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Vegetarian and Plant-Based Diets in Health and Disease Prevention Edited by François Mariotti Academic Press is an imprint of Elsevier 125 London Wall, London EC2Y 5AS, United Kingdom 525 B Street, Suite 1800, San Diego, CA 92101-4495, United States 50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom Copyright © 2017 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-0-12-803968-7 For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals Publisher: Nikki Levy Acquisition Editor: Megan R. Ball Editorial Project Manager: Jaclyn A. Truesdell Production Project Manager: Lisa M. Jones Designer: Matthew Limbert Typeset by TNQ Books and Journals List of Contributors Carlo Agostoni  Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy Sutapa Agrawal  Public Health Foundation of India, Gurgaon, India Ute Alexy  University of Bonn, Bonn, Germany C. Alix Timko  University of Pennsylvania, Philadelphia, PA, United States; Children’s Hospital of Philadelphia, Philadelphia, PA, United States Benjamin Alles  Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Conservatoire National des Arts et Métiers (CNAM), Paris 5, 7, 13 Universities, Bobigny, France Rossella Attini  University of Torino, Torino, Italy Yun-Jung Bae  Shinhan University, Uijeongbu, Korea Neal D. Barnard  Physicians Committee for Responsible Medicine, Washington, DC, United States; George Washington University School of Medicine and Health Sciences, Washington, DC, United States Nawel Bemrah  Risk Assessment Unit – French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France Silvia Bettocchi  Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Università Cattolica del Sacro Cuore, Milan, Italy Marie-Christine Boutron-Ruault  Institut Gustave Roussy, Villejuif, France; University Paris-Saclay, Villejuif, France Patricia Burns  Instituto de Lactología Industrial (CONICET-UNL), Facultad de Ingeniería Química, Universidad Nacional del Litoral, Santa Fe, Argentina Gianfranca Cabiddu  Brotzu Hospital, Cagliari, Italy xxv xxvi List of Contributors Irene Capizzi  University of Torino, Torino, Italy Peter Clarys  Vrije Universiteit Brussel, Brussels, Belgium; Erasmus University College, Brussels, Belgium David A. Cleveland  University of California, Santa Barbara, CA, United States Peter Clifton  University of South Australia, Adelaide, SA, Australia; School of Health Sciences Flinders University, Adelaide, SA, Australia Emilie Combet  University of Glasgow, Glasgow, United Kingdom Pieter C. Dagnelie  Maastricht University, Maastricht, The Netherlands Luc Dauchet  CHRU Lille University Medical Center, Lille, France; Lille University, Lille, France Valentina De Cosmi  Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy Peter Deriemaeker  Vrije Universiteit Brussel, Brussels, Belgium; Erasmus University College, Brussels, Belgium Anthony Fardet  INRA, UMR 1019, UNH, CRNH Auvergne, Clermont-Ferrand, France; Clermont Université, Université d’Auvergne, Clermont-Ferrand, France Massimo Filippi  San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy Ségolène Fleury  Risk Assessment Unit – French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France Meika Foster  University of Otago, Dunedin, New Zealand Quentin Gee  University of California, Santa Barbara, CA, United States Marian Glick-Bauer  City University of New York, New York, NY, United States Daiva Gorczyca  Wroclaw Medical University, Wroclaw, Poland Marcel Hebbelinck  Vrije Universiteit Brussel, Brussels, Belgium List of Contributors xxvii Sydney Heiss  University at Albany, State University of New York, Albany, NY, United States Wolfgang Herrmann  Saarland University Hospital, Homburg, Germany Sarah R. Hoffman  UNC Gillings School of Global Public Health, Chapel Hill, NC, United States Julia M. Hormes  University at Albany, State University of New York, Albany, NY, United States Motoyasu Iikura  National Center for Global Health and Medicine, Tokyo, Japan Piia Jallinoja  University of Helsinki, Helsinki, Finland Nicole Janz  University Clinic Bochum, Bochum, Germany Carol S. Johnston  Arizona State University, Phoenix, AZ, United States Jae G. Jung  Dongguk University Ilsan Hospital, Goyang, Korea; Incheon Sarang Hospital, Incheon, Korea Sarah Jung  Loma Linda University, Loma Linda, CA, United States Hana Kahleova  Institute for Clinical and Experimental Medicine, Prague, Czech Republic Hyoun W. Kang  Dongguk University Ilsan Hospital, Goyang, Korea David L. Katz  Griffin Hospital, Derby, CT, United States Sarah H. Kehoe  MRC Lifecourse Epidemiology Unit, Southampton, United Kingdom Mathilde Kersting  University Clinic Bochum, Bochum, Germany Timothy J. Key  University of Oxford, Oxford, Oxfordshire, United Kingdom Ghattu V. Krishnaveni  CSI Holdsworth Memorial Hospital, Mysore, India Kalyanaraman Kumaran  CSI Holdsworth Memorial Hospital, Mysore, India; MRC Lifecourse Epidemiology Unit, Southampton, United Kingdom xxviii List of Contributors Filomena Leone  University of Torino, Torino, Italy Valentina Loi  Brotzu Hospital, Cagliari, Italy Kelsey M. Mangano  University of Massachusetts Lowell, Lowell, MA, United States Jim Mann  University of Otago, Dunedin, New Zealand François Mariotti  UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, Paris, France Stefania Maxia  Brotzu Hospital, Cagliari, Italy Alessandra Mazzocchi  Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy Sylvie Mesrine  Institut Gustave Roussy, Villejuif, France; University Paris-Saclay, Villejuif, France Yoshihiro Miyamoto  National Cerebral and Cardiovascular Center, Osaka, Japan Diego Moretti  ETH Zürich, Zürich, Switzerland Preetam Nath  S.C.B. Medical College, Cuttack, India Kunihiro Nishimura  National Cerebral and Cardiovascular Center, Osaka, Japan Mari Niva  University of Helsinki, Helsinki, Finland Alexandre Nougadère  Risk Assessment Unit – French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France Derek Obersby  University of West London, London, United Kingdom Michael J. Orlich  Loma Linda University, Loma Linda, CA, United States Terezie Pelikanova  Institute for Clinical and Experimental Medicine, Prague, Czech Republic Giorgina B. Piccoli  University of Torino, Torino, Italy; Le Mans Hospital, Le Mans, France List of Contributors xxix Fabrice Pierre  Université de Toulouse III, Toulouse, France Jorge Reinheimer  Instituto de Lactología Industrial (CONICET-UNL), Facultad de Ingeniería Química, Universidad Nacional del Litoral, Santa Fe, Argentina Gianna C. Riccitelli  San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy Gilles Rivière  Risk Assessment Unit – French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France Maria A. Rocca  San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy Hank Rothgerber  Bellarmine University, Louisville, KY, United States Samir Samman  University of Otago, Dunedin, New Zealand; University of Sydney, Sydney, NSW, Australia Thomas A.B. Sanders  King’s College London, United Kingdom Silvia Scaglioni  Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy Lutz Schomburg  Charité - Universitätsmedizin Berlin, Berlin, Germany Gina Siapco  Loma Linda University, Loma Linda, CA, United States Shivaram Prasad Singh  S.C.B. Medical College, Cuttack, India Frank Thies  University of Aberdeen, Aberdeen, United Kingdom Tullia Todros  University of Torino, Torino, Italy Serena Tonstad  Oslo University Hospital, Oslo, Norway; Loma Linda University, Loma Linda, CA, United States Mathilde Touvier  Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Conservatoire National des Arts et Métiers (CNAM), Paris 5, 7, 13 Universities, Bobigny, France Amalia Tsiami  University of West London, London, United Kingdom xxx List of Contributors Katherine L. Tucker  University of Massachusetts Lowell, Lowell, MA, United States Laura Vacchi  San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy Annukka Vainio  Natural Resources Institute Finland, Helsinki, Finland Marine van Berleere  CHRU Lille University Medical Center, Lille, France Gabriel Vinderola  Instituto de Lactología Industrial (CONICET-UNL), Facultad de Ingeniería Química, Universidad Nacional del Litoral, Santa Fe, Argentina Stephen Walsh  Vrije Universiteit Brussel, Brussels, Belgium Michelle Wien  California State Polytechnic University, Pomona, Pomona, CA, United States P. Winnie Gerbens-Leenes  University of Groningen, Groningen, The Netherlands Ming-Chin Yeh  City University of New York, New York, NY, United States Yoko Yokoyama  Keio University, Kanagawa, Japan Foreword All life must feed. For most creatures, this exigency of survival is simple, if not always easy. Sometimes, food is merely elusive. Sometimes, it runs away. Sometimes, it fights back. Plants, rooted in the bedrock of biology on this planet, feed on sunlight itself. Herbivores feed on such plants. Carnivores, in their turn, feed on those plant-fed herbivores. Only for omnivores are the routine difficulties of acquiring adequate sustenance com- pounded by the complex dilemma of choice. Uniquely, omnivores have choices to make, and we humans are constitutional omnivores. We have been omnivores since before ever our spe- cies became “sapiens,” let alone “sapiens” twice over. Our Homo erectus forebears were omni- vores, too. When we look over that expanse, the sweep of human history, the view of diet grows fairly dim very fast. Just consider how challenging it is to remember exactly what we ate yesterday, and we can readily forgive fairly wide error bars around breakfast in the Paleolithic. Still, there is a quite a bit we do know with confidence about the diet to which we are natively adapted. There was a great diversity of plant foods in it. Animals were wild and, in turn, nourished by their native diets and lean due to their native exertions. Water was the principal relief of thirst. Excesses of saturated fat, added sugar, or refined starch were nowhere to be found. Where the paleoanthropologists debate, they debate the salience of meat in our native diet. Some now contend we were, as long labeled, hunter-gatherers; others contend we were more correctly gatherer-hunters. Perhaps, clans of us were both in different places at different times. Omnivores are opportunists. The relative preponderance of plants, however, is a matter of relative consensus. Across the range of dietary patterns debated, plants predominate by volume when not by calories, and by both at the other extreme. The reasons were almost certainly the obvious: plants do not flee, and they tend not to fight back (although there are exceptions, as those who have ever picked a prickly pear know). Gathering is generally less perilous than hunting with primitive weapons, and more reliably productive. However, we allow for debates about the Stone Age, as modern diets emphasizing animal products and processed foods are a marked departure from our adaptations. All on its own, adaptation would make a case for a return to diets enriched with a variety of minimally processed plant foods, but we have no need to rely on only that. As laid out in the many and diverse chapters of this book, there is an enormous aggregation of modern evidence favoring plant-predominant diets for human health. The basis for plant-based diets in argu- ments addressing environmental impact and ethics may be stronger still, though they are the lesser emphasis here. Across a vast expanse of studies, methods, populations, and outcomes, an emphasis on vegetables and fruits is perhaps the most consistent feature of diets associated with favor- able health outcomes. This book enumerates the many particulars underlying that simple and robust assertion, addressing in turn the what, why, and how of vegetarianism and related dietary variants. The coverage is comprehensive, the evidence is presented clearly and abun- dantly, and the editing is methodical. The result is a source all but encyclopedic. xxxi xxxii FOrEWOrd However strong and diverse the arguments for plant-based eating, they do not alter the omnivorous nature and legacy of Homo sapiens. We are, natively, omnivorous; and omnivores have choices. This expansive, richly referenced, and meticulously edited text is dedicated to the proposi- tion that those choices be well and fully informed. -Fin, David L. Katz, MD, MPH director, Yale University Prevention research Center Griffin Hospital, derby, CT, United States Founder, The True Health Initiative Author (forthcoming): The Truth About Food (HarperOne, 2018)

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