Understanding preferences regarding protein-enriched plant-based products of patients with lived experience of (risk of) malnutrition - a grounded theory study.

One of the greatest challenges of the 21st century is to meet the food needs of a growing world population without exceeding the planetary boundaries. The consumption and production of food products of animal-based origin are an essential part of this puzzle, as they provide important and high-quality nutrients on the one hand and are one of the Big Five drivers of climate change on the other. Meat consumption in developed countries such as Germany is higher than recommended, and the increased intake of processed meat products, in particular, is associated with negative health impacts in these countries. In recent years, a new generation of plant-based alternative products has entered the market, which are designed to imitate animal-based products in terms of sensory and nutritional composition. These products are primarily aimed at consumers who want to reduce the amount of animal-based foods they consume in their daily lives. The marketing of these products particularly serves the niche market of flexitarians.
\nThe dissertation presented uses the example of plant-based meat, cheese, and milk alternatives to show how a change to a sustainable diet is possible. The environmental impact and resource consumption of plant-based products are lower, and the nutritional content and sensory qualities of these products are the focus of this study. The aim was to determine the characterization of the sensory quality of these plant-based alternative products. In addition, the question of nutritionally relevant ingredients in the commercially available products was to be investigated.
\nAt first, an online market analysis of the nutritional composition of plant-based meat and cheese products and animal-based products was conducted. The aim of this study was to fill the research gap regarding the comparison of nutrient composition, especially micronutrients, of processed plant-based meat and cheese products compared to the animal-based products they resemble. The results show that plant-based meat products demonstrate better Nutri-Score values than the animal-based comparators, while the cheese alternatives generally score lower than the respective dairy products. Meat alternative products provide high-quality plant protein, and the contents are in some cases comparable to meat products. In six of twelve meat product groups, plant-based products have significantly higher salt contents than meat products. The salt content in the five cheese product groups is quite high in both plant-based and animal-based products. The results of the micronutrient assessment show that the relationship to the reference values for recommended daily intake is reasonable. In this way, deficiencies and surpluses of vitamins and minerals could be made clear. The daily requirement of copper, iron, magnesium, and zinc can be better covered by the plant-based products analyzed here than animal-based products, which is shown by the reference values. On the other hand, the vitamin requirements of B1, B3, B12, A, and D are not sufficiently covered by plant-based products. The example of cheese alternatives shows that these can cover the requirement just as well if vitamins and minerals are added to the products. In particular, the high sodium content, the high degree of processing, and a large number of ingredients and additives used in the production of these foods are increasingly criticized. Therefore, these modern plant-based alternative products cannot be considered per se as a "healthy" alternative to animal-based products. However, the products have to be evaluated individually due to the considerable heterogeneity.
\nIn the second step, plant-based milk alternatives (based on almond, oat, and soy) were also analyzed for micronutrients and compared with cow's milk, and their sensory quality was evaluated. Cow's milk is a good source of vitamins B2 and B12 as well as of zinc and especially calcium. It is also clear that if plant-based products are fortified with these micronutrients, they can have the same micronutrient content as cow's milk. Based on descriptive analysis by a trained sensory panel, five products of each of the three different raw material bases could be evaluated. The data from the instrumental sensory analysis showed positive correlations with the panel results. Thus, these methods could also be used to analyze and evaluate plant-based alternative products. The nutritional profiles of the individual products differ, sometimes widely, within the product group with the same raw material source and in comparison to cow's milk. Plant-based products are naturally lower in protein, minerals, and vitamins than cow's milk. As a result, these modern plant-based beverages are not nutritionally comparable or equivalent to cow's milk. Because of the wide range of products on the market, consumers should consider nutritional values and ingredients when selecting a product.
\nBased on the results from the first and second studies, a sensory consumer test combined with a questionnaire on plant-based alternative products was conducted. 159 participants divided according to their nutrition style were served three products in two tasting rounds. Interestingly, the vegans did not perceive the attributes of bitter, sour, and astringent for the oat drink. This could be related to higher consumption of vegetables and fruits and their products. Altogether the acceptance of the products was evaluated quite positively. Although omnivores always evaluated the products lower than vegans, the oat drink achieved the best overall liking. The main motivations for consuming plant-based alternatives for all three products were animal welfare and the environment. A larger gap was revealed with the knowledge questions, for example, concerning health aspects. As these products are still relatively new on the market, it is currently difficult for consumers to obtain essential information from independent sources.
\nIn summary, plant-based alternative products are suitable for reducing the consumption of animal-based products and can therefore be used by consumers as a support tool. Due to the variety of products in the different product categories and the heterogeneity, the products have to be evaluated individually according to their nutritional and sensory qualities. Therefore, the need for information on sustainable plant-based alternative products is high so that consumers are familiar with and well informed about the different products.

IFST Winning Articles

From taste to purchase: Understanding the influence of sensory perceptions and informed tasting on plant-based product purchases - An extension of the theory of planned behavior

Plant-based dairy alternatives have many benefits in terms of sustainability, animal welfare, and health, but they can only be successful in the market if consumers perceive them as suitable substitutes for conventional dairy. Consumers' expectations for new products are strongly influenced by the food categories into which they place these products. The present study aims to reveal consumers' categorizations of plant-based dairy products to gain insights into their potential as dairy substitutes. In a free sorting task, 100 participants from the German-speaking part of Switzerland sorted a variety of plant-based and conventional animal-based dairy products into groups, indicating their spontaneous similarity perceptions. Additionally, we assessed the participants' characteristics and attitudes toward plant-based dairy products to test potential differences in categorization strategies among consumer groups. Multidimensional scaling and cluster analysis showed that consumers' mental representations of plant-based dairy and conventional animal-based dairy were clearly separated across a wide range of product types. This pattern was even observed among consumers who ate less meat, had higher exposure to vegan dietary styles, and had less negative attitudes toward dairy alternatives. The results suggest that taxonomic distinctions based on plant or animal origin dominate consumers' perceptions and are likely to hinder the substitution of dairy with plant-based dairy. Nevertheless, they also imply that plant-based products that manage to emphasize shared goals and functional properties akin to conventional dairy products are more likely to form a common goal–derived category in consumers’ minds and thus have better prospects as substitutes.

Plant-based diets have risen in popularity over the last couple of decades, particularly in developed countries. Food manufacturers have developed plant-based alternative products to meet increased demand and enable consumers to replace animal-based products. Such products often use food additives in their composition. A plant-based product range from a UK supermarket was selected, and products were paired with equivalent animal-based products, resulting in 71 pairs. The number and type of food additives and non-food additive ingredients were classified using the UK Food Standards Agency’s list, and differences in number were assessed using the Wilcoxon signed-rank test. Plant-based products had a greater number of food additives, non-food additives, and total ingredients than animal-based products (p < 0.001, r = 0.47, 0.64, 0.67). When products were split into categories, the differences appeared to be concentrated within dairy, meat, and fish alternative products and other savoury items. Plant-based products used a total of 39 different food additives, compared to 31 in animal-based products. To conclude, plant-based vs animal-based products from a UK supermarket had a greater number and variety of food additives and a greater number of non-food additive ingredients. Future research should assess whether these findings hold true across other product ranges and geographical locales.

Introduction: Patients who form kidney stones are typically advised to limit intake of nondairy animal protein. Plant-based meat products may be a processed substitute protein source for these patients and have recently gained popularity because of health concerns, increased retail availability, decreased environmental impact, and meat supply shortages during the COVID-19 pandemic. Despite these perceived benefits and tangential association with whole food plant-based diets, the potential lithogenic risks associated with these products are not well characterized. Methods: The U.S. Department of Agriculture database was queried with a sample of plant-based meat products widely available to U.S. consumers. Nutrient profile data were compiled and compared with animal protein data using standardized serving sizes. Primary protein sources were identified using verified ingredient lists. Oxalate content was extrapolated based on dietary data sources. Results: A total 47 plant-based meat products (16 beef, 11 pork, 10 chicken, and 10 seafood) were analyzed. Compared with their respective animal protein, most products contained on average fewer calories (plant-based beef 77%, pork 94%, chicken 86%, and seafood 83%) and less protein (plant-based beef 68%, pork 96%, chicken 53%, and seafood 54%). Most products used soy protein as the primary protein source (55%). Soy-based beef contained the highest average oxalate content (18 mg per serving), whereas soy-based seafood contained the lowest (7 mg). The most common non-soy protein source was pea protein (30%), containing trace amounts of oxalate. Sodium content was higher in most plant-based products overall (72%) and in each category (plant-based beef 109%, pork 128%, chicken 100%, and seafood 148%). Calcium content was higher (plant-based beef 317%, pork 144%, chicken 291%, and seafood 295%) compared with animal protein. Conclusions: Most plant-based meat products consist of protein sources that are, relative to animal protein sources, higher in oxalate, sodium, and calcium. Stone-forming patients should be counseled about the potential lithogenic risk of these processed products.

In recent years, the position of meat has been challenged in Western food cultures due to its ecological, health and animal welfare impacts. This study examined consumers’ reported changes in their meat and plant protein consumption in a new situation after the prominent market entrance of novel plant-based products in Finland. The study is based on an online survey (N = 1,000) among 18–79-year-old consumers living in Finland. Using latent class analysis, four consumer clusters were identified based on self-reported past changes in meat and plant protein consumption. The largest cluster was ‘No change’ (43.3 % of the respondents), followed by ‘Less red meat, more plant proteins’ (30.4 %), ‘Less red meat, more poultry’ (17.9 %) and ‘No/very little meat, more plant proteins’ (8.4 %). The clusters differed in their sociodemographic characteristics: gender, age, level of education and area of residence. One-way ANOVA showed differences between the clusters in food neophobia, natural concerns, health and pleasure motives. In addition, the clusters held varying attitudes towards meat, beans, and plant-based protein products. The results suggest an increasing interest among consumers in less-meat diets, indicating support for the needed societal transition towards more sustainable patterns of eating.

Plant-based diets (PBDs) are associated with environmental benefits, human health promotion and animal welfare. There is a worldwide shift towards PBDs, evident from the increased global demand for fresh plant-based products (PBPs). Such shifts in dietary preferences accompanied by evolving food palates, create opportunities to leverage technological advancements and strict quality controls in developing PBPs that can drive consumer acceptance. Flavor, color and texture are important sensory attributes of a food product and, have the largest influence on consumer appeal and acceptance. Among these, flavor is considered the most dominating quality attribute that significantly affects overall eating experience. Current state-of-art technologies rely on physicochemical estimations and sensory-based tests to assess flavor-related attributes in fresh PBPs. However, these methodologies often do not provide any indication about the metabolic features associated with unique flavor profiles and, consequently, can be used in a limited way to define the quality attributes of PBPs. To this end, a systematic understanding of metabolites that contribute to the flavor profiles of PBPs is warranted to complement the existing methodologies. This review will discuss the use of metabolomics for evaluating flavor-associated metabolites in fresh PBPs at post-harvest stage, alongside its applications for quality assessment and grading. We will summarize the current research in this area, discuss technical challenges and considerations pertaining to sampling and analytical techniques, as well as s provide future perspectives and directions for government organizations, industries and other stakeholders associated with the quality assessment of fresh PBPs.

This study examined plant-based product (PBP) consumption, related motivations and barriers, and PBP attributes of importance. An online survey collected responses (n = 456) from PBP consumers and non-PBP consumers in the Republic of Ireland (ROI) and the United Kingdom (UK). Responses were analyzed using univariate statistics, binary logistic regression, and Principal Component Analysis. Females, and those living in urban areas were more likely to consume PBPs. Primary motivations for consumption were ‘sustainability,’ ‘animal welfare’ and ‘health.’ Barriers to consumption for non-PBP consumers were ‘not seeing a need to change their diet’ and ‘taste.’ Taste, health, and product information on the label were cited as the most important PBP attributes. Findings are of relevance to PBP manufacturers and marketers; the paper presents related recommendations for PBP marketing strategies, considers how best to target both usage segments (PBP and non-PBP consumers), and evaluates the usefulness of a usage segmentation approach for this product category.

As our global population ages, malnutrition and sarcopenia are increasingly prevalent. Given the multifactorial nature of these conditions, effective management of (risk of) malnutrition and sarcopenia necessitates interprofessional collaboration (IPC). This study aimed to understand primary and social care professionals' barriers, facilitators, preferences, and needs regarding interprofessional management of (risk of) malnutrition and sarcopenia in community-dwelling older adults. We conducted a qualitative, Straussian, grounded theory study. We collected data using online semi-structured focus group interviews. A grounded theory data analysis was performed using open, axial, and selective coding, followed by developing a conceptual model. We conducted five online focus groups with 28 professionals from the primary and social care setting. We identified five selective codes: 1) Information exchange between professionals must be smooth, 2) Regular consultation on the tasks, responsibilities, and extent of IPC is needed; 3) Thorough involvement of older adults in IPC is preferred; 4) Coordination of interprofessional care around the older adult is needed; and 5) IPC must move beyond healthcare systems. Our conceptual model illustrates three interconnected dimensions in interprofessional collaboration: professionals, infrastructure, and older adults. Based on insights from professionals, interprofessional collaboration requires synergy between professionals, infrastructure, and older adults. Professionals need both infrastructure elements and the engagement of older adults for successful interprofessional collaboration.

This article calls into question how different the parallel ontologies of meat are in terms of the realities they enact. It argues that while biofabricated animal material is expected to transform the production and consumption of meat, the material’s ontologies reinforce existing interrelationships between the dominant meat culture and the law. Additionally, the expectations surrounding biofabricated animal material vests the material with transformative power, even though it does not challenge the structural factors, namely law and culture, which underlie the exploitation and commodification of animals. I begin by delineating the co-constituting relationship between law, the realities of meat production and consumption, and meat culture. I then unpack the interface between different ontologies of meat and consider why the contest has taken place in legal terrains. From here, I consider the key expectations that have assigned transformative power to biofabricated animal material. I suggest that these expectations work to reinforce existing meat culture, and the configurations of power that benefit from it, as supported via legal instruments.

In recent years, plant-based diets have gained popularity. The food industry has responded by introducing a range of alternative products that significantly differ from whole-food, plant-based diets in terms of their composition and processing levels. This study aimed to compare the fatty acid composition and fatty acid-based nutritional quality indices of ground beef-based foods with those of their plant-based counterparts available in the Hungarian market. This study examined six plant-based and four beef hamburger patties, along with one plant-based and one beef minced meat product, each with three distinct expiration dates. Following homogenization and lipid extraction, the fatty acid composition was analyzed by gas chromatography. Based on the fatty acid values, several nutritional indices were calculated, including the unsaturation index (UI), atherogenicity index, thrombogenicity index, and hypocholesterolemic/hypercholesterolemic index (hHI). Significant differences (p < 0.01) in fat content were observed between plant-based and animal-based products, based on both label information and gravimetric measurements (plant-based: 10.25% [8.60%; 14.87%], animal-based: 19.67% [16.16%; 26.68%], median [Q1; Q3]). Distinct fatty acid composition profiles were identified between and within the product groups for both animal- and plant-based products. Except for one product, plant-based alternatives exhibited higher UI and hHI (UI: 129.62 [96.84; 146.10]; hHI: 50.13 [45.69; 54.14]) than beef-based products (UI: 8.18 [3.13; 11.59]; hHI: 1.35 [1.23; 1.43]). The findings indicate that plant-based meat alternatives (except those containing coconut oil) have lower saturated and higher polyunsaturated fatty acid compositions than beef-based products, leading to more beneficial nutritional value. Further analytical and clinical studies are necessary to provide a more comprehensive understanding of the long-term health effects of these foods.

Food shortage is a primary challenge as the human population is increasing rapidly. Therefore, the world is looking for ways to establish sustainability in the food system to generate nutritious food with better sensory qualities. To fulfill the animal protein requirements of the world, different meat alternatives are available in the market, like cultured meat, mycoprotein, and insects, but from a sustainable point of view, plant-based meat alternatives are the most suitable. However, in producing these alternatives, industrialists need to be aware of particular challenges and opportunities in production and marketing while manufacturing. The major challenge for industrialists is the consumer acceptance rate, which depends on plant-based products' physical appearance and taste. They can improve the marketing of plant-based meat products by improving plant-based meat alternatives' physical and sensory characteristics. The focus of this paper is to discuss the technologies necessary for the production of plant-based meat alternatives. The current findings suggest that the market scenario will change for plant-based meat producers, in which customer preference and beliefs will have a massive role in the acceptance and marketing of this meat. The development of plant-based meat alternatives is the first step to achieving the goal of sustainable food; more innovations are needed to establish a healthier and sustainable food system as this type of food has a low carbon footprint compared to other products available. Keywords: Plant-based meat, sustainability, food shortage, consumer preference, opportunities, challenges.

Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for social resources and even a high mortality.In Catalonia, CPCHN account for 3.5-5 % of the Catalan population (250,000 to 375,000 patients), and we have data pointing to a high prevalence of malnutrition in CPCHN admitted in hospitals for an acute episode (36 % malnourished, 47 % risk of malnutrition). Nevertheless, the prevalence of DRM in CPCHN in the community has been not sufficiently studied. In addition, health and social risk factors for malnutrition are unknown in these population.Taking all these into account, it is necessary to establish an integrated and a collaborative health and social strategy for the screening and management of nutritional care, mainly from a community-based as well as a patient-centered approach.The strategy to tackle against malnutrition in CPCHN is led by the Department of Health of Catalonia (PPAC, PIAISS), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) and the Family and Community Nursing Association (AIFICC), with the support of the University of Vic. This strategy is based on a Decalogue of actions to fight against malnutrition previously identified by a consensus among experts from scientific societies, social services and public health, incorporating the vision of patients and caregivers. Aims:1. Highlight the DRM problem in CPCHN launching a prevalence study of DRM in the CPCHN selecting a representative sample of Catalonian society.2. Establish an integrated and a collaborative intervention plan (nutritional and social) linked to the detection of malnutrition and/or social dysfunction.Results and impact:1. The prevalence study of DRM in the CPCHN is a prospective observational and multicenter randomized study that has been performed in a region of Catalonia, representative of the Catalan society (80 % urban, 20 % rural). The sample size calculated was 384 patients, a total of 404 patients have been participated. A very high prevalence of malnutrition and risk of malnutrition has been found (46.5 % risk, 5.9 % malnutrition) Living alone, polypharmacy and dysphagia were the most important social and health determinants that influence DRM and will allow us to focus strategies to improve patient care.2. The integrated and collaborative intervention plan to tackle against DRM in CPCHN is based on a protocol that includes the clinical, nutritional and social risk screenings. With this aim, Primary Care teams (doctors and nurses) and Social Service professionals (Primary Care and community resources) are coordinated with the Nutritional Support Unit in the reference hospital in a collaborative manner. The first step has been to incorporate mandatory nutritional and social risk factors screenings in patients identified as CPCHN. A positive nutritional or social screening have been linked to comprehensive nutritional and social assessment plans that will allow diagnosing and encoding malnutrition and identifying patients at risk of social dysfunction. Diagnosis of DRM or social dysfunction is linked to an integrated intervention plan (nutritional and social), that includes case-conferences in the case of patients with complex needs.Highlights: Prior to the development of the strategy for dealing with DRM in CPCHN, a low implementation of nutritional screening was detected. This fact was probably due to a low awareness of DRM, but also for lack of a feasible and efficient plan of approach, that must include not only the health aspects but also the social determinants that accompany the disease.Contingencies: The implementation of this strategy is time-consuming, and requires an integrated health and social work.Tutorials have been attached to the shared medical history of Catalonia to guide professionals in the application of the screenings.Timeline: The prevalence study of DRM in the community has been finished at January 2016.The mandatory screening and the validation of the nutritional and social intervention plan will be implemented during 2016.Conclusion: The results of the prevalence study of DRM in CPCHN could be extrapolated to the rest of Catalonia, allowing us to manage effectively the health and social policies. It will also allow us to analyze the impact of different health care quality indicators linked to the strategy to approach to DRM. Nutritional and social community intervention can be cost-efficient, as demonstrated in the hospital setting, and probably will allow reducing unnecessary admissions, readmissions, complications, need for social resources and will help improve the quality of life in CPCHN. The impact of this strategy is based in detecting and treating in an integrated and collaborative manner DRM in CPCHN.

Plant-based (PB) food products have surged in popularity over the past decade. Available PB products in the UK market were extracted from NielsenIQ Brandbank and compared with animal-based (AB) counterparts in their nutrient contents and calculated Nutri-Scores. The amino acid contents of four beef products and their PB alternatives were analysed by LC-MS/MS. PB products consistently exhibited significantly higher fibre content across all food groups. Protein was significantly higher in AB products from all food groups except beef and ready meals. PB products were more likely to have higher Nutri-Scores compared to AB counterparts, albeit with greater score variability within each food group. Nutrient fortifications were primarily focused on dairy and ready meals; the most supplemented nutrient was vitamin B12 (found in 15% of all products). A higher proportion of EAAs in relation to total protein content was observed in all beef products.