Vegetarian Diets: Planetary Health and Its Alignment with Human Health

Physicochemical, nutraceutical, and sensory evaluation of a milk-type plant-based beverage of extruded common bean (Phaseolus vulgaris L.) added with iron

Milk-type beverages are popular vegan products requiring iron and calcium fortification to improve their nutritional value, as iron deficiency is the world's most prevalent nutritional problem. This research aimed to develop and characterize an extruded common bean (Phaseolus vulgaris L.)-based milk-type beverage added with bean protein isolate and iron. The formulations included flavors (non-flavored, vanilla, and nut) and two iron concentrations (2 and 3 mg FeSO4/100 mL). Extrusion increased the beverages' protein (+17.38 %) and starch digestibility, and reduced their antinutritional compounds (trypsin inhibitors, condensed tannins, and carbonates). Developed beverages' formulations differed from a commercial soybean beverage in their physicochemical properties but were more nutritious (protein: 3.33-3.44 %; fiber: 3.43-4.08 %). Iron-added beverages displayed a medium sensory acceptance (best overall likeness: 5.3-6.2). The developed beverage is a suitable, sensory-accepted, and nutritious bean-based beverage, suggesting novel research lines improving vegan beverage formulations to increase average daily iron intake.

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 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 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.

Beyond gender: Exploring sexual orientation, race and motivations among Brazilian flexitarians

In this study, we analyzed 989 Brazilian individuals identified as flexitarians to explore the relationship between gender, sexual orientation, and meat consumption reduction behavior, while evaluating the impact of motivations driving individuals towards this dietary model. To achieve this goal, we tested the following hypotheses: women consume less meat than men; LGBT women consume less meat than heterosexual women; LGBT men consume less meat than heterosexual men; and women are more motivated by the environmental impact of meat. Our findings revealed that although gender significantly influences motivations, with women showing a greater influence from animal ethics, flexitarians of both genders exhibit similar meat consumption patterns. Neither sexual orientation nor gender influence meat reduction patterns among flexitarians. However, the race/ethnicity of white individuals is a predominant factor among those who reduce meat consumption the most. Consequently, we conclude that (i) the social theories applied to explain gender differences in meat exclusion behavior may not be the most suitable for explaining meat reduction behavior, and (ii) intersectional approaches are needed to investigate flexitarianism.

Plant-Based Meat Analogues: Exploring Proteins, Fibers and Polyphenolic Compounds as Functional Ingredients for Future Food Solutions

As the lack of resources required to meet the demands of a growing population is increasingly evident, plant-based diets can be seen as part of the solution, also addressing ethical, environmental, and health concerns. The rise of vegetarian and vegan food regimes is a powerful catalyzer of a transition from animal-based diets to plant-based diets, which foments the need for innovation within the food industry. Vegetables and fruits are a rich source of protein, and bioactive compounds such as dietary fibres and polyphenols and can be used as technological ingredients (e.g., thickening agents, emulsifiers, or colouring agents), while providing health benefits. This review provides insight on the potential of plant-based ingredients as a source of alternative proteins, dietary fibres and antioxidant compounds, and their use for the development of food- and alternative plant-based products. The application of these ingredients on meat analogues and their impact on health, the environment and consumers' acceptance are discussed. Given the current knowledge on meat analogue production, factors like cost, production and texturization techniques, upscaling conditions, sensory attributes and nutritional safety are factors that require further development to fully achieve the full potential of plant-based meat analogues.

Effects of increasing the availability of vegetarian options on main meal choices, meal offer satisfaction and liking: a pre-post analysis in a French university cafeteria

BACKGROUND

Changing the food environment is an important public health lever for encouraging sustainable food choices. Targeting the availability of vegetarian main meals served in cafeterias substantially affects food choice, but acceptability has never been assessed. We examined the effects of an availability intervention at a French university cafeteria on students' main meal choices, meal offer satisfaction and liking.

METHODS

A four-week controlled trial was conducted in a university cafeteria in Dijon, France. During the two-week control period, vegetarian main meals constituted 24% of the offer. In the subsequent two-week intervention period, this proportion increased to 48%, while all the other menu items remained unchanged. Students were not informed of the change. Student choices were tracked using production data, and daily paper ballots were used to assess student satisfaction with the meal offer and liking of the main meal they chose (score range [1;5]). Nutritional quality, environmental impact, and cost of production of meal choices were calculated for each lunchtime. Food waste was measured over 4 lunchtimes during control and intervention periods. An online questionnaire collected student feedback at the end of the study.

RESULTS

Doubling availability of vegetarian main meals significantly increased the likelihood of choosing vegetarian options (OR = 2.57, 95% CI = [2.41; 2.74]). Responses of the paper ballots (n = 18,342) indicated slight improvements in meal offer satisfaction from 4.05 ± 0.92 to 4.07 ± 0.93 (p = 0.028) and in liking from 4.09 ± 0.90 to 4.13 ± 0.92 (p < 0.001) during control and intervention periods, respectively. The end-of-study questionnaire (n = 510) revealed that only 6% of students noticed a change the availability of vegetarian main meals. The intervention led to a decrease in the environmental impact of the main meals chosen, a slight decrease in nutritional quality, a slight increase in meal costs and no change in food waste.

CONCLUSIONS

Doubling availability of vegetarian main meals in a university cafeteria resulted in a twofold increase in their selection, with students reporting being more satisfied and liking the main meals more during the intervention period. These results suggest that serving an equal proportion of vegetarian and nonvegetarian main meals could be considered in French university cafeterias to tackle environmental issues.

TRIAL REGISTRATION

Study protocol and analysis plan were pre-registered on the Open Science Framework ( https://osf.io/pf3x7/ ).

The Planetary Health Diet and Its Association with Asthma and Airway Inflammation in School-Aged Children

Poor dietary choices have been rising concurrently with an increase in asthma prevalence, especially in children. Dietary indexes that simultaneously measure the healthiness and sustainability of dietary patterns have emerged to address the dual concerns of human and planetary health. Accordingly, we aimed to evaluate adherence to a sustainable dietary pattern and its impact on airway inflammation and asthma. In this study, 660 school-aged children (49.1% females, 7-12 years) were considered. A cross-sectional analysis was performed to assess the association between diet and asthma and airway inflammation according to overweight/obesity. Diet was evaluated through the Planetary Health Diet Index (PHDI). Higher scores represent a healthier and more sustainable diet. Three definitions of asthma were considered based on a self-reported medical diagnosis, symptoms, asthma medication, measured lung function, and airway reversibility. Airway inflammation was assessed by exhaled fractional nitric oxide (eNO). We considered two categories of body mass index: non-overweight/non-obese and overweight/obese. The associations between diet with asthma and airway inflammation were estimated using adjusted binary logistic regressions. The odds of having airway inflammation decreased with the increase in PHDI score. Moreover, children in the non-overweight/non-obesity group in the fourth quartile of the PHDI had lower odds of having airway inflammation compared to children in the first quartile. Our study indicates that a healthier and sustainable diet is associated with lower levels of eNO, but only among children without overweight/obesity.

Association between plant-based dietary index and gallstone disease: A cross sectional study from NHANES

BACKGROUND

The relationship between plant-based diets and gallstone disease has been debated. This study aimed to shed light on the association between plant-based dietary index and the risk of developing gallstone disease.

METHODS

Eligible participants were selected from National Health and Nutrition Examination Survey (NHANES) 2017-2020. Three plant-based diet indexes (PDI, healthy PDI, unhealthy PDI) were calculated using data from two NHANES 24-h dietary recall interviews. Restricted Cubic Spline and multivariate logistic regression were used to analyze the associations. Subgroup analysis was adopted to make the results more robust.

RESULTS

A total of 5673 eligible participants were analyzed. After adjusting for various confounding variables, uPDI was positively associated with gallstone disease (OR = 1.53, 95%CI: 1.02-2.29). No association was found between PDI/hPDI and gallstone disease (p > 0.05). The results of subgroup analysis did not show any positive association between uPDI and gallstones in specific groups.

CONCLUSION

Our study shows that the elevated uPDI are linked to a higher risk of gallstone disease.

Exposure to iodine, essential and non-essential trace element through seaweed consumption in humans

Seaweed consumption has gained popularity due to its nutritional value and potential health benefits. However, concerns regarding the bioaccumulation of several trace elements highlight the need for comprehensive studies on exposure associated with seaweed consumption. To address this gap in knowledge, we carried out a feeding intervention study of three common edible seaweeds (Nori, Kombu, and Wakame) in 11 volunteers, aiming to elucidate the extent of both beneficial and harmful trace element exposure through seaweed consumption in humans. Concentrations of total arsenic, cobalt, copper, cadmium, iodine, molybdenum, selenium, and zinc were measured in urine samples before and following seaweed consumption. Elements concentrations were also measured in the seaweeds provided for the study. Descriptive analysis for each element were conducted and we used quantile g-computation approach to assess the association between the 8-element mixture and seaweed consumption. Differences in urine element concentrations and seaweed consumption were analyzed using generalized estimating equations (GEE). Urinary concentrations of iodine and total arsenic increased after seaweed consumption. When we analyze the 8-element mixture, the largest weight was observed for iodine after Kombu consumption while for total arsenic was observed after Wakame consumption. Similar results were observed when we compared the mean differences between the elements before and after seaweed consumption through the GEE. Seaweed consumption relates with increased urinary iodine and total arsenic concentrations, particularly after Kombu and Wakame consumption.

Industrially Produced Plant-Based Food Products: Nutritional Value and Degree of Processing

The plant-based food market is rapidly growing, offering innovative options to meet consumer expectations. However, a comprehensive analysis of the nutritional quality of these foods is lacking. We aimed to characterize industrial plant-based food products' nutritional value and degree of processing. A cross-sectional study was conducted on two market-leading Portuguese food retail chains by assessing the nutritional composition of all the available pre-packaged plant-based food products (n = 407). These products were categorized into meal alternatives, dairy alternatives, and other products containing dairy/meat alternative ingredients including ready meals and desserts. The products' nutritional quality was assessed according to the cut-offs established by the Portuguese Directorate General of Health [DGS] on total fat, saturated fat, sugar, and salt, and considering the degree of processing using NOVA classification. One-tenth of the products were classified as having a high total fat, saturated fat, sugars, or salt content. In some sub-categories, half of foods were classified as high in saturated fat, and over two-thirds were considered high salt products. Less than one-third exhibit a good nutritional profile based on the national cut-offs. A total of 84.3% of plant-based food products were ultra-processed. These findings emphasize the need to improve the nutritional profile of plant-based options.

The association between food neophobia, bi-dimensional aspects of orthorexia, and anxiety among vegetarians and omnivores

Vegetarianism is a growing trend, and food neophobia and orthorexia nervosa could act as barriers to achieving a healthy vegetarian diet. The aim of this study is to compare the levels of food neophobia, anxiety, and both healthy and pathological aspects of orthorexia among vegetarians and omnivores. Additionally, the study aims to identify the relationships between food neophobia, anxiety, and orthorexia. In this cross-sectional online survey, a total of 324 vegetarian and 455 omnivores adults participated. The questionnaire consisted of four sections: sociodemographic, lifestyle, and health-related characteristics, the Food Neophobia Scale (FNS), the Teruel Orthorexia Scale (TOS), and the Generalized Anxiety Disorders-7 Scale. Vegetarians exhibited lower FNS scores (p < 0.001) and had higher healthy orthorexic scores (p < 0.001) than omnivores. There were no differences between groups for anxiety scores (p > 0.05). Regression analysis indicated that higher food neophobia (OR: 0.953, 95% CI:0.937-0.968) and TOS-OrNe scores (OR: 0.946, 95% CI: 0.901-0.993) were associated with lower odds of following a vegetarian diet. Conversely, higher TOS-HeOr scores (OR: 1.135, 95% CI:1.096-1.176) were linked to an increased likelihood of adopting a vegetarian diet. Furthermore, both FNS and GAD-7 scores showed negative correlations with TOS-HeOR (r = -0.124, p < 0.001 and r = -0.129 p < 0.001, respectively), and positive correlations with TOS-OrNe (r = 0.106, p < 0.001 and r = 0.146, p < 0.001). In conclusion, vegetarians exhibit lower levels of food neophobia and a greater interest in healthy eating than omnivores. Additionally, the distinct correlation between two dimensions of orthorexia and food neophobia and anxiety provides support for the two-dimensional nature of orthorexia.

Environmental impact of the diet of young Portuguese and its relationship with adherence to the Mediterranean Diet

OBJECTIVE

To estimate, in a cohort of young Portuguese adults, the environmental impact (greenhouse gas (GHG) emissions, land use, energy used, acidification and potential eutrophication) of diet according to adherence to the Mediterranean Diet (MD).

METHODS

Data from 1554 participants of the Epidemiologic Health Investigation of Teenagers in Porto (EPITeen) were analysed. Food intake and MD adherence were determined using validated questionnaires. The environmental impact was evaluated with the EAT-Lancet Commission tables, and the link between MD adherence and environmental impact was calculated using adjusted multivariate linear regression models.

RESULTS

Higher adherence (high vs. low) to the MD was associated with lower environmental impact in terms of land use (7.8 vs. 8.5 m2, p = 0.002), potential acidification (57.8 vs. 62.4 g SO2-eq, p = 0.001) and eutrophication (21.7 vs. 23.5 g PO4-eq, p < 0.001). Energy use decreased only in the calorie-adjusted model (9689.5 vs. 10,265.9 kJ, p < 0.001), and GHG emissions were reduced only in a complementary model where fish consumption was eliminated (3035.3 vs. 3281.2 g CO2-eq, p < 0.001). Meat products had the greatest environmental impact for all five environmental factors analysed: 35.7% in GHG emissions, 60.9% in energy use, 72.8% in land use, 70% in acidification and 61.8% in eutrophication.

CONCLUSIONS

Higher adherence to the MD is associated with lower environmental impact, particularly in terms of acidification, eutrophication, and land use. Reducing meat consumption can contribute to greater environmental sustainability.

Cardiovascular health and cancer risk associated with plant based diets: An umbrella review

CONTEXT

Cardiovascular diseases (CVDs) and cancer are the two main leading causes of death and disability worldwide. Suboptimal diet, poor in vegetables, fruits, legumes and whole grain, and rich in processed and red meat, refined grains, and added sugars, is a primary modifiable risk factor. Based on health, economic and ethical concerns, plant-based diets have progressively widespread worldwide.

OBJECTIVE

This umbrella review aims at assessing the impact of animal-free and animal-products-free diets (A/APFDs) on the risk factors associated with the development of cardiometabolic diseases, cancer and their related mortalities.

DATA SOURCES

PubMed and Scopus were searched for reviews, systematic reviews, and meta-analyses published from 1st January 2000 to 31st June 2023, written in English and involving human subjects of all ages. Primary studies and reviews/meta-analyses based on interventional trials which used A/APFDs as a therapy for people with metabolic diseases were excluded.

DATA EXTRACTION

The umbrella review approach was applied for data extraction and analysis. The revised AMSTAR-R 11-item tool was applied to assess the quality of reviews/meta-analyses.

RESULTS

Overall, vegetarian and vegan diets are significantly associated with better lipid profile, glycemic control, body weight/BMI, inflammation, and lower risk of ischemic heart disease and cancer. Vegetarian diet is also associated with lower mortality from CVDs. On the other hand, no difference in the risk of developing gestational diabetes and hypertension were reported in pregnant women following vegetarian diets. Study quality was average. A key limitation is represented by the high heterogeneity of the study population in terms of sample size, demography, geographical origin, dietary patterns, and other lifestyle confounders.

CONCLUSIONS

Plant-based diets appear beneficial in reducing cardiometabolic risk factors, as well as CVDs, cancer risk and mortality. However, caution should be paid before broadly suggesting the adoption of A/AFPDs since the strength-of-evidence of study results is significantly limited by the large study heterogeneity alongside the potential risks associated with potentially restrictive regimens.

Canadian farmers' perceptions of social sustainability in agriculture

Sustainable food production is an important part of dietetic education and training; however, the focus in the dietetic sphere is often on the environmental aspect. Understanding the multi-dimensional nature of sustainability can enhance dietetic students' sustainability competences-such as empathy and change of perspective, systems thinking, and critical thinking and analysis-to help them in their future careers and strengthen their position in society as trusted and knowledgeable food and nutrition professionals. Enhancing public understanding of sustainable food production is imperative as populations become more urban, are less connected to agriculture, and have expectations for sustainably grown/raised food, often without knowing current food production practices or the multiple aspects of sustainability that must be in place for farmers to meet those demands. The goal of this research was to understand Canadian farmers' perceptions of environmental, economic, and social aspects of sustainable food production. Employing a descriptive qualitative approach and constant comparative analysis, four food and nutrition researchers analyzed interviews from 52 farmers from across Canada. Participants had to be English-speaking, produce food through farming on land, and own or rent the land on which they farm. Telephone/video interviews revealed five overarching social themes: (1) the importance of community and social capital, (2) public perception and social license to operate, (3) lack of infrastructure, and (4) deep connections to personal lives. The final theme, mental health issues (5), reflected the consequences of the multiple sources of stress that can undermine the social sustainability of farmers, farm communities, and food production. These findings may help various audiences appreciate the multiple dimensions of sustainable food production; reflect on their values, perceptions, and actions with regard to agriculture; and enhance their compassion and empathy for all farmers.

Association between Beverage Consumption and Environmental Sustainability in an Adult Population with Metabolic Syndrome

Beverages are an important part of the diet, but their environmental impact has been scarcely assessed. The aim of this study was to assess how changes in beverage consumption over a one-year period can impact the environmental sustainability of the diet. This is a one-year longitudinal study of 55-75-year-old participants with metabolic syndrome (n = 1122) within the frame of the PREDIMED-Plus study. Food and beverage intake were assessed using a validated food frequency questionnaire and a validated beverage-specific questionnaire. The Agribalyse® 3.0.1 database was used to calculate environmental impact parameters such as greenhouse gas emission, energy, water, and land use. A sustainability beverage score was created by considering the evaluated environmental markers. A higher beverage sustainability score was obtained when decreasing the consumption of bottled water, natural and packed fruit juice, milk, and drinkable dairy, soups and broths, sorbets and jellies, soft drinks, tea without sugar, beer (with and without alcohol), and wine, as well as when increasing the consumption of tap water and coffee with milk and without sugar. Beverage consumption should be considered when assessing the environmental impact of a diet. Trial registration: ISRCTN, ISRCTN89898870. Registered 5 September 2013.

Towards Sustainable Protein Sources: The Thermal and Rheological Properties of Alternative Proteins

Reducing meat consumption reduces carbon emissions and other environmental harms. Unfortunately, commercial plant-based meat substitutes have not seen widespread adoption. In order to enable more flexible processing methods, this paper analyzes the characteristics of commercially available spirulina, soy, pea, and brown rice protein isolates to provide data for nonmeat protein processing that can lead to cost reductions. The thermal and rheological properties, as well as viscosity, density, and particle size distribution, were analyzed for further study into alternative protein-based food processing. The differential scanning calorimetry analysis produced dry amorphous-shaped curves and paste curves with a more distinct endothermic peak. The extracted linear temperature ranges for processing within food production were 70-90 °C for spirulina, 87-116 °C for soy protein, 67-77 °C for pea protein, and 87-97 °C for brown rice protein. The viscosity analysis determined that each protein material was shear-thinning and that viscosity increased with decreased water concentration, with rice being an exception to the latter trend. The obtained viscosity range for spirulina was 15,100-78,000 cP, 3200-80,000 cP for soy protein, 1400-32,700 cP for pea protein, and 600-3500 cP for brown rice protein. The results indicate that extrusion is a viable method for the further processing of protein isolates, as this technique has a large temperature operating range and variable screw speed. The data provided here can be used to make single or multi-component protein substitutes.

The Effect of Type of Vegetable Fat and Addition of Antioxidant Components on the Physicochemical Properties of a Pea-Based Meat Analogue

In recent years, interest in functional foods and meat analogues has increased. This study investigated the effect of the type of vegetable fat and ingredients with antioxidant activity on the properties of a meat analogue based on textured pea protein. The possibility of using acai oil (AO), canola oil (CO) and olive oil (OO); propolis extract (P); buckwheat honey (H); and jalapeno pepper extract (JE) was investigated. The texture, colour and selected chemical parameters of plant-based burgers were analysed. Results showed that burgers from control group had the lowest hardness, while burgers with honey had the highest. The highest MUFA content was found in samples with olive oil. Samples with honey were characterised by the highest content of polyphenols, flavonoids and antioxidant capacity. The highest overall acceptability was observed in burgers from the JE-CO group. Therefore, it is possible to use selected ingredients with antioxidant activity in the recipe for a plant-based burger with high product acceptability.

Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies

BACKGROUND

There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis.

METHODS

We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach.

RESULTS

In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality.

CONCLUSIONS

Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.

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.

Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial

Importance

Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds).

Objective

To compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention.

Design, Setting, and Participants

This single-center, population-based randomized clinical trial of 22 pairs of twins (N = 44) randomized participants to a vegan or omnivorous diet (1 twin per diet). Participant enrollment began March 28, 2022, and continued through May 5, 2022. The date of final follow-up data collection was July 20, 2022. This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins. Primary analysis included all available data.

Intervention

Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks. Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks.

Main Outcomes and Measures

The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8). Secondary outcome measures were changes in cardiometabolic factors (plasma lipids, glucose, and insulin levels and serum trimethylamine N-oxide level), plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being.

Results

A total of 22 pairs (N = 44) of twins (34 [77.3%] female; mean [SD] age, 39.6 [12.7] years; mean [SD] body mass index, 25.9 [4.7]) were enrolled in the study. After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration (-13.9 [5.8] mg/dL; 95% CI, -25.3 to -2.4 mg/dL), fasting insulin level (-2.9 [1.3] μIU/mL; 95% CI, -5.3 to -0.4 μIU/mL), and body weight (-1.9 [0.7] kg; 95% CI, -3.3 to -0.6 kg).

Conclusions and Relevance

In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.

Trial Registration

ClinicalTrials.gov Identifier: NCT05297825.

A glimpse into plant-based fermented products alternative to animal based products: Formulation, processing, health benefits

Fermented foods and beverages are increasingly being included in the diets of people around the world, as they significantly contribute to flavor and interest in nutrition and food consumption. Plant sources, like cereals and pulses, are employed to produce vegan fermented foods that are either commercially available or the subject of ongoing scientific investigation. In addition, the inclination towards nutritionally healthy, natural, and clean-label products amongst consumers has encouraged the development of vegan fermented products alternative to animal-based products for industrial-scale production. However, as the vegan diet is more restrictive than the vegetarian diet, manufacturing food products for vegans presents a significant problem due to the limited availability of many raw materials. So further research is required on this topic. This paper aims to review the formulation, quality, microbial resources, health benefits, and safety of foods that can be categorised as vegan fermented foods and beverages.

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

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

What is on plates for school meals: focusing on animal- vs. plant-based protein foods

BACKGROUND/OBJECTIVES

This study aimed to analyze the potential of school meals in South Korea as a sustainable tool to reduce carbon emissions by focusing on animal- vs. plant-based protein foods.

MATERIALS/METHODS

By using a stratified proportional allocation method, 536 out of the 11,082 schools nationwide were selected including 21 kindergartens, 287 elementary-, 120 middle- and 108 high schools. A total of 2,680 meals served for 5 consecutive days (June 21-25, 2021) were collected. We analyzed the average serving amounts of protein foods (animal- vs. plant-based) per meal and then, calculated the estimated average amounts of carbon emission equivalents per meal by applying the conversion coefficients. The t-test and analysis of variance were used for statistical analyses (α = 0.05).

RESULTS

The average serving amount of animal-based protein foods per meal was 12.5 g, which was approximately 3 times higher than that of plant-based ones (3.8 g) (P < 0.001); the Meat-group had the highest average amount of 17.0 g, followed by Egg-group (9.6 g), Fish-group (7.6 g), and Beans-and-Nuts-group (3.8 g) (P < 0.05). Specifically, pork (25.1 g) was ranked first, followed by poultry (19.6 g), processed meat products (18.0 g). The estimated average amount of carbon emission equivalents of animal-based protein foods per meal was 80.1 g CO2e, which was approximately 31 times higher than that of plant-based ones (2.6 g CO2e) (P < 0.001); the Meat-group had the highest average amount of 120.3 g CO2e, followed by Fish-group (44.5 g CO2e), Egg-group (25.9 g CO2e), and Beans-and-Nuts-group (2.6 g CO2e) (P < 0.05). Specifically, processed meat products (270.8 g CO2e) were ranked first, followed by pork (91.7 g CO2e), and processed fish products (86.6 g CO2e).

CONCLUSIONS

The results implied that school meals with plant-based alternatives could be a sustainable tool to improve carbon footprint.

Plasma metabolomic profiles of plant-based dietary indices reveal potential pathways for metabolic syndrome associations

BACKGROUND AND AIMS

Plant-based dietary patterns have been associated with improved health outcomes. This study aims to describe the metabolomic fingerprints of plant-based diet indices (PDI) and examine their association with metabolic syndrome (MetS) and its components in a Danish population.

METHODS

The MAX study comprised 676 participants (55% women, aged 18-67 y) from Copenhagen. Sociodemographic and dietary data were collected using questionnaires and three 24-h dietary recalls over one year (at baseline, and at 6 and 12 months). Mean dietary intakes were computed, as well as overall PDI, healthful (hPDI) and unhealthful (uPDI) scores, according to food groups for each plant-based index. Clinical variables were also collected at the same time points in a health examination that included complete blood tests. MetS was defined according to the International Diabetes Federation criteria. Plasma metabolites were measured using a targeted metabolomics approach. Metabolites associated with PDI were selected using random forest models and their relationships with PDIs and MetS were analyzed using generalized linear mixed models.

RESULTS

The mean prevalence of MetS was 10.8%. High, compared to low, hPDI and uPDI scores were associated with a lower and higher odd of MetS, respectively [odds ratio (95%CI); hPDI: 0.56 (0.43-0.74); uPDI: 1.61 (1.26-2.05)]. Out of 411 quantified plasma metabolites, machine-learning metabolomics fingerprinting revealed 13 metabolites, including food and food-related microbial metabolites, like hypaphorine, indolepropionic acid and lignan-derived enterolactones. These metabolites were associated with all PDIs and were inversely correlated with MetS components (p < 0.05). Furthermore, they had an explainable contribution of 12% and 14% for the association between hPDI or uPDI, respectively, and MetS only among participants with overweight/obesity.

CONCLUSIONS

Metabolites associated with PDIs were inversely associated with MetS and its components, and may partially explain the effects of plant-based diets on cardiometabolic risk factors.

Patient-reported outcomes of ayurveda consultation in relation to clinical practice data

BACKGROUND

Clinical practice characteristics and patient-reported outcomes for Ayurveda have not been adequately studied.

METHODS

From January 2 thru February 28, 2022, all clients first seen during the 9-year period ending December 31, 2021, were solicited to respond to a web-based 34-item questionnaire containing 5 items targeting their general experience, 7 focusing on specific results, and 22 examining the implementation and impact of common Ayurvedic recommendations. These data were combined with practice data to develop linear regression models for the main outcome variables to assess improvement and the drivers of change.

RESULTS

170 responses were received from 252 eligible clients: an overall response rate of 67%. Test-retest data for 57 respondents gave a reliability coefficient of 0.83 [0.69-0.91]. The outcomes of consultation were independent of the mode of interaction (in-person vs. telehealth) and whether pulse diagnosis information was available. 85% were at least Satisfied with their overall consultation experience. The mean difference in health from before consultation to the survey was 1.2 [1.0-1.4] on a 7-point scale. 61% reported Much to Exceptional benefit. On average, 63% rated themselves as at least Somewhat Better in terms of physical well-being, emotional well-being, sleep, digestion, bowel function, fitness and energy. These findings were buttressed by clinically significant changes on 4 clinical assessment questionnaires among 60 clients. Engaging in follow-up and adopting recommendations were associated with better outcomes.

CONCLUSIONS

Consultation with a practitioner of Ayurveda may provide substantial probability of durable holistic health benefit and improvement in chronic conditions with minimal risk of harm.

Sustainable Isolation of Bioactive Compounds and Proteins from Plant-Based Food (and Byproducts)

Plant-based food produces significantly less greenhouse gases, and due to its wealth of bioactive components and/or plant-based protein, it becomes an alternative in a sustainable food system. However, the processing and production of products from plant sources creates byproducts, which can be waste or a source of useful substances that can be reused. The waste produced during the production and processing of food is essentially nutrient- and energy-rich, and it is recognized as an excellent source of secondary raw materials that could be repurposed in the process of manufacturing and preparing food, or as feed for livestock. This review offers an overview of the sources and techniques of the sustainable isolation of bioactive substances and proteins from various sources that might represent waste in the preparation or production of food of plant origin. The aim is to uncover novel approaches to use waste and byproducts from the process of making food to provide this waste food an additional benefit, not forgetting the expectations of the end user, the consumer. For the successful isolation of bioactive ingredients and proteins from food of plant origin, it is crucial to develop more eco-friendly and efficient extraction techniques with a low CO2 footprint while considering the economic aspects.

Vegetarian diets in Spain: Temporal evolution through national health surveys and their association with healthy lifestyles

OBJECTIVE

To assess the prevalent consumption trend between 2001 and 2017 and the healthy lifestyles associated with consuming a plant-based diet in the Spanish population.

METHODOLOGY

A representative Spanish sample was analysed (>15 years old) from the Spanish National Health Survey for years 2001 (n=8568), 2006 (n=25,649), 2011 (n=19,027) and 2017 (n=21,986). The population was classified as omnivore, vegetarian, or vegan. The lifestyle variables were physical activity, tobacco and alcohol consumption, and body mass index (BMI). The χ2 test was used to evaluate diet change between 2001 and 2017. T-Student and χ2 were used to compare lifestyles of omnivores and vegetarians/vegans. Logistic regression was used to analyse lifestyles associated with plant-based diets.

RESULTS

0.2% of the Spanish population followed a plant-based diet. Between plant-based diet consumers there was an increase in vegans vs. vegetarians between 2001 (9.5% vs. 90.5%) and 2017 (65.3% vs. 34.7%) (p=0.007). Compared to 2001, following a plant-based diet was more likely in 2006 (OR=2.08, p=0.004), 2011 (OR=1.89, p=0.02) and 2017 (OR=1.75, p=0.04). Those who consume alcohol (OR=0.65, p=0.008), who were overweight (OR=0.48, p<0.001) or who were obese (OR=0.40, p=0.001) were less likely to consume a plant-based diet.

CONCLUSIONS

Despite an increase in the consumption of plant-based diets between 2001 and 2017, there was a low prevalence of consumption in all years studied. There was a greater probability of consuming plant-based diets among the Spanish population with healthy behaviours. These findings could help design strategies focused on healthy nutritional behaviours.

Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials

AIMS

Due to growing environmental focus, plant-based diets are increasing steadily in popularity. Uncovering the effect on well-established risk factors for cardiovascular diseases, the leading cause of death worldwide, is thus highly relevant. Therefore, a systematic review and meta-analysis were conducted to estimate the effect of vegetarian and vegan diets on blood levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B.

METHODS AND RESULTS

Studies published between 1980 and October 2022 were searched for using PubMed, Embase, and references of previous reviews. Included studies were randomized controlled trials that quantified the effect of vegetarian or vegan diets vs. an omnivorous diet on blood lipids and lipoprotein levels in adults over 18 years. Estimates were calculated using a random-effects model. Thirty trials were included in the study. Compared with the omnivorous group, the plant-based diets reduced total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B levels with mean differences of -0.34 mmol/L (95% confidence interval, -0.44, -0.23; P = 1 × 10-9), -0.30 mmol/L (-0.40, -0.19; P = 4 × 10-8), and -12.92 mg/dL (-22.63, -3.20; P = 0.01), respectively. The effect sizes were similar across age, continent, duration of study, health status, intervention diet, intervention program, and study design. No significant difference was observed for triglyceride levels.

CONCLUSION

Vegetarian and vegan diets were associated with reduced concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-effects that were consistent across various study and participant characteristics. Plant-based diets have the potential to lessen the atherosclerotic burden from atherogenic lipoproteins and thereby reduce the risk of cardiovascular disease.

Could Gut Microbiota Composition Be a Useful Indicator of a Long-Term Dietary Pattern?

Despite the known effects of diet on gut microbiota composition, not many studies have evaluated the relationship between distinct dietary patterns and gut microbiota. The aim of our study was to determine whether gut microbiota composition could be a useful indicator of a long-term dietary pattern. We collected data from 89 subjects adhering to omnivorous, vegetarian, vegan, and low-carbohydrate, high-fat diet that were equally distributed between groups and homogenous by age, gender, and BMI. Gut microbiota composition was analyzed with a metabarcoding approach using V4 hypervariable region of the 16S rRNA gene. K-means clustering of gut microbiota at the genus level was performed and the nearest neighbor classifier was applied to predict microbiota clustering classes. Our results suggest that gut microbiota composition at the genus level is not a useful indicator of a subject's dietary pattern, with the exception of a vegan diet that is represented by a high abundance of Prevotella 9. Based on our model, a combination of 26 variables (anthropometric measurements, serum biomarkers, lifestyle factors, gastrointestinal symptoms, psychological factors, specific nutrients intake) is more important to predict an individual's microbiota composition cluster, with 91% accuracy, than the dietary intake alone. Our findings could serve to develop strategies to educate individuals about changes of some modifiable lifestyle factors, aiming to classify them into clusters with favorable health markers, independent of their dietary pattern.

Associations between measures of socio-economic position and sustainable dietary patterns in the NutriNet-Santé study

OBJECTIVE

We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns.

DESIGN

Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively.

SETTING

France.

PARTICIPANTS

29 119 NutriNet-Santé participants.

RESULTS

Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (βprimary v. postgraduate = -0·62, 95 % CI (-0·72, -0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (βmanual workers v. intermediate professionals = -0·43, 95 % CI (-0·52, -0·33) and βemployees v. intermediate professionals = -0·56, 95 % CI (-0·64, -0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status.

CONCLUSIONS

Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.

Physicians' views of patient-planetary health co-benefit prescribing: a mixed methods systematic review

Health professionals are increasingly called to become partners in planetary health. Using patient-planetary health (P-PH) co-benefit prescribing framing, we did a mixed methods systematic review to identify barriers and facilitators to adopting P-PH co-benefit prescribing by physicians and mapped these onto the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). We searched electronic databases from inception until October, 2022, and did a content analysis of the included articles (n=12). Relevant categories were matched to items in the COM-B model and TDF. Nine barriers and eight facilitators were identified. Barriers included an absence of, or little, knowledge of how to change practice and time to implement change; facilitators included having policy statements and guidelines from respected associations. More diverse study designs that include health professionals, patients, and health-care system stakeholders are needed to ensure a more holistic understanding of the individual, system, and policy levers involved in implementing clinical work informed by planetary health.

The effects of vegetarian diets on glycemia and lipid parameters in adult patients with overweight and obesity: a systematic review and meta-analysis

Several randomized controlled trials have reported the effects of vegetarian diets on blood lipids and glucose homeostasis in adults, but not in overweight or obese individuals. Thus, the purpose of this study was to evaluate the effects of vegetarian diets on blood lipids and glucose homeostasis in overweight or obese adults by systematic review and meta-analysis. We searched Medline, Embase, and the Cochrane Library through October 2021. We chose to include overweight or obese patients in the studies of the vegetarian diet for metabolic control. Seven trials with a total of 783 overweight or obese adult were included in the meta-analysis. The analysis of the data revealed that the vegetarian diets significantly reduced low-density lipoprotein cholesterol (LDL-C) (WMD, -0.31; 95% CI, -0.46 to -0.16), total cholesterol (TC) (WMD, -0.37; 95% CI, -0.52 to -0.22), and HbA1c (WMD (%), -0.33; 95% CI, -0.55 to -0.11). The vegetarian diets had an elevated effect on blood triglycerides (WMD, 0.29; 95% CI, 0.11-0.47). However, there were no significant effects of vegetarian diets on high-density lipoprotein cholesterol (HDLC), Fasting plasma glucose(FPG), and HOMA-IR in these individuals. The results of this study suggest that vegetarian diets effectively reduce LDL-C, TC, and HbA1c levels, thus functioning as a promising therapeutic strategy for improving the metabolic dysfunction in overweight or obese individuals. However, further large-scale clinical trials are required to confirm the validity of these findings.

Long-term adherence to healthful and unhealthful plant-based diets and breast cancer risk overall and by hormone receptor and histologic subtypes among postmenopausal females

BACKGROUND

Epidemiological studies assessing the influence of vegetarian diets on breast cancer (BC) risk have produced inconsistent results. Few studies have assessed how the incremental decrease in animal foods and the quality of plant foods are linked with BC.

OBJECTIVES

Disentangle the influence of plant-based diet quality on BC risk between postmenopausal females.

METHODS

Total of 65,574 participants from the E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) cohort were followed from 1993-2014. Incident BC cases were confirmed through pathological reports and classified into subtypes. Cumulative average scores for healthful (hPDI) and unhealthful (uPDI) plant-based diet indices were developed using self-reported dietary intakes at baseline (1993) and follow-up (2005) and divided into quintiles. Cox proportional hazards models were used to estimate adjusted HR and 95% CI.

RESULTS

During a mean follow-up of 21 y, 3968 incident postmenopausal BC cases were identified. There was a nonlinear association between adherence to hPDI and BC risk (Pnonlinear < 0.01). Compared to participants with low adherence to hPDI, those with high adherence had a lower BC risk [HRQ3 compared withQ1 (95% CI): 0.79 (0.71, 0.87) and HRQ4 compared with Q1 (95% CI): 0.78 (0.70, 0.86)]. In contrast, higher adherence to unhealthful was associated with a linear increase in BC risk [Pnonlinear = 0.18; HRQ5 compared with Q1 (95% CI): 1.20 (1.08, 1.33); Ptrend < 0.01]. Associations were similar according to BC subtypes (Pheterogeneity > 0.05 for all).

CONCLUSIONS

Long-term adherence to healthful plant foods with some intake of unhealthy plant and animal foods may reduce BC risk with an optimal risk reduction in the moderate intake range. Adherence to an unhealthful plant-based diet may increase BC risk. These results emphasize the importance of the quality of plant foods for cancer prevention. This trial was registered at clinicaltrials.gov (NCT03285230).

Meat substitutes: Resource demands and environmental footprints

The modern food system is characterized with high environmental impact, which is in many cases associated with increased rates of animal production and overconsumption. The adoption of alternatives to meat proteins (insects, plants, mycoprotein, microalgae, cultured meat, etc.) might potentially influence the environmental impact and human health in a positive or negative way but could also trigger indirect impacts with higher consumption rates. Current review provides a condensed analysis on potential environmental impacts, resource consumption rates and unintended trade-offs associated with integration of alternative proteins in complex global food system in the form of meat substitutes. We focus on emissions of greenhouse gases, land use, non-renewable energy use and water footprint highlighted for both ingredients used for meat substitutes and ready products. The benefits and limitations of meat substitution are highlighted in relation to a weight and protein content. The analysis of the recent research literature allowed us to define issues, that require the attention of future studies.

Dietary protein consumption profiles show contrasting impacts on environmental and health indicators

Patterns of protein intake are strong characteristics of diets, and protein sources have been linked to the environmental and nutrition/health impacts of diets. However, few studies have worked on protein profiles, and most of them have focused on specific diets like vegetarian or vegan diets. Furthermore, the description of the environmental impact of diets has often been limited to greenhouse gas emissions (GHGe) and land use. This paper analyzes the alignment of environmental pressures and nutritional impacts in a diversity of representative protein profiles of a western population. Using data from a representative survey in France (INCA3, n = 1125), we identified protein profiles using hierarchical ascendant classification on protein intake (g) from main protein sources (refined grains, whole grains, dairy, eggs, ruminant meat, poultry, pork, processed meat, fish, fruits & vegetables, pulses). We assessed their diet quality using 6 dietary scores, including assessment of long-term risk for health, and associated 14 environmental pressure indicators using the Agribalyse database completed by the SHARP database for GHGe. Five protein profiles were identified according to the high contributions of ruminant meat, pork, poultry, fish, or, conversely, as low contribution from meat. The profile including the lowest protein from meat had the lowest impact on almost all environmental indicators and had the lowest long-term risk. Conversely, the profile with high protein from ruminant-based foods had the highest pressures on most environmental indicators, including GHGe. We found that the protein profile with low contribution from meat has great potential for human health and environment preservation. Shifting a large part of the population toward this profile could be an easy first step toward building a more sustainable diet.

Nutritionally adequate and environmentally respectful diets are possible for different diet groups: an optimized study from the NutriNet-Santé cohort

BACKGROUND

Research has shown that vegetarian diets have a low environmental impact, but few studies have examined the environmental impacts and nutritional adequacy of these diets together, even though vegetarian diets can lead to nutritional issues.

OBJECTIVES

Our objective was to optimize and compare 6 types of diets with varying degrees of plant foods (lacto-, ovolacto-, and pescovegetarian diets and diets with low, medium, and high meat content) under nutritional constraints.

METHODS

Consumption data in 30,000 participants were derived from the French NutriNet-Santé cohort using an FFQ. Diets were optimized by a nonlinear algorithm minimizing the diet deviation while meeting multiple constraints at both the individual and population levels: nonincrease of the cost and environmental impacts (as partial ReCiPe accounting for greenhouse gas emissions, cumulative energy demand, and land occupation, distinguishing production methods: organic and conventional), under epidemiologic, nutritional (based on nutrient reference values), and acceptability (according to the diet type) constraints.

RESULTS

Optimized diets were successfully identified for each diet type, except that it was impossible to meet the EPA (20:5n-3) + DHA (22:6n-3) requirements in lacto- and ovolactovegetarians. In all cases, meat consumption was redistributed or reduced and the consumption of legumes (including soy-based products), whole grains, and vegetables were increased, whereas some food groups, such as potatoes, fruit juices, and alcoholic beverages, were entirely removed from the diets. The lower environmental impacts (as well as individual indicators) observed for vegetarians could be attained even when nutritional references were reached except for long-chain n-3 (omega-3) fatty acids.

CONCLUSIONS

A low-meat diet could be considered as a target for the general population in the context of sustainable transitions, although all diets tested can be overall nutritionally adequate (except for n-3 fatty acids) when planned appropriately.This trial was registered at clinicaltrials.gov as NCT03335644.

Knowledge of health professionals about vegetarian diets: integrative review

Objective: To assess studies on the knowledge of health professionals regarding vegetarian diets. Methods: This integrative review was conducted from November to December 2020 and updated in January 2022 in 5 databases and the gray literature. Two investigators performed the article selection. The inclusion criteria were scientific articles with any study design that addressed the intended topic with no date or language limitation. Results: Eleven studies were included. The main common finding was that health professionals, except dietitians, were not satisfied with the available nutritional information in general, not only regarding vegetarian diets. Despite this gap, half of the studies showed a positive view by professionals concerning the vegetarian diet.Conclusions: Many professionals do not feel confident about encouraging a vegetarian diet since they do not know the details of its benefits and risks.

Meeting report: plant-rich dietary patterns and health

Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.

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.

Knowledge and perceptions of food sustainability in a Spanish university population

In 2015, the United Nations adopted the 2030 Agenda for Sustainable Development, with 17 Sustainable Development Goals (SDGs) at its core. Besides tackling climate change and the fight to reduce inequality, the SDG number 12 is specifically focused to develop strategies toward food sustainability. The aim of this study, aligned with SDG number 12, was to analyze the level of knowledge and perceptions of food sustainability in a university community from Spain. A descriptive cross-sectional study, based on an online questionnaire, was carried out between July and November 2021 with convenience sampling. The survey included 28 items and was distributed among students, teachers, researchers and administrative staff from a Spanish university. A total of 1,220 participants completed the survey. 70.4% of the respondents heard about the environmental impact of food and more than 50% were aware of the existence of the SDGs. The different aspects related to diet that concerned them the most were food waste, plastic usage, and environmental impact. They reported that a sustainable diet should be mainly based on local and seasonal products and with a low environmental impact as well as no or the minimum food waste. When asked if they were following a sustainable diet, 77% answered affirmatively. Moreover, the food groups more involved in a sustainable diet should be vegetables and fruits, olive oil, legumes, and whole grains. Regarding food waste, 60% of the surveyed population claimed to generate it at home, with the use of leftovers and planning shopping and meals being some of the most important domestic actions to avoid it. Further initiatives must be implemented to increase the level of knowledge as well as to raise the awareness on the importance to translate it into individual and collective actions that allow a shift toward more sustainable practices.

Religious fasting and its impacts on individual, public, and planetary health: Fasting as a "religious health asset" for a healthier, more equitable, and sustainable society

Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism. Individual/clinical, public, global, and planetary health has traditionally been studied as separate entities. Nevertheless, religious fasting, in conjunction with other religious health assets, can provide several opportunities, ranging from the individual to the population, environmental, and planetary levels, by facilitating and supporting societal transformations and changes, such as the adoption of healthier, more equitable, and sustainable lifestyles, therein preserving the Earth's systems and addressing major interconnected, cascading, and compound challenges. In this review, we will summarize the most recent evidence on the effects of religious fasting, particularly Orthodox and Ramadan Islamic fasting, on human and public health. Further, we will explore the potential effects of religious fasting on tackling current environmental issues, with a special focus on nutrition/food restriction and planetary health. Finally, specific recommendations, particularly around dietary intake during the fasting rituals, will be provided to ensure a sustainable healthy planet.

A Global Analysis of National Dietary Guidelines on Plant-Based Diets and Substitutions for Animal-Based Foods

Discussing plant-based diets and substitutions for animal-based foods in food-based dietary guidelines (FBDGs) can be a key step in making dietary recommendations more sustainable and healthy as well as more inclusive. The existing large-scale evaluations of FBDGs do not assess whether and to what extent countries cover the broad spectrum of plant-based diets and have policy positions on vegetarian diets, including vegan diets, and whether they mention specific plant-based alternatives to milk, dairy products, and meat. The main aim of this state-of-the-art review was to determine whether and how FBDGs provide such information. An overall 95 guidelines and 100 corresponding countries were assessed via an exploratory sequential mixed method. This involved qualitative explorative content analysis of the guidelines, followed by hierarchical cluster analysis. Furthermore, the Balanced Food Choice Index (BFCI) was constructed, which measures the extent to which FBDGs provide recommendations that cover the broad spectrum of plant-based diets, with some or no animal-based products. To explore the correlations between FBDGs' recommendations and ecological and economic country characteristics, ordinary least squares regression was used. It was found that most countries do not provide information to their citizens that cover the broad spectrum of plant-based diets, as indicated by the mean score of the BFCI (33.58 of 100 points). A total of 38 guidelines (40%) contain a position on vegetarian diets. Nearly half (45%) of all FBDGs already mention plant-based alternatives to meat or animal milk. The regressions showed that the BFCI correlates positively with countries' ecological efforts and negatively with the importance of animal-based products in their economies. This study demonstrates considerable information insufficiency in current FBDGs worldwide. FBDGs should provide recommendations for the broad spectrum of plant-based diets and balance the ethical, ecological, religious, and economic aspects that play a role in people's food choice.

Protein Quality and Sensory Perception of Hamburgers Based on Quinoa, Lupin and Corn

The need for partial or total substitution of animal protein sources by vegetable sources of high protein quality with good sensory acceptance is a promising alternative. The objective was to develop a hamburger with vegetable protein using a mixture design based on quinoa (Chenopodium quinoa Willd.), Peruvian Andean corn (Zea mays) and Andean lupine (Lupinus mutabilis Sweet). The design of these mixtures allowed obtaining eleven formulations, three of which were selected for complying with the amino acid intake for adults recommended by FAO. Then, a completely randomized design was applied to the selected samples plus a commercial product. Proximal composition was measured on a dry basis (protein, fat, carbohydrates, and ash), calculation of the Protein Digestibility Corrected Amino Acid Score (PDCAAS) and a sensory analysis was carried out using the Check-All-That-Apply (CATA) method with acceptability in 132 regular consumers of vegetarian products. Protein, fat, carbohydrate, and ash contents ranged from 18.5–24.5, 4.1–7.5, 65.4–72.1 and 2.8–5.9%, respectively. The use of Andean crops favored the protein content and the contribution of sulfur amino acids (SAA) and tryptophan from quinoa and lysine and threonine from lupin. The samples with Andean crops were described as easy to cut, soft, good, healthy, legume flavor, tasty and light brown, however the commercial sample was characterized as difficult to cut, hard, dark brown, uneven color, dry and grainy. The sample with 50% quinoa and 50% lupin was the most acceptable and reached a digestibility of 0.92. It complied with the lysine, threonine, and tryptophan intake, with the exception of SAA, according to the essential amino acid pattern proposed by the Food and Agriculture Organization of the United Nations.

Utilizing Nutritional and Polyphenolic Compounds in Underutilized Plant Seeds for Health Application

Plants represent a significant part of the human diet. Humans have utilized every part of plants for survival, and seeds are no exception. Seeds offer high protein, unsaturated fats, fibre, essential vitamins, and minerals for various food applications. They are also a promising reservoir of bioactive compounds, where various phytochemicals, such as polyphenolic compounds, capable of maintaining and improving well-being, are present in abundant quantities. Plants from Malvaceae and Cannabaceae families are known for their fibre-rich stems that benefit humankind by serving numerous purposes. For many centuries they have been exploited extensively for various commercial and industrial uses. Their seeds, which are often regarded as a by-product of fibre processing, have been scientifically discovered to have an essential role in combating hypercholesterolemia, diabetes, cancer, and oxidative stress. Maximizing the use of these agricultural wastes can be a promising approach to creating a more sustainable world, in accordance with the concept of Sustainable Development Goals (SDGs).

Low-carbohydrate vegan diets in diabetes for weight loss and sustainability: a randomized controlled trial

BACKGROUND

Low-carbohydrate, high animal fat and protein diets have been promoted for weight loss and diabetes treatment. We therefore tested the effect of a low-carbohydrate vegan diet in diabetes as a potentially healthier and more ecologically sustainable low-carbohydrate option.

OBJECTIVES

We sought to compare the effectiveness of a low-carbohydrate vegan diet with a moderate-carbohydrate vegetarian diet on weight loss and metabolic measures in diabetes.

METHODS

One hundred and sixty-four male and female participants with type 2 diabetes were randomly assigned to advice on either a low-carbohydrate vegan diet, high in canola oil and plant proteins, or a vegetarian therapeutic diet, for 3 mo, with both diets recommended at 60% of calorie requirements. Body weight, fasting blood, blood pressure, and 7-d food records, to estimate potential greenhouse gas emissions, were obtained throughout the study with tests of cholesterol absorption undertaken at baseline and end of study on 50 participants.

RESULTS

Both low-carbohydrate vegan and vegetarian diets similarly but markedly reduced body weight (-5.9 kg; 95% CI: -6.5, -5.28 kg; and -5.23 kg; 95% CI: -5.84, -4.62 kg), glycated hemoglobin (-0.99%; 95% CI: -1.07, -0.9%; and -0.88%; 95% CI: -0.97, -0.8%), systolic blood pressure (-4 mmHg; 95% CI: -7, -2 mmHg; and -6 mmHg; 95% CI: -8, -3 mmHg), and potential greenhouse gas emissions, but only for potential greenhouse gas emissions was there a significant treatment difference of -0.63 kgCO2/d (95% CI: -0.99, -0.27 kgCO2/d) favoring the low-carbohydrate vegan diet.

CONCLUSIONS

Low-carbohydrate vegan and vegetarian diets reduced body weight, improved glycemic control and blood pressure, but the more plant-based diet had greater potential reduction in greenhouse gas emissions.Trial registration number: clinicaltrials.gov identifier NCT02245399.

The Influence of Framing Plant-Based Products in Terms of Their Health vs. Environmental Benefits: Interactions with Individual Wellbeing

Significant reductions in the consumption of meat and dairy products are required to limit environmental damage and meet climate targets. However, individuals choosing to adopt plant-based diets still form a minority. Whilst different types of message framings have been suggested to be a potential means of encouraging the uptake of plant-based diets, recent findings have often failed to document any differences in people's willingness to reduce their consumption of animal products based on whether messages emphasize the health or environmental benefits of plant-based diets. This research examined whether individual wellbeing might interact with health versus environmental message frames to determine people's liking and willingness to pay for plant-based products. Across two experiments with a university (Study 1) and a non-student, adult sample (Study 2), participants were exposed to different hypothetical labels for plant-based foods and asked to rate their liking and willingness to pay for each. In line with existing findings, results demonstrated a trend whereby showing health (versus environmental) information on food labels did not in itself influence participants perceptions of the food products. Higher levels of positive wellbeing were associated with greater liking and willingness to pay for the plant-based foods (B values ranging from 0.04 to 0.45). Further, there was an interaction effect whereby levels of negative affect were differentially linked to liking and willingness to pay across the health and environmental framing conditions (B values ranging from 0.03 to 0.38). In particular, negative affect appears to have a greater negative impact on the product liking and willingness to pay when environmental label framings are used. This effect was most pronounced for the product liking dependent variable (B = -0.29 in the environmental framing condition). This research therefore extends understandings of the more specific instances in which message framings can impact perceptions of plant-based foods. The implications of the findings for understanding how best to promote uptake of plant-based diets are discussed.

Prevalence of vegan/vegetarian diet and eating behavior among Saudi adults and its correlation with body mass index: A cross-sectional study

Background

Globalization has steered the spread of vegetarianism around the world. Vegetarianism has achieved increased acceptance by different populations.

Objective

The present study aims to assess vegetarian diet, and eating behavior prevalence among Saudi adults and their association with demographics and body mass index.

Method

A cross-sectional study conducted on 1,143 Saudi adults [418 (36.6%) males and 725 (63.4%) females]. An online survey questionnaire containing questions on demographics, type of diet, eating behavior and physical activity was provided to participants for self-administration. Statistical analysis was performed to associate demographic and eating behavior variables with the type of diet using Pearson's Chi-square test and Spearman's partial correlation test was used to correlate BMI and eating behavior.

Results

Prevalence of veganism was 4.7% (n = 54/1,143) and vegetarianism was 7.8% (89/1,143). A significantly higher prevalence of vegan diet was observed in females than males (79.6% vs. 20.4%, p < 0.0001). A significantly higher proportion of participants on vegetarian diet selected "Always" as response for eating breakfast, vegetables and fruits as well as for eating or drinking dairy foods, and for eating canned food than participants on non-vegetarian diet (p < 0.0001). A significantly higher proportion of participants on vegan diet selected 'Never' for eating fast-food and fried food as well as for drinking fizzy or soft drinks (p < 0.0001). A positive moderate correlation was found between BMI and eating fast-food and fried food [r(1, 140) = 0.529, p < 0.0001], drinking fizzy or soft drinks with meals [r(1, 140) = 0.495, p = 0.001], and eating canned food [r(1, 140) = 0.510, p < 0.0001].

Conclusion

Our study shows that vegan and vegetarian diet have gained access into the lifestyle of Saudi adults with a prevalence of 4.7 and 7.8%, respectively. Participants on vegetarian diet showed better lifestyle like higher physical activity level, higher consumption of fruits, vegetables, dairy products and low intake of fast-foods and fizzy beverages.

An overview of the interactions between food production and climate change

This paper provides an overview of how food production influences climate change and also illustrates the impact of climate change on food production. To perform such an overview, the (inter)link between different parts of the food supply chain continuum (agriculture production, livestock farming, food processing, food transport and storing, retail food, and disposal of food waste) and climate change has been investigated through a bibliometric analysis. Besides UN Sustainable Development Goal (SDG) 13, associated with climate change, other SDGs that are associated with this overview are goals #1, #2, #3, #6, #7, #12, and #15. Based on the evidence gathered, the paper provides some recommendations that may assist in efforts to reduce the climate-related impacts of food production.

Consumers' Attitude towards Sustainability in Italy: Process of Validation of a Duly Designed Questionnaire

This study aimed to describe the process of validation of a questionnaire assessing Italian consumers’ perception of food sustainability. The study has a multiphase design. Phase 1 consisted in translating and structuring the questionnaire. Phase 2 aimed at assessing the validity of the content by experts. Phase 3 consisted of a pilot study (n = 150) carried out to revise the questionnaire based on the reactions of consumers representing the target group of the assessment. The questionnaire showed adequate content validity for 11 out of 14 questions (>0.79) and S-CVI/Ave > 0.80. Cronbach’s alpha values ranged from 0.08 to 0.90. The construct with insufficient results (0.08) was changed because it failed to correlate with the rest of the questionnaire. The factor analysis permitted the identification of questions that needed improvement in terms of comprehensibility, elimination of redundancies, and repetitions. The validated questionnaire included 12 questions (71 response options); 3 sections were identified: food sustainability knowledge (4 questions-30 items); sources of proteins alternative to meat (3 questions-20 items); eating behaviors (5 questions-21 items). This study showed the importance of validation before the administration on a large scale of a questionnaire on a topic such as sustainability still lacking large support from consensus documents.