Protein and Amino Acid Adequacy and Food Consumption by Processing Level in Vegans in Brazil

• Published in: JAMA network open 2024-06, Vol.7 (6), p.e2418226
• Main Authors: Leitão, Alice Erwig, Esteves, Gabriel P, Mazzolani, Bruna Caruso, Smaira, Fabiana Infante, Santini, Martin Hindermann, Santo André, Heloísa C, Gualano, Bruno, Roschel, Hamilton
• Format: Article
• Language: English
• Subjects: Adult; Amino Acids; Amino Acids, Essential; Brazil; Cross-Sectional Studies; Diet, Vegan - statistics & numerical data; Dietary Proteins - administration & dosage; Eating - physiology; Female; Food; Food Handling; Humans; Male; Middle Aged; Nutrition, Obesity, and Exercise; Online Only; Original Investigation; Processed foods; Proteins; Ratios; Veganism; Vegans; Young Adult
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2024.18226

Major concerns regarding individuals who adhere to a vegan diet are whether they meet protein and essential amino acid recommendations and how reliant they are on ultraprocessed foods. To investigate whether individuals who adhere to a vegan diet meet protein and essential amino acid recommendations and, as secondary objectives, to determine ultraprocessed food intake and potential factors associated with inadequate protein intake in this population. This cross-sectional survey study was conducted between September 2021 and January 2023 in Brazil among male and female adults (aged 18 years or older) who adhered to a vegan diet recruited from social media platforms. Adherence to a vegan diet and unprocessed and minimally processed foods and ultraprocessed food consumption. Protein and essential amino acid intake and food consumption by processing level were assessed using a 1-day food diary. Nutrient adequacy ratios were calculated by dividing nutrient intake by its recommendation (using scores truncated at 1) for each participant and then finding the mean across participants for each nutrient. The mean adequacy ratio was the mean of all nutrient adequacy ratios. Of 1014 participants who completed the survey, 774 individuals (median [IQR] age, 29 [24-35] years; 637 female [82.3%]) were confirmed as adhering to a vegan diet and provided adequate food recalls, among whom 558 individuals reported body weight and so had relative protein and amino acid intake values available. The median (IQR) body mass index (calculated as weight in kilograms divided by height in meters squared) of participants was 22.6 (20.3-24.8). The nutrient adequacy ratio of protein was 0.93 (95% CI, 0.91-0.94); for essential amino acids, ratios ranged from 0.90 (95% CI, 0.89-0.92) for lysine to 0.98 (95% CI, 0.97-0.99) for phenylalanine and tyrosine. The mean adequacy ratio for protein and all amino acids was 0.95 (95% CI, 0.94-0.96). The median intake level was 66.5% (95% CI, 65.0%-67.9%) of total energy intake for unprocessed and minimally processed food and 13.2% (95% CI, 12.4%-14.4%) of total energy intake for ultraprocessed food. Adjusted logistic regression models showed that consuming protein supplements (odds ratio [OR], 0.06 [95% CI 0.02-0.14]; P