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ENHANCING THE VEGAN MENU
AT RUMC
OUTLINE
Introduction
Objectives
Review of Literature
Methodology
Timeline
Questions & Comments
INTRODUCTION
Shift towards vegetarian food
7.3 million are vegetarian in US
1 million are vegan in US
100 million consciously choose plant-based foods
Why become vegetarian?
Differences in nutrients between vegetarian and omnivore diets
RD’s Role: ensure patients’
nutritional needs are met
Craig & Mangels, 2009
Harris Interactive Service Bureau (2013). Vegetarian Statistics.
INTRODUCTION
Vegetarian: a person who does not eat meat or seafood or
products containing these foods
Lacto-ovo-vegetarian
Eats dairy & eggs
Lacto-vegetarian
Eats dairy
Ovo-vegetarian
Eats eggs
Pesco-vegetarian
Eats fish & seafood
Semi-vegetarian
Eats largely a meatless diet
Vegan
Does not eat any animal
products
Marsh, 2009
PURPOSE OF THE STUDY
The purpose of this study will be to expand and
improve the vegan menu at RUMC by
considering patient desires while ensuring
that unique nutritional needs are met.
OBJECTIVES
 Determine vegan patients’ food preferences
 Evaluate current vegan menu compared to patient
preferences
 Develop five new vegan items
 Evaluate acceptability of new vegan items
REVIEW OF
LITERATURE
PROTEIN
Janelle & Barr, 1995
•N=45, Women (23 vegetarian, 22 non-vegetarian), age 20-40 yr
•Vegans (n=8), lacto-vegetarians (n=15), & non-vegetarians (n=22)
•51-item Three-Factor Questionnaire: dietary restraint, disinhibition, & hunger
scales
•3 Day food records
•Non-vegetarians had (p<.001) higher protein (m=77.1g) than vegetarians
(m=55.3g). Vegans had significantly lower (p<.05) lower intakes of protein
(m=51.9g)
Appleby et al., 2002
•N=11,004, British men (n=2351) and women (n=8653), aged 20-78
•Meat-eaters (n=4,737), fish-eaters (n=1,728), vegetarians (n=3,800),
vegans (n=739)
•Lifestyle questionnaire, included semi-quantitative food frequency (130 Q.)
•Meat-eaters had higher protein intake as a percentage of total energy intake
(m=16.1% in men, m=17.4% in women) compared to vegan protein intake
(m=12.8% in men, m=13.4% in women)
PROTEIN
Rosell et al., 2005
• N=659: meat-eaters (n=196), vegetarians (n=231), &
vegans (n=232)
• Cross-sectional study using a lifestyle questionnaire
• Meat-eaters had higher protein (p<.001) as percent
energy (m=16.7%) intake when compared to
vegetarian (m=13.2%) and vegan (m=12.7%) intake
PROTEIN
Clarys et al., 2013
• N=138, n=69 vegetarians & n=69 omnivores in Belgium
• Healthy Eating Index, 2010 & Mediterranean Diet Score
were used to analyze dietary patterns
• Vegetarians had lower (p<.01) protein (m=66.4g) intake
compared to omnivore protein (m=73.9g) intake
OMEGA 3-FATTY ACIDS
ROSELL ET AL., 2005
-N=659: meat-eaters (n=196), vegetarians (n=231), & vegans
(n=232), UK
-Meat-eaters had lower (p<.001) intakes of EPA and DHA.
-Eicosapentaenoic acid, EPA, was 28% lower in vegetarians
and 53% lower in vegans when compared to meat-eaters
-Docasohexaenoic acid, DHA, was 31% lower in vegetarians
and 59% lower in vegans when compared to meat-eaters
OMEGA 3-FATTY ACIDS
WELCH ET AL., 2010
N=14,422
-Fish eaters (n=12,210), non-fish-eating meat eaters
(n=1,934), vegetarians (n=250), vegans (n=28)
-EPIC Norfolk study, aged 39-78
-7 days of food diaries
-n-3 PUFA, DHA, EPA was highest (p<.001) in fish-eaters
Fish eaters
g/d [M/W]
Meat eaters
g/d [M/W]
Vegetarians
g/d [M/W]
Vegans
g/d [M/W]
EPA (p<.001)
0.13/0.11
0.02/0.02
0.02/0.01
0.01/0.02
DHA (p<.001)
0.19/0.15
0.02/0.01
0.0007/0.0004 0.0/0.0
Welch et al., 2010
Rizzo et al., 2013
 N=71,751: US and Canada
 Non-vegetarian (n=33,634), semi-vegetarian (n=4,042),
pesco-vegetarian (n=6,583), lacto-ovo-vegetarian
(n=21,799), strict vegetarian (n=5,694)
 Self-administered questionnaire: FFQ & 24-hour recall
 Lacto-ovo-vegetarians & strict vegetarians reported
0.0mg DHA in >50% of population
 Vegetarians had lower (p<.05) DHA (m=18.2mg) intake
compared to non-vegetarian DHA (m=182.0mg) intake.
VITAMIN D
•N=199 Black & 229 non-Hispanic
•Adventist Health Study-2, US study
•FFQ, 3-6 (24-hour) telephone diet recalls,
blood sample, sun-exposure data, skin
types categorized
•Vegetarians had lower (p<.005) dietary
vitamin D (m=119.5 IU) compared to
non-vegetarian (m=165.3 IU) intake
•Ethnicity had greater effect on s25(OH)D
than diet
•Blacks had more than 3x deficiency than
non-Hispanic whites among all diets
Chan et
al., 2009
•N=71,751: US & Canada
•Non-vegetarian (n=33,634), semivegetarian (n=4,042), pesco-vegetarian
(n=6,583), lacto-ovo-vegetarian
(n=21,799), strict vegetarian (n=5,694)
•FFQ, 24-hour diet recall
•Vegetarians had lower (p<.05) vitamin D
(m=6.3μg) intake compared to nonvegetarian vitamin D (m=10.6μg) intake.
•Strict vegetarians had vitamin D
(m=0.1μg) intakes in the 5th percentile
Rizzo et
al., 2013
ZINC, CALCIUM, & B12
Janelle & Barr, 1995
 N=45, women (23 vegetarian, 22 non-vegetarian), age
20-40 yr
 Vegetarians had lower (p<.01) zinc (8.3mg) intakes than
non-vegetarians (11.1mg) intakes than vegetarians
(m=8.3mg)
 Vegan had lower (p<.05) intakes of zinc (m=8.5mg)
compared to non-vegetarians (m=11.1mg)
 Vegan had lower (p<.05) intakes of calcium (m=578mg)
compared to non-vegetarians (m=950mg)
 Vegans (m=0.51μg) and vegetarians (m=1.15μg) had
lower (p<.05) intakes of B12 compared to nonvegetarians (m=3.79μg) intakes
VITAMIN B12 & HOMOCYSTEINE
Hermann et al., 2001
o N=104, Germany, categorized by high/low consumers of meat
o High meat-eaters (n=44), low meat-eaters (n=19), lacto-ovo/lactovegetarians (n=34), & vegan (n=7)
o Interviews, 3 (24-hour) dietary recalls
o Consistent dietary pattern for 1 year, vitamin supplementation, &
medications
o Vitamin B12 was higher (p<.01) in high meat-eaters (276μmol/L) blood
levels when compared to low meat-eaters (m=240μmol/L) blood levels.
LIMITATIONS TO STUDIES AND
THE FUTURE OF VEGAN
STUDIES
The term vegetarian is often used to describe a
whole range of diets practiced with varying
degrees of restriction  challenge to
meaningfully compare
Studies define vegetarian diet types differently
and may include meat
Supplemental usage is not always adjusted for
in analysis
Vegan studies often involve small sample sizes
Research is needed to investigate age at which
vegan diet is adopted and health outcomes
EVALUATING FOOD PRODUCTS
FACTORS THAT
DETERMINE CONSUMER
ACCEPTANCE
Packaging
Price
Hashami, 2007
Reau, 2011
Convenience
Sensory
Sensory Panels
Larger panels are
better, but small are
beneficial to gain
insights
Unbiased
Comparative
analysis or scale to
rate magnitude of
acceptance
 Sensory Tools: scorecards
using point scales (5-point
to 9-point). Hedonic is the
most common
 Scales may have different
anchors (intensity or
perception)
 Senses may be
overwhelmed in tasting
 Drink water and eat
unsalted crackers
between tastings
Jones et al., 1955
Small company development: sold in
natural/health food stores
Large food manufacturers launched own
lines
•Burgers, crumbles, patties, entrée meals
Movement of prepared meals to wet soups,
meat substitutes, baking ingredients, snacks,
cereals, energy bars
Vegan products: snacks, cereals, energy bars,
sweets, meat substitutes
Language of claims change to increase
appeal
Technology advances: improving on taste &
texture
Meat alternatives: soy, wheat and now pea
PRODUCT
DEVELOPMENT
FOR
VEGETARIANS/VEGANS
o Vegetarian & Vegan
diets are lower in
protein, omega-3 fatty
acids, vitamin D, zinc,
calcium, & B12
o Sensory panel is an
important in menu
development
o Tools to measure the
senses (5-point scale)
has been found to be
effective
OBJECTIVES
Determine vegan patients’ food preferences
Evaluate current vegan menu compared to
patient preferences
Develop five new vegan items
Evaluate acceptability of new vegan items
VEGAN MENU OPTIONS AT RUMC
Restaurant style menu
-Daily specials (limited)
-House diet is on a 14-day cycle
Menu Distribution
FNS Staff  Patients
 PFSA  Diet Office
Permanent Entrées
Rotating Entrées
Veggie Burger
Jerk Tofu Salad
Vegan Pizza
Mexican Sandwich (tofu
crumbles)
Grilled Vegetable Sandwich
BBQ Vegan Sandwich (tofu
crumbles)
VEGAN HOUSE DIET NUTRIENT ANALYSIS
Energy
Carbohydrate
Protein
Fat
Calcium
Iron
Phosphorous
Average
% Daily Value
1705 kcal
292 g
62 g
39 g
263
10
432
88%
124%
73%
22%
68%
54%
Female, aged 23-50, weighs 120lbs
CBORD (2012)
RESEARCH DESIGN
Descriptive Survey
 Phase I
 Interviews
 Product Development
 Pilot
 Sensory analysis
 Phase II
 Sensory analysis
POPULATION
Target: vegetarian/vegan patients at RUMC
Inclusion: all genders & race aged 18-89, pass
cognitive test
Exclusion: NPO, unable to communicate, food
allergies/intolerances, modified/mechanical diets
SUBJECTS & SAMPLE
Phase I and II:
-Non-probability (convenience) sampling
-Randomly selected vegetarians using CBORD
-10 subjects
Pilot sample:
-FNS employees who follow a vegetarian/vegan diet
DATA COLLECTION PROCESS
Interviews
Recipe Development
Product Evaluation
TOP FOOD SOURCES FOR SPECIFIC NUTRIENTS
Omega-3
Fatty Acids
Vitamin D
Zinc
Calcium &
Vitamin B12 Protein &
Phosphorous
Iron
Vegetable
Oils
Flaxseed
Walnuts
Sunflower
Soybeans
Fortified
Juice, Cereal
& Nut
Butters
Fortified
Cereal
Cashews
Tofu
Pinto &
Kidney
Beans
Black Eyed
Peas
Fortified Soy
& Juice
Broccoli
Almonds
Kale
Mustard
Greens
Whitney & Rolfes, 2008
Fortified
Cereal &
Soy Milk
Fermented
Soy
(Tempeh)
Seaweed
Beans
Legumes
Rice &
Lentils
Soy
Products
DATA COLLECTION
Product Evaluation
• Pilot Study
• Phase II
Dislike
Extremely
Dislike
Neutral
Like
Like
Extremely
How does the food look?
☐
☐
☐
☐
☐
How does the food smell?
How would you rate the
mouth-feel/ texture?
How would you rate the
foods taste?
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Jones et al., 1955
 IBM SPSS (version 19)
will be used for data
analysis
 Descriptive statistics will
be computed for all
variables
 Frequency distribution
December: Phase I
January: Analyze results from interview
February: Develop 5 new vegan menu items
March: Pilot & Phase II
April: Final analysis and Manuscript
July: Defend Thesis
TIMELINE
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QUESTIONS
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