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2023 Australian Dietary Guidelines Review

After a long wait, the review of the 2013 Australian Dietary Guidelines (ADG) has progressed to the next phase — high priority research questions have been announced and the topics look favourable.

During 2021 the National Health and Medical Research Committee (NHMRC), responsible for the ADG review, conducted scoping activities to refine the areas considered for an update.

DFN participated in the scoping phase. The headline topics that were flagged included:

  • Update the ‘lean meat and alternatives’ food group to recommend plant sources of protein in preference to animal sources
  • Remove red meat entirely from the current ‘lean meat and alternatives’ food group
  • Remove milk/yoghurt/cheese and alternatives as a standalone food group
  • Provide clarity about the health benefits of carbohydrates and starches from whole food sources, in the face of dangerous ‘high fat low carb’ diet trends
  • Stronger emphasis on the health benefits of plant-based eating patterns
  • Integration of environmental sustainability considerations into the guidelines, highlighting the co-benefits of plant-based diets for both human and planetary health
  • Proceed with caution on dietary cholesterol due to evidence on its health risks, especially among hyper-responders
  • Ensure the new guidelines recognise the proven affordability of plant-predominant diets in comparison to standard Australian diets
Plant based foods
NHMRC Phases

‘Very high priority’: plant sources of protein, dietary patterns and sustainability

The NHMRC has prioritised a preliminary list of potential topics, ranked from very-high to low priority. It’s a very positive indication that the majority of topics DFN flagged back in 2021 are up for further exploration.

A literature search and public call for systematic reviews based on these topics is currently underway.

The topics that have been identified as the highest priority are intake/exposure and health outcomes for:

  • dietary patterns relevant at a population level (a plant-based diet is referenced as one such pattern)
  • animal vs plant sources of protein (specifically protein intake from plant-based sources vs from animal sources, high vs low intake of plant foods, high vs low intake of animal foods and dairy vs dairy alternatives)
  • high vs low/no intake of ultra-processed foods

Part of the fact-finding work to narrow down the topics was a survey targeted at all people who use the current ADGs, including those who use them for work (clinicians, researchers, educators, policy makers) or as a personal information source (e.g., consumers). A whooping 33% wanted to see plant-based diets included in the updated guidelines.

Plant milks

33% wanted to see plant-based diets included in the updated guidelines.

The full table of priorities can be viewed on the NHMRC website.

A focus on sustainability

The relationship between dietary patterns and/or food intakes and sustainability outcomes was also identified as a very high priority and will be addressed via a separate process.

Glass globe in soil

The NHMRC acknowledges that there is an increasing population interest in eating sustainably and that the health impacts of some of these diets is not known to them, in some part due to the extensive progression there has been in knowledge since the 2013 ADGs.

One important source of knowledge that the NHMRC is likely to be scrutinising is the 2019 EAT-Lancet Commission on Food, Planet, Health. They brought together 37 world-leading scientists from across the globe to answer the question: Can we feed a future population of 10 billion people a healthy diet within planetary boundaries? The answer was a resounding ‘yes’, through a predominantly whole food plant-based diet. DFN looks forward to seeing the critical need for a shift to plant-based nutrition elevated during the exploration of sustainable diets.

Enriching the evidence base

As part of our submission, DFN supplied multiple systematic reviews addressing the NHMRC criteria. The full list of research submitted can be viewed below.

  • Dybvik JS, Svendsen M, Aune D. Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies. Eur J Nutr. 2023 Feb;62(1):51-69. doi: 10.1007/s00394-022-02942-8. Epub 2022 Aug 27. PMID: 36030329; PMCID: PMC9899747.
  • Zhao Y, Zhan J, Wang Y, Wang D. The Relationship Between Plant-Based Diet and Risk of Digestive System Cancers: A Meta-Analysis Based on 3,059,009 Subjects. Front Public Health. 2022 Jun 3;10:892153. doi: 10.3389/fpubh.2022.892153. PMID: 35719615; PMCID: PMC9204183.
  • Gan ZH, Cheong HC, Tu YK, Kuo PH. Association between Plant-Based Dietary Patterns and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Nutrients. 2021 Nov 5;13(11):3952. doi: 10.3390/nu13113952. PMID: 34836208; PMCID: PMC8624676.
  • Jafari S, Hezaveh E, Jalilpiran Y, Jayedi A, Wong A, Safaiyan A, Barzegar A. Plant-based diets and risk of disease mortality: a systematic review and meta-analysis of cohort studies. Crit Rev Food Sci Nutr. 2022;62(28):7760-7772. doi: 10.1080/10408398.2021.1918628. Epub 2021 May 6. PMID: 33951994.
  • Zheng J, Zhu T, Yang G, Zhao L, Li F, Park YM, Tabung FK, Steck SE, Li X, Wang H. The Isocaloric Substitution of Plant-Based and Animal-Based Protein in Relation to Aging-Related Health Outcomes: A Systematic Review. Nutrients. 2022 Jan 9;14(2):272. doi: 10.3390/nu14020272. PMID: 35057453; PMCID: PMC8781188.
  • Gibbs J, Gaskin E, Ji C, Miller MA, Cappuccio FP. The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials. J Hypertens. 2021 Jan;39(1):23-37. doi: 10.1097/HJH.0000000000002604. PMID: 33275398.
  • Kazemi A, Barati-Boldaji R, Soltani S, Mohammadipoor N, Esmaeilinezhad Z, Clark CCT, Babajafari S, Akbarzadeh M. Intake of Various Food Groups and Risk of Breast Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Adv Nutr. 2021 Jun 1;12(3):809-849. doi: 10.1093/advances/nmaa147. PMID: 33271590; PMCID: PMC8166564.
  • Schwingshackl L, Schwedhelm C, Hoffmann G, Knüppel S, Laure Preterre A, Iqbal K, Bechthold A, De Henauw S, Michels N, Devleesschauwer B, Boeing H, Schlesinger S. Food groups and risk of colorectal cancer. Int J Cancer. 2018 May 1;142(9):1748-1758. doi: 10.1002/ijc.31198. Epub 2017 Dec 14. PMID: 29210053.
  • Lee KW, Loh HC, Ching SM, Devaraj NK, Hoo FK. Effects of Vegetarian Diets on Blood Pressure Lowering: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. Nutrients. 2020 May 29;12(6):1604. doi: 10.3390/nu12061604. PMID: 32486102; PMCID: PMC7352826.
  • Koch CA, Kjeldsen EW, Frikke-Schmidt R. Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials. Eur Heart J. 2023 Jul 21;44(28):2609-2622. doi: 10.1093/eurheartj/ehad211. PMID: 37226630; PMCID: PMC10361023.
  • Tomé-Carneiro J, Visioli F. Plant-Based Diets Reduce Blood Pressure: A Systematic Review of Recent Evidence. Curr Hypertens Rep. 2023 Jul;25(7):127-150. doi: 10.1007/s11906-023-01243-7. Epub 2023 May 13. PMID: 37178356; PMCID: PMC10224875.
  • Jarvis SE, Nguyen M, Malik VS. Association between adherence to plant-based dietary patterns and obesity risk: a systematic review of prospective cohort studies. Appl Physiol Nutr Metab. 2022 Dec 1;47(12):1115-1133. doi: 10.1139/apnm-2022-0059. Epub 2022 Aug 19. PMID: 35985038.
  • Craddock JC, Neale EP, Peoples GE, Probst YC. Vegetarian-Based Dietary Patterns and their Relation with Inflammatory and Immune Biomarkers: A Systematic Review and Meta-Analysis. Adv Nutr. 2019 May 1;10(3):433-451. doi: 10.1093/advances/nmy103. PMID: 30947338; PMCID: PMC6520040.
  • Nachvak SM, Moradi S, Anjom-Shoae J, Rahmani J, Nasiri M, Maleki V, Sadeghi O. Soy, Soy Isoflavones, and Protein Intake in Relation to Mortality from All Causes, Cancers, and Cardiovascular Diseases: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Acad Nutr Diet. 2019 Sep;119(9):1483-1500.e17. doi: 10.1016/j.jand.2019.04.011. Epub 2019 Jul 2. PMID: 31278047.
  • Liu Y, Zhu L, Li D, Wang L, Tang H, Zhang C. Stroke risk with vegetarian, low-animal and high-animal diets: A systematic review and meta-analysis. Asia Pac J Clin Nutr. 2022;31(3):422-432. doi: 10.6133/apjcn.202209_31(3).0010. PMID: 36173214.
  • Fan M, Li Y, Wang C, Mao Z, Zhou W, Zhang L, Yang X, Cui S, Li L. Dietary Protein Consumption and the Risk of Type 2 Diabetes: ADose-Response Meta-Analysis of Prospective Studies. Nutrients. 2019 Nov 15;11(11):2783. doi: 10.3390/nu11112783. PMID: 31731672; PMCID: PMC6893550.
  • Gao X, Zheng Q, Jiang X, Chen X, Liao Y, Pan Y. The effect of diet quality on the risk of developing gestational diabetes mellitus: A systematic review and meta-analysis. Front Public Health. 2023 Jan 9;10:1062304. doi: 10.3389/fpubh.2022.1062304. PMID: 36699870; PMCID: PMC9868748.
  • Qi XX, Shen P. Associations of dietary protein intake with all-cause, cardiovascular disease, and cancer mortality: A systematic review and meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis. 2020 Jun 25;30(7):1094-1105. doi: 10.1016/j.numecd.2020.03.008. Epub 2020 Mar 17. PMID: 32451273.
  • Lambert V, Muñoz SE, Gil C, Román MD. Maternal dietary components in the development of gestational diabetes mellitus: a systematic review of observational studies to timely promotion of health. Nutr J. 2023 Mar 7;22(1):15. doi: 10.1186/s12937-023-00846-9. PMID: 36879315; PMCID: PMC9990275.
  • Zargarzadeh N, Mousavi SM, Santos HO, Aune D, Hasani-Ranjbar S, Larijani B, Esmaillzadeh A. Legume Consumption and Risk of All-Cause and Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Adv Nutr. 2023 Jan;14(1):64-76. doi: 10.1016/j.advnut.2022.10.009. Epub 2023 Jan 5. PMID: 36811595; PMCID: PMC10103007.
  • Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, Rasmussen KM, Siega-Riz AM, Stang J, Casavale KO, Spahn JM, Stoody EE. Dietary patterns before and during pregnancy and maternal outcomes: a systematic review. Am J Clin Nutr. 2019 Mar 1;109(Suppl_7):705S-728S. doi: 10.1093/ajcn/nqy216. PMID: 30982868.
  • Mendes V, Niforou A, Kasdagli MI, Ververis E, Naska A. Intake of legumes and cardiovascular disease: A systematic review and dose-response meta-analysis. Nutr Metab Cardiovasc Dis. 2023 Jan;33(1):22-37. doi: 10.1016/j.numecd.2022.10.006. Epub 2022 Oct 21. PMID: 36411221.
  • Bhandari B, Liu Z, Lin S, Macniven R, Akombi-Inyang B, Hall J, Feng X, Schutte AE, Xu X. Long-Term Consumption of 10 Food Groups and Cardiovascular Mortality: A Systematic Review and Dose Response Meta-Analysis of Prospective Cohort Studies. Adv Nutr. 2023 Jan;14(1):55-63. doi: 10.1016/j.advnut.2022.10.010. Epub 2022 Dec 22. PMID: 36811594; PMCID: PMC10102997.
  • Koch CA, Kjeldsen EW, Frikke-Schmidt R. Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials. Eur Heart J. 2023 Jul 21;44(28):2609-2622. doi: 10.1093/eurheartj/ehad211. PMID: 37226630; PMCID: PMC10361023.
  • Benatar JR, Stewart RAH. Cardiometabolic risk factors in vegans; A meta-analysis of observational studies. PLoS One. 2018 Dec 20;13(12):e0209086. doi: 10.1371/journal.pone.0209086. PMID: 30571724; PMCID: PMC6301673.
  • Quintela BCSF, Carioca AAF, de Oliveira JGR, Fraser SDS, da Silva Junior GB. Dietary patterns and chronic kidney disease outcomes: A systematic review. Nephrology (Carlton). 2021 Jul;26(7):603-612. doi: 10.1111/nep.13883. Epub 2021 Apr 28. PMID: 33864650.
  • Farvid MS, Sidahmed E, Spence ND, Mante Angua K, Rosner BA, Barnett JB. Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2021 Sep;36(9):937-951. doi: 10.1007/s10654-021-00741-9. Epub 2021 Aug 29. PMID: 34455534.
  • Ahmad Jabri, Ashish Kumar, Elizabeth Verghese, Anas Alameh, Anirudh Kumar, Muhammad Shahzeb Khan, Safi U. Khan, Erin D. Michos, Samir R. Kapadia, Grant W. Reed, Ankur Kalra, Meta-analysis of effect of vegetarian diet on ischemic heart disease and all-cause mortality, American Journal of Preventive CardiologyVolume 7, 2021,100182, ISSN 2666-6677,
  • Viguiliouk E, Glenn AJ, Nishi SK, Chiavaroli L, Seider M, Khan T, Bonaccio M, Iacoviello L, Mejia SB, Jenkins DJA, Kendall CWC, Kahleová H, Rahelić D, Salas-Salvadó J, Sievenpiper JL. Associations between Dietary Pulses Alone or with Other Legumes and Cardiometabolic Disease Outcomes: An Umbrella Review and Updated Systematic Review and Meta-analysis of Prospective Cohort Studies. Adv Nutr. 2019 Nov 1;10(Suppl_4):S308-S319. doi: 10.1093/advances/nmz113. PMID: 31728500; PMCID: PMC6855952.

Evidence shows plant-based nutrition is a powerful lifestyle prescription. It can:

  • Help prevent [1], manage and reverse cardiovascular disease [2,3] and type 2 diabetes [4,5,6].
  • Prevent obesity [7,8] and promote healthy weight loss [9].
  • Optimise blood pressure and cholesterol, as effective as medication [7,8].
  • Reduce medications [9].
  • Reduce risk of certain cancers including breast [10], prostate [11] and bowel cancer [12].
  • Improve overall health in areas such as sexual function [13,14], gut microbiome [15], joint inflammation [16,17] and mental well-being [18].

What next?

Identified research will be collated and relevant reviews will be selected, in addition to recognising gaps in the evidence. Selected research will be used to update the guidelines and prioritise gaps where new evidence reviews may be required. A limited number of reviews will be commissioned to fill these gaps.

The timeline for the revised ADGs has been shifted out; they now will be launched in 2025.

  1. Kim H, Caulfield LE, Garcia‐Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults. Journal of the American Heart Association. 2019;8(16). doi:10.1161/jaha.119.012865
  2. Ornish D. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. Journal of the American Heart Association. 1998;280(23):2001. doi:10.1001/jama.280.23.2001
  3. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63(7):356-364b.
  4. Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. Association Between Plant-Based Dietary Patterns and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Intern Med. July 2019. doi:10.1001/jamainternmed.2019.2195
  5. Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013;23(4):292-299. doi:10.1016/j.numecd.2011.07.004
  6. Barnard ND, Cohen J, Jenkins DJA, et al. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Diabetes Care. 2006;29(8):1777-1783. doi:10.2337/dc06-0606
  7. Le LT, Sabaté J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 2014;6(6):2131-2147. doi:10.3390/nu6062131
  8. Matsumoto S, Beeson WL, Shavlik DJ, et al. Association between vegetarian diets and cardiovascular risk factors in non-Hispanic white participants of the Adventist Health Study-2. J Nutr Sci. 2019;8:e6. doi:10.1017/jns.2019.1
  9. Wright N, Wilson L, Smith M, Duncan B, McHugh P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutrition & Diabetes. 2017;7(3):e256-e256. doi:10.1038/nutd.2017.3
  10. Hastert TA, Beresford SAA, Patterson RE, Kristal AR, White E. Adherence to WCRF/AICR cancer prevention recommendations and risk of postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(9):1498-1508. doi:10.1158/1055-9965.EPI-13-0210
  11. Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174(3):1065-1069; discussion 1069-1070. doi:10.1097/01.ju.0000169487.49018.73
  12. Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015;16(16):1599-1600. doi:10.1016/S1470-2045(15)00444-1
  13. La J, Roberts NH, Yafi FA. Diet and Men’s Sexual Health. Sexual Medicine Reviews. 2018;6(1):54-68. doi:10.1016/j.sxmr.2017.07.004
  14. Towe M, La J, El-Khatib F, Roberts N, Yafi FA, Rubin R. Diet and Female Sexual Health. Sexual Medicine Reviews. 2020;8(2):256-264. doi:10.1016/j.sxmr.2019.08.004
  15. David LA, Maurice CF, Carmody RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505(7484):559-563. doi:10.1038/nature12820
  16. Clinton CM, O’Brien S, Law J, Renier CM, Wendt MR. Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis. Arthritis. 2015;2015:708152. doi:10.1155/2015/708152
  17. McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8(1):71-75. doi:10.1089/107555302753507195
  18. Blanchflower DG, Oswald AJ, Stewart-Brown S. Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables? Soc Indic Res. 2013;114(3):785-801.
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