Perspective: The Public Health Case for Modernizing the Definition of Protein Quality

Redefining Protein Quality: Integrating Health Outcomes and Environmental Impacts in the Plant-Animal Protein Debate

There is an ongoing debate about the relative merits of plant-based versus animal-based protein sources in terms of human health outcomes and environmental impacts. This viewpoint article reviews and synthesizes the current evidence comparing plant and animal protein sources on measures of human health like cardiovascular disease, cancer, and mortality risk, as well as environmental factors like greenhouse gas emissions, water use, and land requirements. Overall, greater consumption of plant protein sources like legumes, nuts, seeds, and whole grains is associated with reduced risks of cardiovascular diseases, some cancers, and mortality, especially compared to red and processed meats. Crucially, these health benefits align with the dramatically lower environmental footprints of plant proteins across measures like emissions, water use, and land use. However, evidence is mixed for some health outcomes, and more research is still needed. While blanket recommendations should be avoided, the convergence of health and environmental advantages suggests future dietary guidance should emphasize shifting toward more plant-based protein sources. However, evaluations must consider specific foods rather than broad categorizations. New protein production methods like precision fermentation may also reduce environmental impacts while maintaining adequate nutrition.

A Plant-Based Food Guide Adapted for Low-Fat Diets: The VegPlate Low-Fat (VP_LF)

Strong evidence supports the paramount importance of the composition of the diet for health. Not only diet should provide nutritional adequacy, but some foods and dietary components can also support the management of common chronic diseases, with mechanisms independent of nutritional adequacy. Among the various intervention diets, low-fat vegan diets have been shown to be effective for cardiometabolic health, mainly influencing insulin resistance, adiposity, and blood lipids. This type of diet relies on reducing or eliminating all added fats and choosing low-fat foods, mainly unprocessed whole-plant foods. We hereby propose a tool for planning low-fat vegan diets, the VegPlate Low-Fat (VP_LF), which has been obtained from a specific adaptation of the VegPlate method, which was already presented in previous publications for adults and some life stages and situations. The reduction in fats in the diet, which ranges between 10% and 15% of total energy, and the varied inclusion of foods from plant groups make it easier to provide adequate amounts of all nutrients with a normal- or lower-calorie intake, in comparison with diets that do not limit fat intakes. We expect that this new proposal will help nutrition professionals embrace low-fat diets as a first-line intervention for individuals affected by different health conditions who can benefit from these diets.

Meal Protein Quality Score: A Novel Tool to Evaluate Protein Quantity and Quality of Meals

Background

The recent shift toward increased plant-based protein consumption has necessitated the development of new tools to evaluate the quality and quantity of protein in meals, especially given the changing dietary guidelines and the adoption of plant-centric menus in healthcare and other settings.

Objectives

To develop and test the feasibility of the meal protein quality score (MPQS), a novel metric that assesses the protein quality and quantity in meals based on essential amino acid (EAA) content, digestibility, and requirements, with a focus on optimizing protein intake for vulnerable populations, particularly older adults.

Methods

The MPQS integrates digestibility-adjusted EAA intake with total protein consumed in a meal, which, together with the EAA requirements, provides a score from 0 to 100 to reflect EAA coverage adequacy. The score was tested for feasibility by applying it to recipe data from real-life hospital meals and to dietary data from the [New Dietary Strategies Addressing the Specific Needs of Elderly Population for Healthy Aging in Europe] NU-AGE trial, involving detailed 7-d food records from 252 nonvegan participants analyzed over multiple meal moments.

Results

The analyses revealed that the higher the content of plant protein in a meal, the lower the meal protein quality. Also, breakfast meals scored lowest on protein quality, mainly due to low contents of protein overall, and of lysine and methionine. The MPQS effectively highlighted the difference in protein quality between plant-based and animal-based meals, and across different meal types.

Conclusions

The MPQS appears to be a practical tool that facilitates the assessment of meal-based protein quality. The MPQS can be used to guide dietary transitions toward plant-rich diets, ensuring that such shifts do not compromise protein adequacy for at-risk populations. The score allows for guidance in meal planning, leading to improvements in plant-rich meal formulation to meet both individual and public health nutritional needs.

Health Benefits of a Plant-Based Dietary Pattern and Implementation in Healthcare and Clinical Practice

The American College of Lifestyle Medicine recommends eating a predominantly plant-based diet with a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds. At any level, adoption of a plant-based diet can improve one's health through a variety of mechanisms. Increasing intake of plant-based foods often results in increases in fiber intake, decreases in saturated fat intake, and increased intake of essential vitamins and minerals, among other healthful benefits. Despite such potential benefits, many individuals are reluctant or resistant to change their usual dietary behaviors or unable to sustain diet changes over time. This is largely because an individual's decision to adopt a plant-based diet is influenced by a diverse array of motivating factors, priorities, and/or misconceptions about nutrient adequacy of plant-based diets. Here, we discuss key points from a session at the American College of Lifestyle Medicine's annual conference LM2023. Specifically, we review common preconceptions about plant-based diets, provide guidance on removing the barriers to adopting and adhering to plant-based diets, and highlight key literature findings supporting the health benefits of plant-based diets. Last, we discuss how plant-based diets are increasingly being implemented within health care and clinical practice to support Food is/as Medicine approaches.

Digestible indispensable amino acid score (DIAAS): 10 years on

The objective of the review is to revisit the findings of the 2011 Food and Agriculture Organization of the United Nations (FAO) Expert Consultation on Dietary Protein Quality Evaluation in Human Nutrition, and to report on progress on uptake of the findings. It is evident that since 2011 there has been a concerted research effort to enhance an understanding of the protein quality of foods. The validity of the growing pig ileal protein digestibility assay has been confirmed and numerous studies reported using the growing pig as a model to give true ileal amino acid digestibility values for foods as consumed by humans. This has allowed for the determination of digestible indispensable amino acid scores (DIAAS) for a range of foods. A new non-invasive true ileal amino acid digestibility assay in humans which can be applied in different physiological states, called the dual-isotope assay, has been developed and applied to determine the DIAAS values of foods. It is concluded that DIAAS is currently the most accurate score for routinely assessing the protein quality rating of single source proteins. In the future, the accuracy of DIAAS can be enhanced by improved information on: the ideal dietary amino acid balance including the ideal dispensable to indispensable amino acid ratio; dietary indispensable amino acid requirements; effects of processing on ileal amino acid digestibility and lysine bioavailability. There is a need to develop rapid, inexpensive in vitro digestibility assays. Conceptual issues relating DIAAS to food regulatory claims, and to holistic indices of food nutritional and health status are discussed. The first recommendation of the 2011 Consultation regarding treating each indispensable amino acid as an individual nutrient has received little attention. Consideration should be given to providing food label information on the digestible contents of specific indispensable amino acids.

Nutrient Composition of Four Dietary Patterns in Italy: Results from an Online Survey (the INVITA Study)

Though Italy is a native land of Mediterranean diet, its adherence in the Italian population is low, witnessed by the high rates of overweight in its inhabitants. Vegetarian dietary patterns (i.e., lacto-ovo-vegetarian and vegan) are increasing in western countries, and also in Italy, where 9.5% of the population self-declared as vegetarian in 2023. Though the vegetarian diet has been associated with beneficial health effects, speculation on its alleged nutrient inadequacy exists. For this reason, we assessed the nutrient composition of the diet of 470 participants enrolled in an online survey (the INVITA study), who completed a weighted food questionnaire on three different days. Participants were divided into four dietary groups obtained according to their self-declared dietary intakes: 116 Meat Eaters (MEs), 49 Fish Eaters (FEs), 116 Lacto-Ovo-Vegetarians (LOVs), and 189 VegaNs (VNs). The mean intake of most of the main nutrients was similar among all groups and within the normal range expected for the Italian population, supporting the adequacy of diets within our Italian sample, especially the LOV and VN diet. Since the Mediterranean diet is a plant-based diet, some of its components still persist in the current Italian diet, representing a staple also for people adopting a vegetarian diet.

The Need for an Alternative Health Claim Process for Foods Based on Both Nutrient and Contaminant Profiles

Most authorized health claims on foods have been established on the basis of single dietary components, mainly micronutrients, such as vitamins, minerals, and possibly bioactives. Failure to sufficiently define and characterize the nutritional profile of a food product is one of the main reasons for rejection or incomplete status for thousands of health claim applications, whereas the food's contaminant profile is simply not accounted for. The objective of this work was to highlight the accumulating scientific evidence supporting a reform of the health claim evaluation process for foods toward more holistic approaches. This would entail the characterization of multiple nutrient-contaminant pairs and contaminant mixture profiles at contaminant levels currently considered "safe," including their interactions that would impact human health outcome(s) in a net positive or negative direction. The notion of a stable nutritional profile in food commodities has been challenged by studies reporting a variable food contaminant content and a declining content of proteins/micronutrients in crops due to anthropogenic greenhouse gas emissions. A holistic approach in the health claim process for foods would entail the incorporation of cumulative risk assessment and/or risk-benefit protocols that effectively combine health risks and benefits associated with multiple nutritional and contaminant attributes of the food/diet under evaluation.

L-lysine dietary supplementation for childhood and adolescent growth: Promises and precautions

BACKGROUND

L-lysine (lysine) is an essential amino acid that plays a vital role in human nutrition. It serves as a key component in protein synthesis and fulfills critical roles in various physiological activities. For decades, lysine supplements have been extensively used to promote the growth and development of children, particularly in developing countries where cereal-based diets are everyday staples.

AIM OF THE REVIEW

This review aims to provide an overview of the overall effectiveness of lysine supplements concerning the growth of children and adolescents. Additionally, it addresses the potential precautions that should be considered when using lysine supplements in this context.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Receiving lysine oral supplements and lysine-fortified cereal diets were observed to enhance nitrogen retention and improve anthropometric measurements such as height, weight, Z-scores, body mass index, and skinfold thickness. Furthermore, lysine positively influenced the children's developmental quotient and various serological biochemical parameters, such as hormones, immunological indicators, proteins, bone metabolic indicators, and red blood cell parameters. These supplements are generally considered clinically safe, with no reported toxicity where the related side effects are limited to subjective gastrointestinal tract symptoms. It is essential to be cautious about excessive intake of lysine, as it can lead to an imbalance of amino acids, thereby potentially suppressing its intended benefits. When used with appropriate precautions, lysine can serve as a safe supplement with promising benefits for the growth of children and adolescents. Nevertheless, further contemporary research studies on lysine supplementation would be insightful and valuable in better understanding its optimal use, potential benefits, and safety in promoting growth.

Mycelium: A Nutrient-Dense Food To Help Address World Hunger, Promote Health, and Support a Regenerative Food System

There is a need for transformational innovation within the existing food system to achieve United Nations Sustainable Development Goal 2 of ending hunger within a sustainable agricultural system by 2030. Mycelium, the vegetative growth form of filamentous fungi, may represent a convergence of several features crucial for the development of food products that are nutritious, desirable, scalable, affordable, and environmentally sustainable. Mycelium has gained interest as technology advances demonstrate its ability to provide scalable biomass for food production delivering good flavor and quality protein, fiber, and essential micronutrients urgently needed to improve public health. We review the potential of mycelium as an environmentally sustainable food to address malnutrition and undernutrition, driven by food insecurity and caloric dense diets with less than optimal macro- and micronutrient density.

Environmental pressures and pesticide exposure associated with an increase in the share of plant-based foods in the diet

Diets rich in plant-based foods are encouraged for human health and to preserve resources and the environment but the nutritional quality and safety of such diets is debated. This study aimed to model nutritionally adequate diets with increasing plant food content and to characterise the derived diets using a multicriteria approach including, nutrients intake, environmental pressures and exposure to pesticides. Using data of the NutriNet-Santé cohort (N = 29,413), we implemented stepwise optimization models to identified maximum plant-food content under nutritional constraints. Environmental indicators at the production level were derived from the DIALECTE database, and exposure to pesticide residues from plant food consumption was estimated using a contamination database. Plant-based foods contributed to 64.3% (SD = 10.6%) of energy intake in observed diets and may reach up to 95% in modelled diets without jeopardizing nutritional status. Compared to the observed situation, an increase in plant-based foods in the diets led to increases in soy-based products (+ 480%), dried fruits (+ 370%), legumes (+ 317%), whole grains (+ 251%), oils (+ 144%) and vegetables (+ 93%). Animal products decreased progressively until total eviction, except for beef (- 98%). Dietary quality (estimated using the Diet Quality Index Based on the Probability of Adequate Nutrient Intake) was improved (up to 17%) as well as GHGe (up to - 65%), energy demand (up to - 48%), and land occupation (- 56%) for production. Exposures to pesticides from plant-based foods were increased by 100% conventional production and to a much lesser extent by 100% organic production. This study shows that shifting to nutritionally-adequate plant-based diets requires an in-depth rearrangement of food groups' consumption but allows a drastic reduction environmental impact. Increase exposure to pesticide residues and related risks can be mitigated by consuming foods produced with low pesticide input.

The nature of protein intake as a discriminating factor of diet sustainability: a multi-criteria approach

Animal production is responsible for 56-58% of the GHG emissions and limiting meat consumption would strongly contribute to reducing human health risks in Western countries. This study aimed to investigate the nature of protein intake as a discriminating factor for diets' sustainability. Using data from 29,210 French adults involved in the NutriNet-Santé cohort, we identified clusters according to 23 protein sources. A multicriteria (environmental, economic, nutritional and health) sustainability analysis was then conducted on the identified clusters. The economic analysis focused on both food and protein expenditure structures, using a budget coefficient approach. Relative values of clusters compared to the whole sample were calculated. We identified five clusters: milk-based, meat-based, fast food-based, healthy-fish-based, and healthy-plant-based. We found that the healthy-plant-based and healthy-fish-based clusters were the most sustainable, conciliating the compromise between human health (0.25 and 0.53 respectively for the Health Risk Score) and the protection of the environment (- 62% and - 19% respectively for the pReCiPe indicator). Conversely, the highest environmental impacts (+ 33% for the pReCiPe indicator) and the highest health risk (0.95 for the HRS) were observed for the meat-based cluster, which was associated with the lowest nutritional scores (- 61% for the PNNS-GS2 score). The economic analysis showed that the healthy-plant-based cluster was the one with the highest food budget coefficient (+ 46%), followed by the healthy-fish-based cluster (+ 8%), partly explained by a strong share of organic food in the diet. However, the meat-based cluster spent more of their food budget on their protein intake (+ 13%), while the healthy-plant-based cluster exhibited the lowest expenditure for this intake (- 41%). Our results demonstrate that the nature of protein intake is a discriminating factor in diet sustainability. Also, reducing animal protein consumption would generate co-benefits beyond environmental impacts, by being favorable for health, while reducing the monetary cost associated with protein intake.

A Translational Approach to Increase Pulse Intake and Promote Public Health through Developing an Extension Bean Toolkit

Practical, affordable solutions need to be implemented to address global challenges confronting human and environmental health. Despite a myriad of benefits for people and the planet, beans and other pulses (e.g., chickpeas, cowpeas, dry peas, lentils) are under-consumed. To better understand consumer concerns and interests, a Food Habits Survey was conducted and the findings were incorporated into the Colorado State University Extension Bean Toolkit. Guided by the Information-Motivation-Behavioral Skills model, the toolkit included informational social media posts, cooking guidance, and an online class. A convenience sample of participants was recruited through Extension and university networks. After class participation, significant gains in knowledge of pulse nutrition, versatility, and cooking were observed, with an average increase of 1.5 points on a 5-point Likert scale (p < 0.001). Moreover, participants (n = 86) perceived a greater importance of motivators (e.g., nutrition, versatility, environmental benefits) and found barriers (e.g., flatulence, long cooking times, unfamiliarity) to be less discouraging. Most participants reported an intention to eat more pulses, and among those who completed the 1-month follow-up survey, pulse intake frequency increased (p = 0.004). Emphasizing motivating factors while simultaneously mitigating barriers to consumption can help reverse insufficient intake and promote healthy behavior change. Leveraging Extension or similar networks is one way to adopt a translational approach to better reach the public with this information.

Macronutrient quality and the incidence of metabolically unhealthy phenotypes in adults with normal weight and overweight/obesity

OBJECTIVE

We aimed to investigate the associations of macronutrient quality indices with the incident metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUO) phenotypes.

METHODS

This prospective study included 512 metabolically healthy normal weight and 787 metabolically healthy overweight/obese adults from the third study examination of the Tehran Lipid and Glucose Study. The participants were followed through the sixth study examination. Diet was measured with a food frequency questionnaire. The macronutrient quality index (MQI), carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate quality index (HPPQI) were calculated. Hazard ratio (HR) and 95 % confidence interval (95 % CI) were estimated for incident unhealthy phenotypes using Cox regression.

RESULTS

After controlling all possible confounding factors, a one-point higher HPPQI was linked to a 28 % lower risk of MUNW (HR = 0.72; 95 % CI = 0.59, 0.87). Compared to the lowest quartile, the incident MUNW was also lower in the two last quartiles of the HPPQI. A one-unit increase in MQI was associated with a 5 % lower incident MUO (HR = 0.95; 95 % CI = 0.92, 0.99). The incident MUO was also higher for the highest compared to the lowest MQI quartile. In quartiles 2-4 of the HPPQI, incident MUO was lower with respective HRs (95 % CI) of 0.71 (0.54, 0.93), 0.60 (0.45, 0.80), and 0.66 (0.50, 0.86) in the fully-adjusted model.

CONCLUSIONS

A higher overall macronutrient quality was independently associated with a lower incident MUO. A higher dietary protein quality was related to a lower risk for MUNW and MUO.

A Comprehensive Analysis of the Nutritional Composition of Plant-Based Drinks and Yogurt Alternatives in Europe

Concerns for human and planetary health have led to a shift towards healthier plant-based diets. Plant-based dairy alternatives (PBDA) have experienced exponential market growth due to their lower environmental impact compared to dairy products. However, questions have arisen regarding their suitability as dairy substitutes and their role in food-based dietary guidelines (FBDG). Our study aimed to analyse the nutritional profiles of leading PBDA across Europe and compare them with their dairy counterparts. We examined the nutritional profiles of 309 unflavoured PBDA representing the European market leaders, including 249 plant-based drinks (PBD) and 52 plant-based alternatives to yogurt (PBAY). PBD and PBAY, excluding coconut varieties, were low in saturated fat (<1 g per serving). Seventy percent of PBDA were unsweetened, and most had sugar levels comparable to dairy. Except for soya varieties, PBDA protein levels were lower than dairy. Organic PBDA lacked micronutrients due to legal restrictions on fortification. Among non-organic PBDA, 76% were fortified with calcium, 66% with vitamin D, and 60% with vitamin B12. Less than half were fortified with vitamin B2, and a few with iodine (11%) and vitamin A (6%). PBAY were less frequently fortified compared to PBD. PBDA displayed a favourable macronutrient profile despite lower protein levels, which would be compensated for by other protein-dense foods in a usual mixed diet. Enhancing fortification consistency with dairy-associated micronutrients would address concerns regarding PBDA's integration into FBDG. Our analysis supports the inclusion of fortified PBDA in environmentally sustainable FBDG for healthy populations.

Effect of prehabilitation-related DIETary protein intake on Quality of Recovery after elective cardiac surgery (DIETQoR) study: protocol of a randomised controlled trial

INTRODUCTION

Protein malnutrition is associated with higher risks of postoperative complications, mortality, prolonged postoperative stays in hospital, slower physical and mental recovery after surgery and lower subsequent health-related quality of life. To reduce the risk of postoperative morbidity and mortality, nutritional prehabilitation programmes have been developed recently to build up patient's nutritional reserve to withstand the stress of surgery. The intervention involves nutritional screening and counselling, and increasing dietary protein intake in protein-malnourished patients in the several weeks before surgery. However, there are few well-conducted preoperative studies to examine the effect of increasing dietary protein intake on the quality of recovery of malnourished patients after elective cardiac surgery.

METHOD AND ANALYSIS

This randomised controlled trial of malnourished patients undergoing major elective cardiac surgery will compare the quality of postoperative recovery in patients with or without nutritional prehabilitation. One hundred and thirty-two patients will be randomised to receive nutritional prehabilitation (target-adjusted whey protein powder supplementation and an individualised 1 hour session/week counselling by a dietician 1 month before operation date) or standard care (no nutritional prehabilitation). Primary outcomes will be the quality of recovery after surgery (15-item Quality of Recovery) on the third postoperative day. Secondary outcomes will include days (alive and) at home within 30 days, changes in the WHO Disability Assessment Schedule 2.0, changes in health-related quality of life (EQ-5D) and Cardiac Postoperative Morbidity Survey. An outcomes assessor will be blinded to the treatment allocation. Appropriate univariate analyses, generalised estimating equations and multiple regressions will be performed for intention-to-treat and per-protocol analyses.

ETHICS AND DISSEMINATION

The Joint CUHK-NTEC Clinical Research Ethics Committee approved the study protocol (CREC Ref. No.: 2021.703 T). The findings will be presented at scientific meetings, peer-reviewed journals and to study participants.

TRIAL REGISTRATION NUMBER

ChiCTR2200057463.

A comprehensive review on infant formula: nutritional and functional constituents, recent trends in processing and its impact on infants' gut microbiota

Human milk is considered the most valuable form of nutrition for infants for their growth, development and function. So far, there are still some cases where feeding human milk is not feasible. As a result, the market for infant formula is widely increasing, and formula feeding become an alternative or substitute for breastfeeding. The nutritional value of the formula can be improved by adding functional bioactive compounds like probiotics, prebiotics, human milk oligosaccharides, vitamins, minerals, taurine, inositol, osteopontin, lactoferrin, gangliosides, carnitine etc. For processing of infant formula, diverse thermal and non-thermal technologies have been employed. Infant formula can be either in powdered form, which requires reconstitution with water or in ready-to-feed liquid form, among which powder form is readily available, shelf-stable and vastly marketed. Infants' gut microbiota is a complex ecosystem and the nutrient composition of infant formula is recognized to have a lasting effect on it. Likewise, the gut microbiota establishment closely parallels with host immune development and growth. Therefore, it must be contemplated as an important factor for consideration while developing formulas. In this review, we have focused on the formulation and manufacturing of safe and nutritious infant formula equivalent to human milk or aligning with the infant's needs and its ultimate impact on infants' gut microbiota.

Plant to animal protein ratio in the diet: nutrient adequacy, long-term health and environmental pressure

Background

Animal and plant protein sources have contrasting relationships with nutrient adequacy and long-term health, and their adequate ratio is highly debated.

Objective

We aimed to explore how the percentage of plant protein in the diet (%PP) relates to nutrient adequacy and long-term health but also to environmental pressures, to determine the adequate and potentially optimal %PP values.

Methods

Observed diets were extracted from the dietary intakes of French adults (INCA3, n = 1,125). Using reference values for nutrients and disease burden risks for foods, we modeled diets with graded %PP values that simultaneously ensure nutrient adequacy, minimize long-term health risks and preserve at best dietary habits. This multi-criteria diet optimization was conducted in a hierarchical manner, giving priority to long-term health over diet proximity, under the constraints of ensuring nutrient adequacy and food cultural acceptability. We explored the tensions between objectives and identified the most critical nutrients and influential constraints by sensitivity analysis. Finally, environmental pressures related to the modeled diets were estimated using the AGRIBALYSE database.

Results

We find that nutrient-adequate diets must fall within the ~15-80% %PP range, a slightly wider range being nevertheless identifiable by waiving the food acceptability constraints. Fully healthy diets, also achieving the minimum-risk exposure levels for both unhealthy and healthy foods, must fall within the 25-70% %PP range. All of these healthy diets were very distant from current typical diet. Those with higher %PP had lower environmental impacts, notably on climate change and land use, while being as far from current diet.

Conclusion

There is no single optimal %PP value when considering only nutrition and health, but high %PP diets are more sustainable. For %PP > 80%, nutrient fortification/supplementation and/or new foods are required.

Believe It or 'Nut': Why It Is Time to Set the Record Straight on Nut Protein Quality: Pistachio (Pistacia vera L.) Focus

There are growing public health movements to transition towards diets that are plant-based. However, confusion exists with concerns that plant-based proteins (including nuts) may be inferior with respect to protein quality. The present publication evaluates the evolution of protein quality concepts and explains the protein science related to pistachios. Pistachio nuts are a plant-based complete protein providing all nine EAAs in addition to an array of nutrients and phytochemicals. They have a PDCAAS of 73 and 81%, (raw and roasted pistachios, respectively), higher than that of many other tree nuts. From an environmental perspective transitioning towards plant-based diets (including nuts) could have potential to reduce total/green water footprints. Dietary guidelines are evolving yet nuts such as pistachios do not always have a clear place within these. Now appears to be a pertinent time to look at protein quality from the perspective of whole daily diets and dietary patterns, factoring in both health and environmental outcomes. Given updated modes of thinking, nuts such as pistachios have an important role to play in terms of providing ready-to-eat, good-quality, plant-based protein within daily diets.

Friend or Foe? The Role of Animal-Source Foods in Healthy and Environmentally Sustainable Diets

Scientific and political discussions around the role of animal-source foods (ASFs) in healthy and environmentally sustainable diets are often polarizing. To bring clarity to this important topic, we critically reviewed the evidence on the health and environmental benefits and risks of ASFs, focusing on primary trade-offs and tensions, and summarized the evidence on alternative proteins and protein-rich foods. ASFs are rich in bioavailable nutrients commonly lacking globally and can make important contributions to food and nutrition security. Many populations in Sub-Saharan Africa and South Asia could benefit from increased consumption of ASFs through improved nutrient intakes and reduced undernutrition. Where consumption is high, processed meat should be limited, and red meat and saturated fat should be moderated to lower noncommunicable disease risk-this could also have cobenefits for environmental sustainability. ASF production generally has a large environmental impact; yet, when produced at the appropriate scale and in accordance with local ecosystems and contexts, ASFs can play an important role in circular and diverse agroecosystems that, in certain circumstances, can help restore biodiversity and degraded land and mitigate greenhouse gas emissions from food production. The amount and type of ASF that is healthy and environmentally sustainable will depend on the local context and health priorities and will change over time as populations develop, nutritional concerns evolve, and alternative foods from new technologies become more available and acceptable. Efforts by governments and civil society organizations to increase or decrease ASF consumption should be considered in light of the nutritional and environmental needs and risks in the local context and, importantly, integrally involve the local stakeholders impacted by any changes. Policies, programs, and incentives are needed to ensure best practices in production, curb excess consumption where high, and sustainably increase consumption where low.

Food for our future: the nutritional science behind the sustainable fungal protein - mycoprotein. A symposium review

Mycoprotein is a well-established and sustainably produced, protein-rich, high-fibre, whole food source derived from the fermentation of fungus. The present publication is based on a symposium held during the Nutrition Society Summer Conference 2022 in Sheffield that explored 'Food for our Future: The Science Behind Sustainable Fungal Proteins'. A growing body of science links mycoprotein consumption with muscle/myofibrillar protein synthesis and improved cardiometabolic (principally lipid) markers. As described at this event, given the accumulating health and sustainability credentials of mycoprotein, there is great scope for fungal-derived mycoprotein to sit more prominently within future, updated food-based dietary guidelines.

Association between a new dietary protein quality index and micronutrient intake adequacy: a cross-sectional study in a young adult Spanish Mediterranean cohort

PURPOSE

There is no evidence of a dietary index that measures not only the quantity but also the quality of protein. The aim is to investigate the association between a new dietary protein quality index (PQI) and micronutrient intake adequacy in a Mediterranean cohort.

DESIGN

We assessed 17,535 participants' diet at baseline using a semi-quantitative FFQ. The PQI was calculated according to the ratio of protein (g/d) sources: [fish, seafood, lean meat, pulses, eggs, nuts, low-fat dairy, and whole grains]/[red and ultra-processed meats, whole-fat or semi-skimmed dairy, potatoes and refined grains]. Participants were classified into quintiles of PQI. We evaluated the intakes of Fe, Cr, I, K, Mg, Ca, P, Na, Se, Zn and vitamins A, B1, B2, B3, B6, B12, C, E and folic acid. Micronutrient adequacy was evaluated using DRIs. Logistic regression analysis was used to assess the micronutrient adequacy according to quintiles of PQI.

RESULTS

In this cross-sectional analysis, a total of 24.2% and 4.3% participants did not to meet DRIs in ≥ 4 and ≥ 8 micronutrients, respectively. The odds of failing to meet ≥ 4 and ≥ 8 DRI were lower in participants in the highest quintile of protein quality (OR = 0.22; IC 95% = 0.18, 0.26; P-trend < 0.001; and OR = 0.08; IC 95% = 0.05, 0.14; P-trend < 0.001, respectively) as compared to participants in the lowest quintile.

CONCLUSION

Higher PQI was found to be strongly associated with better micronutrient intake adequacy in this Mediterranean cohort. The promotion of high-quality protein intake may be helpful for a more adequate intake of micronutrients. The odds of failing to meet certain numbers of DRIs were lower rather than saying lower risk.

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.

Highly adsorptive protein inorganic nanohybrid of Moringa seeds protein and rice husk nanosilica for effective adsorption of pharmaceutical contaminants

The present study aims to investigate adsorption characteristics and mechanisms of Moringa (MO) seeds protein on nanosilica rice husk and their applications in removal of pharmaceutical residues including the fluoroquinolone antibiotic levofloxacin (LFX) and the nonsteroidal anti-inflammatory drug diclofenac (DCF) in aquatic environment. Molecular weight of MO protein was determined by gel-permeation chromatography (GPC) method while its amino acids were quantified by high performance liquid chromatography (HPLC). The number-(M_n) and weight-average molecular weights (M_w) of MO protein were 1.53 × 10⁴ and 1.61 × 10⁴ g/mol, respectively. Different effective conditions on adsorption protein on nanosilica including contact time, pH, adsorbent dosage, and ionic strength were systematically optimized and found to be 180 min, 10, 10 mg/mL and 1 mM KCl, respectively. The surface charge change by zeta potential, surface modification by Fourier-transform infrared spectroscopy (FT-IR) and adsorption isotherms demonstrated that protein adsorption on nanosilica was governed by both electrostatic and non-electrostatic interactions. Application of protein functionalized nanosilica (ProFNS) in LFX and DCF removal were also thoroughly studied. The selected conditions for LFX and DCF removal using ProFNS were 1 mM KCl for both LFX and DCF; pH 8 and pH 6; contact time 90 and 120 min, and adsorption dosage 10 and 5 mg/ml for LFX and DCF, respectively. Adsorption isotherms of protein on nanosilica as well as LFX and DCF onto ProFNS at different ionic strengths were reasonably fitted by the two-step model while a pseudo-second-order model could fit adsorption kinetic well. The removal of LFX and DCF using ProFNS significantly increased from 51.51% to 87.35%, and 7.97%-50.02%, respectively. High adsorption capacities of 75.75 mg/g for LFX and 59.52 mg/g for DCF, indicate that ProFNS is a great performance for pharmaceutical residues removal in water environment.

Faba Bean: An Untapped Source of Quality Plant Proteins and Bioactives

Faba beans are emerging as sustainable quality plant protein sources, with the potential to help meet the growing global demand for more nutritious and healthy foods. The faba bean, in addition to its high protein content and well-balanced amino acid profile, contains bioactive constituents with health-enhancing properties, including bioactive peptides, phenolic compounds, GABA, and L-DOPA. Faba bean peptides released after gastrointestinal digestion have shown antioxidant, antidiabetic, antihypertensive, cholesterol-lowering, and anti-inflammatory effects, indicating a strong potential for this legume crop to be used as a functional food to help face the increasing incidences of non-communicable diseases. This paper provides a comprehensive review of the current body of knowledge on the nutritional and biofunctional qualities of faba beans, with a particular focus on protein-derived bioactive peptides and how they are affected by food processing. It further covers the adverse health effects of faba beans associated with the presence of anti-nutrients and potential allergens, and it outlines research gaps and needs.

Food-Based Dietary Guidelines and Protein Quality Definitions—Time to Move Forward and Encompass Mycoprotein?

Food-Based Dietary Guidelines (FBDG) lack uniformity globally, with the integration of protein food sources being highly variable. Protein guidance tends to be dichotomous, e.g., animal versus plant with other categories such as fungal proteins being overlooked. In 2019 the EAT Lancet Food in the Anthropocene report was a chief driver questioning the need to supply healthy diets from sustainable food systems. Some countries are developing FBDG that integrate these aspects, but these are quite often protracted, too subtle or misaligned with other countries, diluting the effects of meaningful global change. Protein quality metrics also underpin the dissemination of dietary guidance. However, for protein, these remain based on a food’s essential amino acid profile and digestibility scores, thus are nutritionally and physiologically centric. It has been proposed that this definition is becoming increasingly myopic from a wider societal perspective. Updated indices should include contemporary issues such as protein diversity and environmental outcomes. Taken together, there is opportunity for renewed thinking about both FBDG and protein quality definitions, with scope to include both health and environmental outcomes and need to move towards the concept of protein diversification.

Real ileal amino acid digestibility of pea protein compared to casein in healthy humans: a randomized trial

BACKGROUND

It is necessary to propose plant alternatives to animal proteins that are of good nutritional quality. Pea is a good candidate owing to its high protein content and its well-balanced amino acid (AA) profile.

OBJECTIVES

This study aimed to assess the real ileal AA and nitrogen digestibility (RIDAA and RIDN) of pea protein isolate as compared to milk casein in humans. It also aimed to evaluate their nutritional quality through calculation of the digestible indispensable amino acid score (DIAAS) and to determine the net postprandial protein utilization (NPPU).

METHODS

Fifteen healthy volunteers were included in a randomized, single-blinded, 2-arm, parallel-design trial. They were equipped with a naso-ileal tube. They ingested the test meals, which consisted of 9 successive portions of mashed potatoes containing either pea protein or casein, intrinsically labeled with nitrogen 15. Ileal content, plasma, and urine samples were collected regularly over an 8-h postprandial period.

RESULTS

The mean RIDAA values were 93.6% ± 2.9% for pea protein and 96.8% ± 1.0% for casein, with no difference between the sources (P = 0.22). Leucine, valine, lysine, and phenylalanine were significantly less digestible in pea than in casein. The RIDN values were 92.0% ± 2.7% and 94.0% ± 1.7% for pea protein and casein, respectively, and were not different (P = 0.11). The DIAAS was 1.00 for pea protein and 1.45 for casein. The NPPU was 71.6% ± 6.2% and 71.2% ± 4.9% for pea protein and casein, respectively (P = 0.88).

CONCLUSIONS

Although some AAs are less digestible in pea protein than in casein, the real ileal digestibility and the NPPU were not different. The DIAAS of 1.00 obtained for pea protein demonstrated its ability to meet all AA requirements. This study shows the potential of pea isolate as a high-quality protein. This study was registered at clinicaltrials.gov as NCT04072770.

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

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

Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report

Carbohydrate-containing crops provide the bulk of dietary energy worldwide. In addition to their various carbohydrate forms (sugars, starches, fibers) and ratios, these foods may also contain varying amounts and combinations of proteins, fats, vitamins, minerals, phytochemicals, prebiotics, and anti-nutritional factors that may impact diet quality and health. Currently, there is no standardized or unified way to assess the quality of carbohydrate foods for the overall purpose of improving diet quality and health outcomes, creating an urgent need for the development of metrics and tools to better define and classify high-quality carbohydrate foods. The present report is based on a series of expert panel meetings and a scoping review of the literature focused on carbohydrate quality indicators and metrics produced over the last 10 years. The report outlines various approaches to assessing food quality, and proposes next steps and principles for developing improved metrics for assessing carbohydrate food quality. The expert panel concluded that a composite metric based on nutrient profiling methods featuring inputs such as carbohydrate–fiber–sugar ratios, micronutrients, and/or food group classification could provide useful and informative measures for guiding researchers, policymakers, industry, and consumers towards a better understanding of carbohydrate food quality and overall healthier diets. The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans.

Legume dreams: The contested futures of sustainable plant-based food systems in Europe

With the intensification of agriculture, the simplification of crop rotations, and the rise in demand for meat, dairy and cereal products, legume production and consumption are at an historic low in Europe. But as the environmental consequences of agriculture (biodiversity loss, high greenhouse gas emissions, water pollution) and the health outcomes of modern diets (heart disease, cancer, diabetes, obesity) become better known, so great and varied hopes are being expressed about the future role of legumes in the food system. This paper catalogues and scrutinises these hopes, mapping the promissory narratives now orbiting around legumes. It identifies six food futures, each of which is made possible through the greater use of legumes in various production, processing, marketing and consumption contexts. These promissory narratives are theorised as contrasting responses to three major areas of contestation in the food systems literature. Namely i) the sustainability of livestock management, ii) the role of technology in different visions of the 'good diet', and iii) the merits of different models for how to make agricultural management more sustainable. It identifies the promiscuity of legumes - in terms of the range of food futures they permit - before distilling three points of consensus amongst advocates of the potential of legumes. These points of consensus relate to their nitrogen fixing capacity, their high protein content, and their long-standing historical role in the context of European food and farming. This map of legume dreams serves to guide deliberations amongst researchers, policymakers and industry stakeholders about the futures of plant-based food in Europe.

Sustainable Diets for Cardiovascular Disease Prevention and Management

PURPOSE OF REVIEW

Healthy dietary patterns are recommended for prevention of cardiovascular disease, which remains the leading cause of morbidity and mortality globally. In this review, we discuss dietary patterns that are not only optimal for CVD prevention and management but also sustainable in maximizing health, environmental, and economic benefits.

RECENT FINDINGS

The growing literature on sustainable diets in the context of environmental sustainability includes subtopics of climate change, land use, biodiversity loss, freshwater use, and reactive nitrogen emissions. Similarly, economic sustainability, beyond the retail cost of food, extends to healthcare costs and the economic costs of environmental destruction related to current agricultural practices and food choices. Dietary patterns that are high in plant foods and low in animal foods could maximize health, environmental, and economic benefits; however, questions remain about how to best promote these patterns to achieve wider adoption in an environmentally and economically sustainable way.

Perspective: Defining Carbohydrate Quality for Human Health and Environmental Sustainability

Plant foods are universally promoted for their links to improved human health, yet carbohydrate-containing foods are often maligned based on isolated, reductionist methods that fail to assess carbohydrate foods as a matrix of nutrients and food components. Currently accepted positive carbohydrate quality indices include plant food, whole-grain content, and dietary fiber, while negative health outcomes are linked to high intakes of added sugar and high glycemic index. More recently, negative health aspects have been linked to ultra-processed foods, which are often high in carbohydrates. Yet, carbohydrate staples such as grains and dairy products are both enriched and fortified, resulting in these carbohydrate foods containing important nutrients of concern such as dietary fiber, potassium, vitamin D, and calcium. This Perspective analyzes carbohydrate metrics used in dietary guidance and labeling and finds limitations in accepted indices included in standardized quality carbohydrate definitions and also proposes additional indices to benefit both human and environmental health. As nutrition recommendations shift away from a single-nutrient focus to a more holistic dietary pattern approach that is flexible and adaptable for each individual, it is necessary to determine the quality components that make up these patterns. This review concludes that current approaches that demonize staple carbohydrate foods do little to promote the recommended patterns of foods known to improve health status and reduce disease risk.

Viewpoint: Agri-nutrition research: Revisiting the contribution of maize and wheat to human nutrition and health

Research linking agriculture and nutrition has evolved since the mid-20th century. The current focus is on child-stunting, dietary diversity and 'nutrient-rich' foods in recognition of the growing burdens of malnutrition and non-communicable diseases. This article concerns the global dietary and health contribution of major cereals, specifically maize and wheat, which are often considered not to be 'nutrient-rich' foods. Nevertheless, these cereals are major sources of dietary energy, of essential proteins and micronutrients, and diverse non-nutrient bioactive food components. Research on bioactives, and dietary fibre in particular, is somewhat 'siloed', with little attention paid by the agri-nutrition research community to the role of cereal bioactives in healthy diets, and the adverse health effects often arising through processing and manufacturing of cereals-based food products. We argue that the research agenda should embrace the whole nutritional contribution of the multiple dietary components of cereals towards addressing the triple burden of undernutrition, micronutrient malnutrition, overweight/obesity and non-communicable diseases. Agri-nutrition and development communities need to adopt a multidisciplinary and food systems research approach from farm to metabolism. Agriculture researchers should collaborate with other food systems stakeholders on nutrition-related challenges in cereal production, processing and manufacturing, and food waste and losses. Cereal and food scientists should also collaborate with social scientists to better understand the impacts on diets of the political economy of the food industry, and the diverse factors which influence local and global dietary transitions, consumer behavioural choices, dietary change, and the assessment and acceptance of novel and nutritious cereal-based products.

Macronutrient Quality and All-Cause Mortality in the SUN Cohort

No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3-14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59-1.06; Ptrend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45-0.90; Ptrend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.

Protein Intake and Human Health: Implications of Units of Protein Intake

Understanding the health effects of protein intake is bedeviled by a number of factors, including protein quality and source. In addition, different units, including grams, grams per kilogram body weight (g/kg BW), and percent energy, may contribute to confusion about protein's effects on health, especially BW-based units in increasingly obese populations. We aimed to review the literature and to conduct a modeling demonstration of various units of protein intake in relation to markers of cardiometabolic health. Data from the Framingham Heart Study Offspring (n = 1847; 60.3 y; 62.5% women) and Third Generation (n = 2548; 46.2 y; 55.3% women) cohorts and the NHANES 2003-04 (n = 1625; 46.2 y; 49.7% women) and 2005-06 (n = 1347; 43.7 y; 49.5% women) cycles were used to model cross-sectional associations between 7 protein units (grams, percent energy, g/kg ideal BW, g/kg actual BW, BW-adjusted g/kg actual BW, g/kg lean BW, and g/kg fat-free BW) and 9 cardiometabolic outcomes (fasting glucose, systolic and diastolic blood pressure, total and HDL cholesterol, triglycerides, BMI, waist circumference, and estimated glomerular filtration rate). The literature review indicated the use of myriad units of protein intake, with differential results on cardiometabolic outcomes. The modeling demonstration showed units expressed in BW were confounded by BW, irrespective of outcome. Units expressed in grams, percent energy, and ideal BW showed similar results, with or without adjustment for body size. After adjusting for BW, results of units expressed in BW aligned with results of grams, percent energy, and ideal BW. In conclusion, protein intake in cardiometabolic health appears to depend on protein's unit of expression. Authors should be specific about the use of WHO (g/kg ideal BW) compared with US (g/kg actual BW) units, and ideally use gram or percent energy in observational studies. In populations where overweight/obesity are prevalent, intake based on actual BW should be reevaluated.

Limitations with the Digestible Indispensable Amino Acid Score (DIAAS) with Special Attention to Plant-Based Diets: a Review

PURPOSE OF REVIEW

This review describes several limitations of the Digestible Indispensable Amino Acid Score (DIAAS) with a focus on its application to plant-based dietary patterns.

RECENT FINDINGS

Evaluating protein quality in terms of digestibility is paramount to support and optimize the health and well-being of human populations in situations where food insecurity and protein energy malnutrition are widespread. The Food and Agriculture Organization (FAO) of the United Nations has endorsed the DIAAS to replace the previously recommended Protein Digestibility Corrected Amino Acid Score (PDCAAS) for protein quality assessment. While multiple strengths characterize the DIAAS, substantial limitations remain, many of which are accentuated in the context of a plant-based dietary pattern. Some of these limitations include a failure to translate differences in nitrogen-to-protein conversion factors between plant- and animal-based foods, limited representation of commonly consumed plant-based foods within the scoring framework, inadequate recognition of the increased digestibility of commonly consumed heat-treated and processed plant-based foods, its formulation centered on fast-growing animal models rather than humans, and a focus on individual isolated foods vs the food matrix. The DIAAS is also increasingly being used out of context where its application could produce erroneous results such as exercise settings. When investigating protein quality, particularly in a plant-based dietary context, the DIAAS should ideally be avoided.

Dietary intake of specific amino acids and liver status in subjects with nonalcoholic fatty liver disease: fatty liver in obesity (FLiO) study

PURPOSE

Identification of dietary factors involved in the development and progression of nonalcoholic fatty liver disease (NAFLD) is relevant to the current epidemics of the disease. Dietary amino acids appear to play a key role in the onset and progression of NAFLD. The aim of this study was to analyze potential associations between specific dietary amino acids and variables related to glucose metabolism and hepatic status in adults with overweight/obesity and NAFLD.

METHODS

One hundred and twelve individuals from the Fatty Liver in Obesity (FLiO) study were evaluated. Liver assessment was carried out by ultrasonography, magnetic resonance imaging and analysis of biochemical parameters. Dietary amino acid intake (aromatic amino acids (AAA); branched-chain amino acids (BCAA); sulfur amino acids (SAA)) was estimated by means of a validated 137-item food frequency questionnaire.

RESULTS

Higher consumption of these amino acids was associated with worse hepatic health. Multiple adjusted regression models confirmed that dietary AAA, BCAA and SAA were positively associated with liver fat content. AAA and BCAA were positively associated with liver iron concentration. Regarding ferritin levels, a positive association was found with BCAA. Dietary intake of these amino acids was positively correlated with glucose metabolism (glycated hemoglobin, triglyceride and glucose index) although the significance disappeared when potential confounders were included in the model.

CONCLUSION

These findings suggest that the consumption of specific dietary amino acids might negatively impact on liver status and, to a lesser extent on glucose metabolism in subjects with overweight/obesity and NAFLD. A control of specific dietary amino acid composition should be considered in the management of NAFLD and associated insulin resistance. NCT03183193; June 2017.

High Protein Intake Among Preschoolers in Childcare in a Region at Elevated Risk for Obesity

OBJECTIVES

To compare diet quality of convenience samples of children 2-3 and 4-5 years attending 11 of 75 childcare centers in Hays County, Texas to a nationally representative sample, as part of a needs assessment to inform a childcare center-based intervention.

METHODS

Parents completed 24-h recalls of their child's diet in 2014. Usual dietary intake of the regional and age-matched sample from the National Health and Nutrition Examination Survey (2011-2014) was estimated using the National Cancer Institute method. Diet quality was assessed using the Healthy Eating Index. Quantile regression and t-tests compared nutrient intake and Healthy Eating Index scores between the two samples.

RESULTS

Children ages 2-3 and 4-5 years in the regional sample (n = 124) consumed a higher percent of calories from protein (19%) than children in the national sample (n = 1613; 14%, P < .0.0001). In the regional sample, 21% of children 2-3 years consumed protein in excess of the AMDR compared to fewer than 1% of children in the national sample.

CONCLUSIONS FOR PRACTICE

Assessing regional diet while planning health outreach is important. Among children in childcare in this community, high protein intake may contribute to weight disparity. Workshops with childcare center staff to address center policies, environments, and parent outreach could address replacing some high-protein foods with other nutrient-rich foods.

Effect of branched-chain amino acid supplementation, dietary intake and circulating levels in cardiometabolic diseases: an updated review

PURPOSE OF REVIEW

Branched-chain amino acids (BCAAs) are essential amino acids derived from diet. BCAA supplementation has been recommended in elderly and athletes, but recent studies suggest an association between high dietary BCAAs and blood levels of BCAAs with greater risk of cardiometabolic diseases (CMD). This review aims to integrate current epidemiological evidence analyzing the association between BCAAs and related-CMD risk factors.

RECENT FINDINGS

Most epidemiological studies consistently show that dietary BCAAs are associated with higher risk of type-2 diabetes (T2D) whereas there is limited evidence related with other cardiovascular risk factors. Evidence also exists showing an association between higher circulating BCAA levels and risk of T2D and cardiovascular disease, and also probably with metabolic syndrome and overweight/obesity. Several clinical trials suggest beneficial cardiometabolic effect of BCAAs supplementation, although with a small sample size and short follow-up. Studies show a weak correlation between dietary BCAAs and circulating BCAA levels. Protein quality sources and whole dietary pattern are key aspects to improve our understanding of the effect of BCAAs as well as factors associated with higher protein needs, such as age or frailty.

SUMMARY

Dietary and circulating BCAAs exhibit possible detrimental cardiometabolic effects, but BCAA supplementation may have some positive influence on target groups with nutritional deficiencies.

Dietary Protein and Amino Acids in Vegetarian Diets-A Review

While animal products are rich in protein, the adequacy of dietary protein intake from vegetarian/vegan diets has long been controversial. In this review, we examine the protein and amino acid intakes from vegetarian diets followed by adults in western countries and gather information in terms of adequacy for protein and amino acids requirements, using indirect and direct data to estimate nutritional status. We point out that protein-rich foods, such as traditional legumes, nuts and seeds, are sufficient to achieve full protein adequacy in adults consuming vegetarian/vegan diets, while the question of any amino acid deficiency has been substantially overstated. Our review addresses the adequacy in changes to protein patterns in people newly transitioning to vegetarian diets. We also specifically address this in older adults, where the issues linked to the protein adequacy of vegetarian diets are more complex. This contrasts with the situation in children where there are no specific concerns regarding protein adequacy because of their very high energy requirements compared to those of protein. Given the growing shifts in recommendations from nutrition health professionals for people to transition to more plant-based, whole-food diets, additional scientific evidence-based communications confirming the protein adequacy of vegetarian and vegan diets is warranted.

Environmentally Optimal, Nutritionally Sound, Protein and Energy Conserving Plant Based Alternatives to U.S. Meat

Because meat is more resource intensive than vegetal protein sources, replacing it with efficient plant alternatives is potentially desirable, provided these alternatives prove nutritionally sound. We show that protein conserving plant alternatives to meat that rigorously satisfy key nutritional constraints while minimizing cropland, nitrogen fertilizer (Nr) and water use and greenhouse gas (GHG) emissions exist, and could improve public health. We develop a new methodology for identifying nutritional constraints whose satisfaction by plant eaters is challenging, disproportionately shaping the optimal diets, singling out energy, mass, monounsaturated fatty acids, vitamins B_3,6,12 and D, choline, zinc, and selenium. By replacing meat with the devised plant alternatives—dominated by tofu, soybeans, peanuts, and lentils—Americans can collectively eliminate pastureland use while saving 35–50% of their diet related needs for cropland, Nr, and GHG emission, but increase their diet related irrigation needs by 15%. While widely replacing meat with plants is logistically and culturally challenging, few competing options offer comparable multidimensional resource use reduction.