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Dana Hrnčířová Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University in Prague • In general, people who exclude meat, poultry, fish, and animalderived foods from their diets. • A wide diversity of dietary practices • • • • • Vegans (total vegetarians) Lacto-vegetarians Ovo-vegetarians Lacto-ovo- vegetarians Semi-vegetarians (flexitarians) • Pescaterians • Pollo-vegetarians • Pollo-pescetarians • Raw vegan (raw food diet) • Macrobiotic diet • USA 2012 National Poll • 4% of adults are vegetarians/vegans (approx. 9 million) • 1% are vegans (approx. 2 millions) • No much difference between male, female, region, or age for actual vegetarians (Harris Interactive poll by the Vegetarian Resource Group) • Veg. Statistics - European vegetarian Union http://www.euroveg.eu/lang/en/info/howmany.php • • • • • • Environmental/Ecological Animal welfare, ethics Religious Economical Health Family lifestyle • • • • • • • • Protein quality Vitamin B12 Omega-3 Fatty Acids Vitamin D Calcium Iron Zinc Protein Protein Digestibility Corrected Amino Acid Score mg of limiting amino acid in 1 g of test protein mg of same amino acid in 1 g of reference protein * faecal true digestibility % • E.g. Rice • limiting amino acid - lysine 62 % (of the 2-5 yrs old child needs / g of protein) • Digestibility of protein …. 88 % • PDCAAS for rice: 0,62 x 0,88 = 0,55 1.00 0.92 0.91 0.76 0.75 0.73 0.70 0.59 0.52 0.42 casein, whey (milk proteins), egg white, soy protein beef soybeans fruits black beans vegetables other legumes cereals and derivatives peanuts whole wheat • essential amino acids in a food protein which fall short of meeting the amino acids required by humans • • • • legumes → methionine wheat → lysine maize → tryptophan soya beans → methionine and cysteine • The combination of plant protein foods which when eaten together provide all the essential amino acids. • E.g. Legumes + cereals [Propionyl CoA] Odd Chain FA or Branched Chain AA • Zdroj: NIH Dietary Supplement Fact Sheets for B12. http://ods.od.nih.gov/factsheets/VitaminB12/. Accessed 8-11-2011 • Hematological (megaloblastic anemia) • Neurological (numbness and tingling of arms and legs, difficulty walking, memory loss, disorientation, dementia) • Gastrointestinal (tongue soreness, apetite loss, constipation) • Deficiency of vit. B12 leads to secondary deficiency of folic acid • Adults • Pregnant women • Lactation (i.e. + 0,13 mcg/ 100g of 3 mcg /day 3,5 mcg /day 4 mcg /day mother milk) • Food of animal origin (liver, shellfish, vension, some fish) • Fortified food • Food supplements Food Serving Vitamin B12 (mcg) Clams (steamed) 3 ounces 84.0 Mussels (steamed) 3 ounces 20.4 Crab (steamed) 3 ounces 8.8 Salmon (baked) 3 ounces 2.4 Rockfish (baked) 3 ounces 1.0 Beef (cooked) 3 ounces 2.1 Chicken (roasted) 3 ounces 0.3 Turkey (roasted) 3 ounces 0.3 Egg (poached) 1 large 0.6 Milk (skim) 8 ounces 0.9 Brie (cheese) 1 ounce 0.5 • • • • • • • • • Ischemic Heart Disease Hypertension Diabetes Obesity Cancer Osteoporosis Diverticular Disease Gallstones Rheumatoid Arthritis • Lower risk of death • Adjustment for BMI, smoking habits, social class • Incidence 24% lower in lifelong vegetarians • Incidence 57% lower in lifelong vegans • Lower TCh, LDL-Ch • Higher intakes of fiber, plant sterols; nuts, soy • Lower intakes of SFA • Lower rates of hypertension: • Non-vegetarians > vegetarians > vegans • Lower blood pressure • Non-vegetarians > vegetarians • diet or lower BMI? • Beneficial nutrients • Potassium, magnesium, antioxidants, fiber, fat • 5-10 servings of fruits and vegetables significantly lowers BP • Positive associations between intakes of red meat and processed meat and risk of diabetes after adjusting for BMI, total energy intake, exercise … • Beneficial nutrients: vegetables, whole-grain foods, legumes, and nuts • diets rich in whole-grain foods are associated with improved insulin sensitivity • People consuming 3 servings per day of wholegrain foods are 20-30% less likely to develop DM2 than people consuming 3 servings per week. • 1 serving = 16 g of whole-grain food • Vegetarians maintain lower BMI than non-vegetarians • Non-vegetarians > vegetarians > vegans (BMI) • Lower weight correlates with high intakes of fiber and low intakes of fat • Significantly lower rates of cancer non-dependent on smoking (colorectal and prostate cancer) • Obesity is significant risk factor for breast cancer; meat? • Cancer-protective dietary factors: • Fiber, vit. C, carotenoids, flavonoids, lycopene • fruits, vegetables (lung, mouth, esophagus, stomach) • Legumes (prostate, stomach) • Soy isoflavones (breast) ??? • Dairy products, green leafy vegetables, and calciumfortified plant foods – calcium for vegetarians • no differences in bone mineral density between omnivores and lacto-ovo-vegetarians • Increased intake of friuts and vegetables (K, Mg) - positive effect on the calcium economy • High protein intake, especially animal protein, can produce increased calciuria • Low protein intakes may increase the risk of low bone integrity • The more restricted the vegetarian diet, the greater the challenge to achieve a nutritionally adequate diet. • The goal: consume a variety of foods to obtain all of the needed nutrients. • Nutritional consciousness is essential! Foods 1serving Number of Servings/day Fruits ½ cup fresh/canned/frozen 3–4 Vegetables Whole Grains ½ cup cooked/1 cup raw 4–6 1 slice whole-grain bread 1 cup whole-grain cereal, ½ cup cooked rice/pasta 5–8 ½ cup cooked legumes ½ cup tofu 1 cup soy milk 3–6 Nuts, Seeds ¼ cup nuts or seeds 1–3 Plant Oils 1 teaspoon up to 5 Eggs Dairy 1 egg 4–6 per week 1 cup milk/yogurt ¼ cup cheese ½ cup cottage cheese 1–3 Legumes Oldways 2013 Nutrient Nonvegetarian Lacto-ovo vegetarian Vegan Fat (% total calories) 34-38 30-36 28-33 Cholesterol (total grams) 300-500 150-300 0 Carbohydrate (% total calories) <50 50-55 50-65 Dietary fiber (total grams)/day 10-12 20-35 25-50 Protein (% total calories) 14-18 12-14 10-12 Animal protein (% total protein) 60-70 40-60 0 • Meat replacements: products made to look and taste like meat, fish, poultry • Tofu: a curd made from soybean • Tempeh: a fermented soybean food • Textured soy protein (TSP), soy meat: processed soybeans TOFU TEMPEH TSP • • • • Dietary guidelines for Americans 2010 Position paper of American Dietetic Association 2009 American Heart Association papers Physicians Committee for Responsible Medicine - Dietary Guidelines Goals and Recommendations • Harvard School of Public Health papers • Up-to-date research