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.

A microalgae docosahexaenoic acid supplement does not modify the influence of sex and diet on iron status in Spanish vegetarians or omnivores: A randomized placebo-controlled crossover study.

OBJECTIVE: Plant-based diets are accepted as healthy, provided that are well-planned and include supplements. In this context, iron deficiency is a threat, and data from Spanish vegetarians are scarce. The aim of this study was to determine if a microalgae ω-3 supplement rich in docosahexaenoic acid (DHA) affected iron status in this population. METHODS: Iron biomarkers and nutrient intake (72-h dietary records) were analyzed in 204 usual consumers of lacto-ovo vegetarian (LOV), vegan (VEG), or omnivorous (OMN) diets. A randomized double-blind, placebo-controlled crossover trial was performed in a subgroup (n = 98) to test if a microalgae DHA supplement (250 mg/d for 5 wk) changed iron status. RESULTS: Iron intake was higher in vegetarians than omnivores (P= 0.002), fiber intake was highest in vegans followed by lacto-ovo vegetarians and omnivores, whereas calcium intake was lower in vegans than both lacto-ovo vegetarians and omnivores (all P < 0.001). Women, regardless of diet type, showed lower iron status than men. Erythrocytes, hemoglobin, hematocrit, and serum ferritin were lower in lacto-ovo vegetarians and vegans than omnivores. The prevalence of iron deficiency anemia was low (<10%), but iron depletion (ferritin <15 ng/mL) was higher in lacto-ovo vegetarians than omnivores (P = 0.003). Iron biomarkers were similar in lacto-ovo vegetarians and vegans. The DHA supplementation did not change iron status compared with placebo. CONCLUSIONS: Spanish vegetarians had lower iron status than omnivores. Consumption of eggs and dairy products increased the risk for iron deficiency, but a microalgae DHA supplement had no effect. Dietary strategies to increase iron bioavailability in vegetarians, particularly in lacto-ovo vegetarians and women, are recommended.

Metabolic and nutritional biomarkers in adults consuming lacto-ovo vegetarian, vegan and omnivorous diets in Spain. A cross-sectional study.

Knowledge on the characteristics of consumers who choose plant-based diets and the relationship with nutritional status and disease risk is needed. In the present study, 207 Spanish adults participated in a cross-sectional study, and were classified in three groups: lacto-ovo vegetarian (LOV), vegan (VEG), and omnivore (OMN). Dietary intake, anthropometry, body composition, haematology, and metabolic markers were evaluated. Body composition and body weight did not vary among groups. The majority of these adults performed moderate-vigorous physical activity, and LOV performed more moderate activity than OMN. Total energy intake (En) was similar in the three groups. However, cholesterol and fat intakes (%En) were higher in the order OMN, LOV, VEG, fibre and carbohydrate intakes showed the opposite trend, and protein intake (%En) was higher in OMN than both LOV and VEG (all p < 0.001). Systolic blood pressure (p = 0.04), erythrocytes (p < 0.001), and haematocrit (p < 0.001) were lower in LOV and VEG than OMN, and lymphocyte count was lower in LOV than OMN (p < 0.01). There were marked differences between groups in serum total-cholesterol and LDL-cholesterol that were lower in LOV and VEG than OMN (both p < 0.001). However, glucose, insulin and insulin resistance did not show group differences. Leptin and adiponectin were related with gender and body fat but not with diet. The inflammation marker interleukin-1ß was lower in LOV than OMN but TNF-α did not show differences. All levels were within normal ranges. Conclusion: consumption of plant-based diets compared to omnivorous diets in combination with moderate-high physical activity appears to protect similarly from cardiometabolic diseases in Spanish adults.

Changes in fatty acid levels after consumption of a novel docosahexaenoic supplement from algae: a crossover randomized controlled trial in omnivorous, lacto-ovo vegetarians and vegans.

PURPOSE: To determine serum fatty acids of lacto-ovo vegetarian (LOV), vegan (VEG) and omnivorous (OMN) adults, and to analyse the effects of consuming a docosahexaenoic acid (DHA) supplement of vegetable origin on fatty acid profile. METHODS: A randomized, double-blind, placebo-controlled crossover design was conducted in healthy adults. Volunteers (n = 116) were randomly assigned to a DHA-supplement (dose 250 mg/day), made from the microalgae Schizochytrium sp., or a placebo during 5-week periods separated by a 5-week washout interim period. Compliance and dietary intake were estimated and serum fatty acids were determined by gas chromatography. Results were analysed by mixed linear models. RESULTS: Percentage of linoleic acid (C18:2n6) in serum was the highest among the fatty acids in the three diet groups, followed by oleic (C18:1n9) and palmitic (C16:0) acids. Linoleic (C18:2n6) and alpha-linolenic (C18:3n3) acids were higher in VEG compared to OMN (p < 0.001), while in LOV, their levels were intermediate between the other groups. Women presented higher DHA (C22:6n3) than men (p < 0.001). The DHA-supplement increased serum DHA compared to placebo in the three diet groups (p < 0.001), and a higher increase was observed in VEG followed by LOV (p < 0.001). The ratio serum n-6/n-3 improved by the supplementation but remained higher in LOV and VEG than in OMN. In contrast, the DHA-supplement decreased docosapentaenoic (C22:5n3) and docosatetraenoic (C22:4n6) acids in all diet groups (p < 0.001) and increased the eicosapentaenoic to alpha-linolenic fatty acids ratio (p = 0.016). CONCLUSION: The DHA-supplement at dose of 250 mg/day was effective in increasing serum DHA either in omnivorous, lacto-ovo vegetarian and vegan adults. CLINICAL TRIAL REGISTRATION: Registered at Clinicaltrials.gov ( www. CLINICALTRIALS: gov ), NCT04278482.

Acute supplementation with grapes in obese subjects did not affect postprandial metabolism: a randomized, double-blind, crossover clinical trial.

PURPOSE: The aim of this study was to determine whether grape polyphenols have a "second-meal effect", modulating glucose and lipid elevations in the postprandial period after two successive meals in subjects with obesity. METHODS: A randomized, double-blind, placebo-controlled, acute clinical trial was conducted. Twenty-five obese subjects (BMI = ≥ 30 and < 40 kg/m2) were randomly divided into two groups. At an initial visit, blood was collected in a fasting state and the subjects received breakfast and 46 g of either grape powder (equivalent to 252 g fresh grapes) or placebo, both solved in water. Lunch was provided 5 h later and then blood was collected after 0, 30, 60, 120, 180, 240, 300, 330, 360, and 420 min since arrival. Two weeks later, at a second visit, the subjects received the other powder. The following were determined: glucose, insulin, triglycerides, uric acid, blood count, hemoglobin, viscosity, antioxidant capacity, and satiety perception. RESULTS: Postprandial increases were observed as expected in, for example, glucose and triglycerides after breakfast and lunch. The grape powder supplementation did not cause any significant modification compared to placebo, in these parameters; nor did it significantly modify plasma antioxidant capacity in the 6 h postprandial period. DISCUSSION: Single grape powder supplementation did not modify postprandial responses in obese subjects, probably because the polyphenol dose was insufficient to induce such an effect. The result of a combination of grape with other polyphenol-rich products or chronic supplementation with grape powder on postprandial responses remains to be elucidated. TRIAL REGISTRATION NUMBER: www.clinicaltrials.gov , NCT03741218.

¿Son las dietas vegetarianas nutricionalmente adecuadas? Una revisión de la evidencia científica / Are vegetarian diets nutritionally adequate? A revision of the scientific evidence

El seguimiento de dietas vegetarianas está en auge y, aunque estas se han relacionado con algunos beneficios para la salud, la baja biodisponibilidad de determinados micronutrientes en los alimentos vegetales puede resultar en riesgo de déficit nutricional, por lo que se hace necesaria una adecuada planificación de dichas dietas. En este sentido, se ha evidenciado el déficit de vitamina B12 en vegetarianos y está consensuada la necesidad de ingerir complementos de esta vitamina. La deficiencia de vitamina D puede ser más frecuente que en omnívoros, particularmente durante el invierno, cuando la síntesis cutánea es mínima. La baja biodisponibilidad del hierro, el zinc y el selenio en los alimentos vegetales puede afectar también al estado nutricional de vegetarianos. Además, las dietas vegetarianas suelen ser deficitarias en ácidos grasos poliinsaturados de la serie omega-3, eicosapentaenoico (EPA) y docosahexaenoico (DHA). Por otro lado, estas dietas sí parecen aportar cantidades adecuadas de otras vitaminas, como el ácido ascórbico, el ácido fólico y las vitaminas liposolubles A y E. En esta revisión se presentan las características de la ingesta de macro- y micronutrientes procedentes de las dietas vegetarianas y la relación dieta-salud. Se exponen, además, datos sobre el estado nutricional de adultos que consumen dichas dietas, proponiendo recomendaciones nutricionales primordiales para prevenir deficiencias. Finalmente, se presenta la posible aplicación clínica de intervenciones controladas con dietas vegetarianas

Vegetarian diets are booming and, although these diets have been linked to some health benefits, the low bioavailability of some micronutrients in plant foods may result in risk of nutritional deficiencies, which makes necessary adequate planning of these diets. In this regard, vitamin B12 deficiency in vegetarians has been evidenced and there is a consensus on the need of supplementation of this vitamin. Vitamin D deficiency may be more frequent than in omnivores, particularly during the winter, when skin synthesis is minimal. The low bioavailability of iron, zinc and selenium in vegetables can also affect nutritional status of vegetarians. Furthermore, vegetarian diets are usually deficient in polyunsaturated fatty acids of the omega-3 family, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. On the other hand, these diets appear to provide adequate quantities of other vitamins, such as ascorbic acid, folic acid and the fat-soluble vitamins A and E. In this review, the characteristics of the intake of macro- and micronutrients of vegetarian diets and the diet and health relationships are presented. In addition, data on nutritional status of this population are also shown and suggestions on nutritional recommendations to prevent deficiencies are given. Finally, the possible clinical application of controlled interventions with vegetarian diets is presented

Fatty Acid Profile and Cardiometabolic Markers in Relation with Diet Type and Omega-3 Supplementation in Spanish Vegetarians.

Plant-based diets are becoming increasingly popular, and scientific information concerning the nutritional status in this population is needed. This study determined the fatty acid profile of Spanish lacto-ovo vegetarians (LO-vegetarians) and vegans. Participants were 104 healthy adults, LO-vegetarians (n = 49) and vegans (n = 55). Lifestyle habits and consumption of food and omega-3 supplements were estimated by questionnaires. BMI, blood pressure, and abdominal and body fat were determined. Serum was collected to analyze fatty acids, glucose, lipids, homocysteine, insulin, and leptin. Volunteers were classified according to serum omega-6 to omega-3 (n-6/n-3) ratio into three groups: n-6/n-3 < 10, n-6/n-3 ≥ 10 to 20, and n-6/n-3 > 20. Results showed low cardiovascular risk and high insulin sensitivity with negligible differences between diet types. Linoleic acid (C18:2n-6) was the major serum fatty acid, followed by oleic (C18:1n-9) and palmitic (C16:0) acids. In contrast, serum eicosapentaenoic acid (EPA, C20:5n-3) and docosahexaenoic acid (DHA, C22:6n-3) were (median, interquartile range) 0.27, 0.18% and 1.59, and 0.93%, respectively. Users of n-3 supplements (<10% of total vegetarians) had significantly higher EPA than non-users, while frequent consumption of flax-seeds was associated with increased α-linolenic acid (C18:3n-3). However, neither n-3 supplementation nor food consumption affected DHA levels in this vegetarian population.

[Are vegetarian diets nutritionally adequate? A revision of the scientific evidence]. / ¿Son las dietas vegetarianas nutricionalmente adecuadas? Una revisión de la evidencia científica.

INTRODUCTION: Vegetarian diets are booming and, although these diets have been linked to some health benefits, the low bioavailability of some micronutrients in plant foods may result in risk of nutritional deficiencies, which makes necessary adequate planning of these diets. In this regard, vitamin B12 deficiency in vegetarians has been evidenced and there is a consensus on the need of supplementation of this vitamin. Vitamin D deficiency may be more frequent than in omnivores, particularly during the winter, when skin synthesis is minimal. The low bioavailability of iron, zinc and selenium in vegetables can also affect nutritional status of vegetarians. Furthermore, vegetarian diets are usually deficient in polyunsaturated fatty acids of the omega-3 family, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. On the other hand, these diets appear to provide adequate quantities of other vitamins, such as ascorbic acid, folic acid and the fat-soluble vitamins A and E. In this review, the characteristics of the intake of macro- and micronutrients of vegetarian diets and the diet and health relationships are presented. In addition, data on nutritional status of this population are also shown and suggestions on nutritional recommendations to prevent deficiencies are given. Finally, the possible clinical application of controlled interventions with vegetarian diets is presented.

INTRODUCCIÓN: El seguimiento de dietas vegetarianas está en auge y, aunque estas se han relacionado con algunos beneficios para la salud, la baja biodisponibilidad de determinados micronutrientes en los alimentos vegetales puede resultar en riesgo de déficit nutricional, por lo que se hace necesaria una adecuada planificación de dichas dietas. En este sentido, se ha evidenciado el déficit de vitamina B12 en vegetarianos y está consensuada la necesidad de ingerir complementos de esta vitamina. La deficiencia de vitamina D puede ser más frecuente que en omnívoros, particularmente durante el invierno, cuando la síntesis cutánea es mínima. La baja biodisponibilidad del hierro, el zinc y el selenio en los alimentos vegetales puede afectar también al estado nutricional de vegetarianos. Además, las dietas vegetarianas suelen ser deficitarias en ácidos grasos poliinsaturados de la serie omega-3, eicosapentaenoico (EPA) y docosahexaenoico (DHA). Por otro lado, estas dietas sí parecen aportar cantidades adecuadas de otras vitaminas, como el ácido ascórbico, el ácido fólico y las vitaminas liposolubles A y E. En esta revisión se presentan las características de la ingesta de macro- y micronutrientes procedentes de las dietas vegetarianas y la relación dieta-salud. Se exponen, además, datos sobre el estado nutricional de adultos que consumen dichas dietas, proponiendo recomendaciones nutricionales primordiales para prevenir deficiencias. Finalmente, se presenta la posible aplicación clínica de intervenciones controladas con dietas vegetarianas.