EAT-LANCET SCORE AND MAJOR HEALTH OUTCOMES: THE EPIC-OXFORD STUDY
Knuppel, A*., Papier, K*., Key, T.J., Travis, R.C. *Joint first authorship
Nuffield Department of Population Health, University of Oxford
In January 2019, the EAT-Lancet Commission on Food, Planet and Health’s report defined a universal reference diet to promote human and environmental health. To evaluate its association with the risk of major health outcomes, we used data from 46 069 participants enrolled throughout the UK in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford.
Using data from food frequency questionnaires collected between 1993-2001, we created an ‘EAT-Lancet score’ based on the 14 key recommendations. Participants were assigned a point for meeting each of the recommendations, resulting in possible scores from 0-14. We used multivariable-adjusted Cox proportional hazards models to assess associations between fourths of the EAT-Lancet score and risk of hospitalization or death from ischemic heart disease, stroke and diabetes, and total mortality, ascertained through health record linkage.
High adherence to the EAT-Lancet score was associated with lower risks of ischemic heart disease (HR for highest adherence (scores of 12-14) compared to lowest adherence (scores of 4-9) 0.72, 95%-CI 0.63-0.82) and diabetes (HR 0.41, 95%-CI 0.33-0.50) but was not associated with risk of stroke (HR 1.06, 95%-CI 0.87-1.28) and not clearly associated with total mortality (HR 0.91, 95%-CI 0.83-1.00) in multi-variable adjusted models. No association was explained by one single recommendation, suggesting a cumulative effect.
Conclusion & discussion
In this large prospective cohort of British adults, the EAT-Lancet reference diet shows beneficial associations for ischemic heart disease and diabetes, although no association with stroke and no clear association with mortality. Still, adherence to the EAT-Lancet score might be a marker for healthy lifestyle; therefore residual confounding might operate.
HOUSEHOLD DAIRY PRODUCTION AND CHILD GROWTH: EVIDENCE FROM BANGLADESH
Choudhury, S., Headey, D.
SOAS, University of London
Research from richer countries finds that dairy consumption has strong positive associations with linear growth in children, but surprisingly little evidence exists for developing countries where diets are far less diversified. One exception is a recent economics literature using the notion of incomplete markets to estimate the impacts of cattle ownership on children’s milk consumption and growth outcomes in Eastern Africa. In addition to external validity concerns, an obvious internal validity concern is that dairy producers may systematically differ from non-dairy households, particularly in terms of latent wealth or nutritional knowledge. We re-examine these concerns by applying a novel double difference model to data from rural Bangladesh, a country with relatively low levels of milk consumption and high rates of stunting. We exploit the fact that a cow’s lactation cycles provide an exogenous source of variation in household milk supply, which allows us to distinguish between a control group of households that do not own cows, a treatment group that own cows that have produced milk, and a placebo group of cow-owning households that have not produced milk in the past 12 months.
We find that household dairy production increases height-for-age Z scores by 0.52 standard deviations in the critical 6–23 month growth window, though in the first year of life we find that household dairy supply is associated with a 21.7 point decline in the rate of breastfeeding. The results therefore suggest that increasing access to dairy products can be extremely beneficial to children’s nutrition, but may need to be accompanied by efforts to improve nutritional knowledge and appropriate breastfeeding practices.
REPLACING MEAT WITH ALTERNATIVE PLANT-BASED PRODUCTS (RE-MAP): RESULTS OF A RANDOMISED CONTROLLED TRIAL OF A BEHAVIOURAL INTERVENTION TO REDUCE MEAT
Bianchi, F., Aveyard, P., Stewart, C., Astbury, N.M., Cook, B., Jebb, S.A.
Nuffield Department of Primary Care Health Sciences, University of Oxford
Reducing meat consumption could prevent non-communicable diseases and protect the environment. While preparing vegetarian meals requires new recipes, meat substitutes may offer an easier approach to start reducing meat intake. However, food neophobia can deter their use.
Aim and Methods
To investigate whether receiving an intervention centered on providing free meat substitutes promotes switching from meat to meat substitutes immediately and four weeks after the intervention. 115 healthy adult volunteers who ate meat regularly were recruited through advertisement and individually randomised to the intervention (N=58) or no intervention control condition (N=57). The four-week intervention comprised (i) free plant-based meat substitutes, (ii) information on the benefits of eating less meat, (iii) success stories of people who reduced their meat consumption, and (iv) recipes. The frequency of weekly meat and meat substitutes consumption was measured with a questionnaire at the baseline and at four and eight weeks and analysed using linear regression models adjusting for baseline.
112 participants completed the trial and were included in the analysis. Compared with the no-intervention control, receiving the intervention led to 3.8 fewer weekly meals containing meat at four weeks (b=-3.8; 95%CI=-6.4 to -1.2, p=0.004), but there was no evidence of this at eight weeks (b=-1.4; 95%CI=-4 to 1.2, p=0.28). The intervention led to an additional 6.9 weekly meals containing meat substitutes at four weeks (b=6.9; 95%CI=5.5 to 8.3, p<0.001) and to an additional 3.4 weekly meals containing meat substitutes at eight weeks (b=3.4; 95%CI=1.9 to 5, p<0.001).
Interventions that expose consumers to trying meat substitutes promote their use and may reduce meat consumption, but it is uncertain whether the effect on meat consumption is durable.
USING LANGUAGE TO INCREASE THE ATTRACTIVENESS OF PLANT-BASED FOODS
Daneva, T., Semyte, G., Papies, E.K.
Institute of Neuroscience and Psychology, University of Glasgow
Consumer food choices are heavily influenced by expectations of taste and enjoyment. Plant-based foods, however, are typically anticipated to be less enjoyable than meat-based foods, especially among frequent meat eaters. To address this problem and facilitate sustainable consumer choices, we examined the potential of using language to increase the attractiveness of plant-based foods.
In Study 1, we examined the language used in the labels and descriptions of 240 meat-based, vegetarian and vegan ready meals commercially available in the UK. We found that meat-based foods were more often described with words related to sensory experiences of consuming the food, whereas the vegetarian and vegan foods were more often described in terms of ingredients. Based on the grounded cognition theory of desire (Papies & Barsalou, 2015), we argue that sensory features in food descriptions can induce simulations of eating the food, which can increase a food’s attractiveness. Therefore, in Study 2, we manipulated the labels of 40 meat-based and 40 plant-based foods to either contain features that can induce eating simulations, or not. Specifically, we modified the labels to include sensory, hedonic, and eating context features; or only food ingredients and visual features (“Burger patty with rice based on soya protein, cabbage, and beetroot pieces” vs. “Pub-favourite burger with soft soy, crispy cabbage, aromatic rice, and deliciously sweet beetroot”). 174 participants indicated for each food how attractive they found it, and whether the description made them think about what the food would taste and feel like (i.e., whether it induced consumption simulations). In line with our pre-registered hypotheses, enhanced labels increased consumption simulations and attractiveness, and effects on attractiveness were mediated by consumption simulations. Enhanced labels for plant-based foods were especially effective in influencing frequent meat eaters.
This research suggests that descriptions of plant-based foods can be improved, and that theory-based approaches to food descriptions can help facilitate the transition to a more plant-based diet.
SHIFTING CONSUMER DEMAND FOR PLANT-RICH FOODS: AN INTERVENTION PLAYBOOK FOR THE FOOD SERVICE SECTOR
Attwood, S., Mercer, C., Voorheis, P., Vennard, D.
Better Buying Lab, World Resources Institute
To combat climate change and environmental degradation, a large-scale dietary shift is now needed away from overconsumption of meat, especially from ruminant livestock (beef and lamb), and towards more climate-friendly plant-rich foods. The food service industry is uniquely positioned to accelerate this shift by adopting effective behavior change interventions in their operations to influence customers’ food choices when dining out. The World Resources Institute conducted a systematic scoping review and industry consultation to identify a shortlist of ‘best bet’ behavior change interventions to present as guidance to potential changemakers working in the food service sector. 80 eligible academic publications were subject to full-text review from an original list of 4493 located via database searches. Following data extraction and coding, a total of 57 behavior change interventions were identified from this literature. This long list was subsequently ranked by 69 industry representatives via an online survey, yielding a final short list of 23 interventions judged better than average in terms of perceived effectiveness and feasibility to implement in practice. For both criteria, the highest ranked interventions fell under the category of ‘presentation’ strategies targeting menu layout and design. Industry representatives judged “Use language on menus to emphasize the positive attributes of plant-rich dishes, like their flavor, origins and look-and-feel” (score 6.31 out of 7) as most effective and “List plant-rich dishes in the main body of a menu, not in a separate 'vegetarian' box or 'specials' section” (score 6.19 out of 7) as most feasible to implement in their own operations. Full results of this research will now be published as peer-reviewed industry guidance.
VEGETARIAN DIETS AND RISKS OF TOTAL AND SITE-SPECIFIC FRACTURES: RESULTS FROM THE PROSPECTIVE EPIC-OXFORD STUDY
Tong, T.Y.N., Appleby, P.N., Perez-Cornago, A., Key, T.J
Nuffield Department of Population Health, University of Oxford
There is limited prospective evidence on possible differences in fracture risks between meat-eaters and vegetarians.
In EPIC-Oxford, dietary information was collected at baseline (1993-2001) and at follow-up (≈2010). Participants were categorised into five diet groups (≈20,106 regular meat-eaters: ≥50g of meat per day, ≈9,274 low meat-eaters: <50g of meat per day, ≈8,037 fish-eaters, ≈15,499 vegetarians and ≈1,982 vegans, with minor variations in numbers for each outcome after pre-specified exclusions) at both time points. Using multivariable Cox regression, we estimated the risks of total (n=3,941) and site-specific fractures (arm, n=566; wrist, n=889; hip, n=945; leg, n=366; ankle, n=520; other main sites i.e. clavicle, rib and vertebra, n=467) by diet group over 17.7 years of follow-up, with outcomes identified through record linkage.
Compared with regular meat-eaters, vegetarians had marginally higher risks of total fractures (hazard ratios and 95% confidence intervals: 1.10; 1.00-1.20) and arm fractures (1.28; 1.01-1.63), while vegans had significantly higher risks of total fractures (1.44; 1.21-1.72) and leg fractures (2.06; 1.22-3.47), and marginally higher risks of arm fractures (1.60, 1.01-2.54). For hip fractures, the risks were higher in fish-eaters (1.28; 1.03-1.59), vegetarians (1.27; 1.05-1.55) and vegans (2.35; 1.67-3.30, p-heterogeneity<0.0001) than regular meat-eaters. There were no significant differences in risks of wrist, ankle or other main site fractures by diet groups. Overall, the significant associations appeared stronger without adjustment for body mass index (e.g. 1.52; 1.27-1.81 in vegans for total fractures), and were slightly attenuated with additional adjustment for total protein (1.41; 1.17-1.69) or dietary calcium (1.32; 1.10-1.59).
Overall, non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures, which may be partially related to lower body mass index or lower dietary intakes of protein and calcium in these diet groups.