Not all plant-based diets are associated with benefits on mortality: the Moli-sani Study

Abstract Background Vegetarians diets are characterized by the absence of some animal foods (e.g. red and processed meats), and a high consumption of plant-based foods. However, plant-based foods can include foods with varying nutritional value and health effects. We examined the association of three different pro-vegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), with the risk of all-cause and cardiovascular disease (CVD) mortality in Italians. Methods Longitudinal analysis on 22,912 men and women (mean age 55±12 y) from the Moli-sani Study (2005-2010) followed up for 11.2 y (median). Food intake was assessed by a 188-item FFQ. A provegetarian food pattern (FP) was constructed by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful pro-vegetarian FP, which distinguished between healthy (e.g. fruits, vegetables, legumes) and less-healthy plant foods (e.g. fruit juices, potatoes, sugary beverages), were also built up. Results In multivariable-adjusted analyses controlled for known risk factors, higher adherence to a gPVG was associated with lower all-cause (HR = 0.83; 95%CI 0.73-0.94) but not CVD mortality (HR = 0.90; 0.72-1.12). Increasing adherence to a hPVG was associated with reduced all-cause mortality risk (HR = 0.82; 0.72-0.95) as well as lower risk of CVD mortality (HR = 0.75; 0.59-0.95). Finally, the uPVG was directly associated with both all-cause (HR = 1.17; 1.03-1.33) and CVD mortality risks (HR = 1.23; 0.99-1.53). Conclusions A general pro-vegetarian food pattern was associated with longer survival in Italians. Preferring healthful vegetarian foods provided protection against CVD mortality too. Consistently, a large dietary share of unhealthful vegetarian foods, mostly highly processed, was associated with increased risk mortality. Thus the quality of the plant food consumed is paramount to achieve diet-related benefits on mortality. Key messages • A pro-vegetarian food pattern was associated with longer survival but preferring healthful vegetarian foods provided protection against CVD mortality too. • The quality of the plant food consumed is paramount to achieve diet-related benefits on mortality.


Background:
Ultra-processed food (UPF) is a major public health concern being reportedly associated with increased risk of noncommunicable diseases and lower survival.However, most of the epidemiological evidence has been almost exclusively provided by research conducted in populations of youths or middle-aged adults.We tested the hypothesis that a large dietary share of UPF could be a risk factor also for vulnerable groups, as older adults (!65 years).Methods: Longitudinal analysis on 5,215 men and women (mean age 72AE5 y) from the Moli-sani Study (2005-2010, Italy) followed up for 10.9 y (median).Food intake was assessed by a 188-item FFQ.UPF was defined using the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food consumed (g/d; weight ratio).The overall nutritional quality of the diet was measured by the Food Standard Agency nutrient profiling system dietary index (FSAm-NPS DI).Results: UPF contributed to 8% (min-max 0.0-58.4%) of the total food eaten daily and represented 14.4% (0.0-70.0%) of daily energy intake.In multivariable-adjusted analyses controlled for known risk factors, higher intake of UPF (Q4, !10.2% of total food), as opposed to the lowest (Q1, UPF<4.3%), was associated with increased all-cause mortality (Hazard ratio [HR] = 1.19; 95%CI 1.03-1.39);these results remained unchanged after adjustment for the FSAm-NPS DI (HR = 1.21; 95%CI, 1.04-1.41).A linear doseresponse relationship of 1% increment in UPF intake with all-cause mortality was also observed (p = 0.017; p for nonlinearity = 0.85).

Conclusions:
A large dietary share of UPF was associated with lower survival in older Italians consuming relatively low amounts of these foods.Expanding on previous studies on different age groups, these findings provide further justification to advise people to limit consumption of UPF even at older age.

Key messages:
A large dietary share of ultra-processed food was associated with lower survival in older Italians consuming relatively low amounts of these foods.
These findings provide further justification to advise people to limit consumption of ultra-processed food even at older age. Abstract

Background:
Previous research conducted in 2020 by our team examined the progress made by food manufacturers in reformulation between 2014 and 2017 (i.e., improving the nutrition profile of food staples by reducing salt, sugar, saturated fat and overall energy contribution).Our previous study showed improvements in salt and sugars levels across many food staples, but we found rising energy levels, total fat, and saturated fat in many food categories.

Methods:
This study aimed to explore the ongoing progress in reformulation between 2017 to 2021.We photographed the labels of food staples in supermarkets with the leading market share in the Republic of Ireland (Tesco's, Dunnes, SuperValu, Lidl, Centra, Aldi, and M&S).We extracted the data, collated it in an excel spreadsheet, and analysed it to examine the nutrients of interest to the study (i.e., salt, sugar, fat, saturated fat, energy, carbohydrates, protein, fibre, and micronutrients).We compared the levels captured at this time point with those previously recorded in 2017.

Results:
Eight hundred and seventy-two products were directly compared, including 80 spreads, 34 cereal snacks, 87 fruit juices, 193 cereals, 210 breads, 88 milks, and 169 yoghourts.This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.

Conclusions:
Fat and saturated fat levels that were once on the increase now appear to be reducing, possibly implying that as salt and sugar go up, fat levels go down and vice versa.This may relate to product taste and palatability.

Key messages:
This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.
Fat and saturated fat levels that were once on the increase now appear to be reducing, as salt and sugar go up, fat levels go down.
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