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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (5 April 2022) | Viewed by 133824

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Special Issue Editors

Prof. Dr. Winston Craig

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Guest Editor

School of Public Health, Loma Linda University, Loma Linda, CA, USA
Interests: plant-based diets and chronic diseases; health-promoting properties of phytochemicals; healthy sustainable diets; non-dairy alternatives
Special Issues, Collections and Topics in MDPI journals

Dr. Ujué Fresán

E-Mail Website
Guest Editor

Instituto de Salud Global Barcelona (ISGlobal), Barcelona, Spain
Interests: healthy and environmental diets; sustainable diets; plant-based diets; dietary environmental impact; dietary carbon footprint; food´s LCA

Special Issue Information

Dear Colleagues,

Consumer interest in plant-based diets has been rapidly increasing in the past decade. Non-dairy and non-meat alternatives have gone mainstream. New products are appearing on the market continually. Questions have arisen as to how nutritionally sound and healthy are these products. The marketplace wants products that improve human and planetary health, ultimately worldwide. How sustainable are these plant-based diets. How significantly do they alter traditional dietary patterns? What impact do they have on food security? Do these plant-based meat and dairy alternatives help lessen environmental degradation? Will plant-based diets help in the goal to greatly diminish malnutrition and over-nutrition (leading to obesity) around the world? We invite research papers that describe these issues and provide some answers to the important questions.

Prof. Dr. Winston Craig
Dr. Ujué Fresán
Guest Editors

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Keywords

Plant-based diets
sustainable diets
food security
cardiovascular health
coronary heart disease
diabetes
chronic kidney disease
obesity
cancer
Vegetarian

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Published Papers (11 papers)

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15 pages, 1444 KiB

Open AccessArticle

Plant-Based Diets Improve Maternal–Fetal Outcomes in CKD Pregnancies

by Rossella Attini, Filomena Leone, Antoine Chatrenet, Elisa Longhitano, Viola Casula, Alice Tomasi Cont, Gaia Zaccaria, Eleonora Dalmasso, Ana Maria Manzione, Bianca Masturzo, Massimo Torreggiani, Alberto Revelli, Gianfranca Cabiddu and Giorgina Barbara Piccoli

Nutrients 2022, 14(19), 4203; https://doi.org/10.3390/nu14194203 - 9 Oct 2022

Cited by 5 | Viewed by 3574

Abstract

Reducing protein intake in patients with chronic kidney disease (CKD) limits glomerular stress induced by hyperfiltration and can prevent the progression of kidney disease; data in pregnancy are limited. The aim of this study is to analyze the results obtained in CKD patients who followed a plant-based moderately protein-restricted diet during pregnancy in comparison with a propensity-score-matched cohort of CKD pregnancies on unrestricted diets. A total of 52 CKD pregnancies followed up with a protein-restricted plant-based diet (Torino, Italy) were matched with a propensity score based on kidney function and proteinuria with CKD pregnancies with unrestricted protein intake (Cagliari Italy). Outcomes included preterm (<37 weeks) and very preterm (<34 weeks) delivery and giving birth to a small-for-gestational-age baby. The median age in our cohort was 34 years, 63.46% of women were primiparous, and the median body mass index (BMI) was 23.15 kg/m² with 13.46% of obese subjects. No statistical differences were found between women on a plant-based diet and women who were not in terms of age, parity, BMI, obesity, CKD stage, timing of referral, or cause of CKD. No differences were found between the two groups regarding the week of delivery. However, the combined negative outcome (birth before 37 completed gestational weeks or birth-weight centile <10) occurred less frequently in women following the diet than in women in the control group (61.54% versus 80.77%; p = 0.03). The lower risk was confirmed in a multivariable analysis adjusted for renal function and proteinuria (OR: 0.260 [Q1:0.093–Q3:0.724]; p = 0.010), in which the increase in proteinuria from the first to the last check-up before delivery was lower in patients on plant-based diets (median from 0.80 to 1.87 g/24 h; p: ns) than in controls (0.63 to 2.39 g/24 h p < 0.0001). Plant-based, moderately protein-restricted diets in pregnancy in patients with CKD are associated with a lower risk of preterm delivery and small-for-gestational-age babies; the effect may be mediated by better stabilization of proteinuria. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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10 pages, 822 KiB

Open AccessArticle

Comparison of Plate Waste between Vegetarian and Meat-Containing Meals in a Hospital Setting: Environmental and Nutritional Considerations

by Andrew Berardy, Brianna Egan, Natasha Birchfield, Joan Sabaté and Heidi Lynch

Nutrients 2022, 14(6), 1174; https://doi.org/10.3390/nu14061174 - 11 Mar 2022

Cited by 12 | Viewed by 4319

Abstract

Vegetarian diets can satisfy nutritional requirements and have lower environmental impacts than those containing meat. However, fruits and vegetables are wasted at higher rates than meat. Reducing both food waste (FW) and the environmental impacts associated with food production is an important sustainability goal. Therefore, the aim of this study was to examine potential tradeoffs between vegetarian meals’ lower impacts but potentially higher FW compared to meat-containing meals. To examine this, seven consecutive days of plate FW data from Loma Linda University Medical Center (LLUMC) patients were collected and recorded from 471 meals. Mean total FW and associated greenhouse gas emissions (GHGE) were higher among meat-containing meals (293 g/plate, 604 g CO₂-eq/plate) than vegetarian meals (259 g/plate, 357 g CO₂-eq/plate) by 34 g (p = 0.05) and 240 g CO₂-eq (p < 0.001), respectively. Statistically significant differences were observed in both FW and associated GHGE across major food categories, except fruit, when comparing vegetarian and meat-containing meals. Overall, vegetarian meals were preferable to meat-containing meals served at LLUMC both in terms of minimizing FW and lowering environmental impacts. Other institutions serving vegetarian meal options could expect similar advantages, especially in reduced GHGE due to the high CO₂ embodied in meat. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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12 pages, 789 KiB

Open AccessArticle

Acceptability of Plant-Based Diets for People with Chronic Kidney Disease: Perspectives of Renal Dietitians

by Jordan Stanford, Mikaela Zuck, Anita Stefoska-Needham, Karen Charlton and Kelly Lambert

Nutrients 2022, 14(1), 216; https://doi.org/10.3390/nu14010216 - 4 Jan 2022

Cited by 5 | Viewed by 4490

Abstract

The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians participated in either an online survey (n = 35) or an in-depth interview (n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription included shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation; while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary approaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multidisciplinary team was also considered imperative. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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15 pages, 734 KiB

Open AccessArticle

Pea Proteins Have Anabolic Effects Comparable to Milk Proteins on Whole Body Protein Retention and Muscle Protein Metabolism in Old Rats

by Jérôme Salles, Christelle Guillet, Olivier Le Bacquer, Carmen Malnero-Fernandez, Christophe Giraudet, Véronique Patrac, Alexandre Berry, Philippe Denis, Corinne Pouyet, Marine Gueugneau, Yves Boirie, Heidi Jacobs and Stéphane Walrand

Nutrients 2021, 13(12), 4234; https://doi.org/10.3390/nu13124234 - 25 Nov 2021

Cited by 15 | Viewed by 4337

Abstract

Plant proteins are attracting rising interest due to their pro-health benefits and environmental sustainability. However, little is known about the nutritional value of pea proteins when consumed by older people. Herein, we evaluated the digestibility and nutritional efficiency of pea proteins compared to casein and whey proteins in old rats. Thirty 20-month-old male Wistar rats were assigned to an isoproteic and isocaloric diet containing either casein (CAS), soluble milk protein (WHEY) or Pisane™ pea protein isolate for 16 weeks. The three proteins had a similar effect on nitrogen balance, true digestibility and net protein utilization in old rats, which means that different protein sources did not alter body composition, tissue weight, skeletal muscle protein synthesis or degradation. Muscle mitochondrial activity, inflammation status and insulin resistance were similar between the three groups. In conclusion, old rats used pea protein with the same efficiency as casein or whey proteins, due to its high digestibility and amino acid composition. Using these plant-based proteins could help older people diversify their protein sources and more easily achieve nutritional intake recommendations. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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13 pages, 259 KiB

Open AccessArticle

Nutritional Content and Health Profile of Non-Dairy Plant-Based Yogurt Alternatives

by Winston J. Craig and Cecilia J. Brothers

Nutrients 2021, 13(11), 4069; https://doi.org/10.3390/nu13114069 - 14 Nov 2021

Cited by 39 | Viewed by 9681

Abstract

Yogurt is considered a healthy, nutritious food in many cultures. With a significant number of people experiencing dairy intolerance, and support for a more sustainable diet, consumer demand for dairy alternatives has surged. The aim of this study was to conduct a cross-sectional survey of plant-based yogurt alternatives to assess their nutritional content and health profile. A total of 249 non-dairy yogurt alternatives were analyzed from the nutrition label listed on the commercial package. The various yogurt alternatives contained extracts of coconut (n = 79), almonds (n = 62), other nuts or seeds (n = 20), oats (n = 20), legumes (n = 16), and mixed blends (n = 52). At least one-third of the yogurt alternatives had 5 g or more of protein/serving. Only 45% of the yogurt alternatives had calcium levels fortified to at least 10% of daily value (DV), while only about one in five had adequate vitamin D and B12 fortification at the 10% DV level. One-half of the yogurt alternatives had high sugar levels, while 93% were low in sodium. Except for the coconut-based products, the yogurts were not high in fat or saturated fat. The yogurt alternatives were not fortified as frequently or to the same levels as the corresponding non-dairy, plant-based beverages. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

11 pages, 282 KiB

Open AccessFeature PaperArticle

Modeling the Effect of Environmentally Sustainable Food Swaps on Nutrient Intake in Pregnant Women

by Tian Wang, Allison Grech, Hasthi U. Dissanayake, Sinead Boylan and Michael R. Skilton

Nutrients 2021, 13(10), 3355; https://doi.org/10.3390/nu13103355 - 24 Sep 2021

Cited by 1 | Viewed by 2835

Abstract

Food production greatly contributes to greenhouse gas emissions (GHG), but there remain concerns that consuming environmentally sustainable foods can increase the likelihood of nutritional deficiencies during pregnancy. We identified commonly consumed foods of pregnant women and determined the effect of their replacement with environmentally sustainable alternatives on nutrient intake and measures of environmental sustainability. Dietary intake data from 171 pregnant women was assessed and foods that contributed the most to energy and protein intake were identified. Of these, foods producing the highest GHG emissions were matched with proposed environmentally sustainable alternatives, and their impact on nutrient provision determined. Meats, grains, and dairy products were identified as important sources of energy and protein. With the highest GHG emissions, beef was selected as the reference food. Proposed alternatives included chicken, eggs, fish, tofu, legumes, and nuts. The most pronounced reductions in CO₂ emissions were from replacing beef with tofu, legumes, and nuts. Replacing one serve per week of beef with an isocaloric serve of firm tofu during pregnancy could reduce GHG emissions by 372 kg CO₂ eq and increase folate (+28.1 µg/serve) and fiber (+3.3 g/serve) intake without compromising iron (+1.1 mg/serve) intake. Small dietary substitutions with environmentally sustainable alternatives can substantially reduce environmental impact without compromising nutrient adequacy. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

10 pages, 293 KiB

Open AccessArticle

Nutritional Quality of Plant-Based Cheese Available in Spanish Supermarkets: How Do They Compare to Dairy Cheese?

by Ujué Fresán and Holly Rippin

Nutrients 2021, 13(9), 3291; https://doi.org/10.3390/nu13093291 - 21 Sep 2021

Cited by 35 | Viewed by 9601

Abstract

Plant-based cheese is one of the most increasingly consumed dairy alternatives. Evidence is lacking on their nutritional quality. We aimed to evaluate the nutritional composition of the plant-based cheese options available in Spanish supermarkets, and how they compare with dairy cheese. An audit of plant-based cheese alternatives has been conducted in seven of the most common supermarkets. For each product, the nutritional content per 100 g and ingredients were collected. Data on generic dairy cheese were retrieved from the BEDCA website. Descriptive statistics (median, minimum and maximum) were used to characterize the plant-based cheese products, for both all the products and grouped by main ingredients (i.e., coconut oil, cashew nuts and tofu). Mann–Whitney U tests were used for comparisons between dairy and different types of plant-based cheese. The coconut oil-based products (the large majority of plant-based cheese products, n = 34) could not be considered as healthy foods. Their major ingredients were refined coconut oil and starches and were high in saturated fats and salt. The other smaller groups, cashew nut- (n = 4) and tofu-based (n = 2), showed a healthier nutritional profile. Replacing dairy cheese with these groups could be nutritionally beneficial. Future investigations should address the health effects of substituting dairy cheese with these products. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

16 pages, 987 KiB

Open AccessArticle

Designing Nutritionally Adequate and Climate-Friendly Diets for Omnivorous, Pescatarian, Vegetarian and Vegan Adolescents in Sweden Using Linear Optimization

by Patricia Eustachio Colombo, Liselotte Schäfer Elinder, Anna Karin Lindroos and Alexandr Parlesak

Nutrients 2021, 13(8), 2507; https://doi.org/10.3390/nu13082507 - 22 Jul 2021

Cited by 24 | Viewed by 8313

Abstract

Low-carbon diets can counteract climate change and promote health if they are nutritionally adequate, affordable and culturally acceptable. This study aimed at developing sustainable diets and to compare these with the EAT-Lancet diet. The Swedish national dietary survey Riksmaten Adolescents 2016–2017 was used as the baseline. Diets were optimized using linear programming for four dietary patterns: omnivores, pescatarians, vegetarians and vegans. The deviation from the baseline Riksmaten diet was minimized for all optimized diets while fulfilling nutrient and climate footprint constraints. Constraining the diet-related carbon dioxide equivalents of omnivores to 1.57 kg/day resulted in a diet associated with a reduction of meat, dairy products, and processed foods and an increase in potatoes, pulses, eggs and seafood. Climate-friendly, nutritionally adequate diets for pescatarians, vegetarians and vegans contained fewer foods and included considerable amounts of fortified dairy and meat substitutes. The optimized diets did not align very well with the food-group pattern of the EAT-Lancet diet. These findings suggest how to design future diets that are climate-friendly, nutritionally adequate, affordable, and culturally acceptable for Swedish adolescents with different dietary patterns. The discrepancies with the EAT diet indicate that the cultural dietary context is likely to play an important role in characterizing sustainable diets for specific populations. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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Review

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29 pages, 540 KiB

Open AccessReview

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

by Winston J. Craig, Ann Reed Mangels, Ujué Fresán, Kate Marsh, Fayth L. Miles, Angela V. Saunders, Ella H. Haddad, Celine E. Heskey, Patricia Johnston, Enette Larson-Meyer and Michael Orlich

Nutrients 2021, 13(11), 4144; https://doi.org/10.3390/nu13114144 - 19 Nov 2021

Cited by 137 | Viewed by 43679

Abstract

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. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

34 pages, 2173 KiB

Open AccessReview

Replacement of Meat with Non-Meat Protein Sources: A Review of the Drivers and Inhibitors in Developed Countries

by Marion R. Eckl, Sander Biesbroek, Pieter van’t Veer and Johanna M. Geleijnse

Nutrients 2021, 13(10), 3602; https://doi.org/10.3390/nu13103602 - 14 Oct 2021

Cited by 35 | Viewed by 7654

Abstract

The overconsumption of meat has been charged with contributing to poor health and environmental degradation. Replacing meat with non-meat protein sources is one strategy advocated to reduce meat intake. This narrative review aims to identify the drivers and inhibitors underlying replacing meat with non-meat protein sources in omnivores and flexitarians in developed countries. A systematic search was conducted in Scopus and Web of Science until April 2021. In total, twenty-three studies were included in this review examining personal, socio-cultural, and external factors. Factors including female gender, information on health and the environment, and lower price may act as drivers to replacing meat with non-meat protein sources. Factors including male gender, meat attachment, food neophobia, and lower situational appropriateness of consuming non-meat protein sources may act as inhibitors. Research is needed to establish the relevance of socioeconomic status, race, ethnicity, religion, health status, food environment, and cooking skills. Future studies should prioritize standardizing the definitions of meat and non-meat protein replacements and examining factors across different consumer segments and types of non-meat protein sources. Thereby, the factors determining the replacement of meat with non-meat protein sources can be better elucidated, thus, facilitating the transition to a healthier and more sustainable diet. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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16 pages, 1267 KiB

Open AccessCommentary

Unintended Consequences: Nutritional Impact and Potential Pitfalls of Switching from Animal- to Plant-Based Foods

by Rachel Tso and Ciarán G. Forde

Nutrients 2021, 13(8), 2527; https://doi.org/10.3390/nu13082527 - 23 Jul 2021

Cited by 129 | Viewed by 31898

Abstract

Consumers are shifting towards plant-based diets, driven by both environmental and health reasons. This has led to the development of new plant-based meat alternatives (PBMAs) that are marketed as being sustainable and good for health. However, it remains unclear whether these novel PBMAs to replace animal foods carry the same established nutritional benefits as traditional plant-based diets based on pulses, legumes and vegetables. We modelled a reference omnivore diet using NHANES 2017–2018 data and compared it to diets that substituted animal products in the reference diet with either traditional or novel plant-based foods to create flexitarian, vegetarian and vegan diets matched for calories and macronutrients. With the exception of the traditional vegan diet, all diets with traditional plant-based substitutes met daily requirements for calcium, potassium, magnesium, phosphorus, zinc, iron and Vitamin B12 and were lower in saturated fat, sodium and sugar than the reference diet. Diets based on novel plant-based substitutes were below daily requirements for calcium, potassium, magnesium, zinc and Vitamin B12 and exceeded the reference diet for saturated fat, sodium and sugar. Much of the recent focus has been on protein quality and quantity, but our case study highlights the risk of unintentionally increasing undesirable nutrients while reducing the overall nutrient density of the diet when less healthy plant-based substitutes are selected. Opportunities exist for PBMA producers to enhance the nutrient profile and diversify the format of future plant-based foods that are marketed as healthy, sustainable alternatives to animal-based products. Full article

(This article belongs to the Special Issue Plant-Based Diets: Working towards a Sustainable Future)

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