Simple SummaryAquaculture is now well-established as a provider of protein for human consumption, and its contribution will be paramount to providing food for a nine billion population in 2050. Protein is usually the major constituent of fish feeds and the most expensive ingredient. For years, fishmeal was the preferential protein source in fish diets, but environmental and economic concerns led to the search for more sustainable proteins. Hence, research on alternative protein sources to fishmeal was fruitful, being firstly directed to terrestrial plant ingredients. Recently, research on novel ingredients, such as insect meals, macroalgae, microalgae, and yeasts, has proliferated. However, the impacts of protein and its constituents (amino acids) go beyond fish growth. Thus, this review will provide knowledge on the impacts of alternative/novel protein sources on fish stress and immune responses, disease resistance, and health. Although some negative impacts of alternative ingredients, for instance, on gut integrity and immune responses have been observed, research results also point to the potential beneficial effects of novel ingredients, such as insect meals, on fish health. This information is essential to the development of innovative diets that guarantee the production of healthy fish with high quality standards and optimised welfare conditions.Aquaculture has been challenged to find alternative ingredients to develop innovative feed formulations that foster a sustainable future growth. Given the most recent trends in fish feed formulation on the use of alternative protein sources to decrease the dependency of fishmeal, it is fundamental to evaluate the implications of this new paradigm for fish health and welfare. This work intends to comprehensively review the impacts of alternative and novel dietary protein sources on fish gut microbiota and health, stress and immune responses, disease resistance, and antioxidant capacity. The research results indicate that alternative protein sources, such as terrestrial plant proteins, rendered animal by-products, insect meals, micro- and macroalgae, and single cell proteins (e.g., yeasts), may negatively impact gut microbiota and health, thus affecting immune and stress responses. Nevertheless, some of the novel protein sources, such as insects and algae meals, have functional properties and may exert an immunostimulatory activity. Further research on the effects of novel protein sources, beyond growth, is clearly needed. The information gathered here is of utmost importance, in order to develop innovative diets that guarantee the production of healthy fish with high quality standards and optimised welfare conditions, thus contributing to a sustainable growth of the aquaculture industry.
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