Perspectives from healthcare professionals on the nutritional adequacy of plant-based dairy alternatives: results of a mixed methods inquiry

Background: 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.