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.

Correlation between vegetarian diet and oral health: a systematic review.

OBJECTIVE: Nutrition plays a significant role in preserving the balance of the human body. Considering each person's particular characteristics, diet can directly and indirectly alter the body's immune response. The purpose of this study is to draw attention to the connection between a vegetarian diet and its impact on oral health. MATERIALS AND METHODS: To determine the connection between a vegetarian diet and dental health, a search of the literature was conducted on the PubMed, Scopus, and Web of Science databases. English language and a publication year between January 1, 2013, and March 1, 2023, were the inclusion criteria for the search. RESULTS: There were 167 articles in total that addressed the subject of interest, and 18 of them were chosen for qualitative analysis. CONCLUSIONS: This study suggests that a vegetarian diet may alter oral health, namely periodontal health, tooth erosion, and oral microbiome. Even if the data collected prevents the effect of a vegetarian diet on oral health from being confirmed, this study acts as a starting point for future, more focused research.

Lacto-ovo-vegetarian diet is inversely associated with the osteosarcopenia in older adults.

OBJECTIVE: Osteosarcopenia adversely affects the quality of life and physical health of older adults. We sought to explore the association between dietary patterns and osteosarcopenia in community-dwelling older adults. METHODS: This is a cross-sectional study from Northeast China, in which, we included older community adults aged 60 and above. Through face-to-face interviews, we collected dietary information from participants using a food frequency questionnaire. Subsequently, principal component analysis (PCA) was used to obtain the dietary patterns of the participants. Through physical examination, we obtained the participants' information on osteosarcopenia, which was defined by the coexist of osteopenia and sarcopenia. We analysed the association between dietary patterns and dietary compositions with ostesarcopenia. RESULTS: In this study, a total of 9429 participants were included, and the prevalence of osteosarcopenia in community-dwelling older adults was 6.2%. PCA identified three main dietary patterns, and the lacto-ovo-vegetarian dietary pattern was inversely associated with osteosarcopenia. Compared to the lowest lacto-ovo-vegetarian quartile (Q1), the Q4 group (OR = 0.64, 95% CI:0.49-0.83) was inversely associated with osteosarcopenia. Through the weighted quantile sum regression model, we also found that the overall effect of the lacto-ovo-vegetarian dietary components was inversely associated with osteosarcopenia (OR = 0.58, 95% CI: 0.37-0.92); the largest contributors were vegetables, fresh milk, eggs, and dairy products. CONCLUSION: Overall, we found that a lacto-ovo-vegetarian dietary pattern, particularly the consumption of vegetables, fresh milk, eggs, and dairy products, was inversely associated with osteosarcopenia in older adults. And this might provide new insights for the prevention and treatment of osteosarcopenia.

Dietary Intakes of Long-Chain Polyunsaturated Fatty Acids and Impulsivity: Comparing Non-Restricted, Vegetarian, and Vegan Diets.

BACKGROUND: Research suggests a link between deficiencies in omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and impulsivity among psychiatric populations. However, this association is less evident in non-clinical populations. As omega-3 LCPUFAs are predominantly sourced through fish consumption, non-fish dieters may be more vulnerable to higher impulsivity. METHODS: This cross-sectional observational study explored the association between lower intakes of omega-3 LCPUFA food sources and higher self-reported measures of impulsivity among healthy adults consuming non-restricted, vegetarian, and vegan diets. RESULTS: The results from the validated Food Frequency Questionnaire showed significantly lower estimated omega-3 LCPUFA intakes among vegans and vegetarians when compared with people consuming non-restricted diets. Furthermore, although all groups scored within the normal range of impulsivity measures, vegans scored comparatively higher. Vegans also scored significantly higher in impulsivity control relating to attention than those consuming non-restricted diets. CONCLUSIONS: The significantly lower omega-3 LCPUFA dietary intakes in the vegan diets were associated with higher scores in the second-order attentional aspect of self-reported impulsiveness.

Plant-Based Diets in Children: Secular Trends, Health Outcomes, and a Roadmap for Urgent Practice Recommendations and Research-A Systematic Review.

People are increasingly encouraged to reduce animal food consumption and shift towards plant-based diets; however, the implications for children's health are unclear. In this narrative review of research in high-income settings, we summarize evidence on the increasing consumption of plant-based diets in children and update an earlier systematic review regarding their associations with children's health outcomes. The evidence indicates that vegan, but not vegetarian, diets can restrict growth relative to omnivorous children and increase the risk of being stunted and underweight, although the percentage affected is relatively small. Bone mineral content is reduced in vegetarian and, in particular, vegan children, compared to omnivores. Both vegetarian and vegan children who do not use vitamin B12 supplements manifest with B12 deficiency; however, supplementation rectifies this problem. Both vegetarians and vegans have lower concentrations of 25(OH)D if unsupplemented, and lower body iron stores, but usually have normal iron metabolism markers. Both groups are at risk of iodine deficiency, and this might affect thyroid health. Children consuming a vegan diet have a more favorable lipid profile than omnivorous children; however, the results for a vegetarian diet are inconsistent and vary by outcome. Based on the same scientific evidence, national and international dietary recommendations are heterogeneous, with some countries supporting plant-based diets among infants, children, and adolescents, and others discouraging them. We offer a research roadmap, highlighting what is needed to provide adequate evidence to harmonize dietary recommendations for plant-based diets in children. A number of measures should urgently be introduced at international and national levels to improve the safety of their use in children.

The association between food neophobia, bi-dimensional aspects of orthorexia, and anxiety among vegetarians and omnivores.

Vegetarianism is a growing trend, and food neophobia and orthorexia nervosa could act as barriers to achieving a healthy vegetarian diet. The aim of this study is to compare the levels of food neophobia, anxiety, and both healthy and pathological aspects of orthorexia among vegetarians and omnivores. Additionally, the study aims to identify the relationships between food neophobia, anxiety, and orthorexia. In this cross-sectional online survey, a total of 324 vegetarian and 455 omnivores adults participated. The questionnaire consisted of four sections: sociodemographic, lifestyle, and health-related characteristics, the Food Neophobia Scale (FNS), the Teruel Orthorexia Scale (TOS), and the Generalized Anxiety Disorders-7 Scale. Vegetarians exhibited lower FNS scores (p < 0.001) and had higher healthy orthorexic scores (p < 0.001) than omnivores. There were no differences between groups for anxiety scores (p > 0.05). Regression analysis indicated that higher food neophobia (OR: 0.953, 95% CI:0.937-0.968) and TOS-OrNe scores (OR: 0.946, 95% CI: 0.901-0.993) were associated with lower odds of following a vegetarian diet. Conversely, higher TOS-HeOr scores (OR: 1.135, 95% CI:1.096-1.176) were linked to an increased likelihood of adopting a vegetarian diet. Furthermore, both FNS and GAD-7 scores showed negative correlations with TOS-HeOR (r = -0.124, p < 0.001 and r = -0.129 p < 0.001, respectively), and positive correlations with TOS-OrNe (r = 0.106, p < 0.001 and r = 0.146, p < 0.001). In conclusion, vegetarians exhibit lower levels of food neophobia and a greater interest in healthy eating than omnivores. Additionally, the distinct correlation between two dimensions of orthorexia and food neophobia and anxiety provides support for the two-dimensional nature of orthorexia.

The perceived experience of adhering to vegan diet: a descriptive phenomenological study.

BACKGROUND: Today, raw vegetarianism is considered one of the most important socio-cultural developments in contemporary societies. In this regard, the present study was conducted to describe the perceived experience of people adhering to a vegan diet through a phenomenological perspective. METHODS: This qualitative study explores the perceived experiences of individuals who follow a vegan diet and are part of the self-care campaign in Kermanshah, Iran. sampling was purposeful and face-to-face interviews were conducted with 12 individuals who follow a vegan lifestyle. The data were analyzed after being collected using the seven steps of Collizi. MAXQUDA software (version 12) was used for data management. RESULTS: After qualitative data analysis, we identified 567 codes, which were categorized into 15 sub-themes. From these sub-themes, we derived 4 main themes. The main themes include: In pursuit of redemption (Meaningful framework, In awareness path, Unequaled Disappointment, Chronic and complex conditions), Seeking the New World (Starting with doubt and hesitation, The temptation to return, Constant criticism, Unfamiliar appearance), On the path of overcoming difficulties (Associate problems, Matching the new way, Perceived recommendations), and attaining the expected outcomes (Healthy lifestyle, Therapeutic feedback, Enhancing emotional wellbeing, Feeling of youth). CONCLUSION: Based on the participants' experience, despite the challenging journey, the people with a vegetarian diet experienced partial and complete improvement of all the symptoms of the diseases. They had a healthy lifestyle and felt young and energetic. Likewise, this method had a positive effect on people's mental state and mood.

Profiles of Serum Fatty Acids in Healthy Women on Different Types of Vegetarian Diets.

BACKGROUND: Plant-based dietary patterns are a source of different amounts and proportions of fatty acids (FAs) from those in traditional diets. Information about the full FAs profile provided by plant-based diets is widely lacking. The aim of this study was to present the exact serum profiles of FAs among people on a plant-based diet compared with omnivorous subjects. METHODS: FAs compositions and inflammation statuses (based on serum C-reactive protein (CRP) levels) were studied in serum samples obtained from 102 female volunteers (divided into four groups: vegans, vegetarians, pescatarians, and omnivores). The quality of the volunteers' diets was assessed based on seven-day dietary records. RESULTS: Both vegans and vegetarians had lower total n-3 PUFAs, EPA, and DHA serum levels than omnivores. Decreased levels of these FAs presumably did not cause inflammation in vegetarians and vegans, as vegetarians had similar serum levels of CRP compared to omnivores, and vegans had even lower levels. CONCLUSION: The analysis of serum FAs and CRP levels in vegetarians and vegans suggests that factors other than diet alone influence inflammation and overall health status. Further research on long-term plant-based diet users is needed to better understand this issue, and supplementation with EPA and DHA is worth considering in vegans and vegetarians.

Effect of a plant-based diet on oxidative stress biomarkers in male footballers.

Proper nutrition plays a vital role in modulating oxidative status. There is an increasing popularity of plant-based dietary patterns among athletes. Therefore, the present study aimed to determine the plant-based diet index (PDI) score among male footballers and their non-athlete controls, as well as its relationship with oxidative biomarkers by evaluating the urinary excretion of F2alpha-isoprostane (F2a-IP) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). A group of footballers (n = 45) and a healthy non-athlete group (n = 45) were selected. The two groups were matched based on body mass index (BMI) and age. The mean (standard deviation (SD)) age of the subjects was 22.88 (2.41) years, and their BMI was 22.08 (1.35) kg/m2. Anthropometric indices were evaluated, and fasting morning urine samples were analyzed to measure oxidative biomarkers. The PDI, unhealthy plant-based diet index (uPDI), and healthy plant-based diet index (hPDI) were calculated using valid food frequency questionnaire data. Generalized estimating equation models were used for all analyses. Compared to the non-athlete group, the PDI score was significantly greater in the footballer group (ß = 9.8; P < 0.001), while the differences between the two groups in uPDI and hPDI scores were not significant. Overall, footballers consumed more plant-based foods. By examining the relationship between dietary indices and oxidative biomarkers, only a negative association was observed between PDI score and F2a-IP level (ß = -1.25; P = 0.03). Based on the results, footballers were more adherent to a plant-based diet than non-athletes. In addition, it seems that following plant-based diets (the higher PDI) may exert beneficial effects on lowering F2a-IP levels due to improving the body's antioxidant status.

Experiences of Vegans with General Practitioners in the Austrian Health Care System: A Qualitative Study.

This article explores the factors influencing the choice of general practitioners (GPs) and their role in the health care of vegans in Austria. The number of people identifying as vegan is on the rise, and GPs are increasingly confronted with vegan patients. A qualitative method was chosen for this study, and 14 semi-structured interviews with vegans were conducted between April 2022 and July 2022. Participants were recruited primarily through vegan social media groups. In their experiences with health care, vegans felt treated unequally or sometimes incorrectly. The experiences described highlight that participants felt that most GPs were biased against their veganism. Information exchange among vegans primarily takes place online and through publications of vegan associations, while GPs play a minor role in information provision. As the number of vegans grows, an appreciative way of communicating between GPs and vegan patients ought to be promoted. Voluntary interdisciplinary nutritional training, collaboration of the medical field with support organizations, provision of evidence-based information, and collaboration with dietitians and nutritionists could enrich the care of patients with a vegan diet.

Theory of Food: Unravelling the Lifelong Impact of Childhood Dietary Habits on Adult Food Preferences across Different Diet Groups.

The study investigates the behavioral manifestations of the "Theory of Food" (ToF), a novel theoretical framework centered on the early development of food perceptions. The ToF posits that childhood experiences with food shape cognitive networks influencing adult dietary choices. Stemming from the "Theory of Mind," the ToF hypothesizes that individuals construct an associative world of food images and representations mirroring the socio-cognitive world shaped by proper theory of mind development. The study, involving 249 healthy adults, employs the Cognitive Food Preference Questionnaire (CFPQ) and the Adult Food Preference Profile (AFPP) to explore the correlation between childhood and adult food preferences across diet groups (omnivores, vegetarians, and vegans). Results reveal robust correlations in omnivores, varied patterns in vegetarians, and mixed outcomes in vegans. Notably, omnivores show correlations in grains, fast food, dairy products, vegetables, meat, soft drinks, and snack consumption. Vegetarians exhibit correlations in grains, fast food, dairy products, vegetables, snacks, and, surprisingly, meat consumption. Vegans display correlations in grains, fast food, vegetables, and snacks. The study suggests that childhood dietary habits tend to influence adult food choices, offering insights for future research in the field of theory of food (ToF).

Bone Remodelling, Vitamin D Status, and Lifestyle Factors in Spanish Vegans, Lacto-Ovo Vegetarians, and Omnivores.

Sustainable healthy diets are promoted, and consequently vegetarian diets are currently increasing. However, scientific information on their effects on bone health is scarce. A cross-sectional study was performed in adults (66% women) classified into three groups: omnivores (n = 93), lacto-ovo vegetarians (n = 96), and vegans (n = 112). Nutrient intake, body composition, physical activity, vitamin D status (25-hydroxycholecalciferol, 25-OHD), parathormone (PTH), and bone formation (bone alkaline phosphatase, BAP) and resorption (N-telopeptides of type I collagen, NTx) markers were determined. Lacto-ovo vegetarians and especially vegans showed lower protein, fat, calcium, phosphorous, vitamin D, retinol, iodine, and zinc intakes, and higher carbohydrate, fibre, carotenes, magnesium, and vitamin K intakes compared to omnivores. Body composition was similar in the three groups that performed vigorous physical activity regularly. Body bone mass and muscle mass were positively correlated with BAP, and time performing physical activity with 25-OHD. The prevalence of vitamin D deficiency or insufficiency (25-OHD < 75 nmol/L) was 93.7% in the studied population, and vitamin D deficiency (25-OHD < 25 nmol/L) was significantly higher in vegans. Vegetarians of both groups had increased PTH and NTx with vegans showing significantly higher PTH and NTx than omnivores. Conclusion: Adult vegetarians, especially vegans, should reduce the risk of bone loss by appropriate diet planning and vitamin D supplementation.

Differences in Colorectal Cancer Awareness Between Vegetarians and Nonvegetarians: A National Cross-Sectional Study From Palestine.

PURPOSE: To compare colorectal cancer (CRC) awareness between vegetarians and nonvegetarians in Palestine. MATERIALS AND METHODS: The validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were translated into Arabic and used to assess awareness of CRC signs/symptoms, risk factors, and mythical causes. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered as good awareness. Multivariable logistic regression analysis was used to examine the association between being a vegetarian and displaying good awareness in each domain. RESULTS: This study included 4,623 participants: 560 vegetarians (12.1%) and 4,063 nonvegetarians (87.9%). Lump in the abdomen was the most recognized CRC sign/symptom among both nonvegetarians (n = 2,969, 73.1%) and vegetarians (n = 452, 80.7%). Vegetarians were less likely than nonvegetarians to display good awareness of CRC signs/symptoms (odds ratio, 0.59 [95% CI, 0.48 to 0.72]). Lack of physical activity was the most identified modifiable CRC risk factor in both nonvegetarians (n = 3,368, 82.9%) and vegetarians (n = 478, 85.4%). Similarly, having a bowel disease was the most identified nonmodifiable risk factor among both nonvegetarians (n = 2,889, 71.1%) and vegetarians (n = 431, 77.0%). There were no associated differences between both groups in the awareness levels of CRC risk factors. The most recognized food-related CRC causation myth in nonvegetarians was drinking from plastic bottles (n = 1,023, 25.2%), whereas it was eating burnt food in vegetarians (n = 176, 31.4%). Having a physical trauma was the most recognized food-unrelated myth in both nonvegetarians (n = 2,356, 58.0%) and vegetarians (n = 396, 70.7%). There were no associated differences in the awareness of CRC causation myths between both groups. CONCLUSION: Awareness of CRC was notably low in both Palestinian vegetarians and nonvegetarians. Particularly, vegetarians demonstrated lower awareness of CRC signs and symptoms.

Adherence to plant-based dietary patterns and anthropometric indices among primary school girls in Kerman: A cross-sectional study.

The objective of the study was to evaluate the association between adherence to plant-based dietary patterns and anthropometric indices among primary school girls in Kerman. This cross-sectional study included 330 girls aged 6-12. A reliable and validated dish-based food frequency questionnaire was used to collect dietary data. Weight, height, and mid-arm circumference were measured, and z-score charts from the World Health Organization for girls between the ages of 5 and 19 were utilized. We used Satija et al. method to calculate plant-based diet index scores. After adjusting for age and energy, participants in the higher tertile of the overall plant-based diet index (PDI) had a lower height-for-age z score (HAZ) (0.38±0.12 vs. 0.59±0.12 kg; P = 0.033). Higher unhealthful plant-based diet index (uPDI) scores were significantly associated with decreased HAZ in models 2 (p = 0.028) and 3 (p = 0.035). A higher PDI score was associated with lower odds of being underweight and overweight, respectively (Model 1: P trend = 0.007, <0.001; Model 2: P trend = 0.010, 0.001). A significant inverse association was found between healthful plant-based diet index (hPDI) scores and underweight risk in the crude and adjusted models. (Model 1: P trend = 0.021; model 2: P trend = 0.018; Model 3: P trend = 0.031). Higher uPDI scores were associated with increased odds of being overweight and obese in all three models (Model 1: p trend<0.001; Model 2: p trend<0.001; Model 3: p trend = 0.001). We concluded that children who followed a plant-based diet had lower odds of being overweight and obese. Higher scores on the hPDI were linked to a decreased risk of being underweight, while higher scores on the uPDI were associated with an increased risk of being overweight and obese. The study suggests healthy plant-based diet may benefit children's weight and growth.

Analysis of adherence to a healthy lifestyle among vegetarian and non-vegetarian Peruvian university students: A cross-sectional survey.

BACKGROUND: Evidence shows that a healthy lifestyle can promote physical and mental well-being in the general population. However, there are few studies that assess the adherence to a healthy lifestyle in vegetarian and non-vegetarian university students. The purpose of this study was to evaluate the differences in adherence to a healthy lifestyle between vegetarian and non-vegetarian university students in Peru. METHODS: A cross-sectional study was carried out considering data from 6,846 students selected by non-probabilistic convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used. In addition, sociodemographic and anthropometric data such as weight and height were collected. Body mass index (BMI) was also calculated. RESULTS: Semi-vegetarian and vegetarian students had a high healthy lifestyle score compared to non-vegetarians. In addition, vegetarian diets showed a significantly higher proportion among students with a lower BMI (normal and underweight). Students with excess body weight (overweight and obesity) were less likely to report healthy lifestyle. In the overall population analyzed, it was observed that the levels of health and lifestyle behaviors, such as daily exercise and sunlight exposure, were mostly moderate and low. Additionally, sweets intake was high, while healthy food consumption such as fruits, vegetables, legumes, and whole grains was low. CONCLUSION: The current findings show that although vegetarians had better adherence to a healthy lifestyle, interventions in the university setting are needed to improve healthy lifestyle in university students.

Prevalence and determinants of self-reported low-fat-, low-salt-, and vegetarian diets in patients with cardiovascular disease between 1996 and 2019.

BACKGROUND AND AIMS: Guidelines no longer recommend low-fat diets and currently recommend more plant-based diets to reduce atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, these guidelines have consistently recommended salt-reduced diets. This article describes current self-reported use and time-trends in the self-reported use of low-fat, low-salt and vegetarian diets in ASCVD patients and examines patient characteristics associated with each diet. METHODS AND RESULTS: 9005 patients with ASCVD included between 1996 and 2019 in the UCC-SMART cohort were studied. The prevalence of self-reported diets was assessed and multi-variable logistic regression was used to identify the determinants of each diet. Between 1996-1997 and 2018-2019, low-fat diets declined from 22.4 % to 3.8 %, and low-salt diets from 14.7 % to 4.6 %. The prevalence of vegetarian diets increased from 1.1 % in 1996-1997 to 2.3 % in 2018-2019. Patients with cerebrovascular disease (CeVD) and peripheral artery disease or an abdominal aortic aneurysm (PAD/AAA) were less likely to report a low-salt diet than coronary artery disease (CAD) patients (OR 0.62 [95%CI 0.49-0.77] and 0.55 [95%CI 0.41-0.72]). CONCLUSION: In the period 1996 to 2019 amongst patients with ASCVD, the prevalence of self-reported low-fat diets was low and decreased in line with changes in recommendations in major guidelines. The prevalence of self-reported vegetarian diets was low but increased in line with societal and guideline changes. The prevalence of self-reported low-salt diets was low, especially in CeVD and PAD/AAA patients compared to CAD patients, and decreased over time. Renewed action is needed to promote low-salt diets in ASCVD patients.

Association of dietary patterns with diabetes-related comorbidities varies among diabetes endotypes.

BACKGROUND AND AIMS: Differences of dietary pattern adherence across the novel diabetes endotypes are unknown. This study assessed adherence to pre-specified dietary patterns and their associations with cardiovascular risk factors, kidney function, and neuropathy among diabetes endotypes. METHODS AND RESULTS: The cross-sectional analysis included 765 individuals with recent-onset (67 %) and prevalent diabetes (33 %) from the German Diabetes Study (GDS) allocated into severe autoimmune diabetes (SAID, 35 %), severe insulin-deficient diabetes (SIDD, 3 %), severe insulin-resistant diabetes (SIRD, 5 %), mild obesity-related diabetes (MOD, 28 %), and mild age-related diabetes (MARD, 29 %). Adherence to a Mediterranean diet score (MDS), Dietary Approaches to Stop Hypertension (DASH) score, overall plant-based diet (PDI), healthful (hPDI) and unhealthful plant-based diet index (uPDI) was derived from a food frequency questionnaire and associated with cardiovascular risk factors, kidney function, and neuropathy using multivariable linear regression analysis. Differences in dietary pattern adherence between endotypes were assessed using generalized mixed models. People with MARD showed the highest, those with SIDD and MOD the lowest adherence to the hPDI. Adherence to the MDS, DASH, overall PDI, and hPDI was inversely associated with high-sensitivity C-reactive protein (hsCRP) among people with MARD (ß (95%CI): -9.18 % (-15.61; -2.26); -13.61 % (-24.17; -1.58); -19.15 % (-34.28; -0.53); -16.10 % (-28.81; -1.12), respectively). Adherence to the PDIs was associated with LDL cholesterol among people with SAID, SIRD, and MOD. CONCLUSIONS: Minor differences in dietary pattern adherence (in particular for hPDI) and associations with markers of diabetes-related complications (e.g. hsCRP) were observed between endotypes. So far, evidence is insufficient to derive endotype-specific dietary recommendations. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01055093.

Similarities and differences between vegetarians and vegans in motives for meat-free and plant-based diets.

Plant-based diets are quickly gaining popularity for their benefits to animal welfare, the environment, and public health. Compared to meat-eaters, meat-abstainers such as vegetarians and vegans are especially motivated by animal rights and the environment. However, little is known about the motivational and psychological factors that distinguish vegetarians from vegans, and what prevents vegetarians to shift towards a fully plant-based diet. In a sample of vegans (n = 335) and vegetarians (n = 182), we investigated a) motives for reducing or quitting meat consumption and b) motives for reducing or quitting animal product (dairy and egg products) consumption, as well as moral psychological and social-contextual factors that may explain potential differences. Results demonstrate that vegetarians and vegans tend to be similar in their motives to abstain from meat consumption and are most strongly motivated by animal rights. However, vegetarians are less motivated by health, environmental, and especially animal rights for dairy/egg reduction compared to meat reduction and compared to vegans. Lower moral concern for animals, stronger beliefs in human supremacy over animals, and heightened veganism threat among vegetarians (vs. vegans) partly explained why vegetarians were less strongly motivated by animal rights for dairy/egg reduction. Human supremacy beliefs also explained differences between vegetarians and vegans in health and environmental motives for dairy/egg reduction. Furthermore, vegetarians reported significantly less social support for plant-based diets and perceived more practical barriers to plant-based diets than vegans. These findings reveal meaningful differences in the motivational and psychological profiles of vegetarians and vegans and highlight the value of distinguishing between motives for meat-free diets and motives for plant-based diets.

Plant-based diets and the gut microbiome: findings from the Baltimore Longitudinal Study of Aging.

BACKGROUND: Mounting evidence indicates that although some plant-based diets are healthful, others are not. Changes in the gut microbiome and microbiome-dependent metabolites, such as trimethylamine N-oxide (TMAO), may explain differential health effects of plant-based diets. However, human data are sparse on whether qualitatively distinct types of plant-based diets differentially affect gut microbiome diversity, composition, particularly at the species level, and/or metabolites. OBJECTIVES: We aimed to examine cross-sectional associations of different plant-based indices with adult gut microbiome diversity, composition, and the metabolite TMAO. METHODS: We studied 705 adults in the Baltimore Longitudinal Study of Aging with data for diet, fecal microbiome (shotgun metagenomic sequencing), and key covariates. We derived healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI) using data from food frequency questionnaires. We examined plant-based diet indices with microbiome α-diversity (richness and evenness measures), ß-diversity (Bray-Curtis and UniFrac measures), composition (species level), and plasma TMAO. We used regression models to determine associations before and after adjustment for age, sex, education, physical activity, smoking status, body mass index, and total energy intake. RESULTS: The analytic sample (mean age, 71.0 years, SD = 12.8 years) comprised 55.6% female and 67.5% non-Hispanic White participants. hPDI was positively and uPDI negatively associated with microbiome α-diversity, driven by microbial evenness (Pielou P < 0.05). hPDI was also positively associated with relative abundance of 3 polysaccharide-degrading bacterial species (Faecalibacterium prausnitzii, Eubacterium eligens, and Bacteroides thetaiotaomicron) and inversely associated with 6 species (Blautia hydrogenotrophica, Doreasp CAG 317, Eisenbergiella massiliensis, Sellimonas intestinalis, Blautia wexlerae, and Alistipes shahii). Furthermore, hPDI was inversely associated with TMAO. Associations did not differ by age, sex, or race. CONCLUSIONS: Greater adherence to a healthful plant-based diet is associated with microbiome features that have been linked to positive health; adherence to an unhealthful plant-based diet has opposing or null associations with these features.

Association of plant-based diets with total and cause-specific mortality across socioeconomic deprivation level: a large prospective cohort.

PURPOSE: Current evidence on the association between plant-based diet indices (PDIs) and mortality is inconsistent. We aimed to investigate the association of PDIs with all-cause and cause-specific mortality and to examine whether such associations were modified by socioeconomic deprivation level. METHODS: A total of 189,003 UK Biobank participants with at least one 24-h dietary assessment were included. All food items were categorised into three groups, including healthy plant foods, less healthy plant foods, and animal foods. Three PDIs, including the overall PDI (positive scores for all plant-based food intake and inverse scores for animal-based foods), the healthful PDI (hPDI) (positive scores only for healthy plant food intake and inverse scores for others), and the unhealthful PDI (uPDI) (positive scores only for less healthy plant food intake and inverse scores for others), were calculated according to the quantities of each food subgroup in three categories. The Townsend deprivation index was used as the indicator of socioeconomic deprivation level. Cox proportional hazard models were used to estimate the hazard ratios (HRs) of PDIs for all-cause and cause-specific mortality. The modification effects of socioeconomic deprivation levels on these associations were evaluated. RESULTS: During a median follow-up of 9.6 years, 9335 deaths were documented. Compared with the lowest quintile, the highest quintile of overall PDI was associated with adjusted HRs of 0.87 (95% CI 0.81-0.93) for all-cause mortality and 0.77 (0.66-0.91) for cardiovascular mortality. Compared with the lowest quintile, the highest quintile of hPDI was associated with lower risks of all-cause mortality (0.92, 0.86-0.98), and death caused by respiratory disease (0.63, 0.47-0.86), neurological disease (0.65, 0.48-0.88), and cancer (0.90, 0.82-0.99). Compared with the lowest quintile, the highest quintile of uPDI was associated with an HR of 1.29 (1.20-1.38) for all-cause mortality, 1.95 (1.40-2.73) for neurological mortality, 1.54 (1.13-2.09) for respiratory mortality, and 1.16 (1.06-1.27) for cancer mortality. The magnitudes of associations of hPDI and uPDI with mortality were larger in the most socioeconomically deprived participants (the highest tertile) than in the less deprived ones (p-values for interaction were 0.039 and 0.001, respectively). CONCLUSIONS: This study showed that having a high overall PDI and hPDI were related to a reduced risk of death, while the uPDI was linked to a higher risk of death. Sticking to a healthy plant-based diet may help decrease mortality risks across socioeconomic deprivation levels, especially for those who are the most socioeconomically deprived.