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Associations of dietary intake with cardiometabolic risk in a multi-ethnic cohort: a longitudinal analysis of the Determinants of Adolescence, now young Adults, Social well-being and Health (DASH) study.
Goff, LM, Huang, P, Silva, MJ, Bordoli, C, Enayat, EZ, Molaodi, OR, Cassidy, A, Maynard, M, Harding, S
The British journal of nutrition. 2019;121(9):1069-1079
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Ethnic inequalities in a wide range of chronic diseases are well documented. Poor dietary habits in childhood may contribute to higher rates of chronic diseases such as type 2 diabetes (T2D), hypertension and Coronary Heart Disease (CHD). This study was a longitudinal follow-up of a subsample of the Determinants of Adolescent Social well-being and Health (DASH) study. The researchers aimed to identify dietary patterns and investigate their impact on chronic diseases in young adulthood. The study participants were 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Participants completed a 24-hour dietary intake recall and behaviour questionnaire at age 11-13yrs, and then again at age 21-23yrs. Body mass index (BMI), blood pressure, blood cholesterol and blood sugar were measured. The researchers found that dietary behaviours such as skipping breakfast and a low intake of fruit and vegetables were common. Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels in young adults were higher among those who regularly skipped breakfast. The researchers concluded that skipping breakfast is more common in certain ethnic groups and is associated with risk factors for chronic disease in young adults. They suggest that interventions to improve dietary habits could be targeted at specific population groups.
Abstract
Unfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21-23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21-23 years were higher among those who regularly skipped breakfast at 11-13 years (BMI 1·41 (95 % CI 0·57, 2·26), P=0·001; cholesterol 0·15 (95 % CI -0·01, 0·31), P=0·063) and at 21-23 years (BMI 1·05 (95 % CI 0·22, 1·89), P=0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P=0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups.
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Trends in incidence of total or type 2 diabetes: systematic review.
Magliano, DJ, Islam, RM, Barr, ELM, Gregg, EW, Pavkov, ME, Harding, JL, Tabesh, M, Koye, DN, Shaw, JE
BMJ (Clinical research ed.). 2019;366:l5003
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Incidence measures the proportion of people who develop diabetes over a period of time among the population at risk. The aim of this study is to systematically review literature which reports diabetes incidence trends. This study is a systemic review of 47 studies. A total of 62% (n=29) of the studies exclusively reported on type 2 diabetes, and 38% (n=18) reported on total diabetes. Findings show that the incidence of diagnosed diabetes increased in most populations from the 1960s to the early 2000s, after which a pattern emerged of levelling trends in 30% and declining trends in 36% of the reported populations. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Authors conclude that improvement of the collection, availability, and analysis of incidence data will be important to effectively monitor the epidemic and guide prevention efforts into the future.
Abstract
OBJECTIVE To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. DESIGN Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. DATA SOURCES Medline, Embase, CINAHL, and reference lists of relevant publications. ELIGIBILITY CRITERIA Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. RESULTS Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. CONCLUSIONS The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42018092287.
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Changes in Anxiety and Depression Traits Induced by Energy Restriction: Predictive Value of the Baseline Status.
Rodriguez-Lozada, C, Cuervo, M, Cuevas-Sierra, A, Goni, L, Riezu-Boj, JI, Navas-Carretero, S, Milagro, FI, Martinez, JA
Nutrients. 2019;11(6)
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Anxiety and depression are among the most common mental health problems and are associated with obesity and other chronic illnesses. The number of these disorders has not been reduced despite the increased use of cognitive behavioural therapy and pharmacotherapy. Current evidence suggests diet quality as a modifiable risk factor for mental illnesses. Additional studies are required to investigate the effect of dietary patterns as well as weight loss on improving symptoms. The first aim of this study was to investigate the effect of weight loss on overweight and obese patients, using two calorie-restricted diets, on anxiety and depression symptoms. The second aim was to analyse the role of the baseline psychological features in predicting future weight loss. The study was a randomized, longitudinal, and controlled intervention trial which lasted for 16 weeks. The study indicates that weight loss via calorie-controlled diets could improve depression symptoms in obese and overweight patients. Participants that lost more weight showed a larger amelioration in depression symptoms. The study also suggests that greater anxiety symptoms at the beginning of the intervention could predict a higher weight loss. These results, in addition to the positive effect on body composition, show that weight loss could become part of a health improvement plan.
Abstract
Current evidence proposes diet quality as a modifiable risk factor for mental or emotional impairments. However, additional studies are required to investigate the effect of dietary patterns and weight loss on improving psychological symptoms. The aim of this investigation was to evaluate the effect of energy-restriction, prescribed to overweight and obese participants, on anxiety and depression symptoms, as well as the potential predictive value of some baseline psychological features on weight loss. Overweight and obese participants (n = 305) were randomly assigned for 16 weeks to two hypocaloric diets with different macronutrient distribution: a moderately high-protein (MHP) diet and a low-fat (LF) diet. Anthropometrical, clinical, psychological, and lifestyle characteristics were assessed at baseline and at the end of the intervention. The nutritional intervention evidenced that weight loss has a beneficial effect on trait anxiety score in women (β = 0.24, p = 0.03), depression score in all population (β = 0.15, p = 0.02), particularly in women (β = 0.22, p = 0.03) and in subjects who followed the LF diet (β = 0.22, p = 0.04). Moreover, weight loss could be predicted by anxiety status at baseline, mainly in women and in those who were prescribed a LF diet. This trial suggests that weight loss triggers an improvement in psychological traits, and that anxiety symptoms could predict those volunteers that benefit most from a balanced calorie-restricted intervention, which will contribute to individualized precision nutrition.
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Alpha-Linolenic and Linoleic Fatty Acids in the Vegan Diet: Do They Require Dietary Reference Intake/Adequate Intake Special Consideration?
Burns-Whitmore, B, Froyen, E, Heskey, C, Parker, T, San Pablo, G
Nutrients. 2019;11(10)
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Fish and seafood are good sources of long-chain omega-3 fatty acids, like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A vegan diet does not include animal-sourced foods and is therefore void of EPA and DHA, unless algae-derived omega-3 supplements are consumed. Thus, vegans rely on the body's own production of long-chain fatty acids from plant-derived alpha-linolenic acid (ALA). However, adequate conversion can have several limitations. Vegan diets are generally rich in linoleic acid (LA), an omega-6 fatty acid, which in high levels can impede the conversion of ALA to EPA and DHA. Furthermore, the efficiency of conversion is influenced by gender, age or health conditions like obesity. This review sought to discuss whether vegans require special dietary recommendations for fatty acids and what these suggestions could be. Most studies assessing biological indicators of fatty acid status showed that vegans had lower levels of EPA and DHA compared to omnivores. Thus, the authors concluded that special consideration should be given to ALA and LA intake in vegan diets. In the absence of a set recommendation for a fatty acid ratio, a ratio of 4:1 (omega-6:omega-3) was proposed for vegans and omnivores. A reduction in LA and an increased intake of ALA of 2.2–4.4 g/day (or 1.1 g/day/1000 Kcals) was suggested to achieve such. This article is a useful guide when considering adequate fatty acid balance and omega-3 conversion for individuals following a vegan diet.
Abstract
Good sources of the long-chain n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) include cold-water fish and seafood; however, vegan diets (VGNs) do not include animal-origin foods. Typically, US omnivores obtain enough dietary EPA and DHA, but unless VGNs consume algal n-3 supplements, they rely on endogenous production of long-chain fatty acids. VGN diets have several possible concerns: (1) VGNs have high intakes of linoleic acid (LA) as compared to omnivore/non-vegetarian diets. (2) High intakes of LA competitively interfere with the endogenous conversion of alpha-linolenic acid (ALA) to EPA and DHA. (3) High somatic levels of LA/low ALA indicate a decreased ALA conversion to EPA and DHA. (4) Some, not all VGNs meet the Dietary Reference Intake Adequate Intake (DRI-AI) for dietary ALA and (5) VGN diets are high in fiber, which possibly interferes with fat absorption. Consequently, health professionals and Registered Dietitians/Registered Dietitian Nutritionists working with VGNs need specific essential fatty acid diet guidelines. The purpose of this review was: (1) to suggest that VGNs have a DRI-AI Special Consideration requirement for ALA and LA based on VGN dietary and biochemical indicators of status and (2) to provide suggestions to ensure that VGNs receive adequate intakes of LA and ALA.
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Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review.
Alwarith, J, Kahleova, H, Rembert, E, Yonas, W, Dort, S, Calcagno, M, Burgess, N, Crosby, L, Barnard, ND
Frontiers in nutrition. 2019;6:141
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Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by joint pain and inflammation with both genetic and modifiable risk factors. Research suggests a plant-based diet may play a role in management and remission. The aim of this review was to summarize the associations between plant-based diet patterns and RA symptoms. Current studies indicate an association between improvements in RA symptoms with weight loss and with plant-based diets. Based on these findings, the authors conclude excess weight and diets that include animal products may exacerbate symptoms associated with RA, whereas plant-based diets may help reduce pain and inflammation in these patients. The authors suggest further research is needed to test the effectiveness of plant-based diets on patients with RA.
Abstract
Rheumatoid arthritis (RA), a chronic inflammatory autoimmune disease, affects roughly 1% of the world's population. RA pathogenesis remains unclear, but genetic factors account for 50-60% of the risk while the remainder might be linked to modifiable factors, such as infectious diseases, tobacco smoking, gut bacteria, and nutrition. Dietary triggers may play an inciting role in the autoimmune process, and a compromised intestinal barrier may allow food components or microorganisms to enter the blood stream, triggering inflammation. In addition, excessive body weight may affect pharmacotherapy response and the likelihood of disease remission, as well as the risk of disease mortality. Evidence suggests that changes in diet might play an important role in RA management and remission. Several studies have shown improvements in RA symptoms with diets excluding animal products. Studies have also shown that dietary fiber found in these plant-based foods can improve gut bacteria composition and increase bacterial diversity in RA patients, thus reducing their inflammation and joint pain. Although some of the trigger foods in RA patients are individualized, a vegan diet helps improve symptoms by eliminating many of these foods. This review examines the potential role of a plant-based diet in mediating RA symptoms. Further research is needed to test the effectiveness of plant-based diets on joint pain, inflammation, and quality of life in patients with RA.
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Associations between Dietary Patterns and Bile Acids-Results from a Cross-Sectional Study in Vegans and Omnivores.
Trefflich, I, Marschall, HU, Giuseppe, RD, Ståhlman, M, Michalsen, A, Lampen, A, Abraham, K, Weikert, C
Nutrients. 2019;12(1)
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Colorectal cancer is associated with higher intakes of meat and lower consumption of fibre. Fibre may alter cholesterol and bile acid production and high bile acids may cause changes in the cells of the colon. Vegan diets high in fibre and low in fat may affect bile acid production and this observational study of 72 people aimed to compare bile acids in the faeces and blood of vegans and omnivores. The results showed that vegans had higher fibre and lower fat intakes, compared to omnivores, and although bile acids in the faeces were lower in vegans, blood levels were higher. Fat intake was associated with increased bile acids in the faeces whereas fibre intake was associated with lower levels. Coffee, fish, margarine, fried potatoes, bread, and processed meat were all associated with increased bile acids in the faeces and muesli was associated with lower levels. It was concluded that high fibre, low-fat intakes characteristic of vegan diets, are associated with lower bile acids in the faeces and this could impact colorectal cancer incidence. This study could be used by healthcare professionals to recommend a vegan diet high in fibre and low in saturated fat to individuals with colorectal cancer or those who are at an increased risk.
Abstract
Bile acids play an active role in fat metabolism and, in high-fat diets, elevated concentrations of fecal bile acids may be related to an increased risk of colorectal cancer. This study investigated concentrations of fecal and serum bile acids in 36 vegans and 36 omnivores. The reduced rank regression was used to identify dietary patterns associated with fecal bile acids. Dietary patterns were derived with secondary and conjugated fecal bile acids as response variables and 53 food groups as predictors. Vegans had higher fiber (p < 0.01) and lower fat (p = 0.0024) intake than omnivores. In serum, primary and glycine-conjugated bile acids were higher in vegans than in omnivores (p ≤ 0.01). All fecal bile acids were significantly lower in vegans compared to omnivores (p < 0.01). Processed meat, fried potatoes, fish, margarine, and coffee contributed most positively, whereas muesli most negatively to a dietary pattern that was directly associated with all fecal bile acids. According to the pattern, fat intake was positively and fiber intake was inversely correlated with bile acids. The findings contribute to the evidence that, in particular, animal products and fat may play a part in higher levels of fecal bile acids.
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Effect of two different sublingual dosages of vitamin B12 on cobalamin nutritional status in vegans and vegetarians with a marginal deficiency: A randomized controlled trial.
Del Bo', C, Riso, P, Gardana, C, Brusamolino, A, Battezzati, A, Ciappellano, S
Clinical nutrition (Edinburgh, Scotland). 2019;38(2):575-583
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Vitamin B12 (cyanocobalamin) represents an important and essential water-soluble nutrient involved in the formation of erythrocytes, in the maintenance of the central nervous system, and in cognitive performance. The aim of this study was to evaluate the ability of two different doses (350ug/week vs 2000 mg/week) of sublingual supplements in improving the nutritional status of cyanocobalamin in a group of vegans and vegetarians with a marginal deficiency. Forty subjects were enrolled and randomly divided into two groups of 20 subjects each for a 12-week double-blind (participants and outcome assessors), randomised, controlled, parallel dietary intervention study. Results indicate that as a little as 350ug per week of vitamin B12 supplementation was enough to correct a marginal deficiency of cobalamin and to improve biomarkers of cobalamin status in a group of vegans and vegetarians. Authors conclude that even though vitamin B12 supplementation is important for vegetarians and vegans with a marginal deficiency, the absence of a consensus on vitamin B12 cut-off values and the high individual variability make it difficult to identify the real needs for vegans and vegetarians.
Abstract
BACKGROUND & AIMS Vegetarians and vegans are more vulnerable to vitamin B12 deficiency with severe risks of megaloblastic anemia, cognitive decline, neuropathy, and depression. An easy and simple method of supplementation consists of taking one weekly dosage of 2000 μg. However, single large oral doses of vitamin B12 are poorly absorbed. The present research evaluates the ability of two different sublingual dosages of vitamin B12 (350 μg/week vs 2000 μg/week) in improving cyanocobalamin (vitamin B12) nutritional status in vegans and vegetarians with a marginal deficiency. METHODS A 12-week randomized, double-blind, controlled, parallel intervention trial was performed. Forty subjects with marginal vitamin B12 deficiency were enrolled and randomly divided into two groups: test group Ld (low dose, 350 μg/week) and control group Hd (high dose, 2000 μg/week) vitamin B12 supplementation. Blood samples were collected at baseline and after 15, 30, 60, and 90 days from the intervention for the determination of vitamin B12, related metabolic markers, and blood cell counts. RESULTS Two-way analysis of variance showed a significant effect of time (P < 0.0001) and of time × treatment interaction (P = 0.012) on serum concentration of vitamin B12 that increased after 90-day supplementation (Ld and Hd) compared to baseline. Both the supplements increased (P < 0.0001, time effect) the levels of holotranscobalamin, succinic acid, methionine and wellness parameter, while decreased (P < 0.0001, time effect) the levels of methylmalonic acid, homocysteine and folate compared to baseline. No difference was observed between groups (Ld vs Hd). No effect was detected for vitamin B6 and blood cell count. CONCLUSIONS In our experimental conditions, both supplements were able to restore adequate serum concentrations of vitamin B12 and to improve the levels of related metabolic blood markers in subjects with a marginal deficiency. The results support the use of a sublingual dosage of 50 μg/day (350 μg/week) of cobalamin, instead of 2000 μg/week (provided as a single dose), to reach a state of nutritional adequacy of vitamin B12 in this target population. This study was registered at www.isrctn.org as ISRCTN75099618.
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Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults.
Kim, H, Caulfield, LE, Garcia-Larsen, V, Steffen, LM, Coresh, J, Rebholz, CM
Journal of the American Heart Association. 2019;8(16):e012865
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Plant based diets have been associated with better health outcomes, however mixed results have been shown on their relationship with death by any cause and death due to heart disease. This cohort study of 15792 middle aged people aimed to determine if plant-based diets are associated with a lower risk of heart disease, death due to heart disease or death due to any cause and whether this was on a sliding scale depending on adherence to a healthful plant-based diet. The results showed that individuals following a plant-based diet had a 16% lower risk of heart disease, 32% lower risk of death due to heart disease and a 25% lower risk of death by any cause and individuals who followed a healthier plant-based diet were at an even lower risk of heart disease, death due to heart disease and death due to any cause. Interestingly when margarine was included in an individual’s diet, the decreased risk of heart disease was attenuated. It was concluded that higher adherence to a healthy plant-based diet was associated with a lower risk of heart disease, death due to heart disease and death by any cause. This study could be used by healthcare practitioners to recommend a plant-based diet to those at an increased risk of heart disease.
Abstract
Background Previous studies have documented the cardiometabolic health benefits of plant-based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community-based cohort of middle-aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants' diet was classified using 4 diet indexes. In the overall plant-based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant-based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant-based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant-based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all-cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant-based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all-cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant-based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population.
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The Effects of Vegetarian and Vegan Diets on Gut Microbiota.
Tomova, A, Bukovsky, I, Rembert, E, Yonas, W, Alwarith, J, Barnard, ND, Kahleova, H
Frontiers in nutrition. 2019;6:47
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The difference in gut microbiota composition between individuals following vegan or vegetarian diets and those following omnivorous diets is well documented. A plant-based diet appears to be beneficial for human health by promoting the development of more diverse and stable microbial systems. This diversity appears to have an important association with BMI, obesity, and arterial compliance. This review highlights the effects of different diets, particularly plant-based diets, on the gut microbiota composition and production of microbial metabolites affecting the host health. The ratio between Bacteroidetes and Firmicutes is discussed and how different diets can change it. It explains how diet can affect the three main enterotypes: Prevotella, Bacteroides, and Ruminococcus. The food components proteins, carbohydrates, fats and polyphenols are discussed and how they influence gut microbiota. Up to date knowledge suggests that a plant-based diet may be an effective way to promote a diverse ecosystem of beneficial microbes that support overall health. However, due to the complexity and inter-individual differences, further research is required to fully characterize the interactions between diet, the microbiome, and health outcomes.
Abstract
The difference in gut microbiota composition between individuals following vegan or vegetarian diets and those following omnivorous diets is well documented. A plant-based diet appears to be beneficial for human health by promoting the development of more diverse and stable microbial systems. Additionally, vegans and vegetarians have significantly higher counts of certain Bacteroidetes-related operational taxonomic units compared to omnivores. Fibers (that is, non-digestible carbohydrates, found exclusively in plants) most consistently increase lactic acid bacteria, such as Ruminococcus, E. rectale, and Roseburia, and reduce Clostridium and Enterococcus species. Polyphenols, also abundant in plant foods, increase Bifidobacterium and Lactobacillus, which provide anti-pathogenic and anti-inflammatory effects and cardiovascular protection. High fiber intake also encourages the growth of species that ferment fiber into metabolites as short-chain fatty acids (SCFAs), including acetate, propionate, and butyrate. The positive health effects of SCFAs are myriad, including improved immunity against pathogens, blood-brain barrier integrity, provision of energy substrates, and regulation of critical functions of the intestine. In conclusion, the available literature suggests that a vegetarian/vegan diet is effective in promoting a diverse ecosystem of beneficial bacteria to support both human gut microbiome and overall health. This review will focus on effects of different diets and nutrient contents, particularly plant-based diets, on the gut microbiota composition and production of microbial metabolites affecting the host health.
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Theoretical Food and Nutrient Composition of Whole-Food Plant-Based and Vegan Diets Compared to Current Dietary Recommendations.
Karlsen, MC, Rogers, G, Miki, A, Lichtenstein, AH, Folta, SC, Economos, CD, Jacques, PF, Livingston, KA, McKeown, NM
Nutrients. 2019;11(3)
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Knowledge of plant-based diets is important for clinicians to be able to engage with patients about the health benefits and potential concerns. To date, the nutrient composition and nutrient adequacy of these diets has not been thoroughly assessed. The aim of this study was to estimate theoretical food and nutrient levels of whole-food plant-based (WFPB) and vegan diets and compare these levels to the US dietary recommendations. Self-identified vegan and WFPB diet followers reported their most frequently used books and websites for nutritional information and recipes. Using these sources, 30 days of theoretical meal plans were created, and this data was compared to recommendations from a MyPlate meal plan. This data was analysed to measure adherence to the 2015 Dietary Guidelines for Americans. This analysis showed the theoretical nutrient intake from a WFPB diet deviate significantly from MyPlate recommendations. The WFPB diet offered improved quality compared to the typical US diet, providing more nutrient-dense foods with less refined grains and added sugars. While WFPB diets are of higher quality in general, they risk deficiencies of vitamins B12 and D and calcium without adequate supplementation. Based on this analysis, the authors encourage patients to consider a plant-based dietary pattern with attention given to consuming calcium-rich foods, iodised salt, and using supplements for vitamins B12 and D. The authors comment that future research should examine the actual dietary intakes of these groups, rather than the theoretical, to assess actual nutrient intake and adherence to diet.
Abstract
Public interest in popular diets is increasing, in particular whole-food plant-based (WFPB) and vegan diets. Whether these diets, as theoretically implemented, meet current food-based and nutrient-based recommendations has not been evaluated in detail. Self-identified WFPB and vegan diet followers in the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey reported their most frequently used sources of information on nutrition and cooking. Thirty representative days of meal plans were created for each diet. Weighted mean food group and nutrient levels were calculated using the Nutrition Data System for Research (NDSR) and data were compared to DRIs and/or USDA Dietary Guidelines/MyPlate meal plan recommendations. The calculated HEI-2015 scores were 88 out of 100 for both WFPB and vegan meal plans. Because of similar nutrient composition, only WFPB results are presented. In comparison to MyPlate, WFPB meal plans provide more total vegetables (180%), green leafy vegetables (238%), legumes (460%), whole fruit (100%), whole grains (132%), and less refined grains (-74%). Fiber level exceeds the adequate intakes (AI) across all age groups. WFPB meal plans failed to meet the Recommended Dietary Allowances (RDA)s for vitamin B12 and D without supplementation, as well as the RDA for calcium for women aged 51⁻70. Individuals who adhere to WFBP meal plans would have higher overall dietary quality as defined by the HEI-2015 score as compared to typical US intakes with the exceptions of calcium for older women and vitamins B12 and D without supplementation. Future research should compare actual self-reported dietary intakes to theoretical targets.