A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial

Andrea Braakhuis, Nicola Gillies, Anna Worthington, Scott Knowles, Tamlin Conner, Rajshri Roy, Toan Pham, Emma Bermingham, David Cameron-Smith, Andrea Braakhuis, Nicola Gillies, Anna Worthington, Scott Knowles, Tamlin Conner, Rajshri Roy, Toan Pham, Emma Bermingham, David Cameron-Smith

Abstract

Background: The trend of flexitarian eating patterns is on the rise, with young adults among the biggest adopters claiming health and environmental reasons to reduce red meat intake. Nutrient-dense meat and animal products are often the lynchpin of these diets, even when consumed only occasionally and in moderate amounts. Red meat provides forms and concentrations of essential proteins, lipids, and micronutrients that are scarce in exclusively vegetarian regimens.

Objective: The aim of this study is to consider the effects of moderate consumption of lean red meat as part of an otherwise vegetarian balanced diet and its impact on biomarkers of sustained health and well-being.

Methods: A cohort of healthy, young (20-34 years old, n=80) male and female participants will take part in a 2-arm, parallel randomized controlled trial (RCT) for a duration of 12 weeks, with a 3-month posttrial follow-up. The trial will commence with a 2-week assessment period followed by allocation to the intervention arms. The intervention will include the consumption of red meat or meat alternatives 3 times per week for 10 weeks. Blood samples of the participants will be collected to measure changes in erythrocyte fatty acid distribution, circulating amino acids, neurotransmitters, markers of mineral status, and inflammatory markers. Questionnaires to assess well-being and mental health will be undertaken every 2 weeks. Body composition, physical function, and blood parameters will be assessed at allocation (t0), week 5 into the intervention (t5), and post intervention (t10).

Results: The protocol has been developed using the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) checklist and the outcomes will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial was approved by the New Zealand Ministry of Health's Health and Disability Ethics Committees (protocol 20/STH/157). The results of this study will be communicated via publication.

Conclusions: To our knowledge, this is the first RCT investigating the overarching health consequences of consuming pasture-fed red meat or no meat as part of a healthy diet.

Trial registration: ClinicalTrials.gov NCT04869163; https://ichgcp.net/clinical-trials-registry/NCT04869163.

International registered report identifier (irrid): PRR1-10.2196/30909.

Keywords: biomarkers; diet; dietary restrictions; eating patterns; health; macronutrients; meat; micronutrients; nutrition; protein; vegetarian; well-being.

Conflict of interest statement

Conflicts of Interest: EB has received funding from the Meat Industry Association to investigate the nutrient composition of NZ beef. EB has received funding from meat companies (eg, First Light Foods) to study the health impacts on consuming red meat products (ACTRN12618001022257). There are no other conflicts to declare.

©Andrea Braakhuis, Nicola Gillies, Anna Worthington, Scott Knowles, Tamlin Conner, Rajshri Roy, Toan Pham, Emma Bermingham, David Cameron-Smith. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 21.12.2021.

Figures

Figure 1
Figure 1
Participation grouping within the 2 intervention arms.

References

    1. Hicks TM, Knowles SO, Farouk MM. Global Provisioning of Red Meat for Flexitarian Diets. Front Nutr. 2018;5:50. doi: 10.3389/fnut.2018.00050. doi: 10.3389/fnut.2018.00050.
    1. Kemper J, White S. Young adults' experiences with flexitarianism: The 4Cs. Appetite. 2021 May 01;160:105073. doi: 10.1016/j.appet.2020.105073.S0195-6663(20)31695-0
    1. McAfee A, McSorley E, Cuskelly G, Moss B, Wallace J, Bonham M, Fearon AM. Red meat consumption: an overview of the risks and benefits. Meat Sci. 2010 Jan;84(1):1–13. doi: 10.1016/j.meatsci.2009.08.029.S0309-1740(09)00251-4
    1. Eshel G, Shepon A, Makov T, Milo R. Land, irrigation water, greenhouse gas, and reactive nitrogen burdens of meat, eggs, and dairy production in the United States. Proc Natl Acad Sci U S A. 2014 Aug 19;111(33):11996–2001. doi: 10.1073/pnas.1402183111. 1402183111
    1. Leroy F, Cofnas N. Should dietary guidelines recommend low red meat intake? Crit Rev Food Sci Nutr. 2020;60(16):2763–2772. doi: 10.1080/10408398.2019.1657063.
    1. Larsson SC, Orsini N. Red meat and processed meat consumption and all-cause mortality: a meta-analysis. Am J Epidemiol. 2014 Feb 01;179(3):282–289. doi: 10.1093/aje/kwt261.kwt261
    1. Papier K, Tong TY, Appleby PN, Bradbury KE, Fensom GK, Knuppel A, Perez-Cornago A, Schmidt JA, Travis RC, Key TJ. Comparison of Major Protein-Source Foods and Other Food Groups in Meat-Eaters and Non-Meat-Eaters in the EPIC-Oxford Cohort. Nutrients. 2019 Apr 11;11(4):824. doi: 10.3390/nu11040824. nu11040824
    1. Clinton SK, Giovannucci EL, Hursting SD. The World Cancer Research Fund/American Institute for Cancer Research Third Expert Report on Diet, Nutrition, Physical Activity, and Cancer: Impact and Future Directions. J Nutr. 2020 Apr 01;150(4):663–671. doi: 10.1093/jn/nxz268. 5638292
    1. Rosenfeld DL, Burrow AL. Vegetarian on purpose: Understanding the motivations of plant-based dieters. Appetite. 2017 Sep 01;116:456–463. doi: 10.1016/j.appet.2017.05.039.S0195-6663(17)30338-0
    1. Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017 Nov 22;57(17):3640–3649. doi: 10.1080/10408398.2016.1138447.
    1. Qian F, Riddle MC, Wylie-Rosett J, Hu FB. Red and Processed Meats and Health Risks: How Strong Is the Evidence? Diabetes Care. 2020 Feb;43(2):265–271. doi: 10.2337/dci19-0063. 43/2/265
    1. Appleby PN, Key TJ. The long-term health of vegetarians and vegans. Proc Nutr Soc. 2016 Aug;75(3):287–293. doi: 10.1017/S0029665115004334.S0029665115004334
    1. Gilsing AMJ, Schouten LJ, Goldbohm RA, Dagnelie PC, van den Brandt PA, Weijenberg MP. Vegetarianism, low meat consumption and the risk of colorectal cancer in a population based cohort study. Sci Rep. 2015 Aug 28;5:13484. doi: 10.1038/srep13484. doi: 10.1038/srep13484.srep13484
    1. Etemadi A, Sinha R, Ward MH, Graubard BI, Inoue-Choi M, Dawsey SM, Abnet CC. Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study. BMJ. 2017 May 09;357:j1957. doi: 10.1136/bmj.j1957.
    1. Lee J, McLerran D, Rolland B, Chen Y, Grant E, Vedanthan R, Inoue M, Tsugane S, Gao YT, Tsuji I, Kakizaki M, Ahsan H, Ahn YO, Pan WH, Ozasa K, Yoo KY, Sasazuki S, Yang G, Watanabe T, Sugawara Y, Parvez F, Kim DH, Chuang SY, Ohishi W, Park SK, Feng Z, Thornquist M, Boffetta P, Zheng W, Kang D, Potter J, Sinha R. Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies. Am J Clin Nutr. 2013 Oct;98(4):1032–1041. doi: 10.3945/ajcn.113.062638. ajcn.113.062638
    1. Nutrition Society of New Zealand . Auckland, New Zealand: Auckland University of Technology. Auckland. New Zealand: Bayer; 2019. [2021-11-26]. The Bayer Food Focus Report. .
    1. Larsson CL, Klock KS, Nordrehaug Astrøm A, Haugejorden O, Johansson G. Lifestyle-related characteristics of young low-meat consumers and omnivores in Sweden and Norway. J Adolesc Health. 2002 Aug;31(2):190–198. doi: 10.1016/s1054-139x(02)00344-0.S1054139X02003440
    1. Dobersek U, Wy G, Adkins J, Altmeyer S, Krout K, Lavie CJ, Archer E. Meat and mental health: a systematic review of meat abstention and depression, anxiety, and related phenomena. Crit Rev Food Sci Nutr. 2021;61(4):622–635. doi: 10.1080/10408398.2020.1741505.
    1. Lim SY, Kim EJ, Kim A, Lee HJ, Choi HJ, Yang SJ. Nutritional Factors Affecting Mental Health. Clin Nutr Res. 2016 Jul;5(3):143–152. doi: 10.7762/cnr.2016.5.3.143.
    1. Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clin Transl Med. 2017 Dec;6(1):25. doi: 10.1186/s40169-017-0153-6. doi: 10.1186/s40169-017-0153-6.10.1186/s40169-017-0153-6
    1. Byelashov OA, Sinclair AJ, Kaur G. Dietary sources, current intakes, and nutritional role of omega-3 docosapentaenoic acid. Lipid Technol. 2015 Apr;27(4):79–82. doi: 10.1002/lite.201500013.
    1. McAfee AJ, McSorley EM, Cuskelly GJ, Fearon AM, Moss BW, Beattie JAM, Wallace JMW, Bonham MP, Strain JJ. Red meat from animals offered a grass diet increases plasma and platelet n-3 PUFA in healthy consumers. Br J Nutr. 2011 Jan;105(1):80–89. doi: 10.1017/S0007114510003090.S0007114510003090
    1. Chan A, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 05;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583. 1556168
    1. Drew J, Cleghorn C, Macmillan A, Mizdrak A. Healthy and Climate-Friendly Eating Patterns in the New Zealand Context. Environ Health Perspect. 2020 Jan;128(1):17007. doi: 10.1289/EHP5996.
    1. Ministry of Health, New Zealand Government. Wellington, New Zealand: Ministry of Health; 2011. [2021-11-18]. A Focus on Nutrition: Key findings from the 2008/09 NZ Adult Nutrition Survey. Chapter 6, Dietary Habits. .
    1. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71–83. doi: 10.1016/0022-3999(85)90010-8.
    1. Lairon D, Lopez-Miranda J, Williams C. Methodology for studying postprandial lipid metabolism. Eur J Clin Nutr. 2007 Oct;61(10):1145–1161. doi: 10.1038/sj.ejcn.1602749.1602749
    1. Milan AM, Nuora A, Pundir S, Pileggi CA, Markworth JF, Linderborg KM, Cameron-Smith D. Older adults have an altered chylomicron response to a high-fat meal. Br J Nutr. 2016 Mar 14;115(5):791–799. doi: 10.1017/S000711451500505X.S000711451500505X
    1. Pawlosky R, Hibbeln J, Lin Y, Goodson S, Riggs P, Sebring N, Brown GL, Salem N. Effects of beef- and fish-based diets on the kinetics of n-3 fatty acid metabolism in human subjects. Am J Clin Nutr. 2003 Mar;77(3):565–572. doi: 10.1093/ajcn/77.3.565.
    1. New Zealand Ministry of Health. McIntyre L, Jackson A, Carr H, Carter MA, Mackay S, Gerritsen S. Eating and Activity Guidelines for New Zealand Adults. Wellington: Ministry of Health; 2020.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991 Dec;50(2):179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Stein KD, Jacobsen PB, Blanchard CM, Thors C. Further validation of the multidimensional fatigue symptom inventory-short form. J Pain Symptom Manage. 2004 Jan;27(1):14–23. doi: 10.1016/j.jpainsymman.2003.06.003. S0885392403004573
    1. Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003 Jun;42(Pt 2):111–131. doi: 10.1348/014466503321903544.
    1. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–176. doi: 10.1159/000376585. 000376585
    1. Sproesser G, Klusmann V, Ruby MB, Arbit N, Rozin P, Schupp HT, Renner B. The positive eating scale: relationship with objective health parameters and validity in Germany, the USA and India. Psychol Health. 2018 Mar;33(3):313–339. doi: 10.1080/08870446.2017.1336239.
    1. Sam CHY, Skidmore P, Skeaff S, Wall C, Bradbury KE, Parackal S. Relative Validity and Reproducibility of a Short FoodFrequency Questionnaire to Assess Nutrient Intakesof New Zealand Adults. Nutrients. 2020 Feb 27;12(3):619. doi: 10.3390/nu12030619. nu12030619
    1. Su M, Subbaraj AK, Fraser K, Qi X, Jia H, Chen W, Gomes Reis M, Agnew M, Day L, Roy NC, Young W. Lipidomics of Brain Tissues in Rats Fed Human Milk from Chinese Mothers or Commercial Infant Formula. Metabolites. 2019 Oct 28;9(11):253. doi: 10.3390/metabo9110253. metabo9110253
    1. Prodhan U, Milan A, Thorstensen E, Barnett M, Stewart R, Benatar J, Cameron-Smith D. Altered Dairy Protein Intake Does Not Alter Circulatory Branched Chain Amino Acids in Healthy Adults: A Randomized Controlled Trial. Nutrients. 2018 Oct 15;10(10):1510. doi: 10.3390/nu10101510. nu10101510
    1. Milan AM, D'Souza RF, Pundir S, Pileggi CA, Thorstensen EB, Barnett MPG, Markworth JF, Cameron-Smith D, Mitchell CJ. Older Adults Have Delayed Amino Acid Absorption after a High Protein Mixed Breakfast Meal. J Nutr Health Aging. 2015 Oct;19(8):839–845. doi: 10.1007/s12603-015-0500-5.
    1. Khaksari M, Mazzoleni LR, Ruan C, Kennedy RT, Minerick AR. Determination of water-soluble and fat-soluble vitamins in tears and blood serum of infants and parents by liquid chromatography/mass spectrometry. Exp Eye Res. 2017 Feb;155:54–63. doi: 10.1016/j.exer.2016.12.007.S0014-4835(16)30544-9
    1. Wong JT, Malec PA, Mabrouk OS, Ro J, Dus M, Kennedy RT. Benzoyl chloride derivatization with liquid chromatography-mass spectrometry for targeted metabolomics of neurochemicals in biological samples. J Chromatogr A. 2016 May 13;1446:78–90. doi: 10.1016/j.chroma.2016.04.006. S0021-9673(16)30409-5
    1. Halse RE, Shoneye CL, Pollard CM, Jancey J, Scott JA, Pratt IS, Dhaliwal SS, Norman R, Straker LM, Boushey CJ, Delp EJ, Zhu F, Harray AJ, Szybiak MA, Finch A, McVeigh JA, Mullan B, Collins CE, Mukhtar SA, Edwards KN, Healy JD, Kerr DA. Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial. JMIR Res Protoc. 2019 Feb 25;8(2):e12782. doi: 10.2196/12782. v8i2e12782
    1. Benavides HL, Meireles CL, Benavente V, Mays MH, Wang J. Decreasing Older Adult COVID-19 Risk Factors Using Digital Technology to Implement a Plant-Based-Diet: An Opinion Paper. JMIR Aging. 2021 May 31;4(3):e25327. doi: 10.2196/25327. doi: 10.2196/25327.

Source: PubMed

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