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We report a case of a 60-year-old man who struggled with frequent migraines for 12.5 years, which were refractory to all conventional therapies. Six months before initial consultation, these migraines become chronic. The patient was then advised to follow the Low Inflammatory Foods Everyday (LIFE) diet, a nutrient-dense, dark green leafy vegetable-rich, whole food plant-based diet. Within 2 months, his headache frequency declined from 18 to 24 headache days per month to 1, and he discontinued his preventive and abortive migraine medications. After 3 months, the patient had no headaches. These results far exceed the goal of migraine treatment with medication, which is to reduce migraine frequency by >50% per month. In addition, the results were durable; this patient has been migraine-free for 7.5 years. Serum beta-carotene more than tripled after the patient started the LIFE diet, consistent with its high content of dark green leafy vegetables. Weight, high-sensitivity C-reactive protein (hsCRP), complete blood count (CBC), hydration status, sodium and other electrolytes remained constant throughout the study.

Background/purpose Actually, many individuals have opted for the vegetarian diet. The objective of this study was to evaluate the impact of the vegetarian diet on the oral epithelium through cytopathology. Methods Oral smears of the tongue and buccal mucosa of 60 adult subjects (30 vegetarians and 30 controls) were collected. Smears were analyzed morphologically and for three morphometric variables: nucleus area (NA), cytoplasm area (CA) and nucleus/cytoplasm ratio. Results Vegetarians were classified as ovolactovegetarian (53.3%), vegans (30%) and strict vegetarians (16.7%). The NA and CA of the epithelial cells of vegetarian individuals were smaller when compared to controls both in the region of the buccal mucosa and tongue. However, there was no statistically significant difference according to the Student's t-test. For the NA/CA ratio, cells in the oral mucosa region were larger for vegetarians compared to controls. For the tongue, both groups had the same value and the Mann–Whitney U test confirmed that there is no difference between the groups for this cytomorphometric variable. Results: Vegan individuals had a smaller (but not larger) area of CA when compared to controls for the tongue (vegan = 2604.2 ± 179.2 versus control = 3256.7 ± 463.8 p = 0.013). Most smears showed normal epithelial cells and some individuals had changes of an inflammatory nature, mainly in the tongue. Conclusion Despite the small sample size, the results of this study raise the hypothesis that the vegetarian diet (especially the vegan diet) can compromise the thickness of the oral epithelium of the tongue.

The human gut microbiome plays a central role in health and disease. Environmental factors, such as lifestyle and diet, are known to shape the gut microbiome as well as the reservoir of resistance genes that these microbes harbour; the resistome. In this study we assessed whether long-term dietary habits within a single geographical region (the Netherlands) impact the human gut resistome. Faecal samples from Dutch omnivores, pescatarians, vegetarians and vegans were analysed by metagenomic shotgun sequencing (MSS) (n = 149) and resistome capture sequencing approach (ResCap) (n = 64). Among all diet groups, 119 and 145 unique antibiotic resistance genes (ARGs) were detected by MSS or ResCap, respectively. Five or fifteen ARGs were shared between all diet groups, based on MSS and ResCap, respectively. The total number of detected ARGs by MSS or ResCap was not significantly different between the groups. MSS also revealed that vegans have a distinct microbiome composition, compared to other diet groups. Vegans had a lower abundance of Streptococcus thermophilus and Lactococcus lactis compared to pescatarians and a lower abundance of S. thermophilus when compared to omnivores. In summary, our study showed that long-term dietary habits are not associated with a specific resistome signature.

Purpose There is an ongoing debate whether vegetarian (VG) and especially vegan (VN) diets are nutritionally adequate in early childhood. Hence, the Vegetarian and Vegan Children Study (VeChi Diet Study) aimed to assess the food and nutrient intake of VG and VN infants. Methods The study examined the diets of 1–3-year-old VG, VN, and omnivorous (OM) children (n = 430). Dietary intake was assessed via a 3-day weighed dietary record and compared between groups using ANCOVA. Lifestyle data were collected using a questionnaire. Here, the results of micronutrient and fatty acid intakes are presented. Results Most nutrient intakes (with and without supplements) differed significantly between VN children and the two other groups, with a more favourable overall micronutrient intake in VN, followed by VG children, [e.g., the highest intake of vitamin E (8.3 mg/d vs. VG 7.4 mg/d and OM 5.1 mg/d), vitamin B1 (569 µg/d vs. VG 513 µg/d and OM 481 µg/d), folate (143 µg/d vs. VG 116 µg/d and OM 108 µg/d), magnesium (241 mg/d vs. VG 188 mg/d and OM 164 mg/d), and iron (8.9 mg/d vs. VG 7.3 mg/d and OM 6.0 mg/d)] as well as fat quality [highest intake of polyunsaturated fatty acids (8.7 E% vs. VG 6.9 E% and OM 4.5 E%) and lowest intake of saturated fatty acids (9.1 E% vs. VG 11.9 E% and OM 14.0 E%)]. In contrast, OM children had the highest intake of vitamin B2 (639 µg/d vs. VG 461 µg/d and VN 429 µg/d), calcium (445 mg/d vs. VG 399 mg/d and VN 320 mg/d), iodine (47 µg/d vs. VG 33 µg/d and VN 31 µg/d), and DHA (35.4 mg/d vs. VG 16.6 mg/d and VN 18.4 mg/d). Without supplementation, OM children had the highest average vitamin B12 intake (1.5 µg/d vs. VG 0.6 µg/d and VN 0.2 µg/d), whereas VN children had the highest average vitamin B12 intake with supplementation (73.8 µg/d vs. VG 1.3 µg/d and OM 1.7 µg/d). Without supplementation, none of the groups’ median intakes met the harmonised Average Requirement (h-AR) for vitamin D and iodine. Moreover, VG and VN children did not achieve h-ARs for vitamin B2, vitamin B12, and iron—if a low absorption of iron is anticipated; VN children also did not do so for calcium. Conclusion In early childhood, VN and VG diets can provide most micronutrients in desirable amounts and a preferable fat quality compared to an OM diet. Special focus should be paid to (potentially) critical nutrients, particularly vitamin D, iodine, and DHA for all children regardless of diet, as well as vitamin B2, vitamin B12, calcium, and iron for VG and VN children. Trail registration This study was registered with the German Clinical Trials Register (DRKS00010982) on (September 2, 2016).

Available evidence suggests a favorable association between adherence to a plant-based diet and disease prevention, but data on the link between such dietary intakes and cancer are scarce. We examined the association between the overall plant-based diet (PDI), healthy plant-based diet (hPDI), and unhealthy plant-based diet (uPDI) and risk of glioma. This case–control study was conducted on 128 newly diagnosed glioma patients, and 256 hospital-based controls. Cases were diagnosed by pathological test and controls were selected from hospitalized people in orthopedic and surgical wards. Dietary intakes were assessed using a validated Block-format 123-items food frequency questionnaire. Scores of plant-based dietary patterns were calculated using the method suggested by Satija et al. After controlling for potential confounders, individuals with higher scores of PDI (OR: 0.54, 95% CI: 0.32–0.91, P-trend P-trend P-trend = 0.02). Adherence to PDI and hPDI was associated with a lower odds of glioma, while greater adherence to uPDI was directly associated with the likelihood of glioma. Further prospective cohort studies are needed to examine our findings.

In Canada, unhealthy diets are associated with several chronic conditions, such as type 2 diabetes, cardiovascular disease, and obesity, and thus negatively impact the health and well-being of Canadians. Consequently, unhealthy diets are associated with an increased risk of morbidity and mortality in Canada. Recently, plant-based diets have gained in popularity due to their ability to provide a diet that is nutritionally adequate and health-conscious in addition to supporting environmental sustainability. The adoption of plant-based diets may address the substantial need to improve the health and well-being of Canadians, while also having a positive global environmental impact such as reducing greenhouse gas emissions. The aim of this scoping review was to identify current knowledge on the nutritional adequacy of plant-based diets and their relation with chronic conditions to support improved health and well-being of Canadians while identifying gaps in knowledge. Canadian peer-reviewed literature on diet, nutritional quality, and chronic conditions published between the years 2010 and 2020 were systematically examined. Sixteen articles met the inclusion criteria, with the majority pertaining to the relation between animal- or plant-based nutrition and cancer. Epidemiological studies support the practice of plant-based diets, in comparison to omnivore diets, as a strategy to improve nutritional adequacy and reduce the development of chronic conditions such as obesity, type 2 diabetes, cardiovascular diseases, osteoporosis, and select cancers such as endometrial, colorectal, and breast cancers. Overall, plant-based diets offer an opportunity to improve the health and well-being of Canadians while simultaneously working to counteract climate change, which may have a global reach. Gaps in knowledge were identified and mainly pertained to the lack of valid Canadian quantitative assessments of the long-term health impacts of plant-based diets. Further research should be completed to quantify the long-term health effects of the practice of a plant-based diet across all demographics of the Canadian population.

Plant-based, i.e. vegetarian (without meat and fish) or vegan (exclusively plant-based foods) diets are in trend also among children and adolescents, but data on food intake in this group are lacking. Here, we compare the consumption of food groups of vegetarian (n 145), vegan (n 110) and omnivore (n 135) children and adolescents (6–18 years) in Germany using data of the VeChi Youth Study. Each food item reported in 3 d weighed dietary records was assigned to one of eighteen food groups and individual mean intake per day (g/MJ) was calculated. Group differences were assessed using covariance analyses adjusted for age, sex and other covariates. For food groups with a high number of non-consumers, non-parametric Kruskal–Wallis tests were run. Pairwise comparison of vegetarian and vegan groups indicated significantly higher intakes of legumes, nuts, milk alternatives (all P = 0·0003) and meat alternatives (P = 0·0065) among vegan subjects. Intake of these food groups of omnivore participants was low (Q3:0·0 g/MJ for legumes, milk alternatives and meat alternatives, 0·5 g/MJ for nuts). Dairy intake of vegetarians (11·6 g/MJ) was significantly lower than of omnivore subjects (24·7 g/MJ) (P = 0·0003). Intake of fats/oils and sweet foods was lowest in vegan compared with vegetarian and omnivore participants (P< 0·05). Whole grain intake was higher in vegan participants (14·5 g/MJ) than of vegetarian (9·1 g/MJ) and omnivore (6·5 g/MJ) participants (P = 0·0003). Longitudinal studies are necessary to evaluate the long-term health consequences of vegetarian, vegan and omnivore food patterns, especially in childhood and adolescence.

We explored effects on cognitive function of following plant-based vegetarian compared with non-vegetarian dietary patterns in otherwise healthy older community-dwelling members of the Adventist Health Study-2 cohort (n = 132). Cognition was assessed using a comprehensive neuropsychological battery; a principal components analysis derived processing speed, executive function, and memory/language factors. Mild memory impairment (MMI) (n = 26, 19.7%) was identified by memory tests. Vegetarians consumed (a) meats, fish, and dairy

BACKGROUND: Plant-rich diets are associated with lower cardiometabolic risks and longer survival in the general population, but their association with mortality in cancer survivors is still unclear. OBJECTIVES: We aimed to examine the associations of 3 postdiagnostic plant-based diet indices with all-cause mortality in omnivorous long-term colorectal cancer (CRC) survivors. METHODS: Diet was assessed with FFQs at a median of 6 years after diagnosis in 1404 CRC survivors (56% male; median age, 69 years) in a Northern German prospective cohort study. An overall, a healthful plant-based, and an unhealthful plant-based diet index were derived by scoring intakes of animal foods reversely and intakes of healthy (whole grains, vegetables, fruits, legumes, nuts, oils, tea/coffee) and less healthy plant foods (refined grains, fruit juices, sugar-sweetened beverages, potatoes, sweets/desserts) positively or reversely, depending on the index. Vital status follow-up was conducted via population registries. Cox proportional hazards regression was applied to estimate HRs for all-cause mortality according to plant-based diet adherence. RESULTS: Within 7 years (median) after diet assessment, 204 deaths occurred. The overall plant-based diet index displayed a significant, inverse association with all-cause mortality (HR per 10-point increase in diet index, 0.72; 95% CI, 0.57–0.91). Although not statistically significant, higher healthful plant-based diet scores showed a strong tendency towards lower mortality (HR, 0.82; 95% CI, 0.67–1.01). The unhealthful plant-based diet index was associated with higher mortality, but lost statistical significance after multivariable adjustment (HR, 1.19; 95% CI, 0.96–1.48). A subgroup analysis revealed that the tendency towards a positive association of the unhealthful plant-based diet with mortality was restricted to less physically active individuals (

Background: Plant-based diets have been associated with lower risk of various diseases, including type 2 diabetes, cardiovascular disease, and other cardiometabolic risk factors. However, the association between plant-based diet quality and breast cancer remains unclear. Methods: We prospectively followed 76,690 women from the Nurses' Health Study (NHS, 1984–2016) and 93,295 women from the NHSII (1991–2017). Adherence to an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI) was assessed using previously developed indices. Cox proportional hazards models were used to estimate HR and 95% confidence intervals (CI) for incident invasive breast cancer. Results: Over 4,841,083 person-years of follow-up, we documented 12,482 incident invasive breast cancer cases. Women with greater adherence to PDI and hPDI were at modestly lower risk of breast cancer [(HRQ5 vs. Q1, 0.89; 95% CI, 0.84–0.95); (HRQ5 vs. Q1, 0.89; 95% CI, 0.83–0.94)]. We observed significant heterogeneity by estrogen receptor (ER) status, with the strongest inverse association between hPDI and breast cancer observed with ER-negative tumors [HRQ5 vs. Q1, 0.77; 95% CI, 0.65–0.90; Ptrend < 0.01]. We also found an inverse association between extreme quintiles of healthy plant foods and ER-negative breast cancer [HR, 0.74; 95% CI, 0.61–0.88; Ptrend < 0.01]. Conclusions: This study provides evidence that adherence to a healthful plant-based diet may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors. Impact: This is the first prospective study investigating the relation between healthful and unhealthful plant-based dietary indices and risk of total and subtype-specific breast cancer.

Objective: This study aimed to assess the effects of the combination of a low-fat plant-based diet and soybeans on the frequency and severity of menopausal hot flashes. Methods: Postmenopausal women (n = 38) reporting two or more hot flashes/day were randomly assigned to a low-fat, vegan diet, including ½ cup (86 g) of cooked soybeans daily, or to no diet changes for 12 weeks. Frequency and severity of hot flashes were recorded using a mobile application, and vasomotor, psychosocial, physical, and sexual symptoms were assessed using the Menopause-Specific Quality of Life Questionnaire. Significance was assessed using t-tests (continuous outcomes) and chi-squared/McNemar tests (binary outcomes). Results: Total hot flashes decreased 79% in the intervention group (P

Background and aims The type of fat consumed in animal-based western diets, typically rich in the saturated fat palmitate, has been implicated in cardiometabolic disease risk. In contrast, the most abundant mono- and polyunsaturated fats, more typical in a vegetarian or plant-based diet, potentiate less deleterious effects. This study determined differences in plasma and urine metabolites when switching from omnivorous to vegetarian diet, including metabolites involved in fatty acid utilization. Methods and results A prospective cohort of 38 European (EA) and African American (AA) omnivorous females were matched by age (25.7 ± 5.3y) and BMI (22.4 ± 1.9 kg/m2). Pre-intervention samples were collected while subjects consumed habitual animal-based diet. Changes in metabolites were assessed by ultra-high-performance liquid chromatography-tandem mass spectroscopy (Metabolon, Inc.) upon completing four days of novel vegetarian diet provided by the Vanderbilt Metabolic Kitchen. Changes in several diet-derived metabolites were observed, including increases in compounds derived from soy food metabolism along with decreases in metabolites of xanthine and histidine. Significant changes occurred in metabolites of saturated, monounsaturated and polyunsaturated fatty acids along with significant differences between EA and AA women in changes in plasma concentrations of acylcarnitines, which reflect the completeness of fatty acid oxidation (versus storage). Conclusion These data suggest improvements in fatty acid metabolism (oxidation vs storage), a key factor in energy homeostasis, may be promoted rapidly by adoption of a vegetarian (plant-based) diet. Mechanistic differences in response to diet interventions must be understood to effectively provide protection against the widespread development of obesity and cardiometabolic disease in population subgroups, such as AA women.

Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the coronavirus disease-19 (COVID-19), in December 2019, the infection has spread around the globe. Some of the risk factors include social distancing, mask wearing, hand washing with soap, obesity, diabetes, hypertension, asthma, cardiovascular disease, and dysbiosis. Evidence has shown the incidence of total infection and death rates to be lower in sub-Saharan Africa when compared with North Africa, Europe and North America and many other parts of the world. The higher the metabolic syndrome rate, the higher the risk of SARS-CoV-2 infection. Africa has a lower rate of metabolic syndrome risk than many other continents. This paradox has puzzled several in the biomedical and scientific communities. Published results of research have demonstrated the exciting correlation that the combination of young age of the population coupled with their native plant-based diet has lowered their risk factors. The plant-based diet include whole grains (millet, sorghum), legumes (black-eye peas, dry beans, soybean), vegetables, potato, sweet potato, yams, squash, banana, pumpkin seeds, and moringa leaves, and lower consumption of meat. The plant-based diet results in a different gut microbiota than of most of the rest of the world. This has a significant impact on the survival rate of other populations. The "plant-based diet" results in lower rates of obesity, diabetes and dysbiosis, which could contribute to lower and less severe infections. However, these hypotheses need to be supported by more clinical and biostatistics data.

A plant-based eating pattern is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment. Diets that emphasize whole grains, vegetables, fruits, and legumes and exclude animal products improve blood glucose concentrations, body weight, plasma lipid concentrations, and blood pressure and play an important role in reducing the risk of cardiovascular and microvascular complications. This article reviews scientific evidence on the effects of plant-based diets for the prevention and treatment of type 2 diabetes. The mechanisms by which plant-based diets improve body weight, insulin sensitivity, and β-cell function are described. Practical considerations including education, nutrition adequacy, and adjusting medications will enhance the success of patients who have diabetes., This article examines the evidence on plant-based nutrition for the prevention and treatment of type 2 diabetes, mechanisms, and considerations when recommending such diets.

International audience; Massive animal farming for meat production poses major problems in terms of resource use, environmental impact, and biodiversity. Furthermore, excessive meat consumption has been associated with multiple deleterious health consequences. However, more and better-designed randomized trials are needed to increase the level of evidence on the health impacts of meat. Novel meat alternatives, such as plant- and cell-based meat, are much less impactful to the environment and might replace traditional animal meat in the future, but, despite promising early data, the health consequences of these novel products need further study. This manuscript focuses on the health impacts of meat over 3 main sections: 1) overview of the evidence highlighting the association of meat consumption with health; 2) novel alternatives to meat, including plant-based and cell-based alternatives; and 3) examine the rationale for randomized studies to evaluate the effects of the novel meat alternatives compared with the standard animal meat.

Context Several epidemiological studies have investigated the association between a vegetarian diet and risk of depression, but because of inconsistency between studies, the exact association remains unclear. Objective In this systematic review and meta-analysis, the relationship between vegetarian diets and risk of depression in observational studies was evaluated. Data sources The Medline, Embase, Scopus, ISI Web of Science, and Cochrane Library databases were searched from inception through September 1, 2020. Study selection Observational studies were included that examined mean levels of depression and risk for depression in vegetarians compared with nonvegetarians. Data extraction Pooled effect sizes were estimated using the random-effects model and were reported as standardized mean differences or odds ratios (ORs) with their corresponding 95%CIs. Heterogeneity was tested using the I2 statistic. Results Combining 9 effect sizes in this meta-analysis illustrated that adherence to a vegetarian diet was associated with a 53% greater risk of depression compared with that of omnivores (95%CI, 1.14–2.07; I2 = 69.1%). Subgroup analysis of depression risk suggested that results depended on the type of vegetarian diet and country where the study was conducted. For studies that assessed a semivegetarian diet (OR, 1.86; 95%CI, 1.42–2.44; I2 = 35.7%) and those conducted in Europe and the United States (OR, 1.45; 95%CI, 1.06–1.98; I2 = 73.2%), there was a positive association between a vegetarian diet and depression, but in lacto-ovo vegetarians and Asian countries, a null association was found. Comparing mean depression scores showed no evidence of difference between vegetarians and nonvegetarians (n = 16; standardized mean difference, 0.10; 95%CI, –0.01 to 0.21; I2 = 79.1%). Conclusion Vegetarian diet significantly increased depression risk; however, the findings were not robust, and more studies are required to investigate the vegetarian diet and depression association.

Aims/Introduction Studies have found that a plant‐based diet was associated with a lower risk of type 2 diabetes, but evidence is scarce on such associations in China. The aim of this study was to investigate whether a plant‐based diet is related to a lower risk of type 2 diabetes among Chinese adults. Materials and Methods A total of 37,985 participants were enrolled from the Henan Rural Cohort Study. An overall plant‐based diet index (PDI) was created by assigning positive and reverse scores to 12 commonly consumed food groups. Multivariate logistic regression models and restricted cubic spline analysis were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI). Results After multivariable adjustment, the risk of type 2 diabetes was inversely associated with the PDI (extreme‐quartile OR = 0.88, 95% CI: 0.79–0.98; P = 0.027), the risk associated with a 1 standard deviation (SD) increase in PDI was 4% lower (95% CI, 0.93–1.00; P trend = 0.043) for type 2 diabetes. Moreover, the odds of type 2 diabetes was decreased with an increment of PDI after fitting restricted cubic splines (P trend, This is the first study to evaluate the association between the plant‐based diet index (PDI) and type 2 diabetes in a Chinese rural population. In our study, a higher PDI score was associated with a lower risk of type 2 diabetes, and a 1 standard deviation (SD) increase in PDI was associated with a 4% lower risk of type 2 diabetes.

Background: Plant-based diets (PBDs) are increasingly recommended for human and planetary health. However, comprehensive evidence on the health effects of PBDs in children remains incomplete, particularly in vegans. Objectives: To quantify differences in body composition, cardiovascular risk, and micronutrient status of vegetarian and vegan children relative to omnivores and to estimate prevalence of abnormal micronutrient and cholesterol status in each group. Methods: In a cross-sectional study, Polish children aged 5–10 y (63 vegetarian, 52 vegan, 72 matched omnivores) were assessed using anthropometry, deuterium dilution, DXA, and carotid ultrasound. Fasting blood samples, dietary intake, and accelerometry data were collected. Results: All results are reported relative to omnivores. Vegetarians had lower gluteofemoral adiposity but similar total fat and lean mass. Vegans had lower fat indices in all regions but similar lean mass. Both groups had lower bone mineral content (BMC). The difference for vegetarians attenuated after accounting for body size but remained in vegans (total body minus the head: –3.7%; 95% CI: –7.0, –0.4; lumbar spine: –5.6%; 95% CI: –10.6, –0.5). Vegetarians had lower total cholesterol, HDL, and serum B-12 and 25-hydroxyvitamin D [25(OH)D] without supplementation but higher glucose, VLDL, and triglycerides. Vegans were shorter and had lower total LDL (–24 mg/dL; 95% CI: –35.2, –12.9) and HDL (–12.2 mg/dL; 95% CI: –17.3, –7.1), high-sensitivity C-reactive protein, iron status, and serum B-12 (–217.6 pmol/L; 95% CI: –305.7, –129.5) and 25(OH)D without supplementation but higher homocysteine and mean corpuscular volume. Vitamin B-12 deficiency, iron-deficiency anemia, low ferritin, and low HDL were more prevalent in vegans, who also had the lowest prevalence of high LDL. Supplementation resolved low B-12 and 25(OH)D concentrations. Conclusions: Vegan diets were associated with a healthier cardiovascular risk profile but also with increased risk of nutritional deficiencies and lower BMC and height. Vegetarians showed less pronounced nutritional deficiencies but, unexpectedly, a less favorable cardiometabolic risk profile. Further research may help maximize the benefits of PBDs in children.

The objective of the study was to evaluate associations among diet quality, serum uremic toxin concentrations, and the gut microbiota profile in adults undergoing hemodialysis therapy.This is a cross-sectional analysis of baseline data from a clinical trial involving adults receiving hemodialysis therapy. Usual dietary intake was determined using a diet history method administered by Accredited Practising Dietitians. Two approaches were used for diet quality assessment: (1) using three a priori defined plant-based diet indices-an overall plant-based diet index (PDI), a healthy PDI, and an unhealthy PDI and (2) classification of food group intake. Serum uremic toxins (p-cresyl sulfate and indoxyl sulfate (IS); free and total) were determined by ultra-performance liquid chromatography. Gut microbiota composition was established through sequencing the 16S rRNA gene in stool samples.Twenty-two adults (median age 70.5 [interquartile range: 59-76], 64% male) were included in the final analysis. Higher adherence to the PDI was associated with lower total IS levels (P = .028), independent of dialysis adequacy, urinary output, and blood albumin levels. In contrast, higher adherence to the unhealthy PDI was associated with increases in both free and total IS. Several other direct and inverse associations between diet quality with uremic toxins, microbial relative abundances, and diversity metrics were also highlighted. Diet-associated taxa showed significantly different trends of association with serum uremic toxin concentrations (P .05). Higher adherence to the PDI was negatively associated with relative abundances of Haemophilus and Haemophilus parainfluenzae that were related to elevated total IS levels. In contrast, increased intake of food items considered unhealthy, such as animal fats, sweets and desserts, were associated with bacteria linked to higher IS and p-cresyl sulfate (total and free) concentrations.The quality of diet and food selections may influence uremic toxin production by the gut microbiota in adults receiving hemodialysis. Well-designed dietary intervention trials that adopt multi-omic technologies appropriate for the functional annotation of the gut microbiome are needed to validate our findings and establish causality.

Omega-3 (n-3) fatty acids offer a plethora of health benefits with the majority of evidence showing beneficial effects from marine sources of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Emerging research examines the effects of n-3 dietary intakes on blood markers of vegetarians and vegans, but official guidance for plant based marine alternatives is yet to reach consensus. This scoping review provides an overview of trials investigating bioavailability of plant n-3 oils including EPA and DHA conversion. Searches of MEDLINE, PubMed, CINAHL and clinical trial registers identified randomized controlled trials from January 2010 to September 2020. The ‘Omega-3 index’ (EPA + DHA (O3I)), was used to compare n-3 status, metabolic conversion and bioavailability. Two reviewers independently screened articles and extracted data on outcomes. From 639 identified articles, screening and eligibility checks gave 13 articles. High dose flaxseed or echium seed oil supplements, provided no increases to O3I and some studies showed reductions. However, microalgal oil supplementation increased O3I levels for all studies. Findings indicate preliminary advice for vegetarians and vegans is regular consumption of preformed EPA and DHA supplements may help maintain optimal O3I. Further studies should establish optimum EPA and DHA ratios and dosages in vegetarian and vegan populations.

Consistency among population-based studies investigating the relationship between diet and cognition in older inhabitants in the Mediterranean area is poor. The present study investigated whether diet changes over 12 years were associated with cognitive function in older people in Southern-Italy.From the 'Salus in Apulia Study', that includes the MICOL and GreatAGE Studies, 584 participants were selected, firstly enrolled in MICOL3 (M3) and later in the GreatAGE Study (MICOL4, M4). Foods and micronutrients intake were recorded in both studies, and global cognitive function in M4, assessed with the Mini Mental State Examination.Plant-based foods, particularly coffee and vegetables, as well as vitamin A sources, were inversely associated to age-related cognitive impairment. Alcohol consumption showed a detrimental role on cognition, while red meat appeared to be beneficial in the present study, although its role is traditionally considered harmful for cognitive function.Our study confirmed that a traditional Mediterranean dietary pattern based on agricultural products and low alcohol consumption may help to prevent/delay age-related cognitive impairment.

Background Cats, being obligate carnivores, have unique dietary requirements for nutrients most commonly found in dietary ingredients of animal origin. As such, feeding a diet devoid of animal-derived ingredients has been postulated as a possible cause of nutrient imbalances and adverse health outcomes. A small proportion of cat owners feed strictly plant-based diets to the cats in their care, yet the health and wellness of cats fed these diets has not been well documented. Results A total of 1325 questionnaires were complete enough for inclusion. The only exclusion criterion was failure to answer all questions. Most cats, 65% (667/1026), represented in the survey were fed a meat-based diet and 18.2% (187/1026) were fed a plant-based diet, with the rest fed either a combination of plant-based with meat-based (69/1026, 6.7%) or indeterminable (103/1026, 10%). Cat age ranged from 4 months to 23 years, with a median of 7 years, and was not associated with diet type. No differences in reported lifespan were detected between diet types. Fewer cats fed plant-based diets reported to have gastrointestinal and hepatic disorders. Cats fed plant-based diets were reported to have more ideal body condition scores than cats fed a meat-based diet. More owners of cats fed plant-based diets reported their cat to be in very good health. Conclusions Cat owner perception of the health and wellness of cats does not appear to be adversely affected by being fed a plant-based diet. Contrary to expectations, owners perceived no body system or disorder to be at particular risk when feeding a plant-based diet to cats. This study collected information from cat owners and is subject to bias, as well as methodological limitations. Further research is warranted to determine if these results are replicable in a prospective investigation.

While interest in vegetarian nutrition has been steadily increasing, some aspects have not yet been consistently investigated. One topic requiring evidence-based confirmation is the adoption of a vegetarian diet during pregnancy and lactation. Maternal diet is not only correlated with the fetus's and infant's health, but appears relevant for that of the mother as well. Not only is an adequate delivery of nutrients to the fetus and infant mandatory, but the increased physiological needs of the maternal body require an adequate supply of nutrients and can represent harmful stress events that may lead to well-defined pathological conditions. In this review, we aim to systematically investigate state-of-the-art of vegetarian diets during pregnancy and lactation, focusing on maternal nutritional status and pregnancy outcomes. Data are scarce, often inconsistent and not homogeneous for many of the topics we considered, mainly because only a few studies have been performed in developed countries, whereas other studies have derived from developing countries, where vegetarianism can be a proxy indicator of malnutrition. For this reason, we did not find sufficient data to provide evidence-based information and recommendations. To date, the available literature does not clearly support a negative impact on the mother's health and pregnancy outcomes, but, analogously with the findings in the vegetarian adult population, an improvement in the quality of studies might facilitate finding more information on the possible positive impact of well-planned vegetarian diets during pregnancy and lactation. More epidemiological and interventional studies are warranted, in order to address the question as to whether vegetarian nutrition represents an advantage for the mother or poses nutritional issues that need further attention.

Objective Reducing meat consumption would have substantial benefits both in terms of health and environmental impact, but meat options may be more attractive to customers than meat-free options. This study tested this by presenting UK adults (n = 540) with a series of pictures showing two meal options and asking them to select which they would prefer to eat right now. They completed this task for every possible pair from a pool of six comparator meat-based options and six target options (66 pairs). Participants all saw identical comparator options, and were randomised to see the same pictures of target options but with descriptions that suggested they were either meat-based or vegetarian. Results Selections were used to rank the options for each individual from 1 (most-selected) to 12 (least-selected). Vegetarian target options were ranked worse [by 1.23 places (95% CI: 1.02, 1.44)] than meat target options. Higher self-reported consumption of meat predicted worse mean rankings of target options when these were vegetarian, but not when target options were meat-based. This suggests meat options are preferred to equivalent vegetarian options and may be more likely to be selected. This has implications for interventions aiming to reduce meat consumption to make diets healthier and more sustainable.

BackgroundVegetarian diets are becoming increasingly popular in the USA. Limited research has examined the health consequences of vegetarian diets during pregnancy. We comprehensively examined associations of vegetarianism during pregnancy with maternal and neonatal outcomes.MethodsWe used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Fetal Growth Studies–Singletons, a prospective multi-site cohort of 1948 low-risk pregnant women of four races/ethnicities (White, Black, Hispanic, Asian/Pacific Islander) in the USA (2009–2013). Vegetarianism was self-reported and also defined based on dietary patterns measured using a self-administered first-trimester food-frequency questionnaire (full [lacto-ovo and vegan], pesco-, semi- and non-vegetarians). Neonatal outcomes included birthweight and neonatal anthropometric measures, small for gestational age, small for gestational age with neonatal morbidity and preterm delivery. Maternal outcomes included gestational weight gain, gestational diabetes, hypertensive disorders of pregnancy and gestational anaemia.ResultsNinety-nine (6.2%) women self-reported being vegetarian. The diet-based definition identified 32 (2.0%) full vegetarians, 7 (0.6%) pesco-vegetarians and 301 (17.6%) semi-vegetarians. Neonates of diet-based full vegetarians had higher odds of being small for gestational age [adjusted odds ratio (ORadj) = 2.51, 95% confidence interval: 1.01, 6.21], but not of being small for gestational age with a postnatal morbidity. Full vegetarians had marginally increased the odds of inadequate second-trimester gestational weight gain (ORadj = 2.24, 95% confidence interval: 0.95, 5.27).ConclusionVegetarian diets during pregnancy were associated with constitutionally smaller neonatal size, potentially via the mothers’ reduced gestational weight gain. Notably, vegetarianism was not associated with small-for-gestational-age-related morbidities or other adverse maternal outcomes.

BACKGROUND Despite the rising popularity of plant-based alternative meats, there is limited evidence of the health effects of these products. OBJECTIVES We aimed to compare the effect of consuming plant-based alternative meat (Plant) as opposed to animal meat (Animal) on health factors. The primary outcome was fasting serum trimethylamine-N-oxide (TMAO). Secondary outcomes included fasting insulin-like growth factor 1, lipids, glucose, insulin, blood pressure, and weight. METHODS SWAP-MEAT (The Study With Appetizing Plantfood-Meat Eating Alternatives Trial) was a single-site, randomized crossover trial with no washout period. Participants received Plant and Animal products, dietary counseling, lab assessments, microbiome assessments (16S), and anthropometric measurements. Participants were instructed to consume ≥2 servings/d of Plant compared with Animal for 8 wk each, while keeping all other foods and beverages as similar as possible between the 2 phases. RESULTS The 36 participants who provided complete data for both crossover phases included 67% women, were 69% Caucasian, had a mean ± SD age 50 ± 14 y, and BMI 28 ± 5 kg/m2. Mean ± SD servings per day were not different by intervention sequence: 2.5 ± 0.6 compared with 2.6 ± 0.7 for Plant and Animal, respectively (P = 0.76). Mean ± SEM TMAO concentrations were significantly lower overall for Plant (2.7 ± 0.3) than for Animal (4.7 ± 0.9) (P = 0.012), but a significant order effect was observed (P = 0.023). TMAO concentrations were significantly lower for Plant among the n = 18 who received Plant second (2.9 ± 0.4 compared with 6.4 ± 1.5, Plant compared with Animal, P = 0.007), but not for the n = 18 who received Plant first (2.5 ± 0.4 compared with 3.0 ± 0.6, Plant compared with Animal, P = 0.23). Exploratory analyses of the microbiome failed to reveal possible responder compared with nonresponder factors. Mean ± SEM LDL-cholesterol concentrations (109.9 ± 4.5 compared with 120.7 ± 4.5 mg/dL, P = 0.002) and weight (78.7 ± 3.0 compared with 79.6 ± 3.0 kg, P

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and affects approximately one third of adults in the United States. The disease is becoming a global epidemic as a result of the rising rates of obesity and metabolic disease. Emerging data suggest weight loss of ≥10% overall body weight is beneficial in resolving steatosis and reversing fibrosis. Prospective trials comparing various diets are limited by lack of sufficient power as well as pre- and post-treatment histopathology, and therefore no specific diet is recommended at this time. In this narrative review we examine the pathophysiology behind specific macronutrient components that can either promote or reverse NAFLD to help inform more specific dietary recommendations. Overall, the data supports reducing saturated fat, refined carbohydrates, and red and processed meats in the diet, and increasing the consumption of plant-based foods. Diets that incorporate these recommendations include plant-based diets such as the Dietary Approaches to Stop Hypertension, Mediterranean, vegetarian, and vegan diets. (Clin Mol Hepatol 2020;26:383-400)

The gastrointestinal microbiome is altered in Parkinson’s disease and likely plays a key role in its pathophysiology, affecting symptoms and response to therapy and perhaps modifying progression or even disease initiation. Gut dysbiosis therefore has a significant potential as a therapeutic target in Parkinson’s disease, a condition elusive to disease-modifying therapy thus far. The gastrointestinal environment hosts a complex ecology, and efforts to modulate the relative abundance or function of established microorganisms are still in their infancy. Still, these techniques are being rapidly developed and have important implications for our understanding of Parkinson’s disease. Currently, modulation of the microbiome can be achieved through non-pharmacologic means such as diet, pharmacologically through probiotic, prebiotic, or antibiotic use and procedurally through fecal transplant. Novel techniques being explored include the use of small molecules or genetically engineered organisms, with vast potential. Here, we review how some of these approaches have been used to date, important areas of ongoing research, and how microbiome modulation may play a role in the clinical management of Parkinson’s disease in the future. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13311-020-00942-2) contains supplementary material, which is available to authorized users.

Excessive attention to the animal versus plant binary food choice reflects society's moral views on eating right. To claim that avoidance of animal products is required to prevent chronic disease is not supported by evidence, makes little sense from an evolutionary perspective, and distracts policy makers from common-sense approaches to achieve adequate nutrition. Animal products provide highly bioavailable nutrients, some of which are not easily obtained from plants, and can play a key role in meeting the nutritional challenges of populations in both high- and low-income countries. This role goes beyond the need for protein and relates to vitamins, minerals, and numerous often-overlooked nutrients, such as long-chain fatty acids, taurine, and choline. Restrictive dietary prescriptions that exclude animal products complicate the quest for optimal nutrition by undermining dietary diversity and flexibility, and by introducing a dependency on fortification and supplementation. Thus, a vegan diet may put the general population at increased risk of poor nutrition, a problem of particular concern for those with special nutritional requirements.

Objective:To describe and analyse the sociodemographic, anthropometric, behavioural and dietary characteristics of different types of Swiss (no-)meat eaters.Design:No-, low-, medium- and high-meat eaters were compared with respect to energy and total protein intake and sociodemographic, anthropometric and behavioural characteristics.Setting:National Nutrition Survey menuCH, the first representative survey in Switzerland.Participants:2057 participants, aged 18–75 years old, who completed two 24-h dietary recalls (24-HDR) and a questionnaire on dietary habits, sociodemographic and lifestyle factors. Body weight and height were measured by trained interviewers. No-meat eaters were participants who reported meat avoidance in the questionnaire and did not report any meat consumption in the 24-HDR. Remaining study participants were assigned to the group of low-, medium- or high-meat eaters based on energy contributions of total meat intake to total energy intake (meat:energy ratio). Fifteen percentage of the participants were assigned to the low- and high-meat eating groups, and the remaining to the medium-meat eating group.Results:Overall, 4·4 % of the study participants did not consume meat. Compared with medium-meat eaters, no-meat eaters were more likely to be single and users of dietary supplements. Women and high-educated individuals were less likely to be high-meat eaters, whereas overweight and obese individuals were more likely to be high-meat eaters. Total energy intake was similar between the four different meat consumption groups, but no-meat eaters had lowest total protein intake.Conclusions:This study identified important differences in sociodemographic, anthropometric, behavioural and dietary factors between menuCH participants with different meat-eating habits.

OBJECTIVE To examine the associations between change in plant-centered diet quality and type 2 diabetes risk and change in body size. RESEARCH DESIGN AND METHODS A prospective study conducted in the U.S. enrolled adults ages 18–30 years in 1985–1986 (examination year [Y0]) and followed them through 2015–2016. We analyzed the associations between change in plant-centered diet quality over 20 years (Y0–Y20) and diabetes (Y20–30; n = 2,534) and change (Y0–Y20 and Y20–30) in BMI, waist circumference (WC), and weight (n > 2,434). Plant-centered diet quality was measured using the A Priori Diet Quality Score (APDQS); a higher score favors nutritionally rich plant foods. Cox regression models were used to assess diabetes risk, and linear regression models were used to examine change in body size. RESULTS During a mean follow-up of 9.3 (± 1.7) years, 206 case subjects with incident diabetes were observed. In multivariable analysis, participants with the largest increase in APDQS over 20 years had a 48% (95% CI 0.31–0.85; Ptrend < 0.001) lower risk of diabetes over the subsequent 10 years compared with participants whose score remained stable. Each 1-SD increment in APDQS over 20 years was associated with lower gains in BMI (−0.39 kg/m2; SE 0.14; P = 0.004), WC (−0.90 cm; SE 0.27; P < 0.001) and weight (−1.14 kg; SE 0.33; P < 0.001) during the same period, but not with subsequent changes. CONCLUSIONS Young adults who increased plant-centered diet quality had a lower diabetes risk and gained less weight by middle adulthood.

As the primary healthcare professionals in the school setting, school nurses field questions about diet and exercise. Nurses’ familiarity with nutrition and dietary patterns can help them respond to student concerns. Plant-based diets, those which promote eating mostly fruits and vegetables with smaller portions of animal foods, have recently gained popularity in the United States. Most plant foods are rich in fiber, antioxidants, and complex carbohydrates, as well as vitamins and minerals that support good health and maintenance of a healthy weight. Most children and adolescents can meet their nutrient needs on a plant-based diet, but should be careful to include a wide variety of foods in the diet in order to achieve nutrient adequacy.

Sleep and nutrition are central to an organism’s continued physiological existence. Moreover, both of these functions include significant social-behavioral, educational, and cultural elements. This study examined the effects of two types of nocturnal dinners (“vegetarian” versus “meat”) on the quality and quantity of sleep, as well as on subjective sleepiness and attention levels the following morning. 20 healthy subjects (10 men and 10 women) participated in a lab polysomnography study for two non-consecutive nights at the Sleep Institute at Tel-Hai College. They completed questionnaires (Karolinska Sleepiness Scale (KSS) and Brief Symptom Inventory Questionnaire (BSI)), as well as a computerized attention and concentration test (Conner’s Continuous Performance Test-III (CPT-III)), on the mornings after each night of polysomnography. On the first night, subjects consumed a vegetarian meal made up of non-animal ingredients (vegetables and vegetable proteins). On the second night, they were given a meat meal composed of carbohydrates, fats, and animal proteins. No significant differences were measured in the various sleep parameters: efficacy, structure, and quality of sleep. There were also no significant differences found in the behavioral measures examined: subjective sleepiness (KSS), mood (BSI), and attention and concentration abilities (CPT-III). The findings of this study indicate that, contrary to popular belief, consuming a meat dinner may not affect a person’s quality of sleep, or their ability to function the morning after, differently than a vegetarian dinner. Future studies should further examine the relationship between sleep and nutrition. The clinical trial is registered under the number 0010-18ASMC.

Background An appropriate diet is an important determinant of kidney health. However, the association between vegetarian diets and renal function is unclear. We aimed to study the association between vegetarian diets and renal function in healthy adults. Methods A total of 269 vegetarians and 269 sex- and age-matched nonvegetarian omnivores were enrolled in this cross-sectional study. Basic characteristics and daily dietary intakes were assessed by face-to-face interviews. Blood samples were collected, and renal function was assessed by measuring blood urea nitrogen (BUN), serum creatinine (SCr), uric acid (UA) and the estimated glomerular filtration rate (eGFR). Blood pressure, fasting blood glucose and blood lipid profiles were also assessed. Results The average age of the vegetarians was 35.4 ± 8.6 years, 82.2% of whom were female. We evaluated the association between vegetarian diets and renal function using multivariate analysis. Compared with omnivores, vegetarians had lower BUN [β = − 0.63, 95% confidence interval (CI): (− 0.88, − 0.38)], SCr [β = − 2.04, 95% CI:(− 4.10, 0.02)], and UA levels [β = − 15.15, 95% CI: (− 27.81, − 2.50)] and higher eGFRs [β = 4.04, 95% CI: (0.30, 7.78)] after adjusting for sex, age, body mass index (BMI), physical activity, alcohol consumption, smoking status, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), systolic pressure and fasting blood glucose. Further analysis of food composition and renal function showed that dietary fiber intake was significantly negatively associated with BUN [β = − 0.02, 95% CI: (− 0.03, 0.00)], SCr [β = − 0.14, 95% CI: (− 0.25, 0.04)], and UA levels [β = − 0.72, 95% CI: (− 1.36, 0.07)] and positively associated with the eGFR [β = 0.20, 95% CI: (0.00, 0.40)]. Conclusions Healthy adult vegetarians have better renal function than omnivores, and the higher dietary fiber intake associated with vegetarian diets may contribute to the protective effect on renal function.

Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis. Emerging evidence suggests that plant-based diets could help to prevent chronic kidney disease (CKD), manage its symptoms and metabolic complications and delay disease progression. Here, the authors discuss the potential risks and benefits of these diets in patients with CKD, as well as implementation strategies and knowledge gaps.

Background In persons with CKD, adherence to plant-based diets is associated with lower risk of CKD progression and death, but underlying mechanisms are poorly characterized. We here explore associations between adherence to plant-based diets and measures of insulin sensitivity and inflammation in men with CKD stages 3–5. Methods Cross-sectional study including 418 men free from diabetes, aged 70–71 years and with cystatin-C estimated glomerular filtration rate (eGFR) 2 and not receiving kidney-specific dietetic advice. Information from 7-day food records was used to evaluate the adherence to a plant-based diet index (PBDi), which scores positively the intake of plant-foods and negatively animal-foods. Insulin sensitivity and glucose disposal rate were assessed with the gold-standard hyperinsulinemic euglycemic glucose clamp technique. Inflammation was evaluated by serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6. Associations were explored through linear regression and restricted cubic splines. Results The majority of men had CKD stage 3a. Hypertension and cardiovascular disease were the most common comorbidities. The median PBDi was 38 (range 14–55). Across higher quintiles of PBDi (i.e. higher adherence), participants were less often smokers, consumed less alcohol, had lower BMI and higher eGFR (P for trend Conclusion In elderly men with non-dialysis CKD stages 3–5, adherence to a plant-based diet was associated with higher insulin sensitivity and lower inflammation, supporting a possible role of plant-based diets in the prevention of metabolic complications of CKD. Graphic abstract

Background India has high rates of child undernutrition and widespread lactovegetarianism. Objectives The objective of this study was to examine how nutrition outcomes varied among Indian preschool children in relation to the vegetarian status of their parents. Methods The 2015–2016 National Family Health Survey (NFHS) and the 2011–2012 National Sample Survey (NSS) were used to explore associations between parental vegetarian status and child stunting and wasting at ages 0–59 mo and anemia at ages 6–59 mo. In the NFHS, self-reports on usual consumption of foods were used to classify maternal diets, whereas in the NSS lactovegetarianism was defined at the household level. Results Compared with children of nonvegetarian mothers, children aged 24–59 mo of lactovegetarian mothers were 2.9 percentage points (95% CI: −4.0, −1.9) less likely to be stunted and children aged 6–23 mo were 1.6 points less likely to be wasted (95% CI: −3.0, −0.03), whereas children aged 6–23 mo with vegan mothers were 5.2 points more likely to be stunted (95% CI: 0.1, 9.4). When compared with nonvegetarian households, lactovegetarian households had better socioeconomic status and were more likely to consume dairy frequently. Children in nonvegetarian households consumed nondairy animal-sourced foods (ASFs) with relatively low frequency. The frequency of maternal dairy consumption was significantly associated with lower risks of child stunting and wasting. Conclusions Anthropometric outcomes differed by maternal vegetarian status, which is itself strongly associated with socioeconomic position, location, religion, and caste.

To evaluate the association between the plant-based content of diet and serum testosterone levels in men from the national health and nutrition examination survey (NHANES) database. Data on demographics, diet, and testosterone levels was acquired from the NHANES database. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and a healthful plant-based diet index (hPDI) was developed. A higher score on PDI and hPDI indicates higher consumption of plant foods. A total of 191 participants were included, average age was 45 (30–60) years and average total testosterone level was 546.7 ± 254.7 ng/dL. The mean PDI and hPDI were 50.4 ± 6 and 50.8 ± 7.2, respectively. On multiple linear regression analysis, BMI and age significantly contribute to testosterone levels (p

Prevalence and trends of different vegetarian diets remain unknown, with estimates varying depending on the source. Evidence suggests that vegetarian diets are associated with a more favourable cardiovascular risk profile. The present study aimed to assess the prevalence and trends of different types of vegetarian diets in a population-based representative sample, sociodemographic characteristics of participants following such diets and the association of these diets with cardiovascular risk factors. Using repeated cross-sectional population-based surveys conducted in Geneva, Switzerland, 10 797 individuals participated in the study between 2005 and 2017. Participants were classified as vegetarians, pescatarians, flexitarians or omnivores using an FFQ. Sociodemographic and cardiovascular risk factors were evaluated through questionnaires, anthropometric measurements and blood tests. Findings show prevalence of vegetarians increased from 0·5 to 1·2 %, pescatarians from 0·3 to 1·1 % and flexitarians remained stable at 15·6 % of the population over the study period. Compared with omnivores, vegetarians were more likely to be young (OR 2·38; 95 % CI 1·01, 5·6), have higher education (OR 1·59; 95 % CI 1·01, 2·49) and lower income (OR 1·83; 95 % CI 1·04, 3·21); pescatarians and flexitarians were more likely to be women (pescatarian: OR 1·81; 95 % CI 1·10, 3·00; vegetarian: OR 1·57; 95 % CI 1·41, 1·75) and flexitarians were also more likely to have a lower income (OR 1·31; 95 % CI 1·13, 1·53). Participants who adhered to any diet excluding/reducing meat intake had lower BMI, total cholesterol and hypertension compared with omnivores. The present study shows an increase in the prevalence of vegetarians over a 13-year period and suggests that the different vegetarian diets assessed are associated with a better cardiovascular risk profile.

We report the case of a 13-month-old infant who was referred to the pediatric emergency department because of psychomotor regression with four bone fractures due to nutritional rickets. The reason was prolonged breastfeeding from a vegetarian mother followed by a vegan diet for the infant after weaning. Rickets is one of the many nutritional deficiencies that could affect infants fed vegan or vegetarian diets. These diets are a public health concern requiring adapted information that suggests alternative formulas made from rice or soy proteins and adapted supplementation after weaning.

Introduction: Vegetarian diet is increasingly used in both adults and children. Study aim: The aim of the study was to determine the differences in the body build and reaction time of vegetarian and non-vegetarian children on the background of socio-economic factors. Material and methods: The material consisted of 218 children, including 47 vegetarians (25 boys and 22 girls) and 171 non-vegetarians (93 boys and 78 girls) from 3 to 15 years. The research consisted of a survey and measurements. The survey included questions such as date of birth, child's birth parameters (length, weight, Apgar scores), child's diet (vegetarian/non-vegetarian), mother's diet during pregnancy (vegetarian/non-vegetarian), breastfeeding (yes/no), number of months of breastfeeding, mother's diet during lactation (vegetarian/non-vegetarian), maternal and parental education level (elementary / trade/ college / university), living conditions and the number of siblings. The height and body mass, skin-fat folds on the abdomen, shoulder and arm (sum of 3 skinfolds) were measured, BMI was calculated and the reaction time was assessed using the Quickstick ruler. The General Linear Model, Wald's test, U-Mann-Whitney test and Principal Components Analysis were applied. Results: The results showed that vegetarian children who came from families with a higher socio-economic status than non-vegetarian were significantly longer breastfed. The somatic build of vegetarian children, including height, BMI and the sum of three skinfolds significantly differed from non-vegetarian children. The vegetarian children were shorter, with lower BMI and lower sum of the three skinfolds, as well as their reaction time was longer. Conclusions: Vegetarian diet affects the height, BMI and body fatness, as well as the reaction time in children at the age of 3-15.

It is known that nutritional composition of breast milk is, to a certain extent, related to maternal diet. The question of nutritional adequacy of mothers' milk is often raised whenever a vegetarian or vegan diet during the lactation process is concerned. For this reason, in some countries, the recruitment of vegan lactating women as milk donors is excluded by milk banks. The purpose of this systematic review is to summarize existing knowledge on variability of specific nutrients in breastmilk of mothers adhering to a plant-based diet. The databases, including MEDLINE (Pubmed) and Scopus, were used to identify relevant publications. Data extraction and analysis were conducted following a PRISMA protocol. Thirteen publications concerning the impact of dietary pattern and levels of animal-origin food intake on breast milk composition were included. The systematic review has shown that all non-vegetarian, vegetarian and vegan mothers produce breast milk of comparable nutritional value. Several differences are primarily attributed to fatty acids and some micro-components, primarily vitamin B12. Regardless of dietary choices, nourishment and adequate nutrition have a significant impact on human milk composition - on the basis of the current evidence, vegetarian and vegan mothers are capable of producing nutritionally valuable milk for their infants, as far as the appropriate supplementation compensating for breastfeeding mother's nutritional requirements is provided. Dietary choices should not be a permanent exclusion criterion for donor candidates in human milk banks.

In this case presentation, we present a young vegan patient who developed a CRVO secondary to severe iron-deficiency anaemia (IDA) attributable to menstrual losses and limited iron intake. CRVO is a rare complication of IDA.With rising calls for sustainable diets and rising evidence for a plant-based diet, there has been a rise in popularity of such diet forms. While there are ocular benefits from this diet trend, the potential for nutritional deficiencies including iron needs to be monitored especially in susceptible individuals. Iron is essential for retina metabolism and function; however, excess iron contributes to disease states in the eye. Therefore, supplementation needs to be judicious.

ObjectiveTo determine how a vegetarian diet affects stroke incidence in 2 prospective cohorts and to explore whether the association is modified by dietary vitamin B12 intake.MethodsParticipants without stroke in the Tzu Chi Health Study (cohort 1, n = 5,050, recruited in 2007–2009) and the Tzu Chi Vegetarian Study (cohort 2, n = 8,302, recruited in 2005) were followed until the end of 2014. Diet was assessed through food frequency questionnaires in both cohorts at baseline. Stroke events and baseline comorbidities were identified through the National Health Insurance Research Database. A subgroup of 1,528 participants in cohort 1 were assessed for serum homocysteine, vitamin B12, and folate. Associations between vegetarian diet and stroke incidences were estimated by Cox regression with age as time scale, adjusted for sex, education, smoking, alcohol, physical activities, body mass index (only in cohort 1), hypertension, diabetes, dyslipidemia, and ischemic heart diseases.ResultsVegetarians had lower serum vitamin B12 and higher folate and homocysteine than nonvegetarians. In cohort 1, 54 events occurred in 30,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of ischemic stroke (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.08–0.88). In cohort 2, 121 events occurred in 76,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of overall stroke (HR, 0.52; 95% CI, 0.33–0.82), ischemic stroke (HR, 0.41; 95% CI, 0.19–0.88), and hemorrhagic stroke (HR, 034; 95% CI, 0.12–1.00). Our explorative analysis showed that vitamin B12 intake may modify the association between vegetarian diet and overall stroke (p interaction = 0.046).ConclusionTaiwanese vegetarian diet is associated with a lower risk of ischemic and hemorrhagic strokes.

Vegetarian or vegan nutrition might influence inflammatory processes, thereby reducing the risk of chronic diseases. As the vegan diet becomes more importance in modern societies, data from the “Risks and Benefits of a Vegan Diet”-study has been used to investigate the associations of veganism with a comprehensive spectrum of inflammatory biomarkers, compared to omnivores. This cross-sectional study comprises 36 vegans and 36 omnivores (18 men and 18 women each) aged 30–60 years. No significant differences in any of the investigated inflammatory biomarkers (high-sensitivity C-reactive protein (hsCRP), interleukin-18 (IL-18), interleukin-1 receptor antagonist (IL-1 RA), intercellular adhesion molecule-1 (ICAM-1), adiponectin, omentin-1 and resistin) were observed between vegans and omnivores. However, the duration of a vegan diet was positively correlated with resistin (Spearman r = 0.59), IL-18 concentrations (Spearman r = 0.44) and IL-1 RA (Spearman r = 0.34). Moreover, the present study supports BMI and waist circumference as important factors influencing the inflammatory state. Further research is needed to evaluate associations between a vegan diet and inflammatory biomarkers to provide more evidence about the inflammatory state as underlying mechanisms of a vegan diet to influence the risk of numerous chronic diseases.

Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a "teachable moment." The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.

Current dietary guidelines advocate more plant-based, sustainable diets on the basis of scientific evidence about diet-health relations but also to address environmental concerns. Here, we critically review the effects of plant-based diets on the prevalence of obesity and other health outcomes. Plant-based diets per se have limited efficacy for the prevention and treatment of obesity, but most have beneficial effects in terms of chronic disease risk. However, with the considerable possibilities of translating plant-based diets into various types of dietary patterns, our analysis suggests that potential adverse health effects should also be considered in relation to vulnerable groups of the population. A transition to more plant-based diets may exert beneficial effects on the environment, but is unlikely to affect obesity, and may also have adverse health effects if this change is made without careful consideration of the nutritional needs of the individual relative to the adequacy of the dietary intake.