Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study

Animal board invited review: Dietary transition from animal to plant-derived foods: Are there risks to health?

Animal-derived foods (ADFs) are a very varied group of foods, but many are nutrient rich and contain higher quality protein than provided by plant-derived foods such that a simple replacement of ADF protein is likely to lead to a reduction in overall protein quality. In addition, many ADFs are richer in some nutrients than plant-based foods (e.g. Fe, Ca) and these often have a higher bioavailability. ADFs also provide nutrients that plants cannot supply (e.g. vitamin B12) and some provide beneficial health functionality (e.g. hypotensive) which is not explained by traditional nutrition. However, there remains a good health reason to increase the proportion of plant-derived food in many diets to increase the intake of dietary fibre which is often consumed at very sub-optimal levels. It seems logical that the increased plant-derived foods should replace the ADFs that have the least benefit, the greatest risk to health and the highest environmental impact. Processed meat fits these characteristics and should be an initial target for replacement with plant-based based protein-rich foods that additionally provide the necessary nutrients and have high-quality dietary fibre. Processed meat covers a wide range of products including several traditional foods (e.g. sausages) which will make decisions on food replacement challenging. There is therefore an urgent need for research to better define the relative health risks associated with the range of processed meat-based foods. The aim of this review is to examine the evidence on the benefits and risks of this dietary transition including the absolute necessity to consider initial nutrient status before the replacement of ADFs is considered.

In Healthy Pathways of Dietary Changes, a Very Rapid Reduction of Red Meat Is Possible, but Specific Diet Changes Are Required for Full Reduction-A Graph-Based Analysis

BACKGROUND

Although reducing meat consumption is becoming increasingly popular in Western countries, such a transition to a sustainable diet may pose some nutritional risks.

OBJECTIVES

We aim to analyze the pathways for reaching a low-meat healthy diet and the changes in other food categories needed to rapidly decrease total red meat consumption.

METHODS

We used a recently developed method based on graph theory to represent all possible pathways of stepwise changes that avoid nutritional deficiencies toward a target healthy diet. Initial and target diets were defined as the daily consumption of 33 food groups. For each sex, 3 initial diets were taken from the French representative survey third individual and national study on food consumption survey as the mean observed diet and low (first quintile) and high (fifth quintile) meat consumption. Target diets were identified using multicriteria optimization to minimize the long-term health risk (HR) of chronic diseases while ensuring nutritional adequacy. The Dijkstra algorithm was used to identify the optimal pathways between the initial and target diets, with the aim of reducing meat consumption as quickly as possible and thus minimizing long-term HRs.

RESULTS

Unprocessed red meat was easily minimized in the first steps of the pathways regardless of sex and initial level of meat consumption. However, processed meat could only be decreased later and required prior changes such as increases in fruit, vegetables, and oily fish. During total red meat minimization in females, securing adequate intakes of bioavailable iron had the most substantial impact on the other dietary changes needed.

CONCLUSIONS

Immediate reduction of red meat consumption is possible on the pathway to a healthy diet that avoids any nutrient deficiency. However, early increases in fruit, vegetables, and fish are required before minimizing total red meat early in the diet.

Meat consumption and the risk of hip fracture in women and men: two prospective Swedish cohort studies

PURPOSE

To study the association between meat intake (predominantly red and processed meats) and the risk of hip fracture, as well as the association between meat intake and biomarkers of inflammation, oxidative stress, bone turnover, body composition, and bone mineral density (BMD).

METHODS

Data from the Swedish Mammography Cohort and the Cohort of Swedish men (n = 83,603, 54% men) with repeated investigations and their respective clinical sub-cohorts was utilised. Incident hip fractures were ascertained through individual linkage to registers. Associations were investigated using multivariable Cox and linear regression analyses.

RESULTS

During up to 23 years of follow-up (mean 18.2 years) and 1,538,627 person-years at risk, 7345 participants (2840 men) experienced a hip fracture. Each daily serving of meat intake conferred a hazard ratio (HR) of 1.03 (95% confidence interval [CI] 1.00; 1.06) for hip fracture. In quintile 5, compared to quintile 2, the HR was 1.11 (95% CI 1.01; 1.21) among all participants. In the sub-cohorts, meat intake was directly associated with circulating levels of interleukin-6, C-reactive protein, leptin, ferritin, parathyroid hormone, and calcium.

CONCLUSION

A modest linear association was found between a higher meat intake and the risk of hip fractures. Our results from the sub-cohorts further suggest that possible mechanisms linking meat intake and hip fracture risk may be related to the regulation of bone turnover, subclinical inflammation, and oxidative stress. Although estimates are modest, limiting red and processed meat intake in a healthy diet is advisable to prevent hip fractures.

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.

Bone mineral density and body composition in Australians following plant-based diets vs. regular meat diets

Background and aims

Bone mineral density (BMD) and body composition play an important role in maintaining metabolic health and physical functioning. Plant-based diets (PBDs) are known to be lower in protein and calcium, which can impact BMD and body composition. This study aimed to investigate the relationship between various PBDs compared to regular meat diet and whole-body BMD, body composition, and weight status.

Methods

A cross-sectional study was conducted with adults (n = 240) aged 30-75 years, who habitually followed dietary patterns: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat eater (48 per group). Parameters were measured using dual-energy x-ray absorptiometry (DXA), and multivariable regression analyses were used to adjust for lifestyle confounders, socioeconomic factors, and BMI.

Results

After adjustments, whole-body BMD and body composition were not significantly different between those following PBDs and regular meat diets, except for lacto-ovo vegetarians, who had significantly lower lean mass by -1.46 kg (CI: -2.78, -0.13). Moreover, lacto-ovo vegetarians had a significantly lower T-score by -0.41 SD (CI: -0.81, -0.01) compared to regular meat eaters. Waist circumference was significantly lower in individuals adhering to a PBD compared to a regular meat diet: vegans by -4.67 cm (CI: -8.10, -1.24), lacto-ovo vegetarians by -3.92 cm (CI: -6.60, -1.23), pesco-vegetarians by -3.24 cm (CI: -6.09, -0.39), and semi-vegetarians by -5.18 cm (CI: -7.79, -2.57). There were no significant differences in lean mass (%), fat mass (% and total), android/gynoid measures, body weight, or BMI across dietary patterns. All dietary patterns met the recommended dietary intake for calcium and protein, and 25-hydroxy-vitamin D status was comparable across groups.

Conclusions

This cross-sectional study found that adhering to a PBD characterized by varying degrees of dairy and meat restriction is not associated with meaningful changes in BMD or body composition, provided that the dietary patterns are planned appropriately with adequate levels of calcium and protein.

Associations of different dietary patterns, bone mineral density, and fracture risk among elderly women: the China Osteoporosis Prevalence Study

Objective

Despite the fact that China amounts to one-fifth of the world's population, has a higher proportion of the elderly, and has a higher prevalence of osteoporosis and fracture, limited studies have investigated the association between dietary patterns and bone mineral density (BMD) as well as fracture risk among the elderly Chinese population. We aimed to investigate the association between different dietary patterns and BMD as well as the risk of fractures, and this association may vary between elderly women and men.

Methods

Building upon the China Osteoporosis Prevalence Study, we included 17,489 subjects aged ≥40 years old randomly sampled across 44 counties/districts of 11 provinces or municipalities in China who completed a food frequency questionnaire. BMD was measured by dual x-ray absorptiometry. Vertebral fracture was defined based on lateral spine radiographs using the semi-quantitative technique of Genant.

Results

A diet rich in "carnivorous", "vegetarian", "dairy, fruit, and egg" was significantly associated with higher BMD at total hip (TH), femoral neck (FN), and lumbar spine 1-4 (L1-4). Yet, a diet rich in "beverage and fried food" was associated with a lower BMD at the FN and L1-4. High quartiles of the carnivorous diet were associated with 34%-39% reduced risk of clinical fracture in the past 5 years and vertebral fracture. Stronger associations were observed among women. Sensitivity analysis among postmenopausal women presented even stronger positive associations between carnivorous and vegetarian diets and high BMD, as well as between carnivorous diet and reduced risk of fractures.

Conclusions

Our study suggested that a diet rich in meat, vegetables, and dairy, fruit, and eggs might be associated with greater BMD and a lower fracture risk, while beverage and fried foods may be associated with a lower BMD at L1-4, especially among elderly women. These findings are relevant to provide recommendations on dietary nutrition regarding the elderly population at high risk of osteoporosis and fractures, especially postmenopausal women.

Bone mineral density parameters and related nutritional factors in vegans, lacto-ovo-vegetarians, and omnivores: a cross-sectional study

Introduction

The growing prevalence of vegetarianism determines the need for comprehensive study of the impact of these diets on health and particularly on bone metabolism. We hypothesized that significant dietary differences between vegans, lacto-ovo-vegetarians, and omnivores also cause significant differences in their nutrient status, which may affect bone health.

Methods

The study assessed dual-energy X-ray absorptiometry parameters in lumbar spine and femoral neck, average nutrient intake, serum nutrient concentrations, serum PTH levels, and urinary pH among 46 vegans, 38 lacto-ovo-vegetarians, and 44 omnivores.

Results

There were no differences in bone mineral density (BMD) between the groups. However, the parathyroid hormone (PTH) levels were still higher in vegans compared to omnivores, despite the same prevalence of hyperparathyroidism in all groups. These findings may probably be explained by the fact that each group had its own "strengths and weaknesses." Thus, vegans and, to a lesser extent, lacto-ovo-vegetarians consumed much more potassium, magnesium, copper, manganese, and vitamins B6, B9, and C. At the same time, the diet of omnivores contained more protein and vitamins D and B12. All the subjects consumed less vitamin D than recommended. More than half of vegans and omnivores had insufficiency or even deficiency of vitamin D in the blood. Low serum concentrations of manganese with its quite adequate intake are also noteworthy: its deficiency was observed in 57% of vegans, 79% of lacto-ovo-vegetarians, and 63% of omnivores.

Discussion

Currently, it is no longer possible to conclude that lacto-ovo-vegetarians have lower BMD than omnivores, as our research supported. Vegans in our study also did not demonstrate lower BMD values, only higher PTH blood concentrations, compared to omnivores, however, a large number of studies, including recent, show the opposite view. In this regard, further large-scale research is required. Vegans and lacto-ovo-vegetarians now have a variety of foods fortified with vitamins D and B12, as well as calcium. There is also a great diversity of ethically sourced dietary supplements. The found low concentrations of manganese require further investigation.

Risk of Bone Fracture on Vegetarian and Vegan Diets

PURPOSE OF REVIEW

Bone fractures can have a devastating effect on health, especially in the elderly, undermining their independence for daily activities, and increasing the risk of comorbidities and mortality. Nutrition is a key factor in maintaining an optimal bone health across the lifespan. The number of people that choose to avoid meat or even all animal products is increasing globally, for a diversity of reasons. Properly planned vegetarian and vegan diets are widely recognized as a healthy dietary pattern, but the long-term impact of these diets on bone health and more specifically risk of bone fractures is less clear. Classic studies have observed a slightly lower bone mineral density in vegetarians but have many limitations, including inadequate adjusting for relevant confounding factors, and cross-sectional design. The aim of this review is to summarize and put into context the current evidence on the effect of vegetarian and vegan diets on bone health, with a focus on fracture risk.

RECENT FINDINGS

In recent years, results from many large prospective studies have emerged, which allowed us to assess the risk of incident bone fractures in vegetarians. In these studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. In many recent prospective cohort studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. At least part of this risk could be due to a lower body mass index and a lower intake of nutrients such as calcium, vitamin D, and protein. Some evidence suggests that combined vitamin D and calcium supplementation and other factors such as consumption of protein-rich foods may attenuate this risk. The eventual deleterious effect of vegetarian diets on bone health should be contextualized and balanced with its benefits, such as lower risk of cardiovascular disease and cancer.

Dietary protein and amino acid intakes for mitigating sarcopenia in humans

Adult humans generally experience a 0.5-1%/year loss in whole-body skeletal muscle mass and a reduction of muscle strength by 1.5-5%/year beginning at the age of 50 years. This results in sarcopenia (aging-related progressive losses of skeletal muscle mass and strength) that affects 10-16% of adults aged ≥ 60 years worldwide. Concentrations of some amino acids (AAs) such as branched-chain AAs, arginine, glutamine, glycine, and serine are reduced in the plasma of older than young adults likely due to insufficient protein intake, reduced protein digestibility, and increased AA catabolism by the portal-drained viscera. Acute, short-term, or long-term administration of some of these AAs or a mixture of proteinogenic AAs can enhance blood flow to skeletal muscle, activate the mechanistic target of rapamycin cell signaling pathway for the initiation of muscle protein synthesis, and modulate the metabolic activity of the muscle. In addition, some AA metabolites such as taurine, β-alanine, carnosine, and creatine have similar physiological effects on improving muscle mass and function in older adults. Long-term adequate intakes of protein and the AA metabolites can aid in mitigating sarcopenia in elderly adults. Appropriate combinations of animal- and plant-sourced foods are most desirable to maintain proper dietary AA balance.

Discussion on protein recommendations for supporting muscle and bone health in older adults: a mini review

Muscle and bone tissues are interconnected, and both rely on an adequate protein intake. Recommendations for protein intake for older adults specifically vary across countries. The purpose of this narrative review is to discuss the existing evidence for protein recommendations for supporting muscle and bone health in older adults and to evaluate if a protein intake above the current population reference intake (PRI) for older adults would be scientifically justified. First, this review summarizes the protein recommendations from bodies setting dietary reference values, expert groups, and national health organizations. Next, relevant studies investigating the impact of protein on muscle and bone health in older adults are discussed. In addition, the importance of protein quality for muscle and bone health is addressed. Lastly, a number of research gaps are identified to further explore the added value of a protein intake above the PRI for older adults.

Quality of plant-based diets and frailty incidence: a prospective analysis of UK biobank participants

BACKGROUND

Substantial evidence supports the inverse association between adherence to healthy dietary patterns and frailty risk. However, the role of plant-based diets, particularly their quality, is poorly known.

OBJECTIVE

To examine the association of two plant-based diets with incidence of physical frailty in middle-aged and older adults.

DESIGN

Prospective cohort.

SETTING

United Kingdom.

SUBJECTS

24,996 individuals aged 40-70 years, followed from 2009-12 to 2019-22.

METHODS

Based on at least two 24-h diet assessments, we built two diet indices: (i) the healthful Plant-based Diet Index (hPDI) and (ii) the unhealthful Plant-based Diet Index (uPDI). Incident frailty was defined as developing ≥3 out of 5 of the Fried criteria. We used Cox models to estimate relative risks (RR), and their 95% confidence interval (CI), of incident frailty adjusted for the main potential confounders.

RESULTS

After a median follow-up of 6.72 years, 428 cases of frailty were ascertained. The RR (95% CI) of frailty was 0.62 (0.48-0.80) for the highest versus lowest tertile of the hPDI and 1.61 (1.26-2.05) for the uPDI. The consumption of healthy plant foods was associated with lower frailty risk (RR per serving 0.93 (0.90-0.96)). The hPDI was directly, and the uPDI inversely, associated with higher risk of low physical activity, slow walking speed and weak hand grip, and the uPDI with higher risk of exhaustion.

CONCLUSIONS

In British middle-age and older adults, greater adherence to the hPDI was associated with lower risk of frailty, whereas greater adherence to the uPDI was associated with higher risk.

Nutritional therapy bridges the critical cut-off point for the closed-loop role of type 2 diabetes and bone homeostasis: A narrative review

Currently, osteoporosis-related fractures become the most cutting-edge problem of diabetes-related complications. Rational diet is not only the basis of glycemic management in type 2 diabetes patients, but also the direction of diabetic bone health. This review highlights the importance of micronutrient supplementation (including calcium, magnesium, zinc, vitamin D, vitamin K, and vitamin C) for patients with T2DM, as well as describing the constructive intermediary role of gut flora between T2DM and bone through nutrients predominantly high in dietary fiber. In addition, it is recommended to combine the Mediterranean dietary pattern with other diversified management approaches to prevent OP. Therefore, this provides a theoretical basis for the potential role of islet β-cells in promoting bone health.

Animal board invited review: The contribution of red meat to adult nutrition and health beyond protein

Red meat has been a critical part of human diets for millennia, providing a source of high-quality protein, micronutrients and essential fatty acids. However, as societies evolved and industrialisation reshaped our food systems, there has been a noticeable shift in meat-eating trends driven by concerns about the environmental impact of meat production and its potential risk to health. Yet, despite falling out of favour with some dietary experts and influencers, meat has an important role in a healthy diet and most adults still consume it. This article explores the nutritional value of red meat, authorised nutrition and health claims, how red meat fits into diet, providing the example of the United Kingdom (UK), and the health benefits and risks associated with both eating and avoiding red meat. Benefits of red meat include nutrient density and bioavailability while risks include colorectal cancer at high intakes of processed meats, based on observational studies. Benefits of meat-free diets include a lower risk of chronic diseases, based on observational studies, while risks include nutrient inadequacy, higher bone fracture risk and low protein quality. Hence, a wholesale shift to plant-based diets may not benefit adults who are vulnerable to sub-optimal nutrient intakes, such as women of child-bearing age and the elderly. More evidence from randomised controlled trials is recommended to fully understand the benefits and risks of both meat-containing and meat-free diets.

A comparison of the nutritional content and price between dairy and non-dairy milks and cheeses in UK supermarkets: A cross sectional analysis

Background: Non-Dairy (ND) food consumption is rapidly increasing in the UK and for many consumers plant-based diets are presumed to be healthier than standard diets. ND alternatives have different nutritional compositions, and their consumption could present challenges on a public-health level. Aim: To compare the price and nutritional composition of dairy and ND milks and cheeses in UK supermarkets. Methods: Macro and micronutrient data was recorded from Alpro's website and the 6 leading UK grocers for their own-label ND milks and cheeses. For missing micronutrient values the McCance & Widdowson's dataset was used. 99 total products were extracted: 57 ND milks, 7 dairy milks, 10 dairy cheeses and 25 ND cheeses. Dairy milk and cheese were used as control against which all ND products were compared. Results: Soya and coconut milks had lower values of carbohydrates, sugars, calcium, iodine, and potassium (p < 0.01) than dairy. Almond milk had lower values of carbohydrates (p = 0.01), sugars, calcium, iodine, and potassium (p < 0.01) compared to dairy milk. Protein was significantly (p < 0.01) lower for all ND except soya. Dairy cheeses had higher values for energy, protein, iodine, potassium, riboflavin, vitamin B12 and calcium (p < 0.01) than ND. Median prices were similar between dairy and ND milks, whereas ND cheeses were significantly more expensive compared to dairy (p < 0.01). Conclusions: ND alternatives fall short in several key nutrients compared to dairy. Fortification, accurate labelling and nutrition education are needed to help consumers make healthy and informed choices.

Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women

Importance

Previous research has found that vegetarian diets are associated with lower bone mineral density and higher risk of fractures, but these studies did not differentiate the quality of the plant-based foods.

Objective

To examine the association between the quality of plant-based diets (not necessarily vegan but also omnivorous) and hip fracture risk among postmenopausal women in the Nurses' Health Study.

Design, Setting, and Participants

This cohort study analyzed data from 70 285 postmenopausal women who participated in the US Nurses' Health Study from 1984 through 2014. Data were analyzed from January 1 to July 31, 2023.

Main outcomes and Measures

Hip fractures were self-reported on biennial questionnaires. Diet was assessed every 4 years using a validated semiquantitative food frequency questionnaire. Plant-based diet quality was assessed using 2 previously established indices: the healthful Plant-Based Diet Index (hPDI), for which healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea or coffee) received positive scores, whereas less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets or desserts) and animal foods received reversed scores; and the unhealthful Plant-Based Diet Index (uPDI), for which positive scores were given to less healthy plant foods and reversed scores to healthy plant and animal foods. Quintile scores of 18 food groups were summed, with a theoretical range for both indices of 18 to 90 (highest adherence). Cox proportional hazards regression with time-varying covariates was used to compute hazard ratios (HRs) and 95% CIs for hip fracture.

Results

In total, 70 285 participants (mean [SD] age, 54.92 [4.48] years; 100% White women) were included, and 2038 cases of hip fracture were ascertained during the study and for up to 30 years of follow-up. Neither the hPDI (HR for highest vs lowest quintile, 0.97 [95% CI, 0.83-1.14]) nor the uPDI (HR for highest vs lowest quintile, 1.02 [95% CI, 0.87-1.20]) for long-term diet adherence was associated with hip fracture risk. However, when examining recent intake for the highest vs lowest quintiles, the hPDI was associated with 21% lower risk of hip fracture (HR, 0.79 [95% CI, 0.68-0.92]; P = .02 for trend), and the uPDI was associated with 28% higher risk (1.28 [95% CI, 1.09-1.51]; P = .008 for trend).

Conclusions and Relevance

Findings of this cohort study indicated that long-term adherence to healthful or unhealthful plant-based diets as assessed by hPDI and uPDI scores was not associated with hip fracture risk. Future research should clarify whether the associations observed with recent dietary intake are due to short-term effects of these dietary patterns, reverse causality, or both.

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

BACKGROUND

Vegan diets have recently gained popularity in Switzerland as well as globally. The aim of the present study was to develop a diet quality score for vegans (DQS-V) based on the Swiss dietary recommendations for vegans.

METHODS

The dataset included 52 healthy vegan adults. Dietary intake data were assessed by three-day weighed food records. Body weight and height were measured, and a venous blood sample for the analysis of vitamin and mineral status was collected. Spearman rank correlation coefficients were used due to not-normally distributed data. Dietary patterns were identified using principal component analysis (PCA).

RESULTS

The DQS-V score (mean ± SD) was 48.9 ± 14.7. Most vegans adhered to the recommended portions of vegetables, vitamin C-rich vegetables, fruits, omega-3-rich nuts, fats and oils, and iodized salt. However, the intake of green leafy vegetables, vitamin C-rich fruits, wholegrains, legumes, nuts and seeds, selenium-rich nuts, zero caloric liquid, and calcium-fortified foods was suboptimal. The sample overconsumed sweet-, salty-, fried foods, and alcohol. The DQS-V had a significantly positive correlation with intakes of fibre, polyunsaturated fatty acids, potassium, zinc, and phosphorus intakes (p's < 0.05) but was negatively correlated with vitamin B12 and niacin intakes (p's < 0.05). Two dietary patterns were derived from PCA: 1) refined grains and sweets and 2) wholegrains and nuts. The correlation between the DQS-V and the first dietary pattern was negative (- 0.41, p = 0.004) and positive for the second dietary pattern (0.37, p = 0.01). The refined grains and sweets dietary pattern was inversely correlated with beta-carotene status (- 0.41, p = 0.004) and vitamin C status (r = - 0.51, p = 0.0002).

CONCLUSION

The newly developed DQS-V provides a single score for estimating diet quality among vegan adults. Further validation studies examining the DQS-V in relation to an independent dietary assessment method and to biomarkers of nutritional intake and status are still needed before the general application of the DQS-V.

Nutrition and dietary restrictions in cancer prevention

The composition and pattern of dietary intake have emerged as key factors influencing aging, regeneration, and consequently, healthspan and lifespan. Cancer is one of the major diseases more tightly linked with aging, and age-related mortality. Although the role of nutrition in cancer incidence is generally well established, we are far from a consensus on how diet influences tumour development in different tissues. In this review, we will discuss how diet and dietary restrictions affect cancer risk and the molecular mechanisms potentially responsible for their effects. We will cover calorie restriction, intermittent fasting, prolonged fasting, fasting-mimicking diet, time-restricted eating, ketogenic diet, high protein diet, Mediterranean diet, and the vegan and vegetarian diets.

Effect of dietary diversity on incident of disability in community-dwelling older adults with sarcopenia: A 40-month follow-up longitudinal study

BACKGROUND

Sarcopenia is a clinical issue in older adults that leads to serious adverse health outcomes, including disability. The present study investigated whether dietary diversity affects the incidence of disability in older adults with sarcopenia.

METHOD

Participants were 759 Japanese older adults with sarcopenia (mean age 77.2 ± 6.0 years; 44.4 % men) who were aged ≥65 years at the time of the examination. Sarcopenia was diagnosed according to the recommendations of the European Working Group on Sarcopenia in Older People 2. Dietary diversity was assessed using a diet variety score. This diet variety score assessed the one-week consumption frequency of ten food groups, according to the following responses: "eat almost every day" (1 point), or "not eaten almost daily" (0 points). Older adults with a diet variety score of 3 or more points were defined as having high dietary diversity. Incident disability was certified by long-term care insurance (mean follow-up duration 32 months).

RESULTS

The cumulative disability incidence rates in the older adults with low dietary diversity and high dietary diversity were 23.3 % and 16.9 %, respectively. Cox proportional hazards regression analysis revealed high dietary diversity was associated with a lower risk of incident disability in older adults with sarcopenia (hazard ratio 0.66, 95 % confidence interval 0.47-0.92; p = 0.015), after adjusting for covariates.

CONCLUSIONS

This longitudinal study revealed that high dietary diversity is associated with a lower risk of incident disability among sarcopenic Japanese older adults.

Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein

Falls and osteoporotic fractures are a major public health problem, particularly among older adults. A third of individuals aged 65 years and over fall at least once each year, with up to 20 % of these resulting in serious injury, including fracture. In conjunction with regular exercise, the importance of diet for musculoskeletal health has largely focused upon calcium, vitamin D, and protein, particularly in the context of preventing falls and fractures. Whilst there is evidence for the benefits of these nutrients for musculoskeletal health, other aspects of the diet remain largely underexplored. For example, vegetables are rich sources of macro- and micronutrients that are essential for muscle function and bone health, which are key factors in the prevention of falls and fractures. Recent work has highlighted the importance of nutrients such as vegetable-derived nitrate and vitamin K1 in optimising muscle strength, physical function, and bone quality. In the context of dietary patterns, vegan/plant-based diets have recently gained popularity due to perceived health benefits, animal welfare, or to tackle climate change. The elimination and/or substitution of animal-based products for plant foods (without careful planning and/or expert dietary guidance) could, however, have long-term negative musculoskeletal consequences; a trend uncovered by recent evidence. Within the overarching theme of nutrition for fall and fracture prevention in older populations, the aim of this review is to (i) summarise the current evidence for calcium, vitamin D and protein; (ii) describe the importance of vegetables and selected nutrients, such as nitrate and vitamin K1, for muscle function and bone structural integrity; and (iii) highlight current evidence around different dietary patterns (e.g., plant-based, diet quality, data driven approaches) and their impact on musculoskeletal health.

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

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

Plant-based alternative proteins-are they nutritionally more advantageous?

BACKGROUND

The transition towards sustainable nutrition as well as the exploration of alternative sources of protein have been at the forefront of thinking in the 21st century. However, further research is required to ascertain if a diet composed of alternative plant-based proteins has similar nutritional advantages to a plant-based diet. This study aims to model the replacement of a diet consisting of animal-based proteins with plant-based alternatives (PBA), in a group of Asians.

METHODS

A 4-day food record was collected from 50 individuals residing in Singapore and nutrient profiles were generated for each individual. Food records were analysed, and meat, dairy, and seafood ingredients were substituted gram-for-gram with their PBA. The original and replaced nutrient profiles were compared against each other and the differences in macro and micronutrients were analysed.

RESULTS

A significant increase in carbohydrates, dietary fibre, as well as in micronutrients such as sodium and calcium was observed. Conversely, there was a significant decreased intake in overall energy, protein and fat (p < 0.005).

CONCLUSIONS

The significant nutritional impact of substituting animal-based proteins for PBA may present benefits for bone health and individuals on a caloric restriction diet. However, higher sodium levels may be undesirable for individuals with cardiovascular conditions and hypertension, and the low bioavailability of iron in plant-based sources may present issues for iron deficient populations. Bearing some of these key findings in mind, researchers and manufacturers need to consider these when developing alternative protein products to meet consumer demands for palatable and nutritious plant-based products.

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

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

Genetics of vegetarianism: A genome-wide association study

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

Association between vegetarian diet and gouty arthritis: A retrospective cohort study

BACKGROUND AND AIMS

A vegetarian diet is rich in vegetables, fruits, and soy products. Although vegetarian diet is beneficial for improving the health outcomes such as body mass index, metabolic syndrome, cardiovascular disease, and mortality rate, the association between a vegetarian diet and gout incidence is not well known.

METHODS AND RESULTS

We linked the MJ Health Survey Data and MJ Biodata 2000 with the National Health Insurance Research Database (NHIRD) and the National Registration of Death (2000-2018). Information on the diet was collected from the MJ Health Survey Data, and the incidence of gouty arthritis was confirmed using the NHIRD. The Kaplan-Meier survival curve and log-rank test were used to compare the differences between vegetarian and non-vegetarian participants. Cox regression models were used to estimate the risk of the incidence of gouty arthritis. Among 76,972 participants, 37,297 (48.46%) were men, 2488 (3.23%) were vegetarians and the mean age was 41.65 ± 14.13 years. The mean baseline uric acid level was 6.14 ± 1.65 mg/dL. A total of 16,897 participants developed gouty arthritis, including 16,447 (22.08%) non-vegetarians and 450 (18.9%) vegetarians over a mean follow-up of 19 years. Significant differences were observed in the Kaplan-Meier survival curves between vegetarians and non-vegetarians (log-rank p < 0.001). Vegetarians had a significantly decreased incidence of gouty arthritis compared with non-vegetarians (hazard ratio = 0.87, 95% confidence interval = 0.78-0.98, p = 0.02) after adjusting for potential confounders.

CONCLUSION

People with a vegetarian diet had a significantly decreased risk of developing gouty arthritis compared with non-vegetarians in Taiwan.

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants

BACKGROUND

Meat-free diets may be associated with a higher risk of hip fracture, but prospective evidence is limited. We aimed to investigate the risk of hip fracture in occasional meat-eaters, pescatarians, and vegetarians compared to regular meat-eaters in the UK Biobank, and to explore the role of potential mediators of any observed risk differences.

METHODS

Middle-aged UK adults were classified as regular meat-eaters (n = 258,765), occasional meat-eaters (n = 137,954), pescatarians (n = 9557), or vegetarians (n = 7638) based on dietary and lifestyle information at recruitment (2006-2010). Incident hip fractures were identified by record linkage to Hospital Episode Statistics up to September 2021. Multivariable Cox regression models were used to estimate associations between each diet group and hip fracture risk, with regular meat-eaters as the reference group, over a median follow-up time of 12.5 years.

RESULTS

Among 413,914 women, 3503 hip fractures were observed. After adjustment for confounders, vegetarians (HR (95% CI): 1.50 (1.18, 1.91)) but not occasional meat-eaters (0.99 (0.93, 1.07)) or pescatarians (1.08 (0.86, 1.35)) had a greater risk of hip fracture than regular meat-eaters. This is equivalent to an adjusted absolute risk difference of 3.2 (1.2, 5.8) more hip fractures per 1000 people over 10 years in vegetarians. There was limited evidence of effect modification by BMI on hip fracture risk across diet groups (p_interaction = 0.08), and no clear evidence of effect modification by age or sex (p_interaction = 0.9 and 0.3, respectively). Mediation analyses suggest that BMI explained 28% of the observed risk difference between vegetarians and regular meat-eaters (95% CI: 1.1%, 69.8%).

DISCUSSION

Vegetarian men and women had a higher risk of hip fracture than regular meat-eaters, and this was partly explained by their lower BMI. Ensuring adequate nutrient intake and weight management are therefore particularly important in vegetarians in the context of hip fracture prevention.

TRIAL REGISTRATION

NCT05554549, registered retrospectively.

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

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

The importance of vitamin B12 for individuals choosing plant-based diets

Vitamin B₁₂ is an essential nutrient that is not made by plants; consequently, unfortified plant-based foods are not a reliable supply. Recent estimates suggest high rates of vitamin B₁₂ deficiency among the vegetarian and vegan populations, particularly in pregnant women or women of child-bearing age who, for ethical and health reasons, are shifting towards higher consumption of plant-based foods in ever-increasing numbers. Vitamin B₁₂ plays crucial metabolic roles across the life-course and in particular during pregnancy and in early development (first 1000 days of life). Evidence now implicates vitamin B₁₂ deficiency with increased risk to a range of neuro, vascular, immune, and inflammatory disorders. However, the current UK recommended nutrient intake for vitamin B₁₂ does not adequately consider the vitamin B₁₂ deficit for those choosing a plant-based diet, including vegetarianism and in particular veganism, representing a hidden hunger. We provide a cautionary note on the importance of preventing vitamin B₁₂ deficits for those individuals choosing a plant-based diet and the health professionals advising them.

Anthropocentrism, Natural Harmony, Sentience and Animal Rights: Are We Allowed to Use Animals for Our Own Purposes?

Taking a cue from J.W. Yates' recent work on animal sentience published in this journal, which explores the field and categorizes it as a harmony with nature and a recognition of its values, inferring that the inclusion of animals in the sphere of objective rights is the obligatory step for a real sustainability in all human activities, this opinion paper seeks to challenge some of the claims made in the article and present an alternative perspective on sentience and animal rights. Preliminarily, I propose a semantic word-washing and the use of more precise terms instead of not well-defined ones such as "harmony" in relation to nature and "sentience" in relation to animals, and I affirm that there can be only one point of view, however rich in dialectics, which is the human one for looking at the problems of animal ethics. Below, I present the thesis that concludes that it is not possible to attribute rights to animals, but it is our right and duty to protect their well-being, which requires states to pass laws for their defence. I conclude that while it is acceptable to raise animals for priority human rights (such as food and health), it is also an obligation to properly care for and protect them.

Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.

Dietary Intake and Circulating Amino Acid Concentrations in Relation with Bone Metabolism Markers in Children Following Vegetarian and Omnivorous Diets

Scientific studies reported that most vegetarians meet the total protein requirements; however, little is known about their amino acid intakes. We aimed to assess dietary intake and serum amino acid levels in relation to bone metabolism markers in prepubertal children on vegetarian and traditional diets. Data from 51 vegetarian and 25 omnivorous children aged 4–9 years were analyzed. Dietary intake of macro- and micronutrients were assessed using the nutritional program Dieta 5®. Serum amino acid analysis was performed using high-pressure liquid chromatography technique, 25-hydroxyvitamin D and parathormone–electrochemiluminescent immunoassay, and bone metabolism markers, albumin, and prealbumin levels using enzyme-linked immunosorbent assay. Vegetarian children had a significantly lower intake of protein and amino acids with median differences of about 30–50% compared to omnivores. Concentrations of four amino acids (valine, lysine, leucine, isoleucine) in serum varied significantly by diet groups and were lower by 10–15% in vegetarians than meat-eaters. Vegetarian children also had lower (p < 0.001) serum albumin levels compared to omnivores. Among bone markers, they had higher (p < 0.05) levels of C-terminal telopeptide of collagen type I (CTX-I) than omnivores. Correlation patterns between amino acids and bone metabolism markers differed in the vegetarian and omnivore groups. Out of bone markers, especially osteoprotegerin was positively correlated with several amino acids, such as tryptophan, alanine, aspartate, glutamine, and serine, and ornithine in vegetarians. Vegetarian children consumed apparently sufficient but lower protein and amino acids compared to omnivores. In circulation these differences were less marked than in the diet. Significantly lower amino acid intake and serum levels of valine, lysine, leucine, and isoleucine as well as the observed correlations between serum amino acids and biochemical bone marker levels indicated the relations between diet, protein quality, and bone metabolism.

Distinct dietary risk factors for incident osteoporotic fractures in early and late postmenopausal phase women

INTRODUCTION

Available evidence on favorable nutritional factors for preventing osteoporosis remains controversial. Considering the recent increases in life expectancy, we investigated the relationship between incident osteoporotic fractures and dietary habits in early and late postmenopausal phase women.

MATERIALS AND METHODS

Subjects were Japanese postmenopausal outpatients recruited at a primary care institution in Nagano Prefecture (Nagano Cohort Study). Patients with critical or acute illness or secondary osteoporosis were not included in this study. In total, 1,071 participants were prospectively followed for a mean of 5.8 years. The cohort was divided into early (≤ 70 years) and late (> 70 years) postmenopausal phases based on median age. Dietary nutrient intake was estimated by the food frequency questionnaire method. According to baseline nutrient intake characteristics, we focused on protein/energy and Ca/NaCl intake ratios, which were also divided by the median values.

RESULTS

Kaplan-Meier plots revealed a significantly higher occurrence of fractures for the high protein/energy intake group in early postmenopausal subjects (P = 0.009), whereas the low Ca/NaCl intake group in late postmenopausal subjects exhibited a significantly earlier occurrence of fractures (P = 0.002). Multivariate Cox regression uncovered significant independent risks of higher protein/energy (HR 1.35; 95% CI 1.04-1.74) and lower Ca/NaCl (HR 0.79; 95% CI 0.63-0.99) intake ratios for incident osteoporotic fractures in the early and late postmenopausal cohorts, respectively.

CONCLUSION

Distinct dietary risk factors for osteoporotic fractures were identified in early and late postmenopausal phase women. Appropriate nutritional guidance according to patient age will be important for maintaining bone health and quality of life.

Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK

Importance

Plant-based diets have gained popularity for both environmental and health reasons, but a comprehensive assessment of their quality in relation to risk of mortality and major chronic diseases is lacking.

Objective

To examine whether healthful vs unhealthful plant-based dietary patterns are associated with mortality and major chronic diseases among UK adults.

Design, Setting, and Participants

This prospective cohort study used data from adults in the UK Biobank, a large-scale population-based study. Participants were recruited between 2006 and 2010 and followed up using record linkage data until 2021; follow-up for different outcomes ranged between 10.6 and 12.2 years. Data analysis was conducted from November 2021 to October 2022.

Exposures

Adherence to a healthful vs unhealthful plant-based diet index (hPDI vs uPDI) derived from 24-hour dietary assessments.

Main Outcomes and Measures

The main outcomes were hazard ratios (HRs) and 95% CIs of mortality (overall and cause specific), cardiovascular disease (CVD [total, myocardial infarction, ischemic stroke, and hemorrhagic stroke]), cancer (total, breast, prostate, and colorectal), and fracture (total, vertebrae, and hip) across quartiles of hPDI and uPDI adherence.

Results

This study included 126 394 UK Biobank participants. They had a mean (SD) age of 56.1 (7.8) years; 70 618 (55.9%) were women. The majority of participants (115 371 [91.3%]) were White. Greater adherence to the hPDI was associated with lower risks of total mortality, cancer, and CVD, with HRs (95% CIs) of 0.84 (0.78-0.91), 0.93 (0.88-0.99), and 0.92 (0.86-0.99), respectively, for participants in the highest hPDI quartile compared with the lowest. The hPDI was also associated with lower risks of myocardial infarction and ischemic stroke, with HRs (95% CIs) of 0.86 (0.78-0.95) and 0.84 (0.71-0.99), respectively. By contrast, higher uPDI scores were associated with higher risks of mortality, CVD, and cancer. The associations observed did not show heterogeneity across strata of sex, smoking status, body mass index, or socioeconomic status or with polygenic risk scores (specifically with regard to CVD end points).

Conclusions and Relevance

The findings of this cohort study of middle-aged UK adults suggest that a diet characterized by high-quality plant-based foods and lower intakes of animal products may be beneficial for health, irrespective of established chronic disease risk factors and genetic predisposition.

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

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

Protein intake and bone mineral density: Cross-sectional relationship and longitudinal effects in older adults

BACKGROUND

There are several mechanisms via which increased protein intake might maintain or improve bone mineral density (BMD), but current evidence for an association or effect is inconclusive. The objectives of this study were to investigate the association between dietary protein intake (total, plant and animal) with BMD (spine and total body) and the effects of protein supplementation on BMD.

METHODS

Individual data from four trials that included either (pre-)frail, undernourished or healthy older adults (aged ≥65 years) were combined. Dietary intake was assessed with food records (2, 3 or 7 days) and BMD with dual-energy X-ray absorptiometry (DXA). Associations and effects were assessed by adjusted linear mixed models.

RESULTS

A total of 1570 participants [57% women, median (inter-quartile range): age 71 (68-75) years] for which at least total protein intake and total body BMD were known were included in cross-sectional analyses. In fully adjusted models, total protein intake was associated with higher total body and spine BMD [beta (95% confidence interval): 0.0011 (0.0006-0.0015) and 0.0015 (0.0007-0.0023) g/cm² , respectively]. Animal protein intake was associated with higher total body and spine BMD as well [0.0011 (0.0007-0.0016) and 0.0017 (0.0010-0.0024) g/cm² , respectively]. Plant protein intake was associated with a lower total body and spine BMD [-0.0010 (-0.0020 to -0.0001) and -0.0019 (-0.0034 to -0.0004) g/cm² , respectively]. Associations were similar between sexes. Participants with a high ratio of animal to plant protein intake had higher BMD. In participants with an adequate calcium intake and sufficient serum 25(OH)D concentrations, the association between total protein intake with total body and spine BMD became stronger. Likewise, the association between animal protein intake with total body BMD was stronger. In the longitudinal analyses, 340 participants [58% women, median (inter-quartile range): age 75 (70-81) years] were included. Interventions of 12 or 24 weeks with protein supplementation or protein supplementation combined with resistance exercise did not lead to significant improvements in BMD.

CONCLUSIONS

An association between total and animal protein intake with higher BMD was found. In contrast, plant protein intake was associated with lower BMD. Research is warranted to further investigate the added value of dietary protein alongside calcium and vitamin D for BMD improvement, especially in osteopenic or osteoporotic individuals. Moreover, more research on the impact of a plant-based diet on bone health is needed.

Dietary recommendations in the prevention and treatment of osteoporosis

INTRODUCTION

This article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie - SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d'Informations sur les Ostéoporoses - GRIO) on the role of diet in the prevention and treatment of osteoporosis.

METHODS

The recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to "daily practices" were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies.

RESULTS

A Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and "high quality" protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics.

CONCLUSIONS

These are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Association between the quality of plant-based diets and risk of frailty

BACKGROUND

The Mediterranean diet and other dietary patterns rich in fruits and vegetables have been linked to lower risk of frailty in older adults. However, not all plant-based diets are necessarily healthful, and no previous study has evaluated the role of the quality of plant-based dietary patterns in frailty risk. Our aim was to assess the association between plant-based diet quality and risk of frailty.

METHODS

Prospective cohort consisted with 82 234 women aged ≥60 years from the Nurses' Health Study, who were followed from 1990 through 2014. The dates of analysis were April 14 to June 23, 2021. Dietary data were collected every 4 years using a validated semi-quantitative food frequency questionnaire. The plant-based diet quality was assessed with two indices (range 18-90 points): (a) healthful plant-based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils and tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets/desserts) and animal foods received reverse scores; and (b) unhealthful plant-based diet index (uPDI) where positive scores were given to less healthy plant foods and reverse scores to healthy plant foods and animal foods. Frailty incidence was assessed every 4 years, being defined as having three or more of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses and weight loss ≥5%. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and their 95% confidence interval (CI).

RESULTS

We identified 12 910 incident cases of frailty over 1 176 401 person-year follow-up. In the multivariable analysis, the hPDI was inversely associated with the risk of frailty (hazard ratio [HR] for the highest vs. lowest quintile: 0.77, 95% confidence interval: 0.72-0.81; P trend <0.001). In addition, a 10-unit increment in the hPDI was associated with a relative 15% lower risk of frailty. Conversely, a direct association was found between the uPDI and risk of frailty (HR highest vs. lowest quintile: 1.24 [1.17, 1.32], P trend <0.001). These associations were consistent for each frailty criterion, among participants with no frailty criteria at baseline, after excluding participants with diabetes, cancer and cardiovascular disease at baseline, for alternative versions of the plant-based diet indices (PDIs), in subgroup analysis by categories of potential confounders, and in latency analysis.

CONCLUSIONS

A healthful plant-based diet was associated with lower risk of frailty whereas an unhealthful plant-based diet was associated with higher risk.

Nutritional Status and Habits among People on Vegan, Lacto/Ovo-Vegetarian, Pescatarian and Traditional Diets

Background: This study assessed the possible dependencies between nutritional habits and body composition among subjects with different dietary habits. Materials: A total of 196 healthy (aged 18−50 yrs) participants were enrolled in the study and divided into 4 groups according to their diet: vegans-VEGAN (n = 53), lacto/ovo-vegetarians—VEGE (n = 52), pescatarians-PESCA (n = 28), and omnivores-OMN (n = 43). Methods: The Food Frequency Questionnaire (FFQ) was used, and body composition was assessed on the In-Body120 analyzer. Results: Our result revealed in OMN + PESCA groups a higher average consumption frequency of sweets (p = 0.024), cheese/plant cheese (p < 0.001), eggs and egg dishes/egg substitutes (p < 0.001), butter, margarine/plant margarine (p < 0.001), cream /plant cream (p = 0.018), wine and cocktails (p = 0.028), vodka (p = 0.039) and lower of natural cottage cheese/tofu/tempeh (p < 0.001), vegetable oils (p = 0.036), legumes (p < 0.001) and nuts and seeds(p < 0.001) compared to the VEGAN + VEGE groups. The body composition analysis showed significant differences in skeletal muscle mass (SMM) (p = 0.019) and the content of minerals (p = 0.048) between groups. VEGAN disclosed the lowest average values of body fat mass (BFM), percentage body fat (PBF), and visceral adipose tissue (VAT) than other studied groups. Conclusions: The body composition analysis showed mean values within normal ranges in all of the groups, but some average results of OMN, PESCA, and VEGE compared to VEGAN were not highly satisfactory (in addition to eating behavior outcomes).

Urinary Potential Renal Acid Load (uPRAL) among Vegans Versus Omnivores and Its Association with Bone Health in the Cross-Sectional Risks and Benefits of a Vegan Diet Study

Both veganism and high dietary acid load are linked to unfavorable bone health. However, the specific role of dietary alkali or acid load for the bone health of vegans is so far unknown. Thus, the renal biomarker for dietary acid or alkali load, i.e., urinary potential renal acid load (uPRAL), was measured in 24 h urine samples of 34 vegans and 35 omnivores (50.7% males). Bone health was assessed via calcaneal quantitative ultrasound. Associations between uPRAL and bone health indices were examined using multivariable general linear models. Compared to omnivores, vegans had a significantly lower uPRAL (mean difference = −34.5 mEq/24 h, p < 0.0001), a lower 24 h urinary phosphate excretion (p = 0.0004), a lower 24 h urinary sulfate excretion (p = 0.01), and a higher urine pH value (p < 0.0001). Broadband ultrasound attenuation (BUA) was lower among vegans versus omnivores (p = 0.037), yet it was not associated with uPRAL irrespective of adjustments. This study confirms different acid-base profiles of vegans and omnivores, with a pronounced alkaline excess among vegans and a rather low acid load among a group of omnivores with moderate protein intake. Within this spectrum of alkaline to low acid load, no association with bone health was found.

Self-reported Resistance Training Is Associated With Better HR-pQCT-derived Bone Microarchitecture in Vegan People

CONTEXT

A plant-based lifestyle is a global trend; lower bone mineral density and increased fracture risk in vegan people are reported.

OBJECTIVE

The primary objective was to assess trabecular and cortical bone microarchitecture in vegans and omnivores. Secondary objectives were to evaluate relationships between bone microarchitecture, nutrition parameters, and physical activity.

METHODS

This was an observational study at the Medical Department II, St. Vincent Hospital (tertiary referral center for gastrointestinal, metabolic, and bone diseases, and teaching hospital of the Medical University of Vienna), including 43 healthy nonobese female and male subjects on a plant-based diet for at least 5 years, and 45 healthy nonobese female and male subjects on an omnivore diet for at least 5 years. The main outcome measures were the parameters of trabecular and cortical bone microarchitecture (high-resolution peripheral quantitative computed tomography), serum markers of bone turnover, nutrient intake (nutrition protocol), and self-reported resistance training (physical activity questionnaires).

RESULTS

In the vegan group, trabecular and cortical structure were altered compared with omnivores. Vegans not reporting resistance training had diminished bone microarchitecture compared with omnivores not reporting resistance training. In vegans and omnivores reporting resistance training, bone structure was similar. In both vegan subgroups (resistance training and not resistance training), a small number of correlations between nutrient intake and bone microarchitecture were observed without a conclusive pattern.

CONCLUSION

Bone microarchitecture in vegans differed from matched omnivores but could not be explained solely by nutrient uptake. These differences were attenuated between the subgroups reporting resistance training. In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle.

The role of metabolites under the influence of genes and lifestyles in bone density changes

Purpose

Osteoporosis is a complex bone disease influenced by numerous factors. Previous studies have found that some metabolites are related to bone mineral density (BMD). However, the associations between metabolites and BMD under the influence of genes and lifestyle have not been fully investigated.

Methods

We analyzed the effect of metabolites on BMD under the synergistic effect of genes and lifestyle, using the data of 797 participants aged 55–65 years from the Taizhou Imaging Study. The cumulative sum method was used to calculate the polygenic risk score of SNPs, and the healthful plant-based diet index was used to summarize food intake. The effect of metabolites on BMD changes under the influence of genes and lifestyle was analyzed through interaction analysis and mediation analysis.

Results

Nineteen metabolites were found significantly different in the osteoporosis, osteopenia, and normal BMD groups. We found two high-density lipoprotein (HDL) subfractions were positively associated with osteopenia, and six very-low-density lipoprotein subfractions were negatively associated with osteopenia or osteoporosis, after adjusting for lifestyles and genetic factors. Tea drinking habits, alcohol consumption, smoking, and polygenic risk score changed BMD by affecting metabolites.

Conclusion

With the increased level of HDL subfractions, the risk of bone loss in the population will increase; the risk of bone loss decreases with the increased level of very-low-density lipoprotein subfractions. Genetic factors and lifestyles can modify the effects of metabolites on BMD. Our results show evidence for the precise prevention of osteoporosis.

Vegan nutrition: a preliminary guide for health professionals

Since the beginning of the 21st century, interest in vegan diets has been rapidly increasing in most countries. Misconceptions about vegan diets are widespread among the general population and health professionals. Vegan diets can be health-promoting and may offer certain important advantages compared to typical Western (and other mainstream) eating patterns. However, adequate dietary sources/supplements of nutrients of focus specific to vegan diets should be identified and communicated. Without supplements/fortified foods, severe vitamin B12 deficiency may occur. Other potential nutrients of focus are calcium, vitamin D, iodine, omega-3 fatty acids, iron, zinc, selenium, vitamin A, and protein. Ensuring adequate nutrient status is particularly important during pregnancy, lactation, infancy, and childhood. Health professionals are often expected to be able to provide advice on the topic of vegan nutrition, but a precise and practical vegan nutrition guide for health professionals is lacking. Consequently, it is important and urgent to provide such a set of dietary recommendations. It is the aim of this article to provide vegan nutrition guidelines, based on current evidence, which can easily be communicated to vegan patients/clients, with the goal of ensuring adequate nutrient status in vegans.

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women's Cohort Study

BACKGROUND

The risk of hip fracture in women on plant-based diets is unclear. We aimed to investigate the risk of hip fracture in occasional meat-eaters, pescatarians, and vegetarians compared to regular meat-eaters in the UK Women's Cohort Study and to determine if potential associations between each diet group and hip fracture risk are modified by body mass index (BMI).

METHODS

UK women, ages 35-69 years, were classified as regular meat-eaters (≥ 5 servings/week), occasional meat-eaters (< 5 servings/week), pescatarian (ate fish but not meat), or vegetarian (ate neither meat nor fish) based on a validated 217-item food frequency questionnaire completed in 1995-1998. Incident hip fractures were identified via linkage to Hospital Episode Statistics up to March 2019. Cox regression models were used to estimate the associations between each diet group and hip fracture risk over a median follow-up time of 22.3 years.

RESULTS

Amongst 26,318 women, 822 hip fracture cases were observed (556,331 person-years). After adjustment for confounders, vegetarians (HR (95% CI) 1.33 (1.03, 1.71)) but not occasional meat-eaters (1.00 (0.85, 1.18)) or pescatarians (0.97 (0.75, 1.26)) had a greater risk of hip fracture than regular meat-eaters. There was no clear evidence of effect modification by BMI in any diet group (p-interaction = 0.3).

CONCLUSIONS

Vegetarian women were at a higher risk of hip fracture compared to regular meat-eaters. Further research is needed to confirm this in men and non-European populations and to identify factors responsible for the observed risk difference. Further research exploring the role of BMI and nutrients abundant in animal-sourced foods is recommended.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT05081466.

Plant and Animal Protein Intakes Largely Explain the Nutritional Quality and Health Value of Diets Higher in Plants: A Path Analysis in French Adults

Diets higher in plants are associated with lower risks of chronic diseases. However, animal foods, which are rich in protein, are also rich in some important minerals and vitamins. Using data from a representative survey in France (INCA3, n = 1,125), we used path analyses as a mediation-like approach to decipher the importance of plant and animal proteins in the relationship between the plant-based diet index (PDI) and diet quality. We used three types of diet quality scores, namely, nutrient security, positive nutrient adequacy, and long-term mortality risk of four diet-related diseases (i.e., coronary heart disease, stroke, type 2 diabetes, and colorectal cancer). We identified positive and negative mediations, i.e., changes in plant/animal protein intake that are associated with changes in PDI, and favor or limit the association with the diet quality score. The PDI was positively associated with the risk of long-term mortality but not significantly with nutrient adequacy or nutrient security. A positive mediation by plant protein was found for all diet quality scores (specific indirect effects (SIEs) ranging from 0.04 to 0.10 SD). Conversely, the association between PDI and nutrient adequacy (but not nutrient security) was negatively mediated by animal protein intake (SIE: −0.06 SD). In further detailed models, the association between PDI and diet quality was mainly positively mediated by protein foods from the fruit-vegetables-legumes group (0.01 SD for the nutrient security and 0.02 SD for the nutrient adequacy) and whole grains (0.02 SD for the nutrient adequacy). Our data suggest that the positive impact of plant-based diets on diet quality is largely driven by higher intakes of plant protein foods, especially from fruits-vegetables-legumes and whole grains. Conversely, lower animal protein intake tends to limit the positive impact of plant-based diets on overall positive nutrient adequacy but not security. Protein sources appear critical to healthy plant-based diets.

One person's meat is another's poison: representations of the meat-health nexus in UK news media

Mainstream media play a central role in shaping the ways diet and nutrition are discussed in the public sphere, yet few studies have explored its depictions of the meat-health nexus. Focusing on eight of the most popular news online sites consumed by lower-income groups in the UK-the demographic most likely to eat meat, according to a survey conducted for this study-we carried out content analysis of 128 articles. We found, first, a multiplicity of pro- and anti-meat narratives across all news outlets; second, that the dominant recommendation, found in 40% of our sample, was to eat less or no red meat; and third, that a balanced or neutral sentiment was present in over half of our sample, with a ratio of 3:2 (anti-versus pro-meat) in remaining articles. We found that the editorial leaning of a news outlet was not closely correlated with its overall sentiment towards meat consumption; all were neutral or slightly anti-meat, with the exception of LAD Bible, the only clearly pro-meat outlet. Qualitative analysis uncovered three key themes: the risk of red meat on colorectal cancer, uncertainty around plant-based options, and individual dietary choice. We use case studies guided by these themes to highlight some of the shortcomings of health communication and provide recommendations, with a focus on improved dialogue between journalists and researchers.

Evidence of a vegan diet for health benefits and risks - an umbrella review of meta-analyses of observational and clinical studies

To summarize and evaluate the evidence on the health impact of a vegan diet, we conducted an umbrella review of systematic reviews and meta-analyses. PubMed, Cochrane Library, Web of Science and Epistemonikos were searched up to September 2021. Meta-analyses were recalculated by using a random effects model. The certainty of evidence (CoE) was evaluated by the GRADE approach. For the general healthy population, a vegan diet was effective for reducing body weight [MD (95% CI): -2.52 kg (-3.06, -1.98), n = 8 RCTs; moderate CoE] and was associated with further health benefits (with low CoE), including a lower risk of cancer incidence [SRR (95% CI): 0.84 (0.75, 0.95), n = 2] and a trend for lower risk of all-cause mortality [SRR (95% CI): 0.87 (0.75, 1.01), n = 2], as well as lower ApoB levels [MD (95% CI): -0.19 µmol/L (-0.23, -0.15), n = 7 RCTs). The findings suggested adverse associations for a vegan diet with risk of fractures [SRR (95% CI): 1.46 (1.03, 2.07), n = 3; low CoE]. For persons with diabetes or at high CVD risk, a vegan diet reduced measures of adiposity, total cholesterol, LDL and improved glycemic control (CoE moderate to low). A vegan diet may have the potential for the prevention of cardiometabolic health, but it may also impair bone health. More well-conducted primary studies are warranted.

Plant-based diets and long-term health: findings from the EPIC-Oxford study

The concept of plant-based diets has become popular due to the purported benefits for both human health and environmental impact. Although 'plant-based' is sometimes used to indicate omnivorous diets with a relatively small component of animal foods, here we take it to mean either vegetarian (plant-based plus dairy products and/or eggs) or vegan (100% plant-based). Important characteristics of plant-based diets which would be expected to be beneficial for long-term health are low intakes of saturated fat and high intakes of dietary fibre, whereas potentially deleterious characteristics are the risk of low intakes of some micronutrients such as vitamin B12, vitamin D, calcium and iodine, particularly in vegans. Vegetarians and vegans typically have lower BMI, serum LDL cholesterol and blood pressure than comparable regular meat-eaters, as well as lower bone mineral density. Vegetarians in the EPIC-Oxford study have a relatively low risk of IHD, diabetes, diverticular disease, kidney stones, cataracts and possibly some cancers, but a relatively high risk of stroke (principally haemorrhagic stroke) and bone fractures, in comparison with meat-eaters. Vegans in EPIC-Oxford have a lower risk of diabetes, diverticular disease and cataracts and a higher risk of fractures, but there are insufficient data for other conditions to draw conclusions. Overall, the health of people following plant-based diets appears to be generally good, with advantages but also some risks, and the extent to which the risks may be mitigated by optimal food choices, fortification and supplementation is not yet known.

Nutrition, longevity and disease: From molecular mechanisms to interventions

Diet as a whole, encompassing food composition, calorie intake, and the length and frequency of fasting periods, affects the time span in which health and functional capacity are maintained. Here, we analyze aging and nutrition studies in simple organisms, rodents, monkeys, and humans to link longevity to conserved growth and metabolic pathways and outline their role in aging and age-related disease. We focus on feasible nutritional strategies shown to delay aging and/or prevent diseases through epidemiological, model organism, clinical, and centenarian studies and underline the need to avoid malnourishment and frailty. These findings are integrated to define a longevity diet based on a multi-pillar approach adjusted for age and health status to optimize lifespan and healthspan in humans.