Plant-based meat substitutes are useful for healthier dietary patterns when adequately formulated - an optimization study in French adults (INCA3).

PURPOSE: We studied to what extent plant-based meat substitutes could improve the nutritional adequacy and healthiness of dietary patterns, depending on their nutrient composition. METHODS: From diets observed in French adults (INCA3, n = 1125), modeled diets were identified by allowing various dietary changes, between and within food categories, when two plant-based meat substitutes were made available: an average substitute (from 43 market substitutes) and a theoretical nutritionally designed substitute, fortified or not with zinc and iron at 30% or 50% of Nutrient Reference Values. Under each scenario, healthier but acceptable modeled diets were identified using multi-criteria optimization, by maximizing a health criteria related to Dietary Guidelines while minimizing deviation from the observed diets, under constraints for nutrient adequacy. RESULTS: Without fortification, the average substitute was hardly introduced into modeled diets, whereas the optimized substitute was preferentially introduced, in large amounts, yet together with a moderate reduction of red meat (- 20%). The comparative advantages of the optimized substitute were its higher contribution to vitamins B6 and C, fiber and α-linolenic acid (ALA) intakes, and its lower contribution to sodium intake. When fortified with iron and zinc, substitutes were introduced in larger amounts into modeled diets, with much higher red meat reductions (down to - 90%). The optimized substitute continued to be preferred, leading to healthier modeled diets that deviated less from the observed. CONCLUSION: Plant-based meat substitutes can be levers for healthy diets only when well nutritionally designed with enough zinc and iron for a substantial red meat reduction.

Dietary protein consumption profiles show contrasting impacts on environmental and health indicators.

Patterns of protein intake are strong characteristics of diets, and protein sources have been linked to the environmental and nutrition/health impacts of diets. However, few studies have worked on protein profiles, and most of them have focused on specific diets like vegetarian or vegan diets. Furthermore, the description of the environmental impact of diets has often been limited to greenhouse gas emissions (GHGe) and land use. This paper analyzes the alignment of environmental pressures and nutritional impacts in a diversity of representative protein profiles of a western population. Using data from a representative survey in France (INCA3, n = 1125), we identified protein profiles using hierarchical ascendant classification on protein intake (g) from main protein sources (refined grains, whole grains, dairy, eggs, ruminant meat, poultry, pork, processed meat, fish, fruits & vegetables, pulses). We assessed their diet quality using 6 dietary scores, including assessment of long-term risk for health, and associated 14 environmental pressure indicators using the Agribalyse database completed by the SHARP database for GHGe. Five protein profiles were identified according to the high contributions of ruminant meat, pork, poultry, fish, or, conversely, as low contribution from meat. The profile including the lowest protein from meat had the lowest impact on almost all environmental indicators and had the lowest long-term risk. Conversely, the profile with high protein from ruminant-based foods had the highest pressures on most environmental indicators, including GHGe. We found that the protein profile with low contribution from meat has great potential for human health and environment preservation. Shifting a large part of the population toward this profile could be an easy first step toward building a more sustainable diet.

Nutritional issues and dietary levers during gradual meat reduction - A sequential diet optimization study to achieve progressively healthier diets.

BACKGROUND & AIMS: Reducing meat consumption is a current trend and a strong prospect for the future in Western countries, but its dietary modalities and nutrient challenges remain poorly documented. Using diet optimization under a broad set of constraints, we tried to identify a sequential meat reduction transition and analyze its nutrient issues and dietary levers. METHODS: Based on the consumption of French adults (INCA3, n = 1 125, 18-64 years old), we modeled a transition towards a nutritionally adequate healthy dietary pattern under the constraint of a gradual reduction in meat consumption in successive 10% steps. Using a multi-criteria optimization procedure, the diet modeled at each meat reduction step was to be healthier but close to the previous diet. RESULTS: The most significant changes occurred early in the modeled transition process, with drastic reductions in processed and red meats in favor of poultry, which rapidly became the predominant meat before gradually decreasing from 50% to 100% meat reduction. At the same time, whole grain products, fruits and vegetables consumption increased rapidly to reach a plateau from 50% meat reduction onwards. Some nutrients were limiting, in particular bioavailable iron and zinc, and vitamin A, but sufficient intakes were achieved by restructuring diets based on food groups other than meat. Other nutrients mainly supplied by meat such as vitamin B6 and B12, protein and indispensable amino acids, were never limiting. CONCLUSION: Healthy and nutritionally adequate food patterns can be identified throughout a transition to complete meat reduction. After a 50% reduction in meat consumption, poultry is almost the only meat remaining and its further reduction makes the diet only marginally healthier.

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

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

The potential effects of meat substitution on diet quality could be high if meat substitutes are optimized for nutritional composition-a modeling study in French adults (INCA3).

PURPOSE: While consumer demand for meat substitutes is growing, their varied composition raises questions regarding their nutritional value. We aimed to identify and characterize the optimal composition of a meat substitute that would best improve diet quality after complete meat replacement. METHODS: From an average individual representing the dietary intake of French adults (INCA3, n = 1125), meat was replaced with an equivalent amount of a mostly pulse-based substitute, whose composition was based on a list of 159 possible plant ingredients and optimized non-linearly to maximize diet quality assessed with the PANDiet score (considering adequacy for 32 nutrients), while taking account of technological constraints and applying nutritional constraints to limit the risk of overt deficiency in 12 key nutrients. RESULTS: The optimized meat substitute contained 13 minimally processed ingredients. When used to substitute meat, the PANDiet score increased by 5.7 points above its initial value before substitution (versus - 3.1 to + 1.5 points when using other substitutes on the market), mainly because of higher intakes of nutrients that are currently insufficiently consumed (e.g., alpha-linolenic acid, fiber, linoleic acid) and a lower SFA intake. The meat substitute also mostly compensated for the lower provision of some indispensable nutrients to which meat greatly contributed (e.g., vitamin B6, potassium, bioavailable iron), but it could not compensate for bioavailable zinc and vitamin B12. CONCLUSION: Choosing the correct ingredients can result in a nutritionally highly effective meat substitute that could compensate for reductions in many nutrients supplied by meat while providing key nutrients that are currently insufficiently consumed.

Modeled healthy eating patterns are largely constrained by currently estimated requirements for bioavailable iron and zinc-a diet optimization study in French adults.

BACKGROUND: Healthier dietary patterns involve more plant-based foods than current Western diets rich in animal products containing high amounts of bioavailable iron and zinc. Little consideration is given to the bioavailability of iron and zinc when studying healthy eating patterns. OBJECTIVES: Our aim was to determine whether currently estimated requirements for bioavailable iron and zinc limit the identification of healthier dietary patterns. METHODS: Using dietary data from a representative French survey and multicriteria nonlinear optimization, we identified diets that maximize health criteria based on food-based dietary guidelines and concomitantly depart only minimally from the observed diet while complying with all nutrient reference values either strictly (nonflexible optimization) or by allowing bioavailable iron and zinc below the current reference values, but to a limited extent (flexible optimization). Using a comparative risk assessment model, we estimated the resulting impact on cardiometabolic and colorectal cancer mortality/morbidity and changes to iron-deficiency anemia. RESULTS: Under nonflexible optimization, reference values for bioavailable iron and zinc were the most binding of the 35 nutrient constraints, and modeled diets displayed considerable redistributions within grains and meat. With flexible optimization, modeled diets were healthier as they contained less red meat and more whole-grain products, but would increase iron-deficiency anemia to 5.0% (95% CI: 3.9%, 6.4%). Globally, in terms of disability adjusted life years (DALYs), as the loss due to anemia would represent <30% of the gain otherwise made on chronic diseases, adding flexibility in the iron and zinc reference values would result in a further 18% decrease in the disease burden from 84,768 [95% uncertainty interval (UI): 81,066, 88,470] to 99,689 (95% UI: 95,787, 103,591) DALYs averted. CONCLUSIONS: Currently estimated requirements for bioavailable iron and zinc proved to be critical factors when modeling healthy eating patterns. Considering lower reference values enables the identification of diets that are apparently healthier overall.

Substituting Meat or Dairy Products with Plant-Based Substitutes Has Small and Heterogeneous Effects on Diet Quality and Nutrient Security: A Simulation Study in French Adults (INCA3).

BACKGROUND: Plant-based substitutes are designed to have the same use as animal-based foods in the diet and could therefore assist the transition toward more plant-based diets. However, their nutritional impact has not been characterized. OBJECTIVES: We assessed and compared the effects of plant-based substitutes on the nutritional quality of the diet. METHODS: We simulated separately the substitution of meat, milk, and dairy desserts with 96 plant-based substitutes in the diets of 2121 adults (18-79 y old) from the cross-sectional French Third Individual and National Study on Food Consumption Survey (INCA3; 2014-2015). The quality of initial individual diets and the 203,616 substituted diets was evaluated using the Probability of Adequate Nutrient Intake (PANDiet) scoring system, which assesses the probability of adequate (sufficient and not excessive) nutrient intake; also, nutrient security was evaluated using the SecDiet scoring system, which assesses the risk of overt deficiency. RESULTS: Impacts on PANDiet depended on both the food substituted and the types of substitutes. Soy-based substitutes provided a slight improvement in diet quality (0.8% increase of the PANDiet score when substituting meat), whereas cereal-based substitutes resulted in a 1.1% decrease. Globally, substitutions led to better adequacies for fiber, linoleic acid, α-linolenic acid, vitamin E, folate, and SFAs, but lower adequacies regarding vitamin B-12 and riboflavin, as well as bioavailable zinc and iron when substituting meat, and calcium and iodine when substituting milk/dairy desserts. When they substituted dairy products, calcium-fortified substitutes allowed maintenance of calcium adequacy but there was a higher risk of iodine deficiency when substituting dairy, which may warrant iodine fortification. Substitutions modified the energy share of ultra-processed foods from 29% to 27%-40%, depending on the food substituted and the substitute used. CONCLUSIONS: Plant-based substitutes had a small effect on overall diet quality and heterogeneous impacts on nutrient adequacy and security. Plant-based substitutes that include legumes appear more nutritionally adequate to substitute animal products than do other substitutes.

Contrary to ultra-processed foods, the consumption of unprocessed or minimally processed foods is associated with favorable patterns of protein intake, diet quality and lower cardiometabolic risk in French adults (INCA3).

PURPOSE: While the consumption of ultra-processed foods is steadily increasing, there is a growing interest in more sustainable diets that would include more plant protein. We aimed to study associations between the degree of food processing, patterns of protein intake, diet quality and cardiometabolic risk. METHODS: Using the NOVA classification, we assessed the proportion of energy from unprocessed/minimally processed foods (MPFp), processed foods (PFp) and ultra-processed foods (UPFp) in the diets of 1774 adults (18-79 years) from the latest cross-sectional French national survey (INCA3, 2014-2015). We studied the associations between MPFp, PFp and UPFp with protein intakes, diet quality (using the PANDiet scoring system, the global (PDI), healthful (hPDI) and unhealthful (uPDI) plant-based diet indices) and risk of cardiometabolic death (using the EpiDiet model). RESULTS: MPFp was positively associated with animal protein intake and plant protein diversity, whereas PFp was positively associated with plant protein intake and negatively with plant protein diversity. The PANDiet was positively associated with MPFp (ß = 0.14, P < 0.0001) but negatively with UPFp (ß = - 0.05, P < 0.0001). These associations were modified by adjustment for protein intakes and plant protein diversity. As estimated with comparative risk assessment modeling between extreme tertiles of intake, mortality from cardiometabolic diseases would be decreased with higher MPFp (e.g. by 31% for ischemic heart diseases) and increased with higher UPFp (by 42%) and PFp (by 11%). CONCLUSIONS: In the French population, in contrast with UPFp, higher MPFp was associated with higher animal protein intake, better plant protein diversity, higher diet quality and markedly lower cardiometabolic risk.

Development and evaluation of a new dietary index assessing nutrient security by aggregating probabilistic estimates of the risk of nutrient deficiency in two French adult populations.

Although micronutrient deficiencies affect 2 billion people worldwide, no index focuses on measuring the risk of overt nutrient deficiency. We aimed to develop an index that could capture the nutrient dimension of nutritional security, a nutrient security index (named SecDiet), and evaluate its apparent validity. The SecDiet (range: 0-1) is based on the square-weighted average of the probabilities that the intake of twelve critical nutrients exceeds the threshold value associated with a risk of overt deficiency. Using adult populations from a French representative survey (INCA3, n 1774) and a large cohort (NutriNet-Santé, n 104 382), the content and construct validity of the SecDiet was evaluated by estimating associations of the SecDiet with its components and with relevant socio-demographic characteristics. The SecDiet was high in the overall population (0·93 (SD 0·09) in INCA3) and markedly skewed towards 1 (i.e. lower risk of insufficient intake). It correlated positively with its twelve components (r 0·17-0·78, all P < 0·001). The SecDiet was associated with monthly income (P = 0·002), perception of financial situation, professional situation, food insufficiency and security statuses (all P < 0·001) in the INCA3 population and with monthly income, professional situation and level of education (all P < 0·001) in the NutriNet-Santé population. Unlike a broader nutrient-based quality index taken as comparison, the SecDiet mean decreased and the tail of its distribution notably extended downwards in at-risk sub-populations, thus revealing its specific sensitivity. The SecDiet could be used to screen sub-groups or study the determinants of nutrient insecurity in large population surveys.

Plant-Protein Diversity Is Critical to Ensuring the Nutritional Adequacy of Diets When Replacing Animal With Plant Protein: Observed and Modeled Diets of French Adults (INCA3).

BACKGROUND: There is a current trend in Western countries toward increasing the intake of plant protein. A higher plant-protein intake has been associated with nutritional and health benefits, but these may depend on the pattern of plant-protein sources. OBJECTIVE: We hypothesized that the diversity of plant foods could be important to nutrient adequacy when increasing plant-protein intake in the diet. METHODS: Using data on 1341 adults (aged 18-64 y) from a representative French national dietary survey conducted in 2014-2015 (the third Individual and National Study on Food Consumption Survey-INCA3), we studied the links between plant-protein intake, dietary diversity (using various dimensions), and nutrient adequacy [assessed using the PANDiet (Probability of Adequate Nutrient Intake) scoring system, comprising adequacy (AS) and moderation (MS) subscores]. We simulated substituting plant-protein foods for animal-protein foods using different models of plant-protein diversity. RESULTS: We found that overall diet quality was weakly associated with total and protein diversity and more strongly with plant-protein diversity. Plant-protein intake was inversely associated with animal-protein intake, and positively with the PANDiet and MS, but not with the AS. Plant-protein intake displayed little diversity, mostly taking the form of grains (61% of plant-protein intake), and this diversity was even less marked under a higher plant-protein intake. Finally, modeled substitutions showed that reducing animal-protein intake increased the MS (by 32%) in a similar manner whichever plant protein was used for substitution, whereas it decreased the AS (by 20%) unless using a highly diversified plant-protein mix. These simulated improvements in overall adequacy included marked decreases in adequacy regarding certain nutrients that are typically of animal origin. CONCLUSIONS: We conclude that in French adults the current pattern of plant-protein intake is hindering the nutritional benefits of a transition toward more plant protein, indicating that the consumption of plant-protein-based foods other than refined grains should be encouraged.