The impact of replacing dairy products with plant-based dairy alternatives on iodine and other micronutrients: a modelling study and evaluation of policy options to support population intake.
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BACKGROUND: Consumption of plant-based dairy alternatives (PBDAs) has increased as populations adopt more sustainable diets. However, PBDAs are often not fortified with key nutrients found in dairy products, particularly iodine. Iodine is essential for thyroid function and neurodevelopment, with increased importance during pregnancy, infancy, and adolescence. Iodine is often supplemented to cattle via feed, resulting in dairy products being a rich source. We assessed the impact of partly replacing dairy products with PBDAs on micronutrient intake and whether mandatory fortification of PBDAs or bread could mitigate potential shortfalls. METHODS: This modelling study combined UK national dietary data with market data on PBDA fortification. Dairy-product intake was partly or fully replaced with commercially-available PBDAs on a gram-for-gram basis, aligned with Net Zero and EAT-Lancet targets (20-100% replacement). Usual nutrient intakes were estimated using the National Cancer Institute method, and the effects on nutrient intake, adequacy, and risk of excess were evaluated under current and mandatory fortification scenarios. FINDINGS: Even partial replacement of dairy products with commercially-available PBDAs reduced iodine, calcium, riboflavin, and vitamin B12 intakes, particularly among young children, adolescents, and adult females. Replacement that aligned with the EAT-Lancet targets reduced iodine intake by 13-28%. Mandatory PBDA fortification prevented declines in micronutrient intake, although iodine inadequacy remained high among adolescent females (59% inadequate). Iodine-fortified bread improved iodine intake, reducing inadequacy among adolescent females to 37%. The combination of mandatory iodine fortification of both PBDAs and bread was the most effective strategy, maintaining or improving iodine adequacy across all population groups. There was no risk of excess nutrient intake. INTERPRETATION: Partial replacement of dairy products with PBDAs can reduce micronutrient intake under current market fortification practices, especially among population groups already at risk of iodine deficiency. However, fortification of PBDAs, bread, or both represents a feasible evidence-based strategy to counteract these reductions in micronutrient intakes, minimise the impact on population health, and inform national nutrition policy and fortification strategies during transitions to more sustainable diets. FUNDING: Biotechnology and Biological Sciences Research Council FoodBioSystems.