Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study

Are vegetarians' diets inherently healthy? Ultra-processed food consumption is associated with overweight among vegetarians: the brazilian survey on the health, food, and nutrition of vegetarians

This cross-sectional study investigated ultra-processed food (UPF) consumption and its association with overweight among Brazilian vegetarian adults (n = 925). Data were collected using a self-administered structured online questionnaire. The prevalence of overweight was 26.2% (95% confidence interval [CI] 23.3-29.1). The median UPF consumption was 1.8 times/day (1.0-3.1 interquartile range [IQR]). The multivariable generalised linear model identified an increase in overweight probability as the UPF intake - categorised into quintiles - increases (prevalence ratio [PR] 1.08 [95%CI 1.01-1.17]). Additionally, age (PR 1.03 [95%CI 1.02-1.04]), eating more than three meals/day away from home (PR 1.56 [95%CI 1.08-2.23]), duration of vegetarianism (PR 0.98 [95%CI 0.97-0.99]) and living in the wealthiest regions in the country (PR 1.35 [95%CI 1.06-1.71]) were associated with overweight. Although vegetarians have a lower average UPF intake and overweight prevalence than the general population, UPF exposure can still lead to excessive weight gain or maintenance. This study endorses generalising the Brazilian Dietary Guidelines for the vegetarian population.

Health Benefits of Vegetarian Diets: An Insight into the Main Topics

Vegetarian diets are plant-based diets including all the edible foods from the Plant Kingdom, such as grains, legumes, vegetables, fruits, nuts, and seeds. Dairy and eggs can be added in small amounts in the lacto-ovo-vegetarian subtype, or not at all in the vegan subtype. The abundance of non-processed plant foods-typical of all well-planned diets, including vegetarian ones-can provide the body with numerous protective factors (fiber, phytocompounds), while limiting the intake of harmful nutrients like saturated fats, heme-iron, and cholesterol. The beneficial effects on health of this balance have been reported for many main chronic diseases, in both observational and intervention studies. The scientific literature indicates that vegetarians have a lower risk of certain types of cancer, overall cancer, overweight-obesity, type 2 diabetes, dyslipidemia, hypertension, and vascular diseases. Since the trend of following a vegetarian diet is increasing among citizens of developed countries, the knowledge in the field will benefit from further studies confirming the consistency of these findings and clarifying the effects of vegetarian diets on other controversial topics.

Micronutrient intake and status in young vegans, lacto-ovo-vegetarians, pescatarians, flexitarians, and omnivores

PURPOSE

Whether youth who follow plant-based diets in Nordic countries meet their dietary needs for micronutrients remains unclear. This study aims to evaluate micronutrient intake and status in Norwegian youth following vegan, lacto-ovo-vegetarian, pescatarian, flexitarian and omnivore diets.

METHODS

Cross-sectional design, with healthy 16-to-24-year-olds (n = 165). Participants were asked to complete a questionnaire and four 24-hour dietary recalls. Dried blood spots (DBS) and spot-urine samples were collected for analysis of methyl malonic acid (MMA) (n = 65), haemoglobin (Hb) (n = 164) and urinary iodine concentration (UIC) (n = 163).

RESULTS

Vegans reported highest habitual supplement usage of multivitamin (58%), B12 (90%) and macroalgae consumption (32%), while flexitarians reported highest habitual usage of omega-3 supplements (56%). For daily supplement usage, vegans reported highest use of multivitamins (42%), B12 (79%), iodine (37%) and iron (63%). Increased risk of inadequate intake (energy-adjusted) were found for vitamin D (60% within lacto-ovo-vegetarians), selenium (70% within lacto-ovo-vegetarians, 65% within omnivores), and iodine (63% within vegans). Median MMA levels suggest low risk of insufficient B12 status across all groups (MMA 0.04‒0.37µmol/l) and 2% had MMA levels indicating possible B12 deficiency and 8% had elevated levels. Median Hb levels indicated low risk of anemia across all groups (≥ 12.0 females, ≥ 13.0 g/dl males), though 7% had Hb values indicating risk of mild anemia and 4% risk of moderate anemia. The median UIC indicates mild iodine deficiency in all groups (UIC < 100 µg/l), except vegans, who were moderately iodine deficient (UIC < 50 µg/l).

CONCLUSIONS

Our study indicated that the participating youth had low risk of inadequate intake of most micronutrients, partly due to high supplement usage. However, for iodine, vitamin D, and selenium higher risk of inadequate intake was found. UIC corroborated the low iodine intake among vegans. Thus, we suggest iodine status of youth in Norway should be monitored, especially among young fertile women who omits dietary iodine sources, until a mandatory iodine fortification program is implemented. Furthermore, we suggest that food education on how to secure sufficient nutrients from food in general should be provided to the Norwegian youth population, especially how to secure adequate intake of vitamin D, selenium and iodine.

Effectiveness of the Complete Health Improvement Program in a Geriatric Population

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level (P < .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables (P > .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.

Evidence related to a vegetarian diet and metabolic dysfunction-associated steatotic liver disease: protocol for a scoping review

INTRODUCTION

Metabolic dysfunction-associated fatty liver disease (MASLD) is the hepatic manifestation of metabolic syndrome and the leading cause of chronic liver disease worldwide. Given that there is no pharmacological treatment for MASLD, it is imperative to understand whether lifestyle modifications may improve biochemical and pathological outcomes. One commonly proposed dietary modification is the Mediterranean diet; however, vegetarianism may also be a promising intervention. Vegetarianism has been shown to be associated with reduced morbidity and mortality in metabolic syndrome outcomes in coronary artery disease and diabetes; however, the relationship between vegetarian diet and MASLD is less clear. In this scoping review, we will provide a comprehensive overview of the current body of evidence related to a vegetarian diet and MASLD.

METHODS AND ANALYSIS

The aim of this scoping review is to describe and summarise the current body of evidence related to MASLD and a vegetarian diet. This review will be conducted using Arksey and O'Malley's framework. The literature review will be conducted using the following databases: SCOPUS, Web of Science, CINAHL-Plus, Cochrane Library and Medline. No restriction will be made on publication date. Included studies will encompass clinical trials and observational designs that examine effects or association of vegetarian diet in adults (≥16 years) and report on the incidence, prevalence or progression of MASLD. Grey literature, non-human studies and articles focusing on changes in a specific food or nutraceutical will be excluded. Articles must have an English-language abstract available to be considered for inclusion. Screening and data extraction will be conducted by two independent reviewers. The findings will be summarised with descriptive statistics.

ETHICS AND DISSEMINATION

Approval from a medical ethics committee is not required for this review. Once the review is complete, the findings will be submitted to a peer-reviewed journal.

Exploring Australian News Media Portrayals of Sustainable and Plant-Based Diets

(1) Background: Dietary behaviour transformation is imperative for the attainment of more sustainable food systems, including an increased intake of plant-based foods and lower consumption of red meat and highly processed foods. The influence of news media coverage on public opinion regarding dietary behaviours is significant. Therefore, this study aimed to explore how sustainable/plant-based diets have been portrayed in Australian news media. (2) Methods: The Factiva global news database was used to search news articles published in Australia between 2018 and 2020. Relevant news articles were selected if they included keywords relating to sustainable diets, plant-based diets, and meat alternatives. We used a coding protocol to extract key information, such as date of publication, article topic, and any health, environmental and economic impacts. Then, we performed a framing and thematic analysis of the data. (3) Results: From 357 included articles, more than half of the articles encouraged increasing the intake of plant-based foods (53.5%) and reducing animal-derived food intake (55.2%). Several reasons for such shift from animal protein centric Australian diets were identified throughout the articles such as health benefits (15.4%), environmental impacts (11.2%), animal welfare (4.8%), seasonality and local food intake (5.3%), avoiding overconsumption (4.5%) and food wastage (4.5%). (4) Conclusions: The predominant frame in Australian news coverage about sustainable diets has been about consumption, more plant- and less animal-based products, with little nuance about the complex interplay of diet quality and environment in influencing food choices. Australian news media should broaden its coverage of sustainable diets to include health, environmental, and economic factors to improve public understanding and facilitate informed and sustainable food choices. Further research is needed to enhance comprehension of how the audience perceives media coverage on this topic, which will provide a more thorough understanding.

"Mindset Matters": Perseverance, a balanced approach and structured support as facilitators of whole foods plant-based adoption

Whole foods plant-based diets (WFPBD) show potential for preventing and addressing chronic diseases. However, concerns exist about their acceptability and feasibility. Research on firsthand WFPBD adoption experiences is limited but crucial for promoting dietary change. In a 12-week remotely delivered lifestyle modification program using an ad libitum WFPBD, twenty weight-loss seeking adults (ages 18-75) with overweight or obesity completed self-report surveys and semi-structured interviews via Zoom. The study aimed to explore: (1) experiences with WFPBD adoption; (2) factors that helped or hindered adherence; and (3) perceived salient benefits. Interviews were analyzed inductively through a conventional content analysis, and associations between variables examined with correlational analyses. Participants overall reported WFPBD adoption being a positive, new experience, with an equal number (30%) finding it easy/easier than expected as challenging. Key cited challenges included overwhelm, different eating habits in the household, and meal preparation. Key cited facilitators included adopting an incremental approach to dietary change, persisting after setbacks, and having simple go-to meals. Greater self-compassion and family support, and less sabotage from friends and family corresponded to greater dietary change (rs > 0.45, ps < .05). Participants valued accountability, structure, human support, nutrition psychoeducation and recipes in the program. Three categories emerged regarding perceived benefits of following the WFPBD: physical health benefits, improvements to eating habits, and greater perceived control/agency over health. Results indicate that future interventions should include psychological strategies alongside nutrition education to enhance self-efficacy, address household barriers, and combat feelings of overwhelm through sufficient structure, support, and meal preparation guidance. Messaging around WFPBD may benefit from discussing prevailing positive experiences with adoption, common benefits experienced, and options for an incremental approach given that feasibility and acceptability concerns may deter efforts.

Body mass index, weight change, and cancer prognosis: a meta-analysis and systematic review of 73 cohort studies

BACKGROUND

Identifying the association between body mass index (BMI) or weight change and cancer prognosis is essential for the development of effective cancer treatments. We aimed to assess the strength and validity of the evidence of the association between BMI or weight change and cancer prognosis by a systematic evaluation and meta-analysis of relevant cohort studies.

METHODS

We systematically searched the PubMed, Web of Science, EconLit, Embase, Food Sciences and Technology Abstracts, PsycINFO, and Cochrane databases for literature published up to July 2023. Inclusion criteria were cohort studies with BMI or weight change as an exposure factor, cancer as a diagnostic outcome, and data type as an unadjusted hazard ratio (HR) or headcount ratio. Random- or fixed-effects models were used to calculate the pooled HR along with the 95% confidence interval (CI).

RESULTS

Seventy-three cohort studies were included in the meta-analysis. Compared with normal weight, overweight or obesity was a risk factor for overall survival (OS) in patients with breast cancer (HR 1.37, 95% CI 1.22-1.53; P < 0.0001), while obesity was a protective factor for OS in patients with gastrointestinal tumors (HR 0.67, 95% CI 0.56-0.80; P < 0.0001) and lung cancer (HR 0.67, 95% CI 0.48-0.92; P = 0.01) compared with patients without obesity. Compared with normal weight, underweight was a risk factor for OS in patients with breast cancer (HR 1.15, 95% CI 0.98-1.35; P = 0.08), gastrointestinal tumors (HR 1.54, 95% CI 1.32-1.80; P < 0.0001), and lung cancer (HR 1.28, 95% CI 1.22-1.35; P < 0.0001). Compared with nonweight change, weight loss was a risk factor for OS in patients with gastrointestinal cancer.

CONCLUSIONS

Based on the results of the meta-analysis, we concluded that BMI, weight change, and tumor prognosis were significantly correlated. These findings may provide a more reliable argument for the development of more effective oncology treatment protocols.

Plant-based diets in patients with chronic kidney disease

Dietary protein restriction has been considered to be a nutritional-related strategy to reduce risk for end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease (CKD). However, there is insufficient evidence to recommend a particular type of protein to slow down the CKD progression. Recently, various plant-based diets could demonstrate some additional benefits such as a blood pressure-lowering effect, a reduction of metabolic acidosis as well as hyperphosphatemia, and gut-derived uremic toxins. Furthermore, the former concerns about the risk of undernutrition and hyperkalemia observed with plant-based diets may be inconsistent in real clinical practice. In this review, we summarize the current evidence of the proposed pleiotropic effects of plant-based diets and their associations with clinical outcomes among pre-dialysis CKD patients.

Causal associations between dietary habits and CVD: a Mendelian randomisation study

Over the years, numerous observational studies have substantiated that various dietary choices have opposing effects on CVD. However, the causal effect has not yet been established. Thus, we conducted a Mendelian randomisation (MR) analysis to reveal the causal impact of dietary habits on CVD. Genetic variants strongly associated with 20 dietary habits were selected from publicly available genome-wide association studies conducted on the UK Biobank cohort (n 449 210). Summary-level data on CVD were obtained from different consortia (n 159 836-977 323). The inverse-variance weighted method (IVW) was the primary outcome, while MR-Egger, weighted median and MR Pleiotropy RESidual Sum and Outlier were used to assess heterogeneity and pleiotropy. We found compelling evidence of a protective causal effect of genetic predisposition towards cheese consumption on myocardial infarction (IVW OR = 0·67; 95 % CI = 0·544, 0·826; P = 1·784 × 10-4) and heart failure (IVW OR = 0·646; 95 % CI = 0·513, 0·814; P = 2·135 × 10-4). Poultry intake was found to be a detrimental factor for hypertension (IVW OR = 4·306; 95 % CI = 2·158, 8·589; P = 3·416 × 10-5), while dried fruit intake was protective against hypertension (IVW OR = 0·473; 95 % CI = 0·348, 0·642; P = 1·683 × 10-6). Importantly, no evidence of pleiotropy was detected. MR estimates provide robust evidence for a causal relationship between genetic predisposition to 20 dietary habits and CVD risk, suggesting that well-planned diets may help prevent and reduce the risk of CVD.

Animal protein intake is directly associated with serum level of pentraxin 3 in hemodialysis patients

Inflammation plays an important role in Cardiovascular disease (CVD) pathogenesis as the main cause of mortality in hemodialysis (HD) patients. Despite the relevance of nutrition and dietary intakes for inflammation status, the role of dietary protein sources remains unclear. The aim of this study was to evaluate the association between the different types of dietary protein and pentraxin 3 (PTX3) levels in HD patients. In this multi-center cross-sectional study, 227 adult patients undergoing HD for a minimum 90 days were recruited. A validated 168-item food frequency questionnaire was used to assess dietary intakes. Also, 5 ml blood samples were collected from each patient to measure the concentration of serum PTX3. Overall, 227 patients, including 63 women and 164 men, with a mean age of 58 years, participated in this study. There was a greater intake of animal protein per kilogram dry weight among patients with higher levels of PTX3 (0.46 vs. 0.54 g/kg; P = 0.035). In contrast, consumption of total protein and plant protein per kilogram dry weight was not different across PTX3 levels. Moreover, the chance of increased PTX3 concentration was directly associated with a one-unit increase in animal protein intake per kilogram dry weight, after adjusting for confounders. We did not observe any association between one-unit increases in plant protein intake per kilogram dry weight and chance of increased PTX3. In conclusion, animal protein intake was directly associated with circulating PTX3.

Cross-sectional measurement of adherence to a proposed sustainable and healthy dietary pattern among United States adults using the newly developed Planetary Health Diet Index for the United States

BACKGROUND

Dietary choices are an important avenue for improving food system sustainability. The Planetary Health Diet was proposed by the EAT-Lancet Commission as a reference healthy and sustainable dietary pattern.

OBJECTIVES

To assess adherence to the Planetary Health Diet among United States adults, this study developed and evaluated the Planetary Health Diet Index for the United States (PHDI-US), adapted from the original PHDI validated in the Brazilian population.

METHODS

The PHDI-US has 16 components with scores ranging between 0 and 150, and higher scores indicate better adherence to the Planetary Health Diet. Cross-sectional dietary data from 4741 participants of the National Health and Nutrition Examination Survey 2017-2018 were used to assess the validity and reliability of the PHDI-US.

RESULTS

Validity and reliability tests were acceptable overall: principal component analysis identified 6 components; total PHDI-US and Healthy Eating Index-2015 scores were positively associated (β = 0.67, standard error = 0.03, P <0.0001; R2 = 0.39); concurrent-criterion validity analyses identified significantly lower scores among males, everyday smokers, and younger adults; and the Cronbach's α value was 0.54. The average PHDI-US score was 46.7 out of 150, indicating that the diets of United States adults were far from meeting Planetary Health Diet recommendations. Based on component PHDI-US scores, many United States adults may be able to enhance the quality and sustainability of their diets by increasing intake of plant-based foods, including whole grains, nuts and peanuts, legumes, fruits, and vegetables, and reducing intake of animal-based foods, including red and processed meats.

CONCLUSIONS

The PHDI-US is a new tool that can assess adherence to the Planetary Health Diet and identify key aspects of United States adults' diets that could be altered to potentially improve dietary sustainability and quality.

Feeling morally troubled about meat, dairy, egg, and fish consumption: Dissonance reduction strategies among different dietary groups

A largescale shift towards plant-based diets is considered a critical requirement for tackling ethical, environmental, and global health issues associated with animal food production and consumption. Although previous research has identified psychological strategies that enable meat-eaters to justify and continue meat consumption and feel less morally conflicted about it, research on the psychological strategies that enable consumers to continue dairy, egg, and fish consumption is scarce. We conducted an online survey study using an adjusted version of the Meat-Eating Justification Scale to investigate the use of psychological strategies to cope with cognitive dissonance related to meat, dairy, egg, and fish consumption in omnivores (n = 186), pescatarians (n = 106), vegetarians (n = 143), vegans (n = 203), and flexitarians (n = 63). Results indicated greater use of meat-related dissonance reduction strategies among omnivores as compared to other dietary groups, greater use of fish-related dissonance reduction strategies among fish consumers (omnivores, flexitarians and pescatarians) compared to vegetarians and vegans, and greater use of dairy and egg-related dissonance reduction strategies among dairy and egg consumers (omnivores, flexitarians, pescatarians, and vegetarians) as compared to vegans. This pattern was particularly clear for justifications used to defend animal product consumption, denial of animal suffering, and use of dichotomization when considering meat and fish consumption. These findings highlight the importance of extending the research on dissonance reduction strategies beyond meat consumption and studying the consumption of a range of animal products. This can help in identifying the psychological barriers to adopting a plant-based diet and informing interventions for behaviour change.

Vegetarian and vegan diets: benefits and drawbacks

Plant-based diets have become increasingly popular thanks to their purported health benefits and more recently for their positive environmental impact. Prospective studies suggest that consuming vegetarian diets is associated with a reduced risk of developing cardiovascular disease (CVD), diabetes, hypertension, dementia, and cancer. Data from randomized clinical trials have confirmed a protective effect of vegetarian diets for the prevention of diabetes and reductions in weight, blood pressure, glycosylated haemoglobin and low-density lipoprotein cholesterol, but to date, no data are available for cardiovascular event rates and cognitive impairment, and there are very limited data for cancer. Moreover, not all plant-based foods are equally healthy. Unhealthy vegetarian diets poor in specific nutrients (vitamin B12, iron, zinc, and calcium) and/or rich in highly processed and refined foods increase morbidity and mortality. Further mechanistic studies are desirable to understand whether the advantages of healthy, minimally processed vegetarian diets represent an all-or-nothing phenomenon and whether consuming primarily plant-based diets containing small quantities of animal products (e.g. pesco-vegetarian or Mediterranean diets) has beneficial, detrimental, or neutral effects on cardiometabolic health outcomes. Further, mechanistic studies are warranted to enhance our understanding about healthy plant-based food patterns and the biological mechanisms linking dietary factors, CVD, and other metabolic diseases.

The benefits of dietary fiber: the gastrointestinal tract and beyond

Dietary fiber is considered an essential constituent of a healthy child's diet. Diets of healthy children with adequate dietary fiber intake are characterized by a higher diet quality, a higher nutrient density, and a higher intake of vitamins and minerals in comparison to the diets of children with poor dietary fiber intake. Nevertheless, a substantial proportion of children do not meet the recommended dietary fiber intake. This is especially true in those children with kidney diseases, as traditional dietary recommendations in kidney diseases have predominantly focused on the quantities of energy and protein, and often restricting potassium and phosphate, while overlooking the quality and diversity of the diet. Emerging evidence suggests that dietary fiber and, by extension, a plant-based diet with its typically higher dietary fiber content are just as important for children with kidney diseases as for healthy children. Dietary fiber confers several health benefits such as prevention of constipation and fewer gastrointestinal symptoms, reduced inflammatory state, and decreased production of gut-derived uremic toxins. Recent studies have challenged the notion that a high dietary fiber intake confers an increased risk of hyperkalemia or nutritional deficits in children with kidney diseases. There is an urgent need of new studies and revised guidelines that address the dietary fiber intake in children with kidney diseases.

Vegetarians: Past, Present, and Future Regarding Their Diet Quality and Nutritional Status

The term "vegetarian" usually refers to individuals who exclude meat, fish, poultry and/or their derived products from their diet [...].

Vegetarianism and Its Implications for Body Mass Index, Health, and Dietary Awareness in a Metropolitan City in India: A Cross-Sectional Study

Background This cross-sectional study aimed to assess and analyze the awareness of vegetarianism and its prevalence as a lifestyle practice in an urban population of Hyderabad, India. Methodology A predesigned, semi-structured questionnaire was used to collect data from consenting study participants. The questionnaire was administered, and the response data were extracted and analyzed using Microsoft Excel and Open Epi. The chi-square test was employed, and an appropriate p-value was set for each parametrical calculation and analysis. Results The study revealed that 43.7% of the study group followed a vegetarian diet, while the remaining population consumed a mixed diet. Most vegetarians were born into vegetarian families and adhered to it due to religious beliefs. Additionally, some individuals converted to vegetarianism for perceived health benefits, such as efficient weight management and decreased cholesterol levels. However, many vegetarians reported deficiencies in certain micro and macronutrients, necessitating additional supplementation. Lacto-ovo vegetarians were found to experience the most health benefits from this practice, exhibiting desirable body mass index rates and higher rates of satisfaction. Conclusions Vegetarianism is prevalent in the urban population of Hyderabad, India. The decision to follow a vegetarian lifestyle is influenced by various factors, including religious beliefs and perceived health benefits. However, it is important to address the potential nutrient deficiencies associated with vegetarian diets. Lacto-ovo vegetarians, in particular, seem to derive significant health benefits from their dietary choices.

Cross-Sectional Study to Map Nutritional Quality of Meat, Fish, and Dairy Alternatives in Dutch Supermarkets According to the Dutch Food-Based Dietary Guidelines and Nutri-Score

Due to a growing challenge to feed the world's population and an increased awareness to minimize the impact of our food choices on climate change, a more plant-based diet has gained popularity with a growing number of plant-based products on the market. To stimulate a plant-based diet that also improves long-term health, data are needed to monitor whether these products are healthy alternatives to animal-based foods. Therefore, this study inventoried 916 plant-based meat, fish, and dairy alternatives from eight Dutch supermarkets. The nutritional quality of each product was assessed by (1) the Dutch food-based dietary guidelines and (2) the Nutri-Score. The results show that over 70% of meat, fish, and dairy alternatives have an A/B Nutri-Score (indicating high nutritional quality), but do not comply with the Dutch dietary guidelines. This is mainly due to high salt and low vitamin B12 and iron content (meat and fish alternatives) or low protein and calcium levels (dairy alternatives). In conclusion, the majority of plant-based products are nutritionally not full alternatives of the animal-based equivalents; however, there are still opportunities for reformulation. To aid the consumer in making healthy plant-based food choices, a better alignment between the Nutri-Score and the recommended dietary guidelines is needed.

Adherence to the EAT-Lancet diet and risk of coronary events in the Malmö Diet and Cancer cohort study

BACKGROUND

The EAT-Lancet Commission proposed a globally environmentally sustainable dietary pattern featuring mainly plant-based foods in 2019. However, evidence on this dietary pattern in preventing coronary events is minimal.

OBJECTIVES

We aimed to examine the association between the EAT-Lancet diet and risk of coronary events.

METHODS

The Malmö Diet and Cancer cohort study (recruited between 1991 and 1996) included 23,877 participants aged 44.5-73.6 y (62.5% women) without CVDs and diabetes at baseline. A modified diet history was used to collect the dietary data. An EAT-Lancet diet index (range, 0-42 points) was applied on the basis of 14 food components scored 0 (nonadherence) to 3 (adherence). Coronary events were extracted from the registers. Cox proportional hazards models were used to estimate the HRs and 95% confidential intervals (CIs).

RESULTS

Over a median of 24.9 y of follow-up, 3031 coronary events occurred (incidence rate: 5.89/1000 person-years). After adjusting for age, sex, dietary assessment methods, season, total energy intake, leisure-time physical activity, alcohol consumption, smoking status, educational level, and BMI, the multivariable HR (95% CI) for coronary events among participants who had the highest adherence to the EAT-Lancet diet index (≥23 points, 8.1%) was 0.80 (0.67, 0.96) compared with those who had the lowest adherence (≤13 points, 9.7%) (P-trend = 0.01 across 5 groups of the EAT-Lancet diet). The inverse association was consistent in men and women and was robust after excluding those with misreported energy and significant diet changes or excluding coronary events occurred within the first 2 y of follow-up.

CONCLUSIONS

Our data indicate that adherence to the EAT-Lancet diet was associated with a lower risk of coronary events.

Plant Based Diet and Its Effect on Cardiovascular Disease

Cardiovascular disease remains the leading cause of death globally and here in the United States. Diet has a major impact on the pathogenesis of atherosclerosis and subsequent cardiovascular morbidity and mortality. An unhealthy diet is the most significant potential behavioral and modifiable risk factor for ischemic heart disease. Despite these established facts, dietary interventions are far less frequent than pharmaceutical and procedural interventions in the management of cardiovascular disease. The beneficial effects of a plant-based diet on cardiovascular morbidity and mortality have been demonstrated in a number of recent clinical studies. The significant findings of each study are discussed in this review article, highlighting the role of a healthy plant-based diet in improving cardiovascular outcomes. From a clinician's standpoint, the knowledge and understanding of the facts and data points from these recent clinical studies would ensure more effective patient counseling on the substantial benefits of dietary interventions.

Plant-Based Diets and Lipid, Lipoprotein, and Inflammatory Biomarkers of Cardiovascular Disease: A Review of Observational and Interventional Studies

Plant-based diets (PBDs) are becoming increasingly popular. Thus far, the literature has focused on their association with lipid profiles, with less investigation of lipoprotein and inflammatory profiles. Because pro-atherogenic lipid, lipoprotein, and inflammatory processes may facilitate the development of atherosclerosis, understanding the relation between PBDs and these processes is important to inform risk mitigation strategies. Therefore, the objective of this paper was to review the literature on PBDs and lipid, lipoprotein, and inflammatory biomarkers of cardiovascular disease (CVD). A structured literature search was performed, retrieving 752 records, of which 43 articles were included. Plant-based diets generally associated with favourable lipid and lipoprotein profiles, characterised by decreased total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B concentrations, and less low-grade inflammation, characterised by decreased C-reactive protein concentrations. Effect sizes from PBD interventions were greatest compared to habitual dietary patterns, and for non-low-fat vegan and tightly controlled dietary interventions. Associations between PBD indices and the reviewed biomarkers were less consistent. Findings are discussed with reference to the literature on PBDs and PBD indices and CVD risk, the associations between specific plant food groups and CVD outcomes and the reviewed biomarker outcomes, and the potential mechanisms underpinning associations between PBDs and reduced CVD 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.

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

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

α-linolenic acid interconversion is sufficient as a source of longer chain ω-3 polyunsaturated fatty acids in humans: An opinion

α-linolenic acid (αLNA) conversion into the functionally important ω-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), has been regarded as inadequate for meeting nutritional requirements for these PUFA. This view is based on findings of small αLNA supplementation trials and stable isotope tracer studies that have been interpreted as indicating human capacity for EPA and, in particular, DHA synthesis is limited. The purpose of this review is to re-evaluate this interpretation. Markedly differing study designs, inconsistent findings and lack of trial replication preclude robust consensus regarding the nutritional adequacy of αLNA as a source of EPC and DHA. The conclusion that αLNA conversion in humans is constrained is inaccurate because it presupposes the existence of an unspecified, higher level of metabolic activity. Since capacity for EPA and DHA synthesis is the product of evolution it may be argued that the levels of EPA and DHA it maintains are nutritionally appropriate. Dietary and supra-dietary EPA plus DHA intakes confer health benefits. Paradoxically, such health benefits are also found amongst vegetarians who do not consume EPA and DHA, and for whom αLNA conversion is the primary source of ω-3 PUFA. Since there are no reported adverse effects on health or cognitive development of diets that exclude EPA and DHA, their synthesis from αLNA appears to be nutritionally adequate. This is consistent with the dietary essentiality of αLNA and has implications for developing sustainable nutritional recommendations for ω-3 PUFA.

Diet Therapy and Public Health

A major threat to the achievement of the Sustainable Development Goals and Universal Health Coverage continues to be malnutrition [...].

Vegetarianism, Microbiota and Cardiovascular health: Looking back, and forward

Cardiovascular diseases (CVD) are the leading cause of death globally, with over 17.9 million attributed deaths in 2019. Unhealthy diet is an often-overlooked major modifiable risk factor for CVD. Global Burden of Disease (GBD) estimates suggest that unhealthy diets account for nearly 26% of all deaths, of which 84% were attributed to CVD. Plant-based diets (PBDs), which are a diverse group of dietary patterns focused on plant produce, with flexibility for varying levels of vegetarianism, have been suggested to decrease the incidence of various cardiovascular and cardiometabolic diseases. In this review, we aim to delve into the spectrum of PBDs, revisit objective definitions and classifications, and compare them with standard non-vegetarian diets. We examine plausible mechanisms underlying the cardiovascular benefits of PBDs with a particular focus on the dietary manipulation of gut microbiota-host interaction and its effect on energy metabolism, and local and systemic inflammation. In addition, we explore the evidence on the impact of PBDs on cardiovascular disease, examine the challenges and limitations associated with dietary intervention studies, and devise strategies to draw valid conclusions. Dietary interventions, such as PBDs are one of the most powerful, attainable, cost-effective tools for health and environmental protection at the population level. We conclude with a clear appreciation for PBDs in environmental sustainability, climate change, and animal welfare.

Comparison between Different Groups of Vegetarianism and Its Associations with Body Composition: A Literature Review from 2015 to 2021

BACKGROUND

Vegetarian and vegan diets have become increasingly popular in the last years for many reasons, including their association with various health benefits when compared to omnivorous diets. The main objective of the study was to collect recent (2015-2021) scientific evidence for potential implications between a vegetarian/vegan diet and an individuals' body composition.

METHODS

A literature search was conducted in PubMed, with 22 studies selected for inclusion in our collective evaluation. Of the 22 studies included, there were 12 randomized controlled trials, 1 nonrandomized controlled trial, 1 comparative study, and 8 cross-sectional. The overall sample included in this study consists of 436,178 participants, 10,090 of whom were vegetarians, 5044 vegans, and 421,044 omnivores.

RESULTS

Most studies, 17 out of 22, reported a significant positive relationship between a plant-based diet and body composition.

CONCLUSION

There is scientifically sound evidence that vegan or vegetarian diets are associated with weight and body mass index reduction and, in some cases, fat mass distribution changes.

Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases

Recent advances in cardiology and biological sciences have improved quality of life in patients with complex cardiovascular diseases (CVDs) or heart failure (HF). Regardless of medical progress, complex cardiac diseases continue to have a prolonged clinical course with high morbidity and mortality. Interventional coronary techniques together with drug therapy improve quality and future prospects of life, but do not reverse the course of the atherosclerotic process that remains relentlessly progressive. The probability of CVDs and HF phenotypes to reverse can be supported by the advances made on the medical holistic principle of systems biology (SB) and on artificial intelligence (AI). Studies on clinical phenotypes reversal should be based on the research performed in large populations of patients following gathering and analyzing large amounts of relative data that embrace the concept of complexity. To decipher the complexity conundrum, a multiomics approach is needed with network analysis of the biological data. Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.

Beyond Calorie Tracking: A Pilot Trial of a Remotely Delivered Behavioral Weight Loss Intervention Using an Ad Libitum Plant-Based Diet (Preprint)

Background

Many traditional lifestyle interventions use calorie prescriptions, but most individuals have difficulty sustaining calorie tracking and thus weight loss. In contrast, whole food plant-based diets (WFPBDs) have previously shown significant weight loss without this issue. However, most WFPBD interventions are face-to-face and time-intensive, and do not leverage gold standard behavioral strategies for health behavior change.

Objective

This open pilot trial was the first to evaluate the feasibility of a fully featured, remotely delivered behavioral weight loss intervention using an ad libitum WFPBD.

Methods

Over 12 weeks, participants (N=15) with overweight or obesity received a newly designed program that integrated behavioral weight loss and a WFPBD prescription via weekly web-based modules and brief phone coaching calls. Assessments were performed at baseline, midtreatment (6 weeks), and after treatment (12 weeks).

Results

The intervention was rated as highly acceptable (mean 4.40 out of 5, SE 0.18), and attrition was low (6.7%). In all, intention-to-treat analyses revealed that 69% (10.4/15) of the participants lost 5% of their weight (mean –5.89, SE 0.68 kg). Predefined benchmarks for quality of life were met.

Conclusions

A pilot digital behavioral weight loss intervention with a non–energy-restricted WFPBD was feasible, and the mean acceptability was high. Minimal contact time (80-150 minutes of study interventionist time per participant over 12 weeks) led to clinically relevant weight loss and dietary adherence for most participants (10.4/15, 69% and 11.8/15, 79%, respectively), and quality of life improvements (reliable change indices >1.53). We hope that this work will serve as a springboard for future larger scale randomized controlled studies evaluating the efficacy of such programs for weight loss, dietary change, and quality of life.

Trial Registration

ClinicalTrials.gov NCT04892030; https://clinicaltrials.gov/ct2/show/NCT04892030

Impacts of Commonly Used Edible Plants on the Modulation of Platelet Function

Cardiovascular diseases (CVDs) are a primary cause of deaths worldwide. Thrombotic diseases, specifically stroke and coronary heart diseases, account for around 85% of CVDs-induced deaths. Platelets (small circulating blood cells) are responsible for the prevention of excessive bleeding upon vascular injury, through blood clotting (haemostasis). However, unnecessary activation of platelets under pathological conditions, such as upon the rupture of atherosclerotic plaques, results in thrombus formation (thrombosis), which can cause life threatening conditions such as stroke or heart attack. Therefore, antiplatelet medications are usually prescribed for people who are at a high risk of thrombotic diseases. The currently used antiplatelet drugs are associated with major side effects such as excessive bleeding, and some patients are resistant to these drugs. Therefore, numerous studies have been conducted to develop new antiplatelet agents and notably, to establish the relationship between edible plants, specifically fruits, vegetables and spices, and cardiovascular health. Indeed, healthy and balanced diets have proven to be effective for the prevention of CVDs in diverse settings. A high intake of fruits and vegetables in regular diet is associated with lower risks for stroke and coronary heart diseases because of their plethora of phytochemical constituents. In this review, we discuss the impacts of commonly used selected edible plants (specifically vegetables, fruits and spices) and/or their isolated compounds on the modulation of platelet function, haemostasis and thrombosis.

Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study

BACKGROUND

Prior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population.

METHODS AND FINDINGS

We conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21-95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants' adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06, 95% CI 0.78-1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80-1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71-1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78-1.18), 0.94 (0.76-1.16), and 1.06 (0.86-1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74-1.61), 1.11 (0.76-1.61), and 0.79 (0.52-1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66-1.52), 0.91 (0.61-1.36), and 1.26 (0.84-1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods.

CONCLUSIONS

In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality.

Plant-Based Meat Alternatives: Motivational Adoption Barriers and Solutions

Meat consumption is increasingly being seen as unsustainable. However, plant-based meat alternatives (PBMA) are not widely accepted yet. PBMA aim to imitate the experience of eating meat by mimicking animal meat in its sensory characteristics such as taste, texture, or aesthetic appearance. This narrative review explores the motivational barriers to adopting PBMA while focusing on food neophobia, social norms and rituals, as well as conflicting eating goals that prevent consumers from switching to a plant-based diet. Based on the key characteristics of these motivational barriers, which are informed by research findings in consumer psychology and marketing, solutions are discussed that can help counter the barriers.

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.

Association between Plant-Based Dietary Patterns and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Plant-based diets, characterized by a higher consumption of plant foods and a lower consumption of animal foods, are associated with a favorable cardiovascular disease (CVD) risk, but evidence regarding the association between plant-based diets and CVD (including coronary heart disease (CHD) and stroke) incidence remain inconclusive. A literature search was conducted using the PubMed, EMBASE and Web of Science databases through December 2020 to identify prospective observational studies that examined the associations between plant-based diets and CVD incidence among adults. A systematic review and a meta-analysis using random effects models and dose–response analyses were performed. Ten studies describing nine unique cohorts were identified with a total of 698,707 participants (including 137,968 CVD, 41,162 CHD and 13,370 stroke events). Compared with the lowest adherence, the highest adherence to plant-based diets was associated with a lower risk of CVD (RR 0.84; 95% CI 0.79–0.89) and CHD (RR 0.88; 95% CI 0.81–0.94), but not of stroke (RR 0.87; 95% CI 0.73–1.03). Higher overall plant-based diet index (PDI) and healthful PDI scores were associated with a reduced CVD risk. These results support the claim that diets lower in animal foods and unhealthy plant foods, and higher in healthy plant foods are beneficial for CVD prevention. Protocol was published in PROSPERO (No. CRD42021223188).

Massachusetts General Hospital Revere Food Pantry: Addressing hunger and health at an academic medical center community clinic

Food insecurity is defined by limited access to adequate food. As a result, it is associated with chronic disease for millions of Americans. Healthcare systems take responsibility for improving patient health and thus are well positioned to create food security interventions that improve health. Given that dietary recommendations now emphasize plant-based foods (such as vegetables, fruits, legumes, and whole grains), interventions could prioritize distributing plant-based foods that promote health and reduce food insecurity. We developed a plant-based food pantry at the Massachusetts General Hospital Revere Healthcare Center, an academic medical center-affiliated community clinic that serves many patients with food insecurity. We partnered with a local food bank and used a color-coded nutrition ranking system to prioritize healthy foods. What began as a pilot program for patients with food insecurity and chronic disease expanded to serve the entire clinic population in response to rising community level food insecurity resulting from the COVID-19 pandemic. We developed and modified a workflow that provided an average of 384 recipients (i.e., patients and their household members) with food monthly during the 10-month study period. A total of 117,742 pounds of food was distributed. Next steps for the food pantry will include investigating health outcomes, assessing patient satisfaction with plant-based foods, and securing sustainable funding. Our experience can be used to guide other health organizations interested in the intersection of food security and chronic disease management.

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

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

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

Low Blood-As Levels and Selected Genotypes Appears to Be Promising Biomarkers for Occurrence of Colorectal Cancer in Women

In following study we examined whether blood arsenic (As) levels combined with specific polymorphisms in MT1B, GSTP1, ABCB1, NQO1, CRTC3, GPX1, SOD2, CAT, XRCC1, ERCC2 can be used as a marker for the detection of colorectal cancer (CRC) among Polish women. A retrospective case-control study of CRC included 83 CRC cases and 78 healthy controls. From each study participant pre-treatment peripheral blood was collected for As level measurement by inductively coupled–plasma mass spectrometry (ICP-MS). We estimated the odds ratio (OR) of the association between blood-As levels and CRC using multivariable unconditional logistic regression models. A low blood-As level (0.27–0.67 µg/L) was associated with an increased frequency of CRC (OR: 3.69; p = 0.005). This correlation was significantly greater when participants carried particular gene variants: CAT, rs1001179-nonCC (OR: 19.4; p = 0.001); ABCB1 rs2032582–CC (OR: 14.8; p = 0.024); GPX1 rs1050450-CC (OR: 11.6; p = 0.002) and CRTC3 rs12915189-nonGG (OR: 10.3; p = 0.003). Our study provides strong evidence that low blood-As levels are significantly associated with increased CRC occurrence and that particular gene variants significantly enhanced this correlation however, due to the novelty of these findings, we suggest further validation before a definitive statement that the combined effect of low blood-As levels with specific gene polymorphisms is a suitable CRC biomarker.

A Cross-Sectional Comparison of the Whole Blood Fatty Acid Profile and Omega-3 Index of Male Vegan and Omnivorous Endurance Athletes

Background: Evaluation of the dietary fat consumption in athletes following vegan diets is scarce. The aim of this study was to explore the intakes, availability, and uptake of physiologically relevant fatty acids into whole blood, and consequently the Omega-3 Index (O3I) of endurance athletes following vegan and omnivorous dietary patterns.Materials: Males aged 18 to 55 years, engaging in ≥ four hours of training/week and following a vegan (>6 months) or omnivorous dietary pattern were eligible to participate. A 7-day food and training diary was collected and an incremental ramp running protocol used to determine peak aerobic capacity. A finger prick blood sample was collected to determine the whole blood fatty acid profile and O3I. Participants were grouped as following a vegan or omnivorous diet matched for age, training volume and peak aerobic capacity.Results: The vegan group (n = 12) consumed significantly less dietary total fat (122.2 g/day vs 84.1 g/day p = 0.007), saturated fat (43.74 g/day vs 18.42 g/day p < 0.0001), monounsaturated fat (49.6 g/day vs 35.64 g/day p = 0.039) and long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) compared to the omnivorous group (n = 8). Between group differences in whole blood fatty acid concentrations were observed including; linoleic, eicosapentaenoic, docosahexaenoic, n-6:n-3 and AA:EPA ratios. O3I in both groups were suboptimal (vegan: 4.13%, omnivorous: 5.40%) in terms of cardiac risk.Conclusion: Male endurance athletes should ensure their dietary LC n-3 PUFA intakes, particularly EPA and DHA fatty acids are sufficient to optimize their O3I.

Recent Molecular Mechanisms and Beneficial Effects of Phytochemicals and Plant-Based Whole Foods in Reducing LDL-C and Preventing Cardiovascular Disease

Abnormal lipid metabolism leads to the development of hyperlipidemia, a common cause of multiple chronic disorders, including cardiovascular disease (CVD), obesity, diabetes, and cerebrovascular disease. Low-density lipoprotein cholesterol (LDL-C) currently remains the primary target for treatment of hyperlipidemia. Despite the advancement of treatment and prevention of hyperlipidemia, medications used to manage hyperlipidemia are limited to allopathic drugs, which present certain limitations and adverse effects. Increasing evidence indicates that utilization of phytochemicals and plant-based whole foods is an alternative and promising strategy to prevent hyperlipidemia and CVD. The current review focuses on phytochemicals and their pharmacological mode of actions for the regulation of LDL-C and prevention of CVD. The important molecular mechanisms illustrated in detail in this review include elevation of reverse cholesterol transport, inhibition of intestinal cholesterol absorption, acceleration of cholesterol excretion in the liver, and reduction of cholesterol synthesis. Moreover, the beneficial effects of plant-based whole foods, such as fresh fruits, vegetables, dried nuts, flax seeds, whole grains, peas, beans, vegan diets, and dietary fibers in LDL-C reduction and cardiovascular health are summarized. This review concludes that phytochemicals and plant-based whole foods can reduce LDL-C levels and lower the risk for CVD.

Meat disgust is negatively associated with meat intake - Evidence from a cross-sectional and longitudinal study

Meat consumption is increasingly seen as unsustainable, unhealthy, and unethical. Understanding what factors help people reduce their meat intake is urgently needed. One such factor is meat disgust, a feeling reported by many vegetarians, and which could be a promising basis for meat reduction interventions. However, meat disgust and its impact on meat consumption is poorly understood. We examined meat disgust and its role in vegetarianism and reducing meat intake in a cross-sectional and longitudinal online study. We measured self-reported meat consumption, meat disgust (by self-report and Implicit Association Test), meat liking, self-control, and disgust sensitivity in N = 711 adults (57% omnivores, 28% flexitarians, 15% vegetarians) recruited from a community cohort. Results showed that 73% of vegetarians can be classified as 'meat disgusted', and that meat disgust predicted meat intake better than self-control in omnivores and flexitarians at baseline. Following up a sub-sample of participants (N = 197) after six months revealed that changes in meat intake over time were also associated with changes in meat disgust. This is the first study to quantify the impact of meat disgust on (changes in) meat consumption and its prevalence in the vegetarian and the general population. Our findings advance research into meat disgust and encourage the development of disgust-based interventions to reduce meat intake.

Availability and Nutrient Composition of Vegetarian Items at US Fast-Food Restaurants

BACKGROUND

Consumer demand for vegetarian options is growing. Fast-food restaurants have responded by adding high-profile vegetarian offerings, but little is known about the overall availability or nutrient profile of vegetarian options at these establishments, or how these items compare with nonvegetarian items.

OBJECTIVE

The purpose of this study was to quantify trends in the availability and nutrient profile of vegetarian items in US fast-food restaurants from 2012 to 2018.

DESIGN

This study was a longitudinal analysis of secondary data. We used nutrient data from the MenuStat database for menu offerings at 36 large US fast-food chain restaurants (2012 to 2018). Vegetarian items were identified through automated key word searches and item description hand-coding.

OUTCOME MEASURES

Annual counts and proportions of vegetarian and nonvegetarian items by category, and annual trends and differences in predicted mean calories; saturated, unsaturated, and trans fats; sugar; nonsugar carbohydrates; protein; sodium between and within vegetarian and nonvegetarian items.

STATISTICAL ANALYSIS PERFORMED

We report counts and proportions of vegetarian items by menu category, then use Tobit regression models to examine annual trends and differences in predicted mean nutrients between and within vegetarian and nonvegetarian items. Sensitivity analyses were calorie-adjusted.

RESULTS

The annual proportion of vegetarian items remained consistent (approximately 20%), and counts increased (2012, n = 601; 2018, n = 713). Vegetarian items had significantly fewer calories (2018: -95 kcal) and, even after adjustment for calories, lower saturated fat (-1.6 g), unsaturated fat (-1.8 g), protein (-3.8 g), and sodium (-62 mg) annually (P < .05) compared with nonvegetarian items. Vegetarian items were significantly higher in sugar (2018: +2.0 g; P < .01) and nonsugar carbohydrates (2018: +9.7 g; P < .01), after calorie adjustment, compared with nonvegetarian items.

CONCLUSIONS

Vegetarian items were generally lower in several overconsumed nutrients of public health concern (eg, sodium and saturated fat) than nonvegetarian items, but nutrient changes suggest surveillance remains important as vegetarian options increase in popularity.

Food consumption pattern and dietary diversity of a vegetarian population in Ghana

Objective

This study examined the food consumption pattern and dietary diversity of a vegetarian population in the Greater Accra Region of Ghana.

Methods

A cross-sectional study was employed to examine the nutritional status of four (4) vegetarian groups in the Greater Accra Region of Ghana. One hundred and twenty-two (122) vegetarians were recruited using the total enumeration technique. Food consumption pattern and dietary diversity were assessed using a validated qualitative food frequency questionnaire and a 24-hour dietary recall, respectively. Dietary diversity was calculated using the FAO guidelines.

Results

Sixty eight percent (68%) of the vegetarians reported daily intakes of vegetable protein. Majority of the vegetarians (80.6%) reported daily intakes of cereals and grains while 54% reported daily intakes of tubers. Eighty two percent (82%) and 72% of the vegetarians consumed vegetables and fruits on daily basis respectively. A few of the vegetarians (29%) reported daily intakes of fruit juices. Soft drinks, deep fried foods and fast foods were occasionally consumed. About 40.3% of the vegetarians obtained a dietary diversity score of four (4). Majority of them (68.9%) had low dietary diversity.

Conclusion

The vegetarians had low dietary diversity which may lead to inadequate nutrient intakes. Thus, there is the need for nutrition-related professionals to give appropriate information on a vegetarian diet and educate vegetarians to include a variety of foods in their diet.

Funding

None declared.

A Bidirectional View of Migraine and Diet Relationship

Migraine is a common headache with a large negative impact on health. Several endogenous and exogenous factors can influence the severity and frequency of migraine, for example, lifestyle factors including dietary factors. Consequently, lifestyle modifications and dietary considerations have been reported beneficial to moderate clinical features of migraine. Much effort has been invested in determining the lifestyle factors (eg, stress, exercise, sleep, and diet) that trigger migraine to develop recommendations and guidelines for prevention. Diet has also been investigated with a major focus on the content of the diet and to a lesser extent on the amount, pattern, and quality of diet. Identification of dietary factors in migraine has led to nutritional interventions with a major focus on elimination of triggers, and weight control strategies. Several so-called migraine diets have consequently been proposed, for example, the ketogenic diet. Some theories have considered epigenetic diets or functional food to help in altering components of migraine pathogenesis; however, these theories are less investigated. In contrast, evidence is being accumulated to support that some mechanisms underlying migraine may alter dietary choices, for example type, amount, or patterns. Since a causative relationship is not yet established in migraine-diet relationship as to which comes first, this concept is equally valuable and interesting to investigate. Only limited epidemiological data are available to demonstrate that dietary choices are different among patients with migraine compared with individuals without migraine. Differences are reflected on quality, composition, pattern, and the amount of consumption of dietary components. This view emphasizes a potential bidirectional relationship between migraine and diet rather than a one-way influence of one on the other. This targeted review presents examples from current literature on the effects of diet on migraine features and effects of migraine on dietary choices to draw a perspective for future studies.

Intake and adequacy of the vegan diet. A systematic review of the evidence

BACKGROUND

Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations.

METHODS

A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included.

RESULTS

Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B₂, Niacin (B₃), B₁₂, D, iodine, zinc, calcium, potassium, selenium. Vitamin B₁₂ intake among vegans is significantly lower (0.24-0.49 μg, recommendations are 2.4 μg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B₁, Β₆, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load.

CONCLUSIONS

Following a vegan diet may result in deficiencies in micronutrients (vitamin B₁₂, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.

Changing dietary approaches to prevent cardiovascular disease

PURPOSE OF REVIEW

We have focused on recent research relevant to effects of dietary patterns and major food groups on cardiovascular outcomes, taking into account guidelines and position statements from expert authorities, with an emphasis on important changes in recommendations, some of which remain controversial.

RECENT FINDINGS

Major findings include: refocusing on qualitative patterns of food consumption replacing quantitative prescriptive advice on nutrients; increasing intake of plant foods; substituting saturated fats with polyunsaturated and monounsaturated oils; reducing salt intake; regular consumption of fish with a focus on omega-3 enrichment; not restricting dairy foods, other than butter and cream, with encouragement of some fermented products; reducing cholesterol intake for those at increased cardiovascular risk and diabetes, allowing 7-eggs weekly; restricting processed meats and allowing moderate lean meat consumption; preference for fiber-rich complex carbohydrates and reduced sugar intake; maintaining healthy bodyweight; and although water is the preferred beverage, allowing moderate alcohol consumption to national guidelines and avoiding alcohol in specific cardiovascular disorders.

SUMMARY

The new approach that focuses on healthier patterns of food intake is more readily understood by health practitioners and translatable to consumers and patients.

Wolffia globosa-Mankai Plant-Based Protein Contains Bioactive Vitamin B12 and Is Well Absorbed in Humans

Background: Rare plants that contain corrinoid compounds mostly comprise cobalamin analogues, which may compete with cobalamin (vitamin B₁₂ (B₁₂)) metabolism. We examined the presence of B₁₂ in a cultivated strain of an aquatic plant: Wolffia globosa (Mankai), and predicted functional pathways using gut-bioreactor, and the effects of long-term Mankai consumption as a partial meat substitute, on serum B₁₂ concentrations. Methods: We used microbiological assay, liquid-chromatography/electrospray-ionization-tandem-mass-spectrometry (LC-MS/MS), and anoxic bioreactors for the B₁₂ experiments. We explored the effect of a green Mediterranean/low-meat diet, containing 100 g of frozen Mankai shake/day, on serum B₁₂ levels during the 18-month DIRECT-PLUS (ID:NCT03020186) weight-loss trial, compared with control and Mediterranean diet groups. Results: The B₁₂ content of Mankai was consistent at different seasons (p = 0.76). Several cobalamin congeners (Hydroxocobalamin(OH-B₁₂); 5-deoxyadenosylcobalamin(Ado-B₁₂); methylcobalamin(Me-B₁₂); cyanocobalamin(CN-B₁₂)) were identified in Mankai extracts, whereas no pseudo B₁₂ was detected. A higher abundance of 16S-rRNA gene amplicon sequences associated with a genome containing a KEGG ortholog involved in microbial B₁₂ metabolism were observed, compared with control bioreactors that lacked Mankai. Following the DIRECT-PLUS intervention (n = 294 participants; retention-rate = 89%; baseline B₁₂ = 420.5 ± 187.8 pg/mL), serum B₁₂ increased by 5.2% in control, 9.9% in Mediterranean, and 15.4% in Mankai-containing green Mediterranean/low-meat diets (p = 0.025 between extreme groups). Conclusions: Mankai plant contains bioactive B₁₂ compounds and could serve as a B₁₂ plant-based food source.

Dietary Strategies for Metabolic Syndrome: A Comprehensive Review

Metabolic syndrome is a cluster of metabolic risk factors, characterized by abdominal obesity, dyslipidemia, low levels of high-density lipoprotein cholesterol (HDL-c), hypertension, and insulin resistance. Lifestyle modifications, especially dietary habits, are the main therapeutic strategy for the treatment and management of metabolic syndrome, but the most effective dietary pattern for its management has not been established. Specific dietary modifications, such as improving the quality of the foods or changing macronutrient distribution, showed beneficial effects on metabolic syndrome conditions and individual parameters. On comparing low-fat and restricted diets, the scientific evidence supports the use of the Mediterranean Dietary Approaches to Stop Hypertension (DASH) diet intervention as the new paradigm for metabolic syndrome prevention and treatment. The nutritional distribution and quality of these healthy diets allows health professionals to provide easy-to-follow dietary advice without the need for restricted diets. Nonetheless, energy-restricted dietary patterns and improvements in physical activity are crucial to improve the metabolic disturbances observed in metabolic syndrome patients.

Plant- and animal-based diet quality and mortality among US adults: a cohort study

Not all plant-based and animal foods exert the same health effects due to their various nutrient compositions. We aimed to assess the quality of plant-based v. animal foods in relation to mortality in a prospective cohort study. Using data collected from a nationally representative sample of 36 825 adults in the National Health and Nutrition Examination Survey 1999-2014, we developed a de novo Comprehensive Diet Quality Index (cDQI) that assesses the quality of seventeen foods based on the healthfulness and separately scored the quality of eleven plant-based foods in a plant-based Diet Quality Index (pDQI) and six animal foods in an animal-based Diet Quality Index (aDQI). Mortality from all causes, heart disease and cancer were obtained from linkage to the National Death Index up to 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % CI after multivariable adjustments. During a median follow-up of 8·3 years, 4669 all-cause deaths occurred, including 798 deaths due to heart disease and 1021 due to cancer. Compared with individuals in the lowest quartile, those in the highest quartile of cDQI had a lower risk of all-cause mortality (HR 0·75, 95 % CI 0·65, 0·86; Ptrend < 0·001), which largely reflected the inverse relationship between quality of plant-based foods (pDQI) and all-cause mortality (HR 0·66, 95 % CI 0·58, 0·74; Ptrend < 0·001). No independent association was found for the quality of animal foods (aDQI) and mortality. Our results suggest that consuming healthy plant-based foods is associated with lower all-cause mortality among US adults.

A Vegetarian-Style Dietary Pattern Is Associated with Lower Energy, Saturated Fat, and Sodium Intakes; and Higher Whole Grains, Legumes, Nuts, and Soy Intakes by Adults: National Health and Nutrition Examination Surveys 2013-2016

Consumer demand for plant-based foods is increasing though the reasons may vary. Plant foods are sole sources of dietary fiber, vitamin C, and flavonoids and good sources of vitamin B1, folic acid, potassium, and magnesium. They are low in saturated fat, and do not contain cholesterol and vitamin B12. Plant foods are associated with better body weight and healthy blood lipid profile. This cross-sectional study used nationally representative National Health and Nutrition Examination Survey 2013-2016 data and compared nutrient and food pattern food group intakes of adults eating a vegetarian-style diet with adults eating a nonvegetarian diet. Adults 20+ years (N = 10,064) were grouped using the Dietary Guidelines for Americans 2015-2020 definition of vegetarian-style diet, which is modelled as lacto-ovo-vegetarian diet. Trained dietary interviewers collected self-reported dietary intake data using a 24-h recall and an automated multi-pass method. Means were compared using linear contrasts (p < 0.01). On average, the vegetarians ate an estimated 419 fewer kilocalories, 7 g less saturated fat, and 1274 mg less sodium. The vegetarian-style diet was higher in micronutrient density, except for vitamin B12 and zinc. The vegetarians ate more whole grains, legumes, nuts, and soy products. Fruit, vegetables, and dairy intakes were similar for both groups. A vegetarian-style diet may be advocated to control energy, saturated fat, and sodium intakes.

The association of plant-based dietary patterns with visceral adiposity, lipid accumulation product, and triglyceride-glucose index in Iranian adults

BACKGROUND

We sought to investigate whether adherence to a more plant-based, and less animal-based, diet is associated with visceral adiposity, lipid accumulation product (LAP), and triglyceride-glucose index (TyG) in Iranian adults.

METHODS

This cross-sectional study was conducted on 270 adults aged between 18-75 years old. We created three plant-based diets. including an overall plant-based diet index (PDI), hPDI, and uPDI based on tertiles regarding the intake of animal- or plant-based food items obtained from a semi quantitative food-frequency questionnaire.

RESULTS

Higher hPDI was significantly associated with lower body mass index (BMI) (P-value = 0.01), lower waist circumference (P-value<0.001), and lower waist-hip ratio (P-value<0.001). A significant increase was found for high density lipoproteins (HDL) (P-trend <0.001) with a significant decrease for LAP (P-value = 0.03) in those with higher adherence to hPDI. Moreover, greater adherence to PDI was associated with a significant increase in diastolic blood pressure (DBP) (p-value = 0.01) and fat free mass (FFM) (p-value = 0.01). There were no significant associations between PDIs and TyG and VFA.

CONCLUSION

We found that a higher hPDI score was significantly associated with better anthropometric measurements. A significant increase was found for HDL and a significant decrease was found for LAP on hPDI. However, a higher PDI score was significantly associated with higher DBP and higher FFM.