Plant-Based Milk Alternatives: Types, Processes, Benefits, and Characteristics

Application of legumes in plant-based milk alternatives: a review of limitations and solutions

In recent years, a global shift has been observed toward reducing the consumption of animal-derived foods in favor of healthier and more sustainable dietary choices. This has led to a steady growth in the market for plant-based milk alternatives (PBMAs). Projections suggest that this market will reach a value of USD 69.8 billion by 2030. Legumes, being traditional and nutritious ingredients for PMBAs, are rich in proteins, dietary fibers, and other nutrients, with potential health benefits such as anticancer and cardiovascular disease prevention. In this review, the application of 12 legumes in plant-based milk alternatives was thoroughly discussed for the first time. However, compared to milk, processing of legume-based beverages can lead to deficiencies such as nutritional imbalance, off-flavor, and emulsion stratification. Considering the potential and challenges associated with legume-based beverages, this review aims to provide a scientific comparison between legume-based beverages and cow's milk in terms of nutritional quality, organoleptic attributes and stability, and to summarize ways to improve the deficiencies of legume-based beverages in terms of raw materials and processing method improvements. In conclusion, the legume-based beverage industry will be better enhanced and developed by improving the issues.

Delivery of encapsulated bioactive compounds within food matrices to the digestive tract: recent trends and future perspectives

Encapsulation technologies have achieved encouraging results improving the stability, bioaccessibility and absorption of bioactive compounds post-consumption. There is a bulk of published research on the gastrointestinal behavior of encapsulated bioactive food materials alone using in vitro and in vivo digestion models, but an aspect often overlooked is the impact of the food structure, which is much more complex to unravel and still not well understood. This review focuses on discussing the recent findings in the application of encapsulated bioactive components in fabricated food matrices. Studies have suggested that the integration of encapsulated bioactive compounds has been proven to have an impact on the physicochemical characteristics of the finished product in addition to the protective effect of encapsulation on the fortified bioactive compound. These products containing bioactive compounds undergo further structural reorganization during digestion, impacting the release and emptying rates of fortified bioactive compounds. Thus, by manipulation of various food structures and matrices, the release and delivery of these bioactive compounds can be altered. This knowledge provides new opportunities for designing specialized foods for specific populations.

Mapping the evidence of novel plant-based foods: a systematic review of nutritional, health, and environmental impacts in high-income countries

CONTEXT

Shifting from current dietary patterns to diets rich in plant-based (PB) foods and lower in animal-based foods (ABFs) is generally regarded as a suitable strategy to improve nutritional health and reduce environmental impacts. Despite the recent growth in supply of and demand for novel plant-based foods (NPBFs), a comprehensive overview is lacking.

OBJECTIVES

This review provides a synthesis of available evidence, highlights challenges, and informs public health and environmental strategies for purposeful political decision-making by systematically searching, analyzing, and summarizing the available literature.

DATA SOURCES

Five peer-reviewed databases and grey literature sources were rigorously searched for publications.

DATA EXTRACTION

Study characteristics meeting the inclusion criteria regarding NPBF nutrient composition and health and environmental outcomes in high-income countries were extracted.

DATA ANALYSIS

Fifty-seven peer-reviewed and 36 grey literature sources were identified; these were published in 2016-2022. NPBFs typically have substantially lower environmental impacts than ABFs, but the nutritional contents are complex and vary considerably across brands, product type, and main primary ingredient. In the limited evidence on the health impacts, shifts from ABFs to PB meats were associated with positive health outcomes. However, results were mixed for PB drinks, with links to micronutrient deficiencies.

CONCLUSION

If carefully selected, certain NPBFs have the potential to be healthier and nutrient-rich alternatives to ABFs and typically have smaller environmental footprints. More disaggregated categorization of various types of NPBFs would be a helpful step in guiding consumers and key stakeholders to make informed decisions. To enable informed policymaking on the inclusion of NPBFs in dietary transitions as part of a wider net-zero and health strategy, future priorities should include nutritional food standards, labelling, and subdivisions or categorizations of NPBFs, as well as short- and long-term health studies evaluating dietary shifts from ABFs to NPBFs and standardized environmental impact assessments, ideally from independent funders.

Preparation and characterization of vitamin E/calcium/soy protein isolate nanoparticles for soybean milk beverage fortification

Soybean milk is a rich plant-based source of protein, and phenolic compounds. This study compared the nutritional value of soybean milk, flour, soy protein isolate (SPI) and evaluated the impact of prepared vitamin E/calcium salt/soy protein isolate nanoparticles (ECSPI-NPs) on fortification of developed soybean milk formulations. Results indicated that soybean flour protein content was 40.50 g/100 g, that fulfills 81% of the daily requirement (DV%), the unsaturated fatty acids (USFs), oleic and linoleic content was 21.98 and 56.7%, respectively, of total fatty acids content. In soybean milk, essential amino acids, threonine, leucine, lysine achieved 92.70, 90.81, 77.42% of amino acid scores (AAS) requirement values respectively. Ferulic acid was the main phenolic compound in soybean flour, milk and SPI (508.74, 13.28, 491.78 µg/g). Due to the moisture content of soybean milk (88.50%) against (7.10%) in soybean flour, the latest showed higher nutrients concentrations. The prepared calcium (20 mM/10 g SPI) and vitamin E (100 mg/g SPI) nanoparticles (ECSPI-NPs) exhibited that they were effectively synthesized under transmission electron microscope (TEM), stability in the zeta sizer analysis and safety up to IC50 value (202 ug/mL) on vero cell line. ECSPI-NPs fortification (NECM) enhanced significantly phenolic content (149.49 mg/mL), taste (6.10), texture (6.70) and consumer overall acceptance (6.54). Obtained results encourage the application of the prepared ECSPI-NPs for further functional foods applications.

Review of plant-based milk analogue: its preparation, nutritional, physicochemical, and organoleptic properties

In recent years, the market demand for plant-based milk analogues has been rising because of health concerns with bovine milk, like lactose intolerance and hypercholesteremia. Another reason is the lifestyle changes like adopting veganism. This review aims to offer a layout of the manufacturing process and discuss the different properties of plant-based milk analogues. The health benefits offered by the plant-based milk analogues and measures taken to eliminate the existing limitations are also discussed. Sensory profile and stability of plant-based milk analogues which add to the quality of the product were also taken into account and reviewed. The current review's objective is to present a comprehensive, scientifically comparable overview of the preparation procedures, nutritional content, and sensory characteristics of plant-based milk analogues. This is done while keeping in mind the potential of plant-based milk substitutes and associated challenges.

Augmenting the quality and storage stability of soymilk by incorporation of untreated and ozonated oat 1,4-β-D-glucan

The study aimed to improve the quality and storage stability of novel plant-based soymilk with the incorporation of untreated (UtβG) and modified oat derived 1,4-β-D-glucan (OzβG) at varying concentrations (0, 1, and 2 % labelled as S0, S1 and S2). The treated soymilk was characterized for physical, chemical, nutritional, rheological, particle size, zeta potential, sensory and storage stability characteristics. The results revealed that 1, 4-β-D-glucan incorporation increased the acidity (0.67 to 0.73 %), viscosity (3.4 to 4.7 Cp) and ash content (0.74 to 0.92 %), however color remains natural. The frequency sweep and shear experiments showed that the 1,4-β-D-glucan modified the rheological parameters of the soymilk. The sensory analysis (n = 30) indicated that texture, mouthfeel and overall acceptability (8.38). Compared to OzβG-treated soymilk, UtβG soymilk, especially S2, exhibited superior thickening and rheological properties. The storage study indicated minimal phase separation in 1,4-β-D-glucan-incorporated samples, maintaining stability for 15 days under refrigerated conditions without compromising overall quality. Thus, this study provides valuable insights into the potential application of 1,4-β-D-glucan for improving the technological quality of soymilk that highlights possible implications for its commercialization potential.

Technological and health properties and main challenges in the production of vegetable beverages and dairy analogs

Lactose intolerance affects about 68-70% of the world population and bovine whey protein is associated with allergic reactions, especially in children. Furthermore, many people do not consume dairy-based foods due to the presence of cholesterol and ethical, philosophical and environmental factors, lifestyle choices, and social and religious beliefs. In this context, the market for beverages based on pulses, oilseeds, cereals, pseudocereals and seeds and products that mimic dairy foods showed a significant increase over the years. However, there are still many sensory, nutritional, and technological limitations regarding producing and consuming these products. Thus, to overcome these negative aspects, relatively simple technologies such as germination and fermentation, the addition of ingredients/nutrients and emerging technologies such as ultra-high pressure, pulsed electric field, microwave and ultrasound can be used to improve the product quality. Moreover, consuming plant-based beverages is linked to health benefits, including antioxidant properties and support in the prevention and treatment of disorders and common diseases like hypertension, diabetes, anxiety, and depression. Thus, vegetable-based beverages and their derivatives are viable alternatives and low-cost for replacing dairy foods in most cases.

Leveraging new opportunities and advances in high-pressure homogenization to design non-dairy foods

High-pressure homogenization (HPH) and ultrahigh-pressure homogenization (UHPH) are emerging food processing techniques for stabilizing emulsions and food components under the pressure range from 60 to 400 MPa. Apart from this, they also support increasing nutritional profile, food preservation, and functionality enhancement. Even though the food undergoes the shortest processing operation, the treatment leads to modification of physical, chemical, and techno-functional properties, in addition to the formation of micro-sized particles. This study focuses on recent advances in using HPH/UHPH on plant-based milk sources such as soybeans, almonds, hazelnuts, and peanuts. Overall, this systematic review provides an in-depth analysis of the principles of HPH/UHPH, the mechanism of action, and their applications in other nondairy areas such as fruits and vegetables, meat, fish, and marine species. This work also deciphers the role of HPH/UHPH in modifying food components, their functional quality enhancement, and their provision of oxidative resistance to many foods. HPH is not only perceived as a technique for size reduction and homogenization; however, it does various functions like microbial inactivation, improvement of rheologies like texture and consistency, decreasing of lipid oxidation, and making positive modifications to proteins such as changes to the secondary structure and tertiary structure thereby enhancing the emulsifying properties, hydrophobicity of proteins, and other associated functional properties in many nondairy sources at pressures of 100-300 MPa. Thus, HPH is an emerging technique with a high throughput and commercialization value in food industries.

Consumers' Preferences and Attitudes towards Plant-Based Milk

Plant-based milk (PBM) has become increasingly popular due to its environmental sustainability, health benefits, ingredient abundance, and unique taste. This study aims to identify the main factors that affect consumer preferences and attitudes towards PBM, and to examine the effect of consumer attitudes including environmental awareness, health consciousness, and food neophobia on WTP. We use the double-bounded dichotomy choice (DBDC) method to calculate consumers' willingness to pay (WTP) for PBM. We find that the appearance, taste, nutritional value, and environmental benefits of PBM significantly increase consumers' WTP for it. Consumers with high environmental awareness are more likely to perceive PBM as environmentally friendly and are willing to pay a higher price for it. Consumers with high health consciousness tend to value the environmental benefits of PBM and prioritize purchase convenience, as it aligns with their health-conscious lifestyle, leading to a higher WTP for PBM. The results of our study can help design effective strategies to market plant-based milk and develop sustainable and healthy food systems.

Use of natural biotechnological processes to modify the nutritional properties of bean-based and lentil-based beverages

The market for plant-based beverages (PBBs) is relatively new; hence, to enable its further development, it is important to use new raw materials and improve production technology. The use of natural biotechnological processes can diversify the segment of PBBs, which may offer products with better functionality than those available in the market. Therefore, the present study aimed to determine the effects of fermentation and germination on the nutritional properties of bean-based beverages (BBs) and lentil-based beverages (LBs). The applied processes significantly (p ≤ 0.05) influenced the characteristics of PBBs. Fermentation improved the antioxidant properties (e.g., by increasing the level of 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity by 2-6% and 3-7% for BBs and LBs, respectively) and modified the fatty acid (FA) profile of PBBs. This process increased the share of polyunsaturated FAs in the sn2 position in triacylglycerols, which may promote its absorption in the intestine. The simultaneous use of germination and fermentation was most effective in decreasing oligosaccharide content (< 1.55 mg/kg), which may reduce digestive discomfort after consuming PBBs. We recommend that the designing of innovative legume-based beverages should include the application of fermentation and germination to obtain products with probiotic bacteria and improved nutritional properties.

Colour descriptors for plant-based milk alternatives discrimination

Colour characteristics of plant-based milk alternatives (PBMAs: almond, coconut, cashew, oat, soy) were monitored during long-term storage to select suitable descriptors for PBMAs differentiation. All colour descriptors evaluated varied depending on the raw material used in the plant-based milk alternative production. Long-term storage of plant-based beverages resulted in slightly noticeable (0.5-1.5) and noticeable (1.5-3.0) colour changes. Based on all colour descriptors, an absolute differentiation of PBMAs according to the type of raw material and storage time was achieved using canonical discriminant analysis. The results also indicate the possibility of using colour descriptors to detect the addition of honey to these products. Statistical analysis identified yellowness, browning index and lightness as the most discriminating parameters.

Assessment of the Accuracy of Nutrition Label and Chemical Composition of Plant-Based Milks Available on the Italian Market

Growing health, environmental, and ethical concerns have encouraged interest in plant-based milks (PBMs), but it remains questionable whether the nutrition labeling of these products is adequately reliable for consumers, and whether nutritional standards can be defined for a given PBM type. On this basis, cereal, pseudocereal, nut, and legume PBMs available on the Italian market were analyzed in order to check the accuracy of nutritional labels on packages and generate new or updated compositional data. Most labels provided inaccurate information, especially with respect to the declared energy, fat, and saturated fat. Cereal- and pseudocereal-based PBMs were generally characterized by high MUFA (34.04-59.35%) and PUFA (21.61-52.27%). Almond, soy, rice, and hazelnut beverages displayed the highest levels of total tocopherols (11.29-13.68 mg/L), while buckwheat and spelt PBMs had the highest total polyphenol content (34.25-52.27 mg GAE/100 mL). Major and trace elements greatly varied among samples, being more abundant in buckwheat and coconut-based drinks. A PCA confirmed that nutritional standards cannot be unequivocally established for a given PBM, and indicated that, among the investigated variables, inorganic elements had more weight in the sample differentiation. Overall, to reliably guide consumers in their dietary choices, there is a need for greater accuracy in the development of nutrition labels for PBMs, as well as greater effort in assessing the nutritional quality of the ever-increasing variety of products available on the market.

“Got Milk Alternatives?” Understanding Key Factors Determining U.S. Consumers’ Willingness to Pay for Plant-Based Milk Alternatives

Milk is an important dairy product in U.S. food retail. Lifestyle changes toward climate-conscious consumption, animal welfare, and food safety concerns have increased the popularity of plant-based milk alternatives. This study is focused on such beverages and provides insights and best practice recommendations for marketing managers in the U.S. food retail sector. An online survey was distributed to explore factors explaining the intentions of U.S. consumers to purchase and pay a premium for plant-based milk alternatives. Food curiosity and food price inflation were identified as relevant for both willingness to buy and willingness to pay a price premium. In addition, animal welfare concerns and the green and clean product image of plant-based alternatives were relevant to the willingness to pay a premium for plant-based milk.

Recent innovations and emerging technological advances used to improve quality and process of plant-based milk analogs

The worldwide challenges related to food sustainability are presently more critical than ever before due to the severe consequences of climate change, outbreak of epidemics, and wars. Many consumers are shifting their dietary habits toward consuming more plant-based foods, such as plant milk analogs (PMA) for health, sustainability, and well-being reasons. The PMA market is anticipated to reach US$38 billion within 2024, making them the largest segment in plant-based foods. Nevertheless, using plant matrices to produce PMA has numerous limitations, including, among others, low stability and short shelf life. This review addresses the main obstacles facing quality and safety of PMA formula. Moreover, this literature overview discusses the emerging approaches, e.g., pulsed electric field (PEF), cold atmospheric plasma (CAP), ultrasound (US), ultra-high-pressure homogenization (UHPH), ultraviolet C (UVC) irradiation, ozone (O3), and hurdle technology used in PMA formulations to overcome their common challenges. These emerging technologies have a vast potential at the lab scale to improve physicochemical characteristics, increase stability and extend the shelf-life, decrease food additives, increase nutritional and organoleptic qualities of the end product. Although the PMA fabrication on a large scale using these technologies can be expected in the near future to formulate novel food products that can offer green alternatives to conventional dairy products, further development is still needed for wider commercial applications.

New Route to the Production of Almond Beverages Using Hydrodynamic Cavitation

Perceived as a healthy food, almond beverages are gaining ever-increasing consumer preference across nonalcoholic vegetable beverages, ranking in first place among oilseed-based drinks. However, costly raw material; time and energy consuming pre- and posttreatments such as soaking, blanching and peeling; and thermal sterilization hinder their sustainability, affordability and spread. Hydrodynamic cavitation processes were applied, for the first time, as a single-unit operation with straightforward scalability, to the extraction in water of almond skinless kernels in the form of flour and fine grains, and of whole almond seeds in the form of coarse grains, up to high concentrations. The nutritional profile of the extracts matched that of a high-end commercial product, as well as showing nearly complete extraction of the raw materials. The availability of bioactive micronutrients and the microbiological stability exceeded the commercial product. The concentrated extract of whole almond seeds showed comparatively higher antiradical activity, likely due to the properties of the almond kernel skin. Hydrodynamic cavitation-based processing might represent a convenient route to the production of conventional as well as integral and potentially healthier almond beverages, avoiding multiple technological steps, while affording fast production cycles and consuming less than 50 Wh of electricity per liter before bottling.

Hemp: A Sustainable Plant with High Industrial Value in Food Processing

In the era of SDGs, useful plants which provide valuable industrial outputs and at the same time pose less impact on the environment should be explored. Hemp seems one of the most relevant gluten-free crop plants to meet such requirements. Its high nutritional value is comparable to soy. Moreover, almost the whole body of the hemp plant has a wide array of utility: industrial production of food, fiber, and construction materials. In view of environmental sustainability, hemp requires less pesticides or water in cultivation compared to cotton, a representative fiber plant. This short review investigates hemp's sustainability as a plant as well as its utility value as a highly nutritional material in the food industry. Recent application research of hemp protein in food processing includes plant milk, emulsifiers, fortification of gluten-free bread, plant-based meat production, as well as membrane formation. These studies have revealed distinctive properties of hemp protein, especially in relation to disulfide (S-S)/sulfhydryl (-SH)-mediated interactions with protein from other sources. While its cultivation area and industrial use were limited for a while over confusion with marijuana, the market for industrial hemp is growing rapidly because it has been highly reevaluated in multiple areas of industry. Conclusively, with its sustainability as a plant as well as its distinctive useful property of the seed protein, hemp has promising value in the development of new foods.

Perceptions toward Plant-Based Milk Alternatives among Young Adult Consumers and Non-Consumers in Denmark: An Exploratory Study

The objective of this study was to determine associations among plant-based milk alternatives (PBMAs), sources of information on the PBMAs used, and the consumption of PBMAs among Danish young adult consumers and non-consumers of PBMAs. An online survey was conducted in May 2019. A total of 341 participants (consumers: n = 171; non-consumers: n = 170) aged 16-35 years old completed the survey. Most consumers drank less than one glass of PBMAs per week, and oat drink was the most frequently consumed PBMAs. Oat drinks were primarily consumed with coffee/tea or porridge, while soy drinks were preferred to be consumed alone. Participants who perceived PBMAs as natural, good for health, tasty, or nutritionally equal to cow's milk were more likely to be consumers of PBMAs. Additionally, participants who perceived PBMAs as highly processed or artificial were less likely to be consumers of PBMAs. For consumers, the most used sources of information on PBMAs were package labeling, followed by social media. The study´s results can help to improve marketing campaigns concerning the Danish retail of PBMA, whereby nutritional and sensory characteristics of PBMAs are highlighted through social networks and marketing strategies with product package labeling.

Cow's Milk in Human Nutrition and the Emergence of Plant-Based Milk Alternatives

Cow's milk is considered a complete food, providing high-quality protein and essential micronutrients, including vitamins and minerals. For medical reasons or as a lifestyle choice, consumers are replacing cow's milk with plant-based milk alternatives (PBMA); some perceive them as healthier alternatives to cow's milk due to their low saturated fatty acid content and no cholesterol content. However, the nutritional composition of PBMA is quite variable between different types and even within, which makes a comparison with cow's milk a complex issue. Furthermore, the consumption of PBMA has been associated with the development of some diseases in infants and children. Meanwhile, the consumption of cow's milk in human health is a controversial issue since it has been associated with a favorable effect in some diseases (such as obesity, type 2 diabetes, and Alzheimer's) and a negative effect in others (such as prostate cancer risk and Parkinson's disease); while in some diseases, there is no consensus in the cow's milk consumption effect. The aim of this review is to make a nutritional comparison of cow's milk with PBMA and to clarify the potential health issues related to their consumption.

Plant-based milk: unravel the changes of the antioxidant index during processing and storage - a review

As a nutrient rich emulsion extracted from plant materials, plant-based milk (PBM) has been the latest trend and hot topic in the food industry due to the growing awareness of consumers toward plant-based products in managing the environmental (carbon footprint and land utility), ethical (animal well-fare) and societal (health-conscious) issues. There have been extensive studies and reviews done to discuss the distinct perspective of PBM including its production, health effects and market acceptance. However, not much has been emphasized on the valuable antioxidants present in PBM which is one of the attributes making them stand apart from dairy milk. The amounts of antioxidants in PBM are important. They offered tremendous health benefits in maintaining optimum health and reducing the risk of various health disorders. Therefore, enhancing the extraction of antioxidants and preserving their activity during production and storage is important. However, there is a lack of a comprehensive review of how these antioxidants changes in response to different processing steps involved in PBM production. Presumably, antioxidants in PBM could be potentially lost due to thermal degradation, oxidation or leaching into processing water. Hence, this paper aims to fill the gaps by addressing an extensive review of how different production steps (germination, roasting, soaking, blanching, grinding and filtration, and microbial inactivation) affect the antioxidant content in PBM. In addition, the effect of different microbial inactivation treatments (thermal or non-thermal processing) on the alteration of antioxidant in PBM was also highlighted. This paper can provide useful insight for the industry that aims in selecting suitable processing steps to produce PBM products that carry with them a health declaration.

Greenhouse gas emissions in the food system: Current and alternative dietary scenarios

BACKGROUND: There is a growing interest in diets due to the high contribution to greenhouse gas emissions (GHGE). OBJECTIVE: The study was aimed to estimate the impact on GHGE of replacing the current diet with eight alternative diets, which would be associated with GHGE, to contribute to the discussion of how dietary changes affect the GHGE. METHODS: The latest National Nutrition and Health Survey was utilized to determine the nutrient composition of Turkey’s current diet, with eight dietary scenarios designed to meet the National Dietary Guidelines. RESULTS: The current diet had the highest GHGE with 3254.50 g CO2eq/person/day with beef, lamb, and cheese products accounting for the majority of emissions (18.61%, 17.15%, and 10.89%, respectively). The Model diet had a GHGE of 2994.18 g CO2eq/person/day, whereas vegetarian diets had the lowest (lacto-ovo vegetarian diet with 1944.95 g CO2eq/person/day and vegan diet with 1166.80 g CO2eq/person/day). Low energy efficiencies were associated with high diet-related GHGE levels. CONCLUSION: When evaluating future dietary guidelines for a sustainable diet, our study highlighted the need of integrating both health and environmental aspects. The present study found that dietary changes would significantly contribute to lowering GHGE. These findings will be beneficial in informing Turkey’s nutrition, agriculture, and public policymakers.

The Role of Bovine and Non-Bovine Milk in Cardiometabolic Health: Should We Raise the "Baa"?

Although causality is yet to be confirmed, a considerable volume of research has explored the relationships between cow milk consumption, type II diabetes, and cardiovascular disease. Contrastingly, it has not been comprehensively examined whether milk of non-bovine origin can provide cardiometabolic protection. This narrative review outlines the marked differences in macronutrient composition, particularly protein and lipid content, and discusses how whole milk product (and individual milk ingredients) from different species could impact cardiometabolic health. There is some data, although primarily from compositional analyses, animal studies, and acute clinical trials, that non-bovine milk (notably sheep and goat milk) could be a viable substitute to cow milk for the maintenance, or enhancement, of cardiometabolic health. With a high content of medium-chain triglycerides, conjugated linoleic acid, leucine, and essential minerals, sheep milk could assist in the prevention of metabolic-related disorders. Similarly, albeit with a lower content of such functional compounds relative to sheep milk, goat and buffalo milk could be plausible counterparts to cow milk. However, the evidence required to generate nutritional recommendations for ‘non-bovine milk’ is currently lacking. Longer-term randomised controlled trials must assess how the bioactive ingredients of different species’ milks collectively influence biomarkers of, and subsequently incidence of, cardiometabolic health.