The Effect of Plant-Based and Mycoprotein-Based Meat Substitute Consumption on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of Controlled Intervention Trials
Round 1
Reviewer 1 Report
This paper is well written and it provides an interesting contribution to improve the knowledge on the effects of intake of meat substitute on cardiometabolic risk factors at short-term. It is interesting to have chosen to focus this systematic review and meta-analysis on plant-based and mycoprotein-based meat substitutes. The study was well designed to evaluate the objectives set. However, the discussion section is a bit too long, especially the part of the environmental impact. The authors should focus on the effect of meat substitutes on cardiometabolic risk factor reduction and a little less on the environmental impact which distracts the reader from the main findings. I suggest to the authors to improve the discussion.
Author Response
Dear Reviewer,
Thank you for your praise and constructive criticism. As suggested, I have cut the discussion down to make it more relevant to the study findings. I hope you find the changes satisfactory.
Best wishes,
Joshua
Reviewer 2 Report
1. The manuscript “The Effect of Plant-Based and Mycoprotein-Based Meat Substitutes on Cardiometabolic Risk Factors: A Systematic Review and Meta-analysis of Controlled Intervention Trials” consolidated the outcome of clinical trials on the use of plant-based meat substitutes on the cardiometabolic risk factor. Although interesting, the manuscript has less rigour and focuses on the questions of the study.
2. The manuscript should have been more focused on the issues of diet perspective rather than environmental and political. It would better comply with the theme of the journal. The introduction reads an excellent perspective on meat usage's climatic and ethical aspects and its future risks. But that is not the question of the study.
3. Similarly, the discussion sections like Eutrophication, Freshwater Use, Land Use, and Greenhouse Gas Emissions have no relevance to the study question and thus must be skipped.
4. Again, lines 85-104 are irrelevant to the present study, where cardiometabolic risk factors are chosen concerning plant- and fungal-based foods.
5. While the plant-based meat alternate existed long, the mycoprotein-based product has brought into the a major thrust in the industry. Beyond the study's objective, a paragraph on comparative safety and efficacy on human health in digestion, absorption and metabolism should be added for the reader's perspective.
6. The title is divided into plant-based and mycoprotein-based protein, but the outcome measurement on several cardiometabolic aspects were measured on plant-based alone.
7. Figures 2-8 shows a measurement of individual risk factor that included both significant and non-significant changes. TC, TG, and LDL-C should be highlighted. Others should be present in the text.
8. The search term used “meat-based-substitute”; however, the study title segregates plant-based and mycoprotein-based groups.
9. Keywords like “plant-based diet” could potentially confound data analysis.
10. The study title missed a key term, “intake or consumption”, before cardiometabolic risk factor.
11. Overall, the authors failed to address the issue precisely in this study's chosen subject.
Author Response
Dear reviewer,
Thank you for your thorough feedback. I have made some modifications based upon your suggestions:
1-4. I’ve significantly reduced the discussion on planetary health by 60% (680 words) and removed the content covering sustainability from the introduction.
5. I have added a section (4.3.2.) covering food safety.
6. The lack of data on the effect of mycoprotein on BP and weight is acknowledged in the limitations section. I believe the title of the paper is still accurate as it documents the effects of plant-based and mycoprotein based meat substitutes on MULTIPLE cardiometabolic risk factors. The title does not claim that the same number of risk factors would be presented for both types of meat substitute.
7. The forest plot figures for the outcomes showing non-significant changes are still required in the main text as they also present the risk of bias evaluations.
8. The search term “meat-based-substitute” was not used. However, the search terms “meat substitute” and “meat alternative” were used. These search terms are central to finding relevant studies. I believe this was a misreading by the reviewer.
9. The search term “Plant-based diet” was used to identify studies that used meat substitutes but did not report their use in the titles or abstracts. Yes, other dietary factors may have been responsible for the observed changes. This is stated in the limitations section.
10. I have altered the title to “The Effect of Plant-Based and Mycoprotein-Based Meat Substitute Consumption on Cardiometabolic Risk Factors: A Systematic Review and Meta-analysis of Controlled Intervention Trials”
I hope you find the changes sufficient to accept this paper for publication.
Kind regards,
Joshua
Reviewer 3 Report
This is a very good review with important implications for public health.
I have however, few comments which should be mentioned in the paragraph 4.1 -Limitations of the study and in the Discussion.
1.Analyzing the data of the effects of plant-based meat substitutes on total cholesterol and triglyceride changes in the compared groups the authors included in meta-analysis studies from 1977-2022. Having in mind the analytical methods for lipid biomarkers, this does not cause doubts from the methodological point of view as both assay methods are well standardized for many years. The situation is different however, for the two other lipid parameters analyzed : LDL-C and HDL-C. In the period between 1977-2022 (LDL-C) and 1989-2022 (HDL-C) LDL-C was assessed mostly with the use of calculation methods and later with the direct methods. The direct methods differ significantly depending on the producer of the kits and the results obtained are characterized by differences up to over 20% . Therfore the changes in concentrations of LDL-C and HDL-C, in particular, may be affected by an error which should be underlined in the Limitations.
2. Comparing all laboratory data, within-subject and between-subject biological variation should also be taken into account which for lipids ranges at least from 9-15% and the information about this should also be kept in mind when choosing the reports for meta-analysis and interpreting the results/ changes of lipids as the effect of PBD.
For ex. TC change of 0.50 mmo/L is almost equal to CVi (within-subject biological variation) whereas TG change of 0.15 mmol/L is almost twice lower than CVi for TG. In my opinion, as the magnitude of change is not much promissing, it is worth to mention the above issues in the Discussion.
Author Response
Dear reviewer,
Thank you very much for your constructive feedback. Beyond improving the quality of the current paper your suggestions will stick with me during my future work in the plasma lipid field.
I have added a few sentences to the limitations section covering the potential error from changes in assessment methodology and the possibility of the observed changes being attributable to within-subject biological variation. I hope you find these amendments sufficient.
Kind regards,
Joshua
Round 2
Reviewer 2 Report
The revised manuscript ".... Systematic Review and Meta-analysis of Controlled Intervention Trials" has been streamlined with its objective.
The rationale for meat substitutes is unquestionable from Planetary Health and climatic perspectives. In addition, meat substitutes fulfil the dietary requirements and support health. That way, the present review can attract the reader's mind to re-evaluate their decision.
If at all authors are determined to include section 4.3.3. Planetary Health (lines 603- 727) should be added as the rationale for the work and placed in the introduction.
Author Response
Dear reviewer,
Thank you for your suggestion. I have added a few sentences to the introduction to set the environmental rationale of investigating the health effects of meat substitutes.
Kind regards
