Abstract
Healthcare professionals are important sources of nutrition and health information for Americans. As plant-based (PB) dairy alternative products increase in popularity, concerns have been raised about their nutritional adequacy, and whether consumers understand nutritional differences to dairy. Healthcare professionals directly advise consumers on dietary choices, therefore we sought to examine their understanding and opinions of PB dairy alternatives. Methods: We analyzed comments submitted to the U.S. Food and Drug Administration (FDA) by health professionals (n=191) in 2018–2019 in response to a request for public comment on the nutrition of PB dairy alternatives and the use of dairy terms like “milk”, “cheese”, and “yogurt” on their labels. Survey data from healthcare professionals (n=417) was collected in 2020-2021. Comments and survey responses to open-ended questions were coded using template analysis and thematically analyzed. Logistic regression models examined perceptions across health professional characteristics for close-ended survey responses. Results: Three-fourths of health professionals believe consumers are confused about the nutritional differences between dairy and PB dairy alternatives. Over half (53%) do not believe either product is nutritionally superior to the other. Many believe dairy products have higher nutrient value, but also believe PB dairy alternatives can be part of a healthful diet. Compared to other types of health professionals, dietetics professionals demonstrated a more accurate understanding of the nutritional value of both products and were more likely to believe nutrients like protein (OR 2.02; 95% CI 1.22-3.34, p=0.006) and vitamin D (OR 2.46; 95% CI 1.48–4.09, p=0.001) may be nutrients of concern for PB dairy alternative consumers. They were also more likely to believe consumers are confused about these products (OR 3.44; 95% CI 1.65–7.21; p=0.001). Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives. Conclusions: Although PB dairy alternatives have nutritional value in certain diets, responses from health professionals suggest that changing their labeling to be different than dairy may reduce confusion. Improved nutrition education among health professionals may also be necessary.
Generated Summary
This mixed-methods study investigated health professionals’ perspectives on plant-based (PB) dairy alternatives and their labeling in the U.S. The study analyzed comments submitted to the U.S. Food and Drug Administration (FDA) by health professionals (n=191) regarding PB dairy alternatives and the use of dairy terms like “milk”, “cheese”, and “yogurt” on their labels, and collected survey data from healthcare professionals (n=417) in 2020-2021. The research aimed to examine health professionals’ understanding and opinions of PB dairy alternatives, given their role in advising consumers on dietary choices. The study’s approach involved coding comments and survey responses using template analysis and thematic analysis. Logistic regression models were used to examine perceptions across health professional characteristics for close-ended survey responses. The study’s scope included a cross-sectional design, with a focus on healthcare professionals in the U.S., aiming to assess their knowledge and perceptions of PB dairy alternatives and their labeling.
Key Findings & Statistics
- Three-fourths of health professionals believe consumers are confused about the nutritional differences between dairy and PB dairy alternatives.
- Over half (53%) do not believe either product is nutritionally superior to the other.
- Dietetics professionals demonstrated a more accurate understanding of the nutritional value of both products and were more likely to believe nutrients like protein (OR 2.02; 95% CI 1.22-3.34, p=0.006) and vitamin D (OR 2.46; 95% CI 1.48–4.09, p=0.001) may be nutrients of concern for PB dairy alternative consumers.
- They were also more likely to believe consumers are confused about these products (OR 3.44; 95% CI 1.65–7.21; p=0.001).
- Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives.
- Of the 8,052 original comments received by the FDA in response to this request for comment, less than 2.5% (n=191) were submitted by health professionals.
- About one-third (32.8%) believed dairy products were nutritionally superior to PB dairy alternatives, and 14.2% believed PB dairy alternatives were nutritionally superior to dairy products.
- About half (53.0%) did not believe that either was nutritionally superior.
- The study sample consisted of 350 practicing health professionals and 67 students. RDNs and dietetics students made up 44.4% of the sample.
- Sixty-four percent (n=123) of health professionals who commented on the Federal Register mentioned nutrition and health aspects of dairy and/or PB dairy alternatives within their comment.
- Of health professionals who supported the use of dairy terms on PB labels, 57% commented on their nutrition and health aspects, compared to 87% of those who opposed the use of dairy terms on PB labels.
- Survey respondents’ top reasons identified by health professionals for why some consumers choose PB dairy alternatives over dairy were nutrition and health concerns (85.0%), dairy allergy or intolerance (82.4%), and animal welfare concerns (64.9%).
- 40.1% of health professionals believed calcium intake may be a concern in diets that replace dairy with PB alternatives, and about one-third believed vitamin D and protein intake may be of concern.
- Compared to other health professionals, dietetics professionals were more likely to say that consumers do not understand the nutritional differences between dairy products and their PB counterparts in both unadjusted (OR 2.72; 95% CI 1.43–5.18, p=0.002) and adjusted (OR 3.44; 95% CI 1.65–7.21; p=0.001) models.
- Dietetics professionals were more likely than other health professionals to believe dairy is nutritionally superior to PB dairy alternatives in unadjusted (OR 1.70; 95% CI 1.08-2.69; p=0.022) and adjusted models (OR 2.27; 95% CI 1.33-3.87, p=0.003), and less likely to believe PB dairy alternatives are nutritionally superior to dairy in unadjusted (OR 0.26; 95% CI 0.12–0.56; p=0.001) and adjusted models (OR 0.19; 95% CI 0.08–0.50, p=0.001).
- In both unadjusted and adjusted models, dietetics professionals were more likely than other health professionals to believe protein (unadjusted: OR 1.69; 95% CI 1.06–2.69, p=0.026; adjusted: OR 2.02; 95% CI 1.22-3.34, p=0.006), vitamin D (unadjusted: OR 2.06; 95% CI 1.29–3.28, p=0.002; adjusted: OR 2.46; 95% CI 1.48–4.09, p=0.001), and potassium (unadjusted: OR 7.43; 95% CI 2.50-22.08, p<0.001;
Other Important Findings
- Many health professionals believed consumers are confused about the nutritional differences between dairy and PB dairy alternatives.
- The study found that many health professionals took a neutral stance on the overall health outcomes related to consuming both products, specifically stating that although dairy is a better source of nutrients, neither product is nutritionally superior to the other.
- Health professionals recognized the beneficial nutrition qualities of dairy in one’s diet, in terms of essential nutrients, especially protein, calcium, and vitamin D, but also understood that PB alternatives have their own nutritional properties that may suit individual nutritional needs.
- Dietetics professionals had a greater understanding of the nutrient adequacy of both products and believed more consumer confusion exists than other healthcare professionals.
- A greater proportion of Federal Register participants discussed PB dairy alternatives being a nutritionally superior choice compared to survey respondents.
- Fewer health professionals who commented on the Federal Register believed consumers are confused about the nutritional differences.
- Health professionals also identified dairy allergy or intolerance, and taste preference as key reasons for choosing PB alternatives.
Limitations Noted in the Document
- The study had an uneven distribution of health professional types within the survey sample, with a majority of respondents being dietetics and nursing professionals.
- A significant portion of the sample (32%) came from Vermont, a state with a prominent dairy industry, which could influence the results.
- The sample was predominantly female and non-Hispanic white, potentially limiting the generalizability of the findings.
- The use of an online recruitment strategy may have limited the range of healthcare professionals.
- The use of qualitative data, while providing detailed responses, made it challenging to confirm the origin of all comments.
- Potential for interpretation bias in coding the comments.
Conclusion
The study concludes that many health professionals believe that consumers are confused about the nutritional differences between dairy and PB alternatives, and some believe that prohibiting the use of dairy terms in PB packaging may help reduce confusion. The findings underscore important knowledge gaps among non-dietetics health professionals around the nutritional adequacy of PB dairy alternatives, and the nutritional value dairy may have in the standard American diet. The results suggest that stakeholders who submit comments to the Federal Register, which are then taken into account in the rulemaking process, may represent over-polarized views on nutrition issues. The study emphasizes the need for improved nutrition education and training, especially focusing on the nutritional needs of patients who follow PB dietary patterns, to help ensure health providers are equipped to help consumers make informed health decisions. Key quotes from the document highlight these points: “Three-fourths of health professionals believe consumers are confused about the nutritional differences between dairy and PB dairy alternatives.” “Compared to other health professionals, dietetics professionals were more likely to say that consumers do not understand the nutritional differences between dairy products and their PB counterparts in both unadjusted (OR 2.72; 95% CI 1.43–5.18, p=0.002) and adjusted (OR 3.44; 95% CI 1.65–7.21; p=0.001) models.” “[Dietetics professionals] were more likely to believe that protein, vitamin D, and potassium may be lacking in the diets of individuals who do not consume dairy…” The study’s findings suggest a nuanced understanding of the nutritional aspects of dairy and its alternatives is essential for healthcare professionals to provide accurate and helpful dietary advice, particularly as PB products gain popularity.