Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
The "Planetary Health Diet" – What’s it All About?
A report was launched on January 17, 2019 by The EAT- Lancet Commission on Food, Planet, Health that presents “a global planetary health diet that is healthy for both people and planet” (1). (Note: to download the complete report you must log into your Lancet account or complete the free registration to the Lancet website). EAT is “a global, non-profit start-up dedicated to transforming our global food system through sound science, impatient disruption and novel partnerships” (2).
The EAT-Lancet Commission brought together “37 experts from 16 countries in various fields of human health, agriculture, political sciences and environmental sustainability to develop global scientific targets for healthy diets from sustainable food production” (3). With the population set to reach 10 billion people by 2050, researchers stressed the link between what we eat and human and planetary health. Future food production must be intensified in regards to sustainability to meet the needs of the growing population within the planetary limits for climate change, biodiversity loss, land and water use, as well as nitrogen and phosphorous cycles (1).
In this important report, authorities have attempted to look at “nutrition, health impacts, ecosystems and feasibility with culture” and provide strategic and practical information for policy development. It is basically calling for a transformation of the food we eat and ”getting it right with food will be an important way for countries to achieve the targets of the UN Sustainable Development Goals and the Paris Agreement on climate change” (1).
“Ensuring that all certified health professionals have a demonstrable level of competence surrounding planetary health diets”, the EAT-Lancet Commission prepared a brief for professionals (3): with information about what they should know and what they should do to contribute to the “Great Food Transformation” (1).
An overview of the diet recommendations include reducing the consumption of animal protein so that proteins should be from plant sources as much as possible and reducing the consumption of ultra-processed foods and added sugar. While this is nothing new, as we have been hearing these recommendations for years, what is new is the more specific guidelines for food group consumption (1,3):
The whole grains portions are adjusted to meet energy targets. In addition, the diet has room for 31 g of sugar and about 50 g worth of oils, such as olive oil, and no dairy fats such as butter.
- Nuts (peanuts and tree nuts) - 50 g a day
- Beans, Chickpeas, Lentils and Other Legumes (dried) - 50 g a day
- Soy Foods (dry) - 25 grams a day
- Fish - 28 g a day
- Eggs - 13 g a day (about 1.5 eggs per week)
- Meat and Poultry - 14 g a day of red meat and 29 g a day of poultry
- Dairy and Dairy Products (including cheese) - 250 g a day (the equivalent of one glass of milk)
- Carbs - Whole grains including rice, wheat and corn (dry) - 232 g a day and 50 g a day of starchy vegetables
- Vegetables and Fruit - vegetables (300 g) and fruit (200 g) a day.
For Additional Content:
- Willet W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019 Jan 16. pii: S0140-6736(18)31788-4. doi: 10.1016/S0140-6736(18)31788-4. Citation available from: https://www.ncbi.nlm.nih.gov/pubmed/30660336
- EAT Forum – About EAT. [cited 2019 Jan 21]. Available from: https://eatforum.org/about/
- EAT- Lancet Commission. Brief for healthcare professionals. January 2019. Available from: https://eatforum.org/content/uploads/2019/01/EAT_brief_healthcare-professionals.pdf
Malnutrition in Infants Fed Plant-based Beverages
Cases (n=34) of protein-energy malnutrition have been described in France among infants who were fed plant-based beverages/drinks (age at diagnosis 8.8 + 3.8 months) (1). These cases were discovered when pediatricians were asked to see these children because of fatigue or a growth deficit. One of these infants died, one-third had malnutrition, 29% (10/34) had a seizure, one suffered from respiratory distress and one had a bone fracture. Among the children who had blood work done, 60% (12/20) had anemia, 55% (11/20) had hypoalbuminemia, and 40% (8/20) had hyponatremia. The children were all fed plant-based drinks, mostly almond, chestnut and rice drinks. Previous reports involved smaller numbers of children (2).
The infants’ health improved after resuming a normal infant diet (which was not described), although one-third of the parents were not happy about the change in diet (1). The parents stated that their main influencers to give the plant-based drinks to their infants were the media (44%) and “alternative medical professionals” (38%). The researchers attributed the malnutrition to the low protein and energy contents of these drinks.
Although it is not possible to state with certainty that the malnutrition was caused by the plant-based drinks, the fact that 30 children (who were assessed) overcame their illnesses when placed on a normal infant diet suggests that this was the case. These cases may represent the health halo, a belief that these drinks are healthier than other choices.
For information on the recommendations for the use of plant-based beverages in infants, see PEN® Practice Question: What are the recommendations for the use of plant-based beverages (e.g. soy, rice, almond, coconut and oat milk/beverage) during the complementary feeding period in infants?
- Lemale J, Salaun JF, Assathiany R, Garcette K, Peretti N, Tounian P. Replacing breastmilk or infant formula with a nondairy drink in infants exposes them to severe nutritional complications. Acta Paediatr. 2018 Jun 20. doi: 10.1111/apa.14437. [Epub ahead of print]. Citation available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=29923219.
- Dietitians of Canada. Trending Topics: Plant-based Beverages – Are They Really Healthier for Young Children? In: Practice Based Evidence in PEN® [PEN]. 2017 Aug 29. Available from: http://www.pennutrition.com/resourcestools.aspx?trcatid=496&trid=26285&sr=plant-based#. Access only by subscription.
Article Analysis: Plant-based Diets and Chronic Disease
Plant-based Diet for the Management of Type 2 Diabetes
A review of the literature was conducted on the use of a plant-based diet in the management of type 2 diabetes as recommended by the Canadian Diabetes Association (1). Thirteen studies met the inclusion criteria. The authors defined a plant-based diet as: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs as well as all refined and processed foods”. In observational studies the consumption of a plant-based diet was associated with decreased prevalence of type 2 diabetes. The observational studies may be limited in accuracy since people on plant-based diets tend to be more physically active, have more education, and have lower BMIs, which could account for some or all of the differences in diabetes prevalence. In addition, intervention studies indicate that a plant-based diet is equal to, or more effective than, other diets in managing type 2 diabetes. Plant-based diets were associated with improving body weight, cardiovascular risk factors and insulin sensitivity. Two of the five intervention studies recommended lower glycemic load foods only for their plant-based diet intervention groups, which may have contributed to the positive findings. It is not clear whether the benefits seen in the intervention studies were due to a lower consumption of meat and animal products and/or refined and processed foods or due to an increased consumption of vegetables. Recommendations are included in the paper for increasing client's acceptability and implementation of plant-based diets along with ways to enhance the capacity of health professionals to support the adoption of plant-based diets by individuals with type 2 diabetes.
Coincidentally, the American Academy of Nutrition and Dietetics recently published a position paper on vegetarian diets that also supports plant-based diets for better glycemic control in type 2 diabetes (2).
For your clients, see the new handout on PEN: Plant-based Diet Guidelines
- Rinaldi S, Campbell EE, Fournier J, O'Connor C, Madill J. A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Can J Diabetes. 2016 Oct;40(5):471-7. doi: 10.1016/j.jcjd.2016.02.011. Epub 2016 Jul 28. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27476051