used for statistical analysis.

RESULTS

Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) decreased significantly in the vegan group with no change in the control group (treatment effect -24.7 mEq/day [95% CI -30.2 to -19.2]; p < 0.001; and -23.8 mEq/day [95% CI -29.6 to -18.0]; p < 0.001, respectively). Body weight decreased by 6.4 kg in the vegan group, compared with 0.5 kg in the control group (treatment effect -5.9 kg [95% CI -6.8 to -5.0]; Gxt, p < 0.001), largely due to a reduction in fat mass and visceral fat. HOMA-IR index decreased and PREDIM increased in the vegan group. After adjustment for energy intake, changes in PRAL and NEAP correlated positively with changes in body weight (r = +0.37; p < 0.001; and r = +0.37; p < 0.001, respectively), fat mass (r = +0.32; p < 0.001; and r = +0.32; p < 0.001, respectively), visceral fat (r = +0.19; p = 0.006; and r = +0.15; p = 0.03, respectively), and HOMA (r = +0.17; p = 0.02; and r = +0.20; p = 0.006, respectively), and negatively with changes in PREDIM (r = -0.22; p = 0.002; and r = -0.27; p < 0.001, respectively).

CONCLUSION

Dietary acid load as part of a plant-based diet was associated with changes in body weight, body composition, and insulin sensitivity, independent of energy intake. Mechanistic explanations suggest that the relationship may be causal.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT03698955.

Nutrient status and growth in vegan children

Vegan diets have risen in popularity over the past 9 years. However, few studies have examined nutrient status and the effect of a vegan diet on the growth of children. This study analysed the existing literature on the health impact and growth impact of selected nutrients in vegan children. We assessed the intake of calories and protein, as well as the nutrients iron, calcium, vitamin D, cobalamin and folate. With a small percentage of outliers, vegan children showed normal growth and were less often obese. We found limited evidence that children on a vegan diet can obtain all the examined nutrients. Furthermore, as proper planning and supplementation by caregivers is needed, it is currently unknown how often vegan children follow well-planned diets. Deficiencies in cobalamin, calcium, and vitamin D seem to be the biggest risks associated with a poorly planned vegan diet. For a more definitive assessment, data on the intake and nutrient status of omega-3 fatty acids, zinc, iodine, and selenium in vegan children are needed. Future research should account for demographic shifts in those following a vegan diet, and should discriminate between vegan sub-populations that are open or closed towards scientific approaches, towards health in general, and toward supplementation. Studies should assess the modes and dosages of supplementation and the use of fortified foods or drinks, as well as adherence to the diet itself. Plant ferritin as a source of iron and endogenous cobalamin synthesis warrants further scientific inquiry. In summary, the current literature suggests that a well-planned vegan diet using supplementation is likely to provide the recommended amounts of critical nutrients to provide for normal progression of height and weight in children, and can be beneficial in some aspects. However, data on 5 critical nutrients are still missing, hampering a more definitive conclusion.