Modeling the Impact of Substituting Meat and Dairy Products with Plant-Based Alternatives on Nutrient Adequacy and Diet Quality.

BACKGROUND: Novel plant-based meat and dairy alternatives are designed to mimic and replace animal-sourced products, yet their nutritional composition differs from traditional alternatives such as legumes and beans. The nutritional impacts of switching from animal-sourced to traditional or novel plant-based alternatives remains unclear. OBJECTIVES: This study aimed to model the impact of partial and complete substitution of animal-sourced meat and dairy products with traditional or novel plant-based alternatives on diet quality and nutrient adequacy in a nationally representative sample of Australian adults. METHODS: Dietary data (1 24-h recall) from the Australian Health Survey 2011-2013 (n = 9115; ≥19 y) were analyzed. Four models simulated partial or complete substitution of animal-sourced meat and dairy with traditional or novel plant-based alternatives. Diet quality was assessed using the Dietary Guideline Index (DGI), and nutrient adequacy was determined using age- and sex-specific nutrient reference values. Modeled diets were compared to a baseline diet using survey-weighted paired t tests. RESULTS: DGI scores improved by 0.3% to 6.0% for all models across all sex and age groups compared to baseline. Improvements in diet quality were greatest for the complete substitution to traditional alternatives (5.1% average increase in DGI). Overall, inclusion of plant-based alternatives (complete or partial) decreased saturated fat and increased dietary fiber. Long-chain n-3 polyunsaturated fatty acids decreased to below adequate intakes for all complete substitution models. Substitution with traditional alternatives decreased sodium and increased calcium, whereas substitution with novel alternatives increased sodium and decreased calcium. CONCLUSIONS: All models using traditional alternatives, and the partial substitution using novel alternatives, showed small but statistically significant improvements in diet quality. Nutrient adequacy varied between models, with nutrients including saturated fat, sodium, calcium, and long-chain fatty acids implicated. Findings highlight the importance of informed choices when switching to traditional or novel plant-based alternatives to prevent suboptimal dietary intake.

#Fail: the quality and accuracy of nutrition-related information by influential Australian Instagram accounts.

BACKGROUND: Social media is a popular source of information about food and nutrition. There is a high degree of inaccurate and poor-quality nutrition-related information present online. The aim of this study was to evaluate the quality and accuracy of nutrition-related information posted by popular Australian Instagram accounts and examine trends in quality and accuracy based on author, topic, post engagement, account verification and number of followers. METHODS: A sample of posts by Australian Instagram accounts with ≥ 100,000 followers who primarily posted about nutrition was collected between September 2020 and September 2021. Posts containing nutrition-related information were evaluated to determine the quality and accuracy of the information. Quality was assessed using the Principles for Health-Related Information on Social Media tool and accuracy was assessed against information contained in the Australian Dietary Guidelines, Practice-based Evidence in Nutrition database, Nutrient Reference Values and Metafact. RESULTS: A total of 676 posts were evaluated for quality and 510 posts for accuracy, originating from 47 Instagram accounts. Overall, 34.8% of posts were classified as being of poor quality, 59.2% mediocre, 6.1% good and no posts were of excellent quality. A total of 44.7% of posts contained inaccuracies. Posts authored by nutritionists or dietitians were associated with higher quality scores (ß, 17.8, CI 13.94-21.65; P < 0.001) and higher accuracy scores (OR 4.69, CI 1.81-12.14, P = 0.001) compared to brands and other accounts. Information about supplements was of lower accuracy (OR 0.23, CI 0.10-0.51, P < 0.001) compared to information about weight loss and other nutrition topics. Engagement tended to be higher for posts of lower quality (ß -0.59, P = 0.012), as did engagement rate (ß -0.57, P = 0.016). There was no relationship between followers or account verification and information quality or accuracy and no relationship between engagement and accuracy. CONCLUSIONS: Nutrition-related information published by influential Australian Instagram accounts is often inaccurate and of suboptimal quality. Information about supplements and posts by brand accounts is of the lowest quality and accuracy and information posted by nutritionists and dietitians is of a higher standard. Instagram users are at risk of being misinformed when engaging with Australian Instagram content for information about nutrition.

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults: a mixed methods analysis.

BACKGROUND: Low fruit and vegetable consumption is a leading contributor to non-communicable disease risk. However, understanding of barriers and facilitators to fruit and vegetable intake in rural settings is limited. This study used a mixed methods approach to determine the barriers and facilitators to increasing fruit and vegetable intake in rural Australian adults and to identify if these varied by gender. METHODS: Quantitative and qualitative data were used from the 2019 Active Living Census, completed by adults living in north-west Victoria, Australia. Data were collected on fruit and vegetable intakes and barriers and facilitators to meeting fruit and vegetable recommendations. Multivariate logistic regression analyses were used to investigate the association between facilitators, classified using the socio-ecological framework, and meeting recommendations. Machine learning was used to automate content analysis of open ended information on barriers. RESULTS: A total of 13,464 adults were included in the quantitative analysis (51% female; mean age 48 [SE 0.17] years) with 48% and 19% of participants consuming the recommended two serves of fruit and five serves of vegetables daily, respectively. Strongest facilitators to fruit consumption were at the individual level: never smoked (OR: 2.12 95% CI: 1.83-2.45) and not drinking alcohol (OR: 1.47 95% CI: 1.31-1.64). Strongest facilitators for vegetable consumption were found at all levels; i.e., individual level: used to smoke (OR: 1.48 95% CI: 1.21-1.80), social-environmental level: living with three or more people (OR: 1.41 95% CI: 1.22-1.63), and physical-environmental level: use community gardens (OR: 1.20 95% CI: 1.07-1.34). Qualitative analyses (fruit n = 5,919; vegetable n = 9,601) showed that barriers to fruit consumption included a preference for other snacks and desire to limit sugar content, whilst lack of time and unachievable guidelines were barriers for vegetables. Barriers and facilitators differed by gender; females experienced barriers due to having a more varied diet while males reported a dislike of the taste. CONCLUSIONS: Barriers and facilitators to fruit and vegetable consumption among rural Australian adults were identified across all levels of the socio-ecological framework and varied between fruit and vegetables and by gender. Strategies that address individual, social, and physical-level barriers are required to improve consumption.

Novel approach to investigate the association between type 2 diabetes risk and dietary fats in a dietary pattern context: a scoping review.

The effect of dietary fat on type 2 diabetes (T2D) risk is unclear. A posteriori dietary pattern methods have been increasingly used to investigate how dietary fats impact T2D risk. However, the diverse nutrients, foods and dietary patterns reported in these studies requires examination to better understand the role of dietary fats. This scoping review aimed to systematically search and synthesize the literature regarding the association between dietary patterns characterized by dietary fats and T2D risk using reduced rank regression. Medline and Embase were searched for cross-sectional, cohort or case-control studies published in English. Of the included studies (n = 8), five high-fat dietary patterns, mostly high in SFA, were associated with higher T2D risk or fasting glucose, insulin and Homeostasis Model Assessment (HOMA) levels. These were mostly low-fiber (n = 5) and high energy-density (n = 3) dietary patterns characterized by low fruit and vegetables intake, reduced fat dairy products and higher processed meats and butter intake. Findings from this review suggest that a posteriori dietary patterns high in SFA that increase T2D risk are often accompanied by lower fruits, vegetables and other fiber-rich foods intake. Therefore, healthy dietary fats consumption for T2D prevention should be encouraged as part of a healthful dietary pattern.

A scoping review of approaches used to develop plant-based diet quality indices.

Plant-based dietary patterns are comprised of a range of foods, and increasingly, diet quality indices are used to assess them and their associations with health outcomes. As the design of these indices varies, a review of existing indices is necessary to identify common features, strengths, and considerations. This scoping review aimed to synthesize the literature on plant-based diet quality indices by examining their 1) basis for development, 2) scoring methodology, and 3) validation approaches. MEDLINE, CINAHL, and Global Health databases were systematically searched from 1980 to 2022. Observational studies were included if they assessed plant-based diets in adults, using an a priori methodology with food-based components. Studies conducted among pregnant/lactating people were excluded. Thirty-five unique plant-based diet quality indices were identified in 137 included articles published between 2007 and 2022. Indices were developed to reflect epidemiological evidence for associations between foods and health outcomes (n = 16 indices), previous diet quality indices (n = 16), country-specific dietary guidelines (n = 9), or foods from traditional dietary patterns (n = 6). Indices included 4 to 33 food groups, with fruits (n = 32), vegetables (n = 32), and grains (n = 30) the most common. Index scoring comprised of population-specific percentile cutoffs (n = 18) and normative cutoffs (n = 13). Twenty indices differentiated between healthy and less healthy plant-based foods when scoring intakes. Validation methods included construct validity (n = 26), reliability (n = 20), and criterion validity (n = 5). This review highlights that most plant-based diet quality indices were derived from epidemiological research, the majority of indices differentially scored healthy and unhealthy plant and animal foods, and indices were most often evaluated for construct validity and reliability. To ensure best practice use and reporting of plant-based dietary patterns, researchers should consider the basis for development, methodology, and validation when identifying appropriate plant-based diet quality indices for use in research contexts.

Associations between Dietary Patterns and Malnutrition, Low Muscle Mass and Sarcopenia in Adults with Cancer: A Scoping Review.

Dietary patterns examine the combinations, types and quantities of foods consumed in the diet. Compared to individual nutrients, dietary patterns may be better associated with cancer-related malnutrition, low muscle mass and sarcopenia. This scoping review identified associations between dietary patterns, assessed using data-driven methods (i.e., statistical methods used to derive existing dietary patterns) and hypothesis-orientated methods (i.e., adherence to diet quality indices), and malnutrition, low muscle (lean) mass and sarcopenia. MEDLINE, Embase and CINAHL databases were searched up to September 2021. Of the 3341 studies identified, seven studies were eligible for review. Study designs included experimental (n = 5) and observational (n = 2), and people with prostate, ovarian and endometrial, bladder, breast, and gastrointestinal cancers. One study used data-driven methods to derive dietary patterns, finding adherence to a 'fat and fish' diet was associated with lower odds of low muscle mass. Two studies examined adherence to hypothesis-orientated methods including the Mediterranean Diet Adherence Screener and Healthy Eating Index 2010 and four studies used 'non-traditional' approaches to analyse dietary patterns. Hypothesis-orientated dietary patterns, developed to improve general health and prevent chronic disease, and 'non-traditional' dietary patterns demonstrated inconsistent effects on muscle (lean) mass. All studies investigated muscle (lean) mass, omitting malnutrition and sarcopenia as cancer-related outcomes. This scoping review highlights the limited research examining the effect of dietary patterns on cancer-related outcomes.