Vegetarian Diets During Pregnancy: with supplementation, ovo-vegetarian, lacto-vegetarian, vegan, and pescatarian adaptations of USDA Food Patterns can be nutritionally adequate.

BACKGROUND: The 2020-2025 Dietary Guidelines for Americans (DGA) includes a lacto-ovo vegetarian pattern (the Healthy Vegetarian Dietary Pattern; HVDP) as one recommended dietary patterns during pregnancy. OBJECTIVE: To adapt the HVDP for vegan, ovo-vegetarian, lacto-vegetarian, and pescatarian diets during pregnancy. DESIGN: Using food pattern modeling, four adaptations of the HVDP were developed at energy levels that may be appropriate during pregnancy (1800, 2000, 2200, 2400, and 2600 kcal/day). Models were run both with and without the addition of a composite prenatal supplement. MAIN OUTCOME MEASURES: Main outcome measures were macro- and micronutrient adequacy without exceeding recommendations for saturated fat and added sugar. STATISTICAL ANALYSIS PERFORMED: The 2020-2025 DGA Food Pattern Modeling Report was used to define food groups and nutrients in the HVDP. The HVDP was revised to remove dairy and/or eggs or to add seafood. RESULTS: Across all examined energy levels (1800, 2000, 2200, 2400, and 2600 kcal per day), modeled dietary patterns provided sufficient macronutrients. Without prenatal supplements, each dietary pattern met most, but not all, micronutrient recommendations. Micronutrients that were below recommendations in patterns without supplements included vitamin D, iron, vitamin E, sodium, and choline. With the addition of an "composite" prenatal supplement to these patterns, the nutrients below 100% of recommendations were vitamin D, choline, and sodium. CONCLUSIONS: Overall, these results show that a HVDP and similar diets without meat, eggs, dairy, and/or seafood can provide most nutrients needed during pregnancy, albeit with some micronutrient challenges similar to those diets that include meat and other animal products.

Modeling Ovo-vegetarian, Lacto-vegetarian, Pescatarian, and Vegan USDA Food Patterns and Assessing Nutrient Adequacy for Lactation among Adult Females.

Background: Among its recommended dietary patterns for Americans, including lactating mothers, the 2020 Dietary Guidelines for Americans (DGA) includes a Healthy Vegetarian Dietary Pattern (HVDP). However, the DGA does not provide guidance for adapting the HVDP for vegetarians who avoid dairy (ovo-vegetarian) or eggs (lacto-vegetarian), eat fish (pescatarians), or avoid all animal foods (vegan). Objective: To determine whether models of the HVDP for different vegetarian diets could provide sufficient nutrition during lactation, a life stage with unique nutrient needs. Methods: Adaptations of the HVDP were developed at the 2200 and 2400 kcal levels using similar methods to the 2020 DGA. We compared these models with both the original HVDP and Dietary Reference Intakes (DRIs) for women ages 19 to 30 and ages 31 to 50 during lactation mo 1 to 12. All models were developed both with and without the addition of a multivitamin and -mineral prenatal supplement, commonly consumed by women throughout lactation. Results: All models (original HVDP, ovo-vegetarian, lacto-vegetarian, pescatarian, vegan) at all energy levels met the Adequate Macronutrient Distribution Ranges. Like the original HVDP and other dietary patterns in the DGA, the vegetarian adaptations in this study did not contain enough vitamin D, vitamin E, or choline to meet DRIs across all models and energy levels. With the prenatal supplement added, the models did not contain enough sodium, vitamin D, or choline. Some models also contained < 100% of the DRIs for sodium, zinc, vitamin A, and vitamin B6. Amounts of all other micronutrients met DRIs. Conclusions: Adaptations of the HVDP can provide adequate amounts of most nutrients, including nutrients of concern, during lactation to meet the needs of mothers during this life stage.

Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.

BACKGROUND: A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is "ultra-processed," in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA. OBJECTIVE: The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA. DESIGN: To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015). RESULTS: In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline. CONCLUSIONS: Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.

Modeling lacto-vegetarian, pescatarian, and "pescavegan" USDA food patterns and assessing nutrient adequacy for healthy non-pregnant, non-lactating adults.

Introduction: The 2020-2025 Dietary Guidelines for Americans (DGA) includes a Healthy Vegetarian Dietary Pattern (HVDP) with dairy foods and eggs as one of its three recommended dietary patterns for non-pregnant, non-lactating healthy adults. This study evaluates whether pescatarian, lacto-vegetarian, and "pescavegan" adaptations of the HVDP can be nutritionally adequate if modeled with foods recommended by the DGA. Methods: The nutrient composition of these three alternative models of the HVDP were assessed at 1, 800-, 2, 000-, 2, 200-, and 2,400- kcal/day using similar food pattern modeling procedures as the 2020 DGA. For the pescatarian and pescavegan models, 0.5 ounce-equivalent of refined grains per day was replaced with seafood. For the lacto-vegetarian and pescavegan models, eggs were replaced with equal proportions of the other vegetarian protein foods. In the pescavegan model, dairy foods were replaced by a dairy alternative group comprised of fortified soy milk and soy yogurt. Results: All models at all energy levels were within Acceptable Macronutrient Distribution Ranges (AMDRs) for all macronutrients, contained ≤5% of total kcal from saturated fat, and met recommendations for most micronutrients. Nutrients provided below the Dietary Reference Intakes (DRIs) in these models included iron, sodium, vitamin D, vitamin E, and choline. Micronutrients provided at less than 50% of their respective DRIs included vitamin D and choline. Discussion: Adapting the HVDP for lactovegetarian, pescatarian, and pescavegan dietary patterns provided adequate amounts of macronutrients and most micronutrients.

Application of dairy-free vegetarian and vegan USDA food pattern models for non-pregnant, non-lactating healthy adults.

The 2020 Dietary Guidelines for Americans (DGA) recommends a Healthy Vegetarian Dietary Pattern (HVDP) but does not provide guidance for dairy-free vegetarian (ovo-vegetarian) or vegan diets. A recent study from our lab modeled ovo-vegetarian and vegan HVDPs for healthy adults and found minimal impacts on nutrient content. However, since these models provide only recommendations for food group amounts, the objective of this study was to determine the feasibility of implementing the 2000 kcal ovo-vegetarian and vegan models by developing sample menus and evaluating them for nutrient adequacy and diet quality. We implemented a search strategy for ovo-vegetarian and vegan recipes on the MyPlate.gov website, using the most frequently consumed foods from each food group as a guide. We then developed 5-day sample menus for each model and analyzed these menus for diet quality using the Healthy Eating Index Score-2015 (HEI-2015) and nutrient content. The HEI-2015 scores were 99.4 and 98.4 for the vegan and ovo-vegetarian menus, respectively. These sample menus did not achieve a perfect score of 100 due to sodium and refined grains (both menus), added sugars (ovo-vegetarian menu only), and fatty acid profiles (vegan menu only). Mean total energy was 1860 kcal (vegan) and 1880 kcal (ovo-vegetarian). Amounts of all macronutrients were within the Acceptable Macronutrient Distribution Ranges, but amounts of some micronutrients were below 90% of recommended levels. Healthy adults may be able to follow ovo-vegetarian and vegan diets with careful planning, but this study reveals challenges in meeting micronutrient needs with these eating patterns. PRACTICAL APPLICATION: This study assessed the quality and nutrient adequacy of sample vegan and dairy-free vegetarian menus developed based on adaptations of the 2000 kcal vegetarian dietary pattern from the 2020 Dietary Guidelines for Americans. We found that our sample vegan and dairy-free vegetarian menus, created with publicly available resources, contained enough servings of fruits, vegetables, grains, protein foods, dairy, and oils, but did not provide enough vitamin D, vitamin E, choline, zinc (for males), and iron (for females). Following vegan and ovo-vegetarian diets requires careful planning to ensure sources of these micronutrients are included in adequate amounts.