Abstract
Plant-based (PB) dietary patterns have seen an upsurge in popularity over the past two decades. With this, has come an increase in consumption of PB alternatives to animal food products, including alternatives to dairy. However, because PB dairy alternatives are nutritionally different from dairy, there is concern that consumers of these products may unknowingly fall short on essential nutrients in their diet. Healthcare providers are key sources of nutrition information for U.S. consumers. This work examined U.S. healthcare professionals’ beliefs and recommendations regarding dairy and PB dairy alternatives. Two methods were used: (1) analysis of all public comments submitted the U.S. Food and Drug Administration (FDA) by health professionals (n=191) in response to a request for public comment on the nutrition and use of dairy terms on PB product labels, and (2) a national survey of healthcare professionals’ (n=417) beliefs on the nutrition and labeling of PB dairy alternatives, personal dietary habits, and professional recommendations on dairy and dairy alternatives. Comments and open-ended survey responses were coded in NVivo using a template approach and analyzed by themes. Close-ended survey responses were analyzed in SPSS. Unadjusted and adjusted logistic regression models examined demographic and professional characteristics associated with beliefs about the nutrition, consumer awareness, and labeling of PB dairy alternatives, and examined if personal dietary preference predicted nutrition recommendations on dairy and dairy alternatives. Three fourths of health professionals who participated in the survey believed consumers are confused about the nutritional differences between dairy and dairy alternatives, yet over half did not consider either product nutritionally superior, and most would recommend both dairy (81%) and dairy alternatives (72%) to their patients. Still, many believed dairy to have higher nutrient value. Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives, and less than one fourth mentioned concern for consumer confusion. Survey data showed that, 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 and vitamin D may be lacking in the diets of those who prefer dairy alternatives. Personal preference for PB milk and PB dietary patterns were associated with greater odds of recommending PB dairy alternatives and lessor odds of recommending dairy to a patient. Improved nutrition training focused on PB nutrition and reducing personal bias in practice may be necessary in certain healthcare disciplines to ensure healthcare providers are equipped to help consumers make informed nutrition decisions. Furthermore, health professionals who participated in the federal rulemaking process may represent over-polarized views on PB dietary patterns.
Generated Summary
This mixed-methods study aimed to investigate healthcare professionals’ (HCPs) perceptions and recommendations regarding dairy and plant-based (PB) dairy alternatives. The study utilized two main approaches: an analysis of comments submitted by health professionals to the U.S. Food and Drug Administration (FDA) concerning the labeling of PB dairy products, and a national survey of HCPs regarding their beliefs, dietary habits, and recommendations related to dairy and PB alternatives. The research explored the nutritional adequacy of PB dairy alternatives, consumer understanding of these products, and the potential influence of HCPs’ personal dietary preferences on their professional advice. The study sample included 191 health professionals who commented on the FDA’s request and 417 health professionals who completed an online survey. Data analysis involved thematic analysis of open-ended responses, and multivariate logistic regression models to assess associations between demographic and professional characteristics and HCPs’ beliefs and recommendations. The study sought to determine whether HCPs’ own dietary choices influenced the advice they provided to patients.
Key Findings & Statistics
- Of the 8,052 original comments received by the FDA, less than 2.5% (n=191) were submitted by health professionals.
- 55.5% of health professional commenters reported living in the U.S., with 9.4% residing in a “dairy state”.
- 49.7% of all commenters and 42.4% of health professional commenters expressed a preference for PB dairy alternatives.
- Only 7.4% of all commenters and 11.0% of health professionals indicated a preference for dairy products.
- A substantial portion of all commenters (41.3%) and health professional commenters (46.6%) did not indicate a preference for dairy vs. dairy alternatives.
- 64% of health professionals commenting on the Federal Register (n=123) 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.
- 62% of health professionals discussed the nutritional merits of PB dairy alternatives, and 35% discussed the nutritional demerits.
- The most common nutrition and health topic mentioned by survey respondents was nutrient value, specifically protein and calcium.
- 85% of survey respondents cited nutrition and health concerns as a reason for choosing PB dairy alternatives, followed by dairy allergy or intolerance (82.4%) and animal welfare concerns (64.9%).
- 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; 53% did not believe that either was nutritionally superior.
- 77.2% believed that consumers do not understand the nutritional differences between dairy products and PB alternatives.
- 80.7% of health professionals would recommend dairy and 71.6% would recommend PB dairy alternatives.
- 40.1% of health professionals believed calcium intake may be a concern in diets replacing dairy with PB alternatives, while about one-third believed vitamin D and protein intake may be of concern.
- Those aged 55 years and older were more likely to believe dairy products were nutritionally superior to PB dairy alternatives (OR 2.99; 95% CI 1.44-6.21, p=0.003).
- HCPs from a dairy state were less likely to believe PB dairy alternatives are nutritionally superior to dairy (OR 0.26; 95% CI 0.11-0.59, p=0.001).
- Dietetics professionals were more likely than other health professionals to believe dairy is nutritionally superior to PB dairy alternatives (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 (OR 0.19; 95% CI 0.08-0.50, p=0.001).
- Respondents aged 55 years and older were more likely than those aged 18-34 years to believe vitamin A would be a nutrient of concern for individuals that replace dairy with PB alternatives (OR 5.23; 95% CI 1.81–15.06, p=0.002).
- Dietetics professionals were more likely than other health professionals to believe protein (OR 2.02 95% CI 1.22–3.34, p=0.006), vitamin D (OR 2.46; 95% CI 1.48-4.09, p=0.001), and potassium (OR 7.18; 95% CI 2.35–21.95, p=0.001) would be a nutrient of concern for individuals that replace dairy with PB alternatives.
- Those from a dairy state were less likely to agree (OR 0.30; 95% CI 0.10-0.86; p=0.025) or disagree (OR 0.39; 95% CI 0.19-0.77; p=0.007) that consumers understand the nutritional differences between the products.
Other Important Findings
- Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives.
- Dietetics professionals demonstrated a more accurate understanding of the nutritional value of both dairy and PB products.
- 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.
- Most HCPs recognized the beneficial nutrition qualities of dairy, but also understood that PB alternatives have their own nutritional properties that may suit individual needs.
- HCPs who preferred PB milk or followed PB dietary patterns were more likely to recommend dairy alternatives and less likely to recommend dairy.
- The use of dairy names in PB product labels is contributing to a misunderstanding among consumers.
Limitations Noted in the Document
- There was an uneven distribution of health professional types within the survey sample, with the majority being dietetics and nursing professionals.
- The sample included a large minority (32%) from Vermont, potentially influencing the results.
- The majority of the sample was female and non-Hispanic white.
- The use of qualitative data may have resulted in some comments being interpreted incorrectly, although all coders performed several rounds of preliminary practice to ensure agreement among coding.
Conclusion
The study revealed that while many health professionals recognize the nutritional value of both dairy and PB dairy alternatives, concerns remain about consumer understanding of the nutritional differences between these products. There is a need for improved nutrition education, particularly among non-dietetics HCPs, to address knowledge gaps regarding the nutritional adequacy of PB alternatives and the role of dairy in a balanced diet. The results showed that HCPs’ personal preferences influenced their recommendations, with those preferring PB milk more likely to recommend PB dairy alternatives. The study’s findings support the idea that the FDA’s labeling regulations may contribute to consumer confusion. The research underscores the need for evidence-based nutrition recommendations, a reduction in personal bias in practice, and the inclusion of registered dietitians on healthcare teams to improve the quality of nutrition advice provided to consumers. Key quotes include: “These are healthy alternatives with superior nutritional quality.”, and “Dairy products are critical to the healthy diet of children and adults.” The study suggests 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. These insights are crucial for guiding healthcare professionals in offering informed and unbiased dietary advice that aligns with current scientific evidence and patients’ individual needs.