Nutrition Science
Essential Amino Acid Density
Differences in Animal- and Plant-Based Dietary Patterns Designed for
Older Women
Maya Fussell, MS, RDN
Allison Contillo, BS, RDN
Downloaded from http://journals.lww.com/nutritiontodayonline by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 06/01/2021
Heidi Druehl, MS
Nancy R. Rodriguez, PhD, RDN
The essential amino acid (EAA) content of animal-based
proteins contributes to their superior quality compared with
plant-based proteins. Recently, there has been a growing
trend toward plant-based meal patterns. However, the im-
pact of adapting a primarily plant-based meal pattern in
the context of US Department of Agriculture’ Healthy Eating
Patterns based on the Dietary Guidelines for Americans and
healthy aging is not known. The EAA content, adequacy,
and density (the amount of EAA relative to total calories or
total protein) of animal- and plant-based protein equiva-
lents in the context of 4 healthy eating patterns, omnivore,
Maya Fussell, MS, RDN, completed her MS degree in Nutritional Sci-
ences with Dr. Rodriguez at the University of Connecticut.
Allison Contillo, BS, RDN, is a doctoral student in Nutritional Sciences at
the University of Connecticut where her research with Dr. Rodriguez fo-
cuses on rehabilitative nutrition.
Heidi Druehl, MS, completed her graduate degree in Nutritional Sciences
at the University of Connecticut under Dr. Rodriguez's direction.
Nancy R. Rodriguez, PhD, RDN, is from the Department of Nutritional
Sciences, University of Connecticut. She is a professor of Nutritional Sci-
ences in the College of Agriculture, Health, and Natural Resources (CAHNR)
with joint appointments in the Departments of Kinesiology and Allied
Health Sciences. Her current scholarship efforts focus on relationships be-
tween protein quantity, protein quality, and muscle health, with specific re-
gard for healthy aging and rehabilitative nutrition. She has been a practicing
dietitian for more than 35 years.
This work is supported in part by the Beef Checkoff and the US Depart-
ment of Agriculture National Institute of Food and Agriculture, Hatch pro-
ject accession number 1016873.
N.R.R. serves on speaker bureaus for National Cattlemen's Beef Association
(NCBA) and National Dairy Council (NDC) and on Danone's Sports Nutrition
Advisory Board. She has received research funding from NCBA, NDC, the
Egg Nutrition Center, and the US Department of Agriculture. The other
authors have no conflicts of interest to disclose.
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-
NC-ND), where it is permissible to download and share the work provided
it is properly cited. The work cannot be changed in any way or used
commercially without permission from the journal.
Correspondence: Nancy R. Rodriguez, PhD, RDN, Department of Nutritional
Sciences, 27 Manter Road, Unit 4017, University of Connecticut, Storrs, CT
06269-4017 (nancy.rodriguez@uconn.edu).
Copyright © 2021 The Authors. Wolters Kluwer Health, Inc. All rights
reserved.
DOI: 10.1097/NT.0000000000000466
70 Nutrition Today®
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
vegetarian, vegan energy matched, and vegan protein
matched, were determined. The EAA content of all 4 meal
patterns met established EAA Recommended Dietary Allow-
ances. However, matching total protein to accommodate
recommended protein intakes for healthy aging resulted
in an additional 300 calories for the vegan protein
matched eating pattern. The implications for this work
for healthy aging with specific regard for protein ade-
quacy, energy balance, EAA density, current dietary rec-
ommendations, and professional practice are considered.
The surplus calories that accompany higher-protein, EAA
adequate plant-based meal patterns require further con-
sideration in the context of healthy aging. Essential amino
acid density is a novel approach with potential for effective
integration of protein quality and protein quantity in con-
figuring healthy eating patterns for optimal health across
the lifespan. Nutr Today 2021;56(2):70–75
he benefits of higher-protein diets for supporting
T increases in and maintenance of muscle is well es-
tablished. Most of this work has been done using
high-quality animal protein sources such as meat and dairy
products. Available science shows that animal-derived
proteins better support muscle protein synthesis than
plant-based proteins because of their higher amounts of
essential amino acids (EAAs), nutrients that cannot be
made by the body and must be provided in the diet.1 The
lower quality of plant-based proteins may be overcome
by eating more total protein or blending complementary
plant-based proteins to provide EAAs in amounts similar
to animal proteins.2–4 Although this may be an acceptable
way to achieve a higher-protein diet and provide the EAA
needed to promote optimal muscle health, there may be
unintended consequences in the context of the total diet
for older persons.
The impact of these dietary protein options in the frame-
work of the US Department of Agriculture’s (USDA) Health
Eating Meal Patterns based on the Dietary Guidelines for
Americans (DGA) and healthy aging is not known. Notably,
protein quality, a critical concept in considering nutrient
density of foods, is not addressed in the DGA. Furthermore,
the DGA definition of nutrient-dense foods focuses on foods
Volume 56, Number 2, March/April 2021
that “provide vitamins, minerals, and other substances that
contribute to adequate nutrient intakes”5 without mention
of EAAs. In fact, randomized control trials investigating the
effects of habitual consumption of recommended eating
patterns on health outcomes in older adults (eg, sarcopenia)
are lacking.
Proteins that provide sufficient amounts of all of the
EAAs to support growth and development are considered
complete, high-quality proteins. Applying the Digestible
Indispensable Amino Acid Score6 method to quantify pro-
tein quality is not easily extended to the design of healthy
eating patterns or the evaluation of their EAA content. The
underlying premise of the Recommended Dietary Allow-
ance (RDA) for protein is that EAA requirements are met.7
This specific aspect of the RDA has been lost in the context
of meeting the higher protein needs of older individuals.8
Meeting EAA requirements is most easily done by incor-
porating high-quality, complete proteins at each meal (ie,
lean meats, eggs, and dairy foods). However, consumers
are hesitant to consume and health professionals are reluc-
tant to recommend routine consumption of animal proteins
owing to concerns for increased risk for chronic diseases
(ie, cardiovascular disease and cancer) and for sustain-
ability of the environment.2 The consequences of imple-
menting a primarily plant-based diet that may be EAA
insufficient for optimal protein utilization have not been
fully delineated. This narrative review extends this line of
inquiry to the DGA recommended Healthy Eating Patterns
with a focus on animal- versus plant-based meal patterns.
The working hypothesis for this document is that consider-
ation for the EAA density, the amount of EAA relative to to-
tal calories and total protein, of healthy eating patterns is a
novel approach to ensure meal patterns simultaneously
meet recommended protein intakes, as well as EAA require-
ments, for healthy aging.
MEAL PATTERN DESIGN
The Healthy US-Style and Healthy Vegetarian Eating Patterns5
were used to create an omnivore (O), vegetarian (V), and 2
vegan meal patterns: protein matched (VPM) and energy
matched (VEM). Using the reference height and weight
for an average healthy sedentary 51-year woman, 65 in
and 57.5 kg, respectively, the 1600 calorie requirement
for weight maintenance was calculated using the Harris
Benedict equation (Appendix 2 in Ref 5). The O and V meal
patterns used animal- and plant-based foods to meet the
daily recommended ounce-equivalents of protein and
dairy foods. The vegan meal patterns include plant-based
protein (ie, legumes, soy nuts, and seeds) and dairy alterna-
tives (soymilk) to achieve recommended ounce-equivalents of
protein and dairy foods.
In brief, an ounce-equivalent identifies the amounts
of foods from each food group with similar nutritional
Volume 56, Number 2, March/April 2021
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
content. For protein, ounce-equivalents are 1 oz of meat,
poultry, or fish; 1/4 cup of cooked beans; 1 egg; 1 tbsp of
peanut butter or nut butter; and 1/2 oz of nuts or seeds.5
A 1 cup dairy equivalent is 1 cup of milk, yogurt, or soymilk;
1.5 oz of natural cheese; or 2 oz of processed cheese.5
Macronutrient Composition of Meal Patterns
The O, V, and VEM meal patterns are isocaloric (1600 ± 60
calories), and the O, V, and VPM meal patterns are
isonitrogenous (~74 ± 3 g protein). Protein intake was
set at the average protein consumption level of 51-year-
old women, 1.3 g/kg,5 an amount also within the range
recommended for healthy aging. 9 Fat provided ~32% of
the calories for all meal patterns, with remaining calories
from carbohydrate.
Recommended Servings of Protein Foods and
Substitutions in Meal Patterns
Meal patterns were modeled per USDA food patterns and
recommended servings of protein and dairy foods, as well
as dietary preferences for protein sources for a 1600-calorie
meal plan.5 Specifics regarding substitutions for protein
ounce and 1 cup dairy equivalents for respective meal pat-
terns are detailed below.
O Meal Pattern
The O meal pattern, modeled after the USDA Healthy US
Style Eating Pattern, provides mostly animal protein sources
to meet the recommended 5-oz protein and 3-cup dairy
equivalents. The protein ounce equivalents used in the O
meal pattern included 3 oz of lean beef, 1 tbsp of almond
butter, and 1/2 oz of walnuts.5 Dairy sources include 16 oz
of low-fat cow's milk and 1 cup of low-fat vanilla yogurt.
V Meal Pattern
The V meal pattern, modeled after the USDA's Healthy
Vegetarian Meal Pattern, includes animal- and plant-based
protein sources to meet recommended servings of protein
and dairy, incorporates dairy and eggs, and eliminates other
animal-based proteins such as meat, poultry, and seafood
(Appendix 5 in Ref 5). To accommodate these changes
and maintain levels of protein, energy, and fat for meal pat-
terns, half the number of animal and plant equivalents in the
O meal pattern were used for the V plan. For example, the
3 oz serving of lean beef was replaced with 1 hard-boiled
egg and 2 hard-boiled egg whites (1.5 ounce-equivalent).
The combined 2 oz serving of walnut and almond butter
was replaced with a black bean and quinoa burger, which
provides 1/4 cup of black beans (1 plant-protein ounce-
equivalent) and 1 serving of whole grains. Dairy servings
were the same as the O meal pattern.
VEM Meal Pattern
Adapted from USDA's Healthy Vegetarian Meal Pattern, the
VEM meal pattern provided equal amounts of plant-based
proteins and dairy alternatives in place of the animal proteins
Nutrition Today® 71
and dairy in the V meal pattern were eliminated (Appendix
5 in Ref 5). Substitutions between animal and plant sources
were energy matched. The 464 calories derived from eggs
and cow's milk products in the V meal plan were replaced
with ~478 calories from nuts, seeds, fortified soymilk, and
fortified soy yogurt. Complementary proteins were paired
at each meal (ie, whole grain foods with fortified soy bev-
erages; legumes with whole grains, nuts/seeds or soy; soy
with nuts and or seeds).
VPM Meal Pattern
The VPM meal pattern was also adapted from the USDA's
Healthy Vegetarian Meal Pattern. To keep total protein in
the VPM, O, and V meal patterns the same, an additional
2.5 ounce-equivalent of plant-based proteins and 2.5 serv-
ings of whole grains were added. Therefore, the VPM meal
pattern includes 3 servings of fortified plant-based dairy al-
ternatives, 5 ounce-equivalents of plant-based proteins,
and 8 servings of whole grains. Substitutions between ani-
mal and plant sources were energy matched by replacing
lean beef and dairy products in the O meal pattern with ap-
proximately the same number of calories from legumes,
soybeans, fortified soymilk, and soy yogurt (490 vs 480 cal-
ories, respectively).
MEAL PATTERN ANALYSES
Meal patterns were analyzed using Nutritionist Pro IV Soft-
ware (Axxya Systems LLC, Redmond, Washington), which
includes foods from the USDA Standard Reference Data-
base and provides EAA profiles for most, but not all, foods.
Therefore, authors developed meal patterns using foods
that had complete EAA profiles and that were included in
the DGA's protein, dairy, and grain food groups. The con-
tribution of protein from plant and animal sources was de-
termined for each meal pattern. Animal proteins were
defined as grams of protein in meat, poultry, eggs, seafood,
cow's milk, and cow's milk yogurt, and plant proteins were
defined as grams of protein in legumes, soy, nuts, seeds,
soymilk, soymilk yogurt, grains, vegetables, and fruit. The
total amount of EAA and the branched chain amino acids
(BCAA) leucine, isoleucine, and valine, for the O, V. VEM,
and VPM patterns was compared with the respective RDA
value for the 57 kg female reference (mg/kg/d).
Energy and Protein Content
The energy, macronutrient, and protein composition of the
meal patterns are presented in the Table. Calories were
similar for the O, V, and VEM meal patterns, averaging
1630 ± 40 calories. Matching protein with O and V for the
VPM meal pattern resulted in an additional 300 calories,
exceeding the 1600 calorie intake recommended for the
hypothetical female subject.5 The O, V, and VPM meal pat-
terns provide similar amounts of protein, whereas the pro-
tein content of the VEM meal pattern was approximately
72 Nutrition Today®
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
20 g less than the other meal patterns. Animal protein sources
supplied 74% and 52% of total protein for the O and V meal
patterns, respectively. Plant-protein sources comprised
100% of the dietary protein for the vegan meal patterns.
EAA and BCAA Content
The EAA content for all meal patterns exceeded the RDA of
12 g/d in providing 34, 30, 21, and 23 g/d EAA for O, V,
VEM, and VPM, respectively (Figure 1). Similarly, total
BCAA content for all meal patterns (14, 13, 7, and 10 g/d
for O, V, VEM, and VPM, respectively) exceeded the RDA
(grams per day). The leucine content of the vegan meal
patterns is approximately 60% of that provided in O and
V. Recommended intakes for protein (~25 g) and leucine
(2.5–3 g)9 per meal were not consistently met in meal pat-
terns, the former being sufficient in the lunch or dinner of
the O, V, and VPM meal patterns (O: 35 g at dinner; V:
25 g at lunch; VPM: 30 g at lunch) and the latter only met
at dinner for the O meal pattern. Interestingly, using the
DGA Healthy Eating Patterns as templates for meal pattern
design resulted in protein being skewed to the dinner meal
for all meal patterns. The per-meal leucine recommendation
(2.5–3 g)9 was met only at dinner for the O meal pattern.
EAA Density
Extending the definition of nutrient density (ie, the concen-
tration of nutrients per amount of the respective food or
calorie content of the food),10 EAA density was calculated
for total protein and total calories for each meal pattern
(Figure 2A, B, respectively). The EAA density decreased
moving from O to V to VEM to VPM meal patterns. This
decline was more evident when EAA density was expressed
relative to total calories.
TRANSLATION TO PRACTICE
This work is novel in its aim to determine and compare the
EAA content, adequacy, and density between animal- and
plant-based protein equivalents in the context of 4 healthy
eating patterns based on current recommended Healthy
Eating Patterns: O, V, VEM, and VPM. We hypothesized that
vegan meal patterns, either isocaloric or isonitrogenous, that
rely on plant-based protein sources would not meet EAA
requirements.7 In contrast, the EAA content of all 4 meal
patterns met the established RDAs for these essential nutri-
ents. However, lower EAA content for vegan meal patterns
was noted. This exercise translated into protein intake
above the RDA (ie, 1.0 g/kg) yet below amounts recom-
mended for healthy aging for the VEM meal pattern
(1.2–2.0 g/kg).9 Using whole foods to source protein for
the VPM plan resulted in an additional 300 calories. Ex-
tending the concept of EAA density relative to total protein
and calories is a unique approach to insight regarding pro-
tein quality for healthy eating patterns that are consistent
with current recommendations for healthy aging. The
Volume 56, Number 2, March/April 2021
 TABLE Energy and Macronutrient Content of Omnivore, Vegetarian, Vegan Energy
Matched, and Vegan Protein Matched Meal Patterns
Omnivore Vegetarian Vegan Energy Matched Vegan Protein Matched
Energy, kcal 1615 1677 1614 1972

Fat, g 58 57 58 68

Fat, energy % 32 31 33 31

Carbohydrate, g 212 234 230 278

Carbohydrate, energy % 52 56 57 56

Protein, g 75 73 56 73

Protein, energy % 18 18 14 16

Protein, g/kg BW 1.3 1.3 1.0 1.3

Animal protein, g 49 38 0 0

Animal protein, protein % 64 52 0 0

Plant protein, g 20 21 56 73

Plant protein, protein % 36 48 100 100

Abbreviation: BW, body weight.

implications for this work for healthy aging with specific

FIGURE 1. Total essential amino acid (EAA) content of the omnivore,
vegetarian, vegan energy matched, and vegan protein matched meal
patterns compared with Recommended Dietary Allowance for female
reference.
regard for protein adequacy, energy balance, EAA den-
sity, current dietary recommendations, and professional
practice are considered below.
Protein Adequacy
All 4 meal patterns met the RDA for protein and, with the
exception of the VEM pattern (~1.0 g/kg/d), achieved a
protein intake within the range recommended for healthy
aging (1.3 g/kg/d).9 Evidence shows that protein intakes
above the RDA and within the recommended ranges better
support maintenance of lean body mass and function in
older adults.11–13 The lower amount of protein allowed in
the VEM meal pattern illustrates the challenge in protein
adequacy of a 1600-calorie vegan meal pattern for older
women.5 The VPM meal pattern accommodates the amount
of protein recommended for healthy aging at the expense of
additional calories.
Energy Balance
Providing a recommended amount of protein to support
healthy aging increased the calorie content of the VPM by
~300 calories, an amount that would be significant to en-
ergy balance in older sedentary women. In the absence
of increased energy expenditure to offset the additional
energy intake, positive energy balance and subsequent
weight gain would occur. The prevalence of obesity, and its
associated cardiometabolic complications, and sarcopenia

Volume 56, Number 2, March/April 2021 Nutrition Today® 73

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

FIGURE 2. A, Essential amino acid (EAA) density of meal patterns calculated for total protein. B, EAA density of meal patterns calculated for total calories.
among US adults continues to increase.14,15 Critically, the
calorie cost of obtaining adequate protein and meeting
EAA requirements from plant-based protein sources should
not be overlooked when developing and implementing
healthy eating patterns for older populations.
EAA Density
All of the healthy eating patterns presented met the RDA
for EAA and BCAA.7 However, this information must be
cautiously considered given the diligence and knowledge
specific to food exchanges and ounce-equivalents required
to develop the vegan meal patterns for this work. In fact, all
meal patterns were developed by a proficient registered
dietitian nutritionist with expertise in mindful construction
of individual meal plans.16 To increase the EAA content of
the vegan meal pattern, a mix of legumes, soy products,
and whole grains was added. These plant-based proteins
have a lower EAA density (EAA: energy) compared with
animal-based proteins. Therefore, the 23 g of EAA in the
VPM meal pattern was accompanied by 300 additional cal-
ories. The low EAA density of both vegan meal patterns
demonstrates the challenges in achieving a calorie-conscious,
high-quality protein pattern that is plant-protein sourced and
meets dietary protein recommendations for healthy aging.
High-quality proteins such as lean beef, dairy, and eggs
have a more robust and consistent EAA profile and are rich
sources of the BCAA leucine. As whole foods consumed in
healthy eating patterns, higher-quality animal-based pro-
teins are more anabolic than their plant-based protein
counterparts.17 Because leucine is a nutrient signal that
stimulates skeletal muscle protein synthesis,18 protein recom-
mendations for aging include consuming 2.5 to 4 g of leucine
at each meal as a countermeasure to the age-related anabolic
resistance to dietary protein.9 Only the dinner in the O meal
74 Nutrition Today®
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
pattern achieved the 2.5 g leucine threshold. This meal in-
cluded 3 oz of extra lean beef, which provided 1800 mg of
leucine and 130 calories. In comparison, the lunch in the
VPM meal pattern provided approximately 2 g of leucine
sourced from 1 cup of soymilk, 1 cup of quinoa, and 1/2
cup of soybeans.
Thoughtful assembly of these plant-based proteins,
however, did not provide sufficient leucine to elicit an an-
abolic response in muscle of older adults.17 To increase
the leucine content of exclusively plant-based meals, larger
amounts of soymilk (>1 cup), tofu, tempeh, or soy beans
(>3/4 cup) may need to be consumed at each meal. The
volume of food needed to provide comparable leucine in-
takes is substantial, increasing the caloric density of exclu-
sively plant-based meal patterns. These additional calories
may pose a greater challenge for older women compared
with older men since males have higher energy require-
ments across the lifespan. Further, the sodium content of
plant-based meat substitutes may inadvertently increase so-
dium intake. Because plant-based proteins exhibit a com-
plete EAA profile that is often limiting in amounts of 1 or
more EAA,17,19 combining plant- and animal-based proteins
at each meal facilitates the complete and balanced EAA pro-
file necessary for maintaining muscle mass, strength, and
function in older individuals.
Our findings suggest that including moderate amounts
of leucine-rich animal proteins is a feasible strategy to opti-
mize dietary protein intakes, meet EAA requirements, and
enhance leucine content and protein quality of meals in
healthy eating patterns to maintain muscle in older adults.
The calorie efficiency of animal-based proteins, such as
beef, eggs, and dairy, coupled with the EAA and nutrient
density of these foods, remains a cornerstone of a whole
foods approach to healthy eating patterns.
Volume 56, Number 2, March/April 2021
SUMMARY AND RECOMMENDATIONS
Maintaining muscle health and appropriate body com-
position is a cornerstone of healthy aging. Because calorie
needs generally decrease with age, consuming adequate
EAA should be considered in concert with recommended
dietary protein levels. We propose that EAA density is
an efficient approach to gain insight regarding protein
quality and assist practitioners in developing healthy eat-
ing patterns that align with positive health outcomes for
healthy aging.
The authors recognize that the current project repre-
sents meticulous development of vegan meal patterns to
ensure provision of adequate protein and EAA, as well as
micronutrients. All meal patterns provided adequate iron
and calcium; however, both vegan meal patterns were
low in vitamin B12, indicating that a similar modeling ap-
proach specific to essential micronutrient content of rec-
ommended eating patterns would be worthwhile. The
time required to develop and educate clients on the intrica-
cies of vegan meal patterns in context of healthy aging may
be considered a limitation by practitioners and a burden for
the consumer. The caveat of additional calories that ac-
company higher-protein, EAA-adequate plant-based meal
patterns requires further deliberation in the context of
healthy aging for men as well as women. Essential amino
acid density is an intriguing and novel tactic for effectively
integrating protein quality and protein quantity in de-
signing healthy eating patterns for optimal health across
the lifespan.
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Nutrition Today® 75