Consuming less ultra-processed food is associated with inadequate protein intake among vegan dieters

Importance Major concerns regarding vegan dieters are whether they meet protein and essential amino acids (EAA) recommendations, and how reliant they are on ultra-processed foods (UPF). Objectives To investigate whether vegan dieters meet protein and EAA recommendations. As secondary objectives, to determine UPF intake and potential predictors of inadequate protein intake in this population. Design A survey conducted between September 2021 and January 2023. Setting Brazil. Participants Vegan dieters of both sexes, aged 18 years or older, following a vegan diet for at least 6 months. Exposure Adherence to a vegan diet, and unprocessed and minimally processed foods (UMPF) and UPF consumption. Main outcome measures Protein and EAA intake, and food consumption according to processing level (Nova classification). Results One thousand and fourteen participants completed the survey, and 774 confirmed vegan dieters with adequate food recalls were included in the analysis. Most participants (74%) met daily protein intake according to the Recommended Dietary Allowance (RDA) (median: 1.12 g·kg−1·day−1, 95%CI 1.05; 1.16). Median EAA intake was also above RDA (with 71–91% meeting recommendations). Median UMPF intake was 66.5% (95%CI 65.0; 67.9) of total energy intake (TEI), whereas UPF consumption was 13.2% TEI (95%CI 12.4; 14.4). Adjusted logistic regression models showed that consuming protein supplements or textured soy protein, higher caloric, and higher UPF intakes were associated with reduced odds of inadequate protein intake, and that higher UMPF intakes were associated with increased odds of inadequate protein intake. Conclusions and Relevance The majority of vegan dieters attained protein and EAA intake recommendations, largely based their diet on UMPF, and had a significantly lower proportion of UPF as compared to previous reports on vegans and overall Brazilian population. Importantly, participants consuming less UPF more likely exhibited inadequate protein intake, suggesting the importance of ultra-processed proteins for this population. Question Do vegan dieters meet protein needs, and how reliant are they on ultra-processed foods (UPF)? Findings In this large survey including 774 vegan dieters, 74% had adequate daily protein intake. Unprocessed and minimally processed foods and UPF consumption accounted for 66.5% and 13.2% of total energy intake. Consuming protein supplements and textured soy protein, and higher caloric and UPF intakes were associated with reduced odds of inadequate protein intake, whereas higher UMPF intakes were associated with increased odds of inadequate protein intake. Meaning Most vegan dieters attain protein recommendations, while being less likely to do so when consuming less UPF. ### Competing Interest Statement BG and HR have received research grants and supplement donations for scientific studies from AlzChem, Natural Alternatives International, DuPont, J.B.S., and NotCompany. BG has also received support for participation in scientific conferences, and honorarium for speaking at lectures from AlzChem. Additionally, he serves as a member of the Scientific Advisory Board for AlzChem. None of these fundings are related to the present study in any aspect. ### Funding Statement GPE, BM, FS, HCSA, BG and HR were supported by Sao Paulo Research Foundation - FAPESP (grants #2019/14820-6, #2019/14819-8, #2020/07860-9, #2022/02229-4 and #2017/13552-2). AE and MHS were supported by Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) - Finance Code 001. HR and BG were supported by National Council for Scientific and Technological Development-CNPq (#308307/2021-6 and #301914/2017-6). These funding agencies did not have any role in any aspect of the current study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The protocol was approved by the ethics committee of the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo under the protocol CAAE: 77624517.8.0000.5357. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data pertaining to this study can be shared, alongside statistical code, upon request.