The Impacts of Dietary Change on Greenhouse Gas Emissions, Land Use, Water Use, and Health: A Systematic Review

Do consumers prefer pasture-raised dual-purpose cattle when considering meat products? A hypothetical discrete choice experiment for the case of minced beef

Livestock production is criticised for animal welfare conditions and its impact on the environment. Pasture-raised dual-purpose cattle may be able to provide an opportunity for more sustainable livestock production. Despite societal interest and substantial grazing opportunities in several regions of northern Europe, the market share of sustainably produced beef is currently low. This study investigated consumer preferences and willingness-to-pay for pasture-raised beef from dual-purpose cattle. Data were obtained from a hypothetical choice experiment (n = 513), attributing the type of husbandry (stable-based, pasture-raised, pasture-raised using nature conservation areas), breed (no description, single-purpose, dual-purpose), production method (conventional, organic), origin (locally produced, produced in Germany), and price (5.98, 11.98, 17.98, 23.98 €/kg), and were analysed using random parameter logit modelling. The most important overall attribute was 'type of husbandry' followed by 'breed', indicating consumers' concerns for animal welfare and naturalness. Our analyses revealed a clear preference for pasture-raised dual-purpose cattle, demonstrating great market potential for animal welfare-friendly meat products.

Farmed Mussels: A Nutritive Protein Source, Rich in Omega-3 Fatty Acids, with a Low Environmental Footprint

The world’s ever-growing population presents a major challenge in providing sustainable food options and in reducing pressures on the Earth’s agricultural land and freshwater resources. Current estimates suggest that agriculture contributes ~30% of global greenhouse gas (GHG) emissions. Additionally, there is an increased demand for animal protein, the production of which is particularly polluting. Therefore, the climate-disrupting potential of feeding the planet is likely to substantially worsen in the future. Due to the nutritional value of animal-based protein, it is not a simple solution to recommend a wholesale reduction in production/consumption of animal proteins. Rather, employing strategies which result in the production of low carbon animal protein may be part of the solution to reduce the GHGs associated with our diets without compromising diet quality. We suggest that farmed mussels may present a partial solution to this dilemma. Mussel production has a relatively low GHG production and does not put undue pressure on land or fresh water supplies. By drawing comparisons to other protein sources using the Australian Food and Nutrient Database and other published data, we demonstrate that they are a sustainable source of high-quality protein, long-chain omega-3 fatty acids, phytosterols, and other key micronutrients such as B-12 and iron. The aim of this review is to summarise the current knowledge on the health benefits and potential risks of increasing the consumption of farmed mussels.

Diets within Environmental Limits: The Climate Impact of Current and Recommended Australian Diets

Planetary boundaries are an important sustainability concept, defining absolute limits for resource use and emissions that need to be respected to avoid major and potentially irreversible earth system change. To remain within the safe operating space for humanity, there is a need for urgent adoption of climate-neutral diets, which make no additional contribution to warming. In the first study of its kind, a new climate metric, the Global Warming Potential Star (GWP*), was used to assess greenhouse gas (GHG) emissions associated with 9341 Australian adult diets obtained from the Australian Health Survey. Dietary climate footprints averaged 3.4 kg CO₂-equivelent per person per day, with total energy intake explaining around one quarter of the variation. Energy-dense and nutrient-poor discretionary foods contributed around one third. With lower climate footprint food choices, a diet consistent with current Australian dietary guidelines had a 42% lower climate footprint. Currently, it is not possible to define a climate-neutral dietary strategy in Australia because there are very few climate-neutral foods in the Australian food system. To bring Australian diets into line with the climate stabilization goals of the Paris Agreement, the most important need is for innovation across the agricultural and food processing industries to expand the range of climate-neutral foods available.

Iron Status of Vegans, Vegetarians and Pescatarians in Norway

Although plant-based diets provide well-established physical and environmental health benefits, omitting meat or meat products has also been associated with a risk of being deficient in specific nutrients, such as iron. As data on the iron status among Norwegian vegans, vegetarians and pescatarians are lacking, the present study aimed to assess iron status in these groups of healthy adults. Blood markers for iron status were measured in 191 participants (18-60 years old) comprising 106 vegans, 54 vegetarians and 31 pescatarians: serum-ferritin (S-Fe), serum-iron (S-Iron) and serum-total iron binding capacity (S-TIBC). Serum-transferrin-saturation (S-TSAT) was estimated (S-Iron/S-TIBC × 100). The median concentration of blood markers for iron status were within the normal range with no difference between the different dietary practices. In total, 9% reported iron supplement use the last 24 h. S-Fe concentrations below reference (<15 μg/L) were found in 8% of the participating women, of which one participant reported iron supplement use. In multiple regression analysis, duration of adherence to dietary practices and the female gender were found to be the strongest predictors for decreased S-Fe concentration. In conclusion, although the participants were eating a plant-based diet, the majority had sufficient iron status. Female vegans and vegetarians of reproductive age are at risk of low iron status and should have their iron status monitored.

The cost of eating more sustainable diets: A nutritional and environmental diet optimisation study

We aim to identify the dietary changes to improve nutrition and reduce diet-related greenhouse gas emission (GHGE) simultaneously in Brazil, taking into account the heterogeneity in food habits and prices across the country. Food consumption and prices were obtained from two nationwide surveys (n = 55,970 households and 34,003 individuals). Linear programming models were performed to design optimised diets most resembling the observed diets, and meeting different sets of constraints: (i) nutritional, for preventing chronic diseases and meeting nutrient adequacy; (ii) socio-cultural: by respecting food preferences; and (iii) environmental: by reducing GHGE by steps of 10%. Moving toward a diet that meets nutritional recommendations led to a 14% to 24% cost increase and 10% to 27% GHGE reduction, depending on the stringency of the acceptability constraints. Stronger GHGE reductions were achievable (up to about 70%), with greater departure from the current diet, but not achieving calcium and potassium goals. Diet cost increment tended to be mitigated with GHGE reduction in most models, along with reductions in red meat, chicken, eggs, rice, and high-fat sugar sodium foods.

The association between plant-based diet and erectile function in Chinese young healthy men: A population-based study

The study was designed and conducted to evaluate the plant-based diet status and its association with erectile function (EF) in Chinese young healthy men. From July 2018 to May 2020, 116 objectively proved physically and psychologically healthy men were selected. Clinical questionnaires, detailed physical examinations and blood tests were all assessed. An overall plant-based diet index (PDI) and a healthful plant-based diet index (hPDI) were developed from each participant to measure plant-based diet quantitatively. The EF was measured by both the International Index of Erectile Function-5 (IIEF-5) and the surrogated measures of endothelial function, peripheral levels of nitric oxide (NO) and E-selectin. In subjects, the mean PDI and hPDI were 53.8 ± 8.2 and 54.7 ± 8.9 respectively. Results of multivariate analysis showed that both PDI and hPDI were negatively associated with BMI (all p < .05), but had no relationships with NO, E-selectin, TT levels and IIEF-5 scores (all p > .05). In a subgroup of male population, Chinese young healthy men, the plant-based diet, measured by PDI and hPDI, was not related to erectile function. The population can adhere to plant-based diet to keep healthy without concerns of negative influence on erectile function.

Food systems are responsible for a third of global anthropogenic GHG emissions

We have developed a new global food emissions database (EDGAR-FOOD) estimating greenhouse gas (GHG; CO₂, CH₄, N₂O, fluorinated gases) emissions for the years 1990-2015, building on the Emissions Database of Global Atmospheric Research (EDGAR), complemented with land use/land-use change emissions from the FAOSTAT emissions database. EDGAR-FOOD provides a complete and consistent database in time and space of GHG emissions from the global food system, from production to consumption, including processing, transport and packaging. It responds to the lack of detailed data for many countries by providing sectoral contributions to food-system emissions that are essential for the design of effective mitigation actions. In 2015, food-system emissions amounted to 18 Gt CO₂ equivalent per year globally, representing 34% of total GHG emissions. The largest contribution came from agriculture and land use/land-use change activities (71%), with the remaining were from supply chain activities: retail, transport, consumption, fuel production, waste management, industrial processes and packaging. Temporal trends and regional contributions of GHG emissions from the food system are also discussed.

Climate action for health and wellbeing in cities: a protocol for the systematic development of a database of peer-reviewed studies using machine learning methods

Cities produce more than 70% of global greenhouse gas emissions. Action by cities is therefore crucial for climate change mitigation as well as for safeguarding the health and wellbeing of their populations under climate change. Many city governments have made ambitious commitments to climate change mitigation and adaptation and implemented a range of actions to address them. However, a systematic record and synthesis of the findings of evaluations of the effect of such actions on human health and wellbeing is currently lacking. This, in turn, impedes the development of robust knowledge on what constitutes high-impact climate actions of benefit to human health and wellbeing, which can inform future action plans, their implementation and scale-up. The development of a systematic record of studies reporting climate and health actions in cities is made challenging by the broad landscape of relevant literature scattered across many disciplines and sectors, which is challenging to effectively consolidate using traditional literature review methods. This protocol reports an innovative approach for the systematic development of a database of studies of climate change mitigation and adaptation actions implemented in cities, and their benefits (or disbenefits) for human health and wellbeing, derived from peer-reviewed academic literature. Our approach draws on extensive tailored search strategies and machine learning methods for article classification and tagging to generate a database for subsequent systematic reviews addressing questions of importance to urban decision-makers on climate actions in cities for human health and wellbeing.

Conservative to disruptive diets for optimizing nutrition, environmental impacts and cost in French adults from the NutriNet-Santé cohort

Improving the sustainability of diets requires the identification of diets that meet the nutritional requirements of populations, promote health, are within planetary boundaries, are affordable and are acceptable. Here we explore the extent to which dimensions of sustainability could be optimally aligned and identify more sustainable dietary solutions, from the most conservative to the most disruptive, among 12,166 participants of the NutriNet-Santé cohort. We aim to concomitantly lower environmental impacts (including greenhouse gas emissions, cumulative energy demand and land occupation), increase organic food consumption and study departure from observed diets (considered as a proxy for acceptability). From the most conservative to the most disruptive scenario, optimized diets were gradually richer in fruits, vegetables and soya-based products and markedly poorer in animal-based foods and fatty and sweet foods. The contribution of animal protein to total protein intake gradually decreased by 12% to 70% of the observed value. The greenhouse gas emissions from food production for the diets gradually decreased across scenarios (as a percentage of observed values) by 36-86%, land occupation for food production by 32-78% and energy demand by 28-72%. Our results offer a benchmark of scenarios of graded dietary changes against graded sustainability improvements.

Chinese Consumers' Attitudes and Potential Acceptance toward Artificial Meat

The interest for artificial meat has recently expanded. However, from the literature, perception of artificial meat in China is not well known. A survey was thus carried out to investigate Chinese attitudes toward artificial meat. The answers of 4666 respondents concluded that 19.9% and 9.6% of them were definitely willing and unwilling to try artificial meat respectively, whereas 47.2% were not willing to eat it regularly, and 87.2% were willing to pay less for it compared to conventional meat. Finally, 52.9% of them will accept artificial meat as an alternative to conventional meat. Emotional resistance such as the perception of "absurdity or disgusting" would lead to no willingness to eat artificial meat regularly. The main concerns were related to safety and unnaturalness, but less to ethical and environmental issues as in Western countries. Nearly half of the respondents would like artificial meat to be safe, tasty, and nutritional. Whereas these expectations have low effects on willingness to try, they may induce consumers' rejection to eat artificial meat regularly, underlying the weak relationship between wishes to try and to eat regularly. Thus, potential acceptance of artificial meat in China depends on Chinese catering culture, perception of food and traditional philosophy.

Development and testing of the Sustainable Nutrition Environment Measures Survey for retail stores in Ontario

OBJECTIVE

To develop and test a tool to assess the price and availability of low-carbon footprint and nutritionally balanced dietary patterns in retail food environments in Ontario, Canada.

DESIGN

Availability and price of selected food from discount and regular grocery stores (n 23) in urban/rural areas of northern/southern Ontario were assessed with the Sustainable Nutrition Environment Measures Survey in 2017.

SETTING

Ontario, Canada.

RESULTS

Inter-rater reliability was high for price (intra-class correlation coefficients = 0·819) and for availability (Cohen's κ = 0·993). The tool showed 78 % of the selected food items were available in all stores. Overall, price differences were small between urban and rural locations, and northern and southern Ontario. The greatest price difference was between discount and regular stores.

CONCLUSIONS

The tool showed excellent inter-rater agreement. Researchers and public health dietitians can use this tool for research, practice and policy to link consumer-level health outcomes to the retail environment.

Recent Trends in Dietary Habits of the Italian Population: Potential Impact on Health and the Environment

Population growth, globalization, urbanization, and economic pressures are causing changes in food consumption all over the world. The study's aims are (1) to evaluate trends in food habits in Italy to highlight deviations from the traditional Mediterranean diet, (2) to analyze the features of the present Italian diet that should be modified to meet evidence-based global scientific targets for a healthy and sustainable diet proposed by the EAT-Lancet Commission. Trends in food availability for human consumption during the period 2000-2017 were assessed using the food balance sheets (FBSs). Greenhouse gas (GHG) emission was estimated according to life cycle assessment (LCA) analyses. During the study period, the availability of animal fat and beef meat greatly declined (-58% and -32%, respectively), followed by fruit, potatoes, vegetables, milk, and non-tropical oils (-20%, -15%, -13%, -14%, and -11%, respectively). A substantial increase has occurred for tropical oils, fish, and nuts (+156, +26%, and +21%, respectively). In order to meet the targets of consumption proposed by the EAT-Lancet Commission, the consumption of legumes and nuts should be almost doubled, whereas the consumption of meat, eggs, dairy products, animal fat, tropical oils, and sugars should be reduced by proportions ranging from 60% to 90%. If implemented, these changes would reduce the diet-related greenhouse gas emission by nearly 50%. In conclusion, these data call for nutritional education programs and interventions on the food system aimed at promoting a healthier and more environmentally sustainable diet. To this end, the availability and affordability of products with a better impact on human health and the environment should be promoted.

Consumption Preferences of Pulses in the Diet of Polish People: Motives and Barriers to Replace Animal Protein with Vegetable Protein

Today, with easy access to information, people are aware of the health benefits of pulses and their significant role in sustainable consumption. Despite this, the consumption of pulses still remains low in many developed and developing countries. The authors of the study attempted to fill the gaps in knowledge about determinants that influence the consumption of pulses. The study was conducted to identify the motives and barriers which, according to a consumer, influence the level of consumption of pulses. An attempt was made to determine to what extent a consumer is influenced by culinary trends (using the multiple linear regression equation). The survey was conducted on a sample of 1067 Polish respondents. The sample was representative and selected to reflect the social demographic distribution of the respondents. In the research, descriptive statistics were used, as well as a t-test, linear regression statistics, and discriminant function analysis. Pulses are more often considered by women to be healthy and nutritious products as well as a good alternative to meat products. The price of pulses products is very important. Men also consider those qualities to be encouraging to consume pulses, but to a lesser extent than women. The lack of knowledge and skills to prepare tasty meals from pulses is one of the most important barriers which, both in the case of women and men, prevents consumers from eating pulses more often. Identified types of diets of the respondents in the research sample showed differences in the regularity of consumption of different selected pulse products. The obtained results indicated that Polish consumers are influenced by other cuisines of the world in their preferences. The most influential cuisines were the Middle Eastern and Mediterranean, with a variety of dishes that are prepared based on pulse products. It should be emphasized that to increase the consumption of pulses, it is necessary to continue educating society through various channels, e.g., culinary, health, information programs, or by inviting celebrities who enjoy the great trust of the society to take part in the advertisement.

Contributions of dairy products to environmental impacts and nutritional supplies from United States agriculture

Questions regarding the balance between the contribution to human nutrition and the environmental impact of livestock food products rarely evaluate specific species or how to accomplish the recommended depopulation. The objective of this study was to assess current contributions of the US dairy industry to the supply of nutrients and environmental impact, characterize potential impacts of alternative land use for land previously used for crops for dairy cattle, and evaluate the impacts of these approaches on US dairy herd depopulation. We modeled 3 scenarios to reflect different sets of assumptions for how and why to remove dairy cattle from the US food production system coupled with 4 land-use strategies for the potential newly available land previously cropped for dairy feed. Scenarios also differed in assumptions of how to repurpose land previously used to grow grain for dairy cows. The current system provides sufficient fluid milk to meet the annual energy, protein, and calcium requirements of 71.2, 169, and 254 million people, respectively. Vitamins supplied by dairy products also make up a high proportion of total domestic supplies from foods, with dairy providing 39% of the vitamin A, 54% of the vitamin D, 47% of the riboflavin, 57% of the vitamin B₁₂, and 29% of the choline available for human consumption in the United States. Retiring (maintaining animals without milk harvesting) dairy cattle under their current management resulted in no change in absolute greenhouse gas emissions (GHGE) relative to the current production system. Both depopulation and retirement to pasture resulted in modest reductions (6.8-12.0%) in GHGE relative to the current agricultural system. Most dairy cow removal scenarios reduced availability of essential micronutrients such as α-linolenic acid, Ca, and vitamins A, D, B₁₂, and choline. Those removal scenarios that did not reduce micronutrient availability also did not improve GHGE relative to the current production system. These results suggest that removal of dairy cattle to reduce GHGE without reducing the supply of the most limiting nutrients to the population would be difficult.

Intentions to Consume Sustainably Produced Fish: The Moderator Effects of Involvement and Environmental Awareness

The purpose of this study is to apply the conceptual framework of the theory of planned behavior (TPB) to explain the consumption of sustainable produced fish in Sweden. We seek to understand the moderating role of food product involvement and environmental awareness as extensions of traditional constructs such as attitudes, social norms, and perceived behavioral control. The data were derived from a representative sample of 1974 Swedish consumers. Structural equation modeling was applied to test the relationships between constructs and evaluate the reliability and the validity of the constructs. Attitudes had a significantly positive effect on intention to consume fish in general and sustainably produced fish in particular. Social norms had significantly positive effect on intention to consume fish in general, but no effect on intention to consume sustainably produced fish. Behavioral control had no effect on behavioral intention. Interestingly, involvement negatively moderated the effect of attitudes on both intention to consume more fish and to consume more sustainably produced fish. Environmental awareness also negatively moderated the effect of attitudes on intention to consume more sustainably produced fish. It seems that attempts to create food product involvement and environmental awareness among consumers may have the opposite effect—a boomerang effect—than what conventional wisdom and much of the research on fish consumption indicates. Theoretical and practical implications of the findings are discussed.

Risk-benefit in food safety and nutrition - Outcome of the 2019 Parma Summer School

Risk-benefit assessment is the comparison of the risk of a situation to its related benefits, i.e. a comparison of scenarios estimating the overall health impact. The risk-benefit analysis paradigm mirrors the classical risk analysis one: risk-benefit assessment goes hand-in-hand with risk-benefit management and risk-benefit communication. The various health effects associated with food consumption, together with the increasing demand for advice on healthy and safe diets, have led to the development of different research disciplines in food safety and nutrition. In this sense, there is a clear need for a holistic approach, including and comparing all of the relevant health risks and benefits. The risk-benefit assessment of foods is a valuable approach to estimate the overall impact of food on health. It aims to assess together the negative and positive health effects associated with food intake by integrating chemical and microbiological risk assessment with risk and benefit assessment in food safety and nutrition. The 2019 Parma Summer School on risk-benefit in food safety and nutrition had the objective was to provide an opportunity to learn from experts in the field of risk-benefit approach in food safety and nutrition, including theory, case studies, and communication of risk-benefit assessments plus identify challenges for the future. It was evident that whereas tools and approaches have been developed, more and more case studies have been performed which can form an inherent validation of the risk-benefit approach. Executed risk-benefit assessment case studies apply the steps and characteristics developed: a problem formulation (with at least 2 scenarios), a tiered approach until a decision can be made, one common currency to describe both beneficial and adverse effects (DALYs in most instances). It was concluded that risk-benefit assessment in food safety and nutrition is gaining more and more momentum, while also many challenges remain for the future. Risk-benefit is on the verge of really enrolling into the risk assessment and risk analysis paradigm. The interaction between risk-benefit assessors and risk-benefit managers is pivotal in this, as is the interaction with risk-benefit communicators.

The Role of Healthy Diets in Environmentally Sustainable Food Systems

Background:

The global food system is directly linked to international health and sustainability targets, such as the United Nation’s Sustainable Development Goals, Paris Agreement climate change targets, and the Aichi Biodiversity Targets. These targets are already threatened by current dietary patterns and will be further threatened by 2050 because of a growing population and transitions toward diets with more calories, animal-source foods, and ultra-processed foods. While dietary changes to healthier and predominantly plant-based diets will be integral to meeting environmental targets, economic, social, and cultural barriers make such dietary transitions difficult.

Objective:

To discuss the role of healthy diets in sustainable food systems and to highlight potential difficulties and solutions of transitioning toward healthier dietary patterns. To do so, we synthesize global knowledge and conduct a series of case studies on 4 countries that differ in their social, economic, political, and dietary contexts: Brazil, Vietnam, Kenya, and Sweden.

Conclusions:

No single “silver bullet” policy solution exists to shift food choices toward sustainable healthy diets. Instead, simultaneous action by the public sector, private sector, and governments will be needed.

Climate change mitigation through dietary change: a systematic review of empirical and modelling studies on the environmental footprints and health effects of 'sustainable diets'

The adoption of healthy diets with low environmental impact has been widely promoted as an important climate change mitigation strategy. Typically, these diets are high in plant-sourced and low in animal-sourced and processed foods. Despite the fact that their environmental impacts vary, they are often referred to as 'sustainable diets'. Here we systematically review the available published evidence on the effect of 'sustainable diets' on environmental footprints and human health. Eight databases (OvidSP-Medline, OvidSP-Embase, EBSCO-GreenFILE, Web of Science Core Collection, Scopus, OvidSP-CAB-Abstracts, OvidSP-AGRIS, and OvidSP-Global Health) were searched to identify literature (published 1999-2019) reporting health effects and environmental footprints of 'sustainable diets'. Available evidence was mapped and pooled analysis was conducted by unique combinations of diet pattern, health and environmental outcome. Eighteen studies (412 measurements) met our inclusion criteria, distinguishing twelve non-mutually exclusive sustainable diet patterns, six environmental outcomes, and seven health outcomes. In 87% of measurements (n = 151) positive health outcomes were reported from 'sustainable diets' (average relative health improvement: 4.09% [95% CI -0.10-8.29]) when comparing 'sustainable diets' to current/baseline consumption patterns. Greenhouse gas emissions associated with 'sustainable diets' were on average 25.8%[95%CI -27.0 to -14.6] lower than current/baseline consumption patterns, with vegan diets reporting the largest reduction in GHG-emissions (-70.3% [95% CI: -90.2 to -50.4]), however, water use was frequently reported to be higher than current/baseline diets. Multiple benefits for both health and the environment were reported in the majority (n = 315[76%]) of measurements. We identified consistent evidence of both positive health effects and reduced environmental footprints accruing from 'sustainable diets'. The notable exception of increased water use associated with 'sustainable diets' identifies that co-benefits are not universal and some trade-offs are likely. When carefully designed, evidence-based, and adapted to contextual factors, dietary change could play a pivotal role in climate change mitigation, sustainable food systems, and future population health.

A cross-sectional survey of the readiness of consumers to adopt an environmentally sustainable diet

BACKGROUND

The current food system is responsible for significant environmental damage therefore, encouraging consumers to adopt an environmentally sustainable diet is a key public health challenge. Dietary guidelines have been developed that outline recommendations for purchasing and consuming food in an environmentally sustainable manner, but they have not yet been incorporated in UK national dietary guidelines.

METHODS

Via an online survey of UK adults, we evaluated consumers' perceptions of the environmental benefit of various sustainable diet recommendations, their readiness to adopt these behaviours using the stage of change construct of the Transtheoretical Model, the factors that influenced their food choices, and their current consumption of plant- and animal-based sources of protein. Additionally, we investigated how demographic characteristics and food choice motives were associated with perceived environmental benefit of and readiness to adopt these sustainable diet recommendations.

RESULTS

The survey was completed by 442 participants (66% female, 80% aged 25-54 years, 85% with higher education). The majority of participants considered the recommendations to 'reduce consumption of air-freighted foods' (79%), 'reduce food waste' (75%), and 'buy locally grown produce' (78%) to have a high environmental benefit, whereas a smaller proportion of participants perceived 'prioritise plant-based proteins' (42%) and 'choose organic produce' (27%) to have a high environmental benefit. Differences in perceptions and readiness to adopt sustainable dietary behaviours were observed between demographic groups, with women significantly more likely than men to be in action/maintenance (A/M) stages of change for prioritising plant proteins (OR 0.54), and younger participants more likely to be in pre-contemplation/contemplation (PC/C) stages of change for 'choose organic produce' (OR 2.03) and 'choose sustainable fish' (OR 2.45). Health, cost, environmental sustainability and taste were the most commonly reported food choice motives. Reporting environmental sustainability as a food choice motive was associated with readiness to adopt sustainable diet recommendations.

CONCLUSIONS

We found that consumers in the UK are engaged with some aspects of sustainable diets but remain resistant to others. The results of this study indicate that acceptable dietary guidelines could be developed to address environmental sustainability. Several behaviours were identified that consumers were willing to adopt, but there were barriers preventing them, highlighting that policy action is required to enable behaviour change to occur. Differences between demographic groups highlight potential targets for future campaigns promoting sustainable diets.

Acceptability and feasibility of a café-based sustainable food intervention in the UK

Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n = 16) and customers (n = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

BACKGROUND

Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets.

OBJECTIVE

To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns.

METHODS

We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it.

CONCLUSIONS

The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Historical and projected future range sizes of the world's mammals, birds, and amphibians

Species' vulnerability to extinction is strongly impacted by their geographical range size. Formulating effective conservation strategies therefore requires a better understanding of how the ranges of the world's species have changed in the past, and how they will change under alternative future scenarios. Here, we use reconstructions of global land use and biomes since 1700, and 16 possible climatic and socio-economic scenarios until the year 2100, to map the habitat ranges of 16,919 mammal, bird, and amphibian species through time. We estimate that species have lost an average of 18% of their natural habitat range sizes thus far, and may lose up to 23% by 2100. Our data reveal that range losses have been increasing disproportionately in relation to the area of destroyed habitat, driven by a long-term increase of land use in tropical biodiversity hotspots. The outcomes of different future climate and land use trajectories for global habitat ranges vary drastically, providing important quantitative evidence for conservation planners and policy makers of the costs and benefits of alternative pathways for the future of global biodiversity.

Meet the Meat Alternatives: The Value of Alternative Protein Sources

PURPOSE OF REVIEW

Meat alternatives are non-animal-based proteins with chemical characteristics and aesthetic qualities comparable to meat. The global increase in meat consumption is associated with the adverse environmental impacts such as increased greenhouse gas emissions contributing to global warming and higher water/land use. In this review, we focus on the development, availability, and nutritional value of various meat alternatives and their impact on meat consumption.

RECENT FINDINGS

Changing dietary patterns and drive for environmental conservation contribute to the recent increase in the consumption of environmental friendly sources of proteins such as plant-based and mycoprotein-based meat alternatives. Perceived lack of naturalness and poor cultural acceptance present as roadblocks for widespread societal acceptance for meat alternatives. Continued research and efforts are needed to make the meat alternatives more aesthetically appealing with improved nutritive value.

Healthy diets can create environmental trade-offs, depending on how diet quality is measured

Background

There is an urgent need to assess the linkages between diet patterns and environmental sustainability in order to meet global targets for reducing premature mortality and improving sustainable management of natural resources. This study fills an important research gap by evaluating the relationship between incremental differences in diet quality and multiple environmental burdens, while also accounting for the separate contributions of retail losses, inedible portions, and consumer waste.

Methods

Cross sectional, nationally-representative data on food intake in the United States were acquired from the National Health and Nutrition Examination Survey (2005–2016), and were linked with nationally-representative data on food loss and waste from published literature. Survey-weighted procedures estimated daily per capita food retail loss, food waste, inedible portions, and consumed food, and were summed to represent Total Food Demand. Diet quality was measured using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. Data on food intake, loss, and waste were inputted into the US Foodprint Model to estimate the amount of agricultural land, fertilizer nutrients, pesticides, and irrigation water used to produce food.

Results

This study included dietary data from 50,014 individuals aged ≥2 y. Higher diet quality (HEI-2015 and AHEI-2010) was associated with greater per capita Total Food Demand, as well as greater retail loss, inedible portions, consumer waste, and consumed food (P < 0.001 for all comparisons). Consumed food accounted for 56–74% of agricultural resource use (land, fertilizer nutrients, pesticides, and irrigation water), retail loss accounted for 4–6%, inedible portions accounted for 2–15%, and consumer waste accounted for 20–23%. Higher diet quality was associated with lower use of agricultural land, but the relationship to other agricultural resources was dependent on the tool used to measure diet quality (HEI-2015 vs. AHEI-2010).

Conclusions

Over one-quarter of the agricultural inputs used to produce Total Food Demand were attributable to edible food that was not consumed. Importantly, this study also demonstrates that the relationship between diet quality and environmental sustainability depends on how diet quality is measured. These findings have implications for the development of sustainable dietary guidelines, which requires balancing population-level nutritional needs with the environmental impacts of food choices.

Animal Welfare and Livestock Supply Chain Sustainability Under the COVID-19 Outbreak: An Overview

The COVID-19 pandemic, caused by the emergence of a new strain of coronavirus (SARS-CoV-2) around the end of December 2019, has caused a worldwide public health emergency and a socioeconomic crisis during 2020. The lockdown imposed to cope with the health issues caused by the outbreak of the disease has dramatically challenged and negatively affected all the economic sectors of the modern global economy. Specifically, the livestock sector and its related industries are among the most impacted sectors. This is mainly ascribed to the limitations of animal movement and the decrease of production inputs' availability. Other factors negatively affecting the sustainability of the livestock sector have been the shortage of workers due to the lockdown/curfew, the strong decrease in the purchasing power of the consumer, and the intensification of health care tasks. Such an impact is not only highly relevant because of their economic consequences, but also because of the effects of the lockdown and sanitary rules on animal care and welfare. The current review aims to offer: (a) a comprehensive overview of the impact of COVID-19 on the welfare of farm animals and on the performance of livestock farming systems, on food chain sustainability, and finally, on the global economy and food security; and (b) a prospective outline of alleviation actions.

Assessing Community Contributions to Sustainable Food Systems: Dietitians Leverage Practice, Process and Paradigms

Food systems are not sustainable, and efforts to address this are paralyzed by the complex networks of food system actors and factors that interact across sectoral and geographic scales. Actions at the community level can positively contribute toward globally sustainable food systems (SFS). Assessing such contributions has two central challenges: 1) a lack of methods that support alignment between communities and across scales, balanced against the need to involve the community in developing relevant indicators; and 2) the absence of adequate, fine grained data relevant to the community. Addressing these two challenges, this paper illustrates a proposed procedure that supports community engagement with, and assessment of, their contributions. Engaged by a community of Canadian dietitians, researchers used the Delphi Inquiry method, guided by the Framework for Strategic Sustainable Development, to address the first challenge, and causal loop diagrams informed by the Cultural Adaptation Template to address the second. Indicators were developed for dietitian-identified actions and outcomes for SFS. Modeling indicator interactions provide insight into how some actions are influenced by and reinforce the value placed on SFS within the professional cultural paradigm, as well as priority areas for action and measurement. Process-oriented assessment is useful in the context of partial and subjective understandings of a dynamic system, and supports continual adjustment in action. This article offers theoretical and practical insight for community engagement in addressing some of the systemic challenges in food systems. It accommodates community-based knowledge, applies process-indicators, and emphasizes the importance of cultural paradigms as a driving force of community-level actions, and overall system change. Under current conditions, facilitating SFS literacy among dietitians can amplify adaptations for broader SFS development.

Analysis of Sustainability Knowingness, Attitudes and Behavior of a Spanish Pre-Service Primary Teachers Sample

In the context of climatic emergency, teaching for sustainability is crucial to transform damaging behavioral social paths into sustainable ones. In this contribution, we focus on the relevance of the Degree in Primary Education to reach this change, assessing through the Sustainability Consciousness Questionnaire (SCQ) the sustainability awareness of a sample of 151 students of this bachelor’s degree. SPSS and JASP statistical programs were used for data analyses and graphical representations. The results support that this test is appropriate to estimate the different dimensions of sustainability consciousness of Spanish pre-service primary teachers. Specifically, we found that these students assign higher scores to items of sustainability knowingness and sustainability attitudes above all in the social dimension. Some gender differences are found in sustainability behavior, which is higher in the male subset for the economic dimension. Correlation analysis reveals positive associations between sustainability knowingness and sustainability attitudes, whereas sustainability behavior is positively related to both constructs but only in the social dimension. These results highlight the necessity of teaching sustainability looking for behavioral changes in the Degree of Primary Education.

Transboundary Environmental Footprints of the Urban Food Supply Chain and Mitigation Strategies

Food supply has been the central issue of human development for millennia and has become increasingly critical in an urbanizing world. However, the environmental footprints and associated mitigation strategies of food consumption have rarely been comprehensively characterized at urban or regional scales. Here, we analyze the water, carbon, reactive nitrogen, and phosphorus footprints of food consumption in Chinese urban regions and demonstrate how such information can help to formulate tailored mitigation strategies. The results show that in three of the largest urban regions of China, 44-93% of the four footprints are embodied in transboundary food supply. The size of the footprints and the effectiveness of mitigation measures in food supply chain vary across the environmental footprints and urban regions. However, targeting agriculture and food processing sectors in Hebei, Shandong, and Henan provinces can reduce these footprints by up to 47%. Our findings show that the analysis of the environmental footprints along the transboundary food supply chains could inform individualized and effective mitigation targets and strategies.

Níveis de Concordância com Regras Descritivas sobre Comportamentos Alimentares entre Veg(etari)anos

Resumo O vegetarianismo é uma prática que exclui carnes e pode evitar outros produtos de origem animal. Esta última modalidade está muito associada ao veganismo, uma filosofia que defende a libertação animal. Aderir a tais condições implica no seguimento de algumas normas que norteiam comportamentos alimentares e interações sociais. Partindo desse pressuposto, objetivou-se avaliar o nível de concordância, entre vegetarianos e veganos, quanto a regras que descrevem comportamentos alimentares. A pesquisa contou com 398 participantes, sendo 198 não estritos e 200 estritos, que responderam a um questionário on-line autoaplicável. Os dados, analisados via teste t, apontaram maiores níveis de concordância com comportamentos mais restritos entre vegetarianos estritos e veganos os quais também relataram maior embasamento em valores. Este estudo, que trouxe uma ótica de análise para os comportamentos alimentares em termos de localização de reforços, pode contribuir com novas práticas em saúde direcionadas às pessoas vegetarianas e veganas.

Dietas saudáveis e sustentáveis no âmbito do sistema alimentar no século XXI

RESUMO O objetivo deste ensaio foi o de realizar análise reflexiva sobre o tema das dietas sustentáveis, salientando a necessidade de debater o que seria uma alimentação adequada, dado o impacto ambiental do sistema alimentar atual. Inicia-se com uma digressão sobre a construção dessa temática para, na sequência, traçar paralelos entre dietas saudáveis e sustentáveis. Para tanto, utilizaram-se bases de dados e literatura cinzenta. O conceito de dietas sustentáveis vem sendo construído com o objetivo de agregar às preocupações nutricionais, culturais e econômicas, as questões ambientais que envolvem todo o sistema alimentar, pensando a garantia de Segurança Alimentar e Nutricional no presente e futuro. No entanto, as pesquisas realizadas têm mostrado a complexidade em conjugar todas essas preocupações na formulação de uma dieta adequada. Em linhas gerais, autores estudados concordam que uma alimentação com baixo impacto ambiental é geralmente consistente com uma boa nutrição. Porém, mesmo dentro desses padrões alimentares, haverá alguns alimentos mais sustentáveis do que outros, baseados em fatores da cadeia de suprimentos, dependendo de como e onde os alimentos foram produzidos, fabricados e transportados. O campo científico da nutrição e as diretrizes e políticas alimentares devem dar a devida consideração à sustentabilidade ao estabelecer metas voltadas para a nutrição saudável.

The Climate and Nutritional Impact of Beef in Different Dietary Patterns in Denmark

There is public focus on the environmental impact, and in particular, the emissions of greenhouse gases (GHG), related to our food consumption. The aim of the present study was to estimate the carbon footprint (CF), land use and nutritional impact of the different beef products ready to eat in different real-life dietary patterns. Beef products accounted for 513, 560, 409 and 1023 g CO₂eq per day, respectively, in the four dietary patterns (Traditional, Fast-food, Green, and High-beef). The total CFs of these diets were 4.4, 4.2, 4.3 and 5.0 kg CO₂eq per day (10 MJ)_, respectively. The Green diet had almost the same CF as the Traditional and the Fast-food diets despite having the lowest intake of beef as well as the lowest intake of red meat in total. A theoretical substitution of beef with other animal products or legumes in each of these three diets reduced the diets' CF by 4-12% and land use by 5-14%. As regards nutrients, both positive and negative impacts of these substitutions were found but only a few of particular nutritional importance, indicating that replacing beef with a combination of other foods without a significant effect on the nutrient profile of the diet is a potential mitigation option.

Adherence to the Mediterranean Diet and Environmental Impact of the Diet on Primary School Children Living in Parma (Italy)

The key role of diet in both human health and environmental sustainability is well known. However, there is a lack of studies investigating the environmental impact of children's dietary behavior. The aim of this observational study was to investigate the dietary environmental impact in a sample of primary school children living in Parma (Italy, n = 172, 8-10 years), in relation to their adherence to the Mediterranean diet (MD). Children completed a 3-day food record in both winter and spring. Dietary records were processed to obtain: (i) adherence to the MD and (ii) mean daily carbon and ecological footprints. Adherence to the MD was similar in winter and spring, with almost half of the participants showing a medium MD score. Carbon and ecological footprints were higher during winter, and the main dietary contributors were red and processed meat for both indexes. A small positive correlation was observed between adherence to the MD and total carbon and ecological footprints. This study provided the first analysis of the relationship between adherence to the MD and environmental impact of primary school children. Further research is needed to better investigate the environmental impact of primary school children's diet and the possible relationship between the MD and environmental sustainability.

Nutritional Quality and Health Effects of Low Environmental Impact Diets: The "Seguimiento Universidad de Navarra" (SUN) Cohort

Current dietary patterns are negatively affecting both the environment and people's health. Healthy diets are generally more environmentally friendly. However, few studies have focused on the health consequences of diets with low environmental impact. We analyzed differences in the dietary composition (types of food, macro- and micro-nutrients) of those diets with high and low environmental impact, according to greenhouse gas emission and resources use (water, land and energy) using data from a Spanish cohort (17,387 participants), collected by means of a validated food frequency questionnaire. Cox analyses were used to assess the association of dietary environmental impact with total mortality risk. At a given level of energy intake, diets with lower environmental impact contained higher amounts of plant-based foods and lower levels of animal-derived products. Less polluting diets involved higher amounts of polyunsaturated fats and dietary fiber and lower amounts of saturated fats and sodium. However, diets associated with less environmental damage also contained more added sugars, but lower levels of vitamin B12, zinc and calcium. We did not detect any association between dietary environmental impact and risk of mortality. Diets should not only produce minimal environmental impact, but the maximum overall benefits for all key dimensions encompassed in sustainable diets.

Gender Differences in Attitudes to Vegans/Vegetarians and Their Food Preferences, and Their Implications for Promoting Sustainable Dietary Patterns–A Systematic Review

Limiting meat consumption has recently become one of the key issues linked to public health and environmental sustainability. This is reflected in the strong emphasis on increasing promotion of plant-based nutritional styles, such as vegan and vegetarian diets. Vegan/vegetarian diets appeal to certain demographic groups more than to others. The most striking difference, however, is found between the sexes. Men and women differ in their preferences for plant products and in their attitudes to meat consumption. There are also differences between their motivations to start and/or follow a vegan/vegetarian diet. Major differences have also been observed in men’s and women’s attitudes towards people following plant-based diets. Vegetarian diets are generally considered to be less masculine than meat-based diets, and omnivores exhibit more prejudice against vegetarian men than women. This study follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) systematic literature review model. The Web of Science and PubMed databases were searched (up to January 2020) to identify studies, which analysed variables directly or indirectly related to inter-sex differences with regard to the vegan/vegetarian diet. After the screening process based on the relevance and quality criteria, 29 articles were included in the study. The purpose of this review is to raise awareness of these gender differences, not only as regards social perceptions, but also in terms of individual attitudes to vegetarian/vegan diets. Ignoring those differences hinders the promotion of plant-based diets and may explain the relatively meager success of previous efforts to promote sustainable nutritional styles.

A three-dimensional dietary index (nutritional quality, environment and price) and reduced mortality: The "Seguimiento Universidad de Navarra" cohort

Several healthy diet indices have been associated with mortality risk. However, the ideal diet should not only be healthy but also environmentally friendly and affordable. The study aimed to determine if a new Sustainable Diet Index (SDI), which takes into account the nutritional quality, environmental impacts and market price of diets, was associated with all-cause and cause-specific mortality. Using data from the "Seguimiento Universidad de Navarra" Project, a prospective cohort study of Spanish university graduates, the study included 15,492 participants who were recruited between December 1999 and March 2014 and followed-up for a median of 10 years. Cox regression was used to determine the relationship of SDI and its components with all-cause and cause-specific mortality risk. Hazard ratios with adjustment for several confounders were calculated. The weights for the foods contributing to the SDI were assessed with multiple regression analyses and variability with nested regression analyses. The highest quartile of the SDI scores was associated with a 59% relative reduction in all-cause mortality (HR 0.41, 95% CI 0.23-0.75; p_trend < 0.001) and 79% reduction in cardiovascular mortality (HR 0.21, 95% CI 0.05-0.85; p_trend < 0.001). SDI was positively correlated with beans and potato consumption but negatively correlated with red meat intake. Red and processed meats, fatty dairy products and fish consumption accounted for most of the variability in the SDI. Altogether, dietary patterns accounting not only for nutritional quality of the food but also the impact on the environment and affordability could still provide health benefits.

What Policies Address Both the Coronavirus Crisis and the Climate Crisis?

The coronavirus pandemic has led many countries to initiate unprecedented economic recovery packages. Policymakers tackling the coronavirus crisis have also been encouraged to prioritize policies which help mitigate a second, looming crisis: climate change. We identify and analyze policies that combat both the coronavirus crisis and the climate crisis. We analyze both the long-run climate impacts from coronavirus-related economic recovery policies, and the impacts of long-run climate policies on economic recovery and public health post-recession. We base our analysis on data on emissions, employment and corona-related layoffs across sectors, and on previous research. We show that, among climate policies, labor-intensive green infrastructure projects, planting trees, and in particular pricing carbon coupled with reduced labor taxation boost economic recovery. Among coronavirus policies, aiding services sectors (leisure services such as restaurants and culture, or professional services such as technology), education and the healthcare sector appear most promising, being labor intensive yet low-emission-if such sectoral aid is conditioned on being directed towards employment and on low-carbon supply chains. Large-scale green infrastructure projects and green R&D investment, while good for the climate, are unlikely to generate enough employment to effectively alleviate the coronavirus crisis.

Demographic Scenarios of Future Environmental Footprints of Healthy Diets in China

Dietary improvement not only benefits human health conditions, but also offers the potential to reduce the human food system’s environmental impact. With the world’s largest population and people’s bourgeoning lifestyle, China’s food system is set to impose increasing pressures on the environment. We evaluated the minimum environmental footprints, including carbon footprint (CF), water footprint (WF) and ecological footprint (EF), of China’s food systems into 2100. The minimum footprints of healthy eating are informative to policymakers when setting the environmental constraints for food systems. The results demonstrate that the minimum CF, WF and EF all increase in the near future and peak around 2030 to 2035, under different population scenarios. After the peak, population decline and aging result in decreasing trends of all environmental footprints until 2100. Considering age-gender specific nutritional needs, the food demands of teenagers in the 14–17 year group require the largest environmental footprints across the three indicators. Moreover, men’s nutritional needs also lead to larger environmental footprints than women’s across all age groups. By 2100, the minimum CF, WF and EF associated with China’s food systems range from 616 to 899 million tons, 654 to 953 km³ and 6513 to 9500 billion gm² respectively under different population scenarios. This study builds a bridge between demography and the environmental footprints of diet and demonstrates that the minimum environmental footprints of diet could vary by up to 46% in 2100 under different demographic scenarios. The results suggest to policymakers that setting the environmental constraints of food systems should be integrated with the planning of a future demographic path.

Demand-Side Food Policies for Public and Planetary Health

Background: The current food system has major consequences for the environment and for human health. Alignment of the food policy areas of mitigating climate change and public health will ensure coherent and effective policy interventions for sustaining human health and the environment. This paper explores literature on demand-side policies that aim to reduce consumption of animal-based foods, increase plant-based foods, and reduce overconsumption. Methods: We searched for publications, published between January 2000 and December 2019, considering the above policy domains. Articles were distinguished for type of policy instrument, for topic via keywords and examples were given. Results: The majority of demand-side policies focus on preventing overweight and obesity, using all types of policy instruments including more forceful market-based policies. Hardly any examples of public policies explicitly aiming to lower animal-based foods consumption were found. Policies combining health and sustainability objectives are few and mainly of the information type. Discussion: Moving towards environmentally sustainable and healthy diets is challenging as the implemented demand-side policies focus largely on human health, and not yet on environmental outcomes, or on win-wins. Policies targeting foods from the health perspective can contribute to lower environmental impacts, by indicating suitable animal-based food replacers, and aiming at avoiding overconsumption of energy dense-nutrient poor foods. Preferred policies include a variety of instruments, including strong measures. Conclusions: Working solutions are available to ensure coherent and effective demand side food policies aligning public health and environmental aims. Implementation of aligned and effective policy packages is urgent and needed.

The healthiness and sustainability of national and global food based dietary guidelines: modelling study

OBJECTIVE

To analyse the health and environmental implications of adopting national food based dietary guidelines (FBDGs) at a national level and compared with global health and environmental targets.

DESIGN

Modelling study.

SETTING

85 countries.

PARTICIPANTS

Population of 85 countries.

MAIN OUTCOME MEASURES

A graded coding method was developed and used to extract quantitative recommendations from 85 FBDGs. The health and environmental impacts of these guidelines were assessed by using a comparative risk assessment of deaths from chronic diseases and a set of country specific environmental footprints for greenhouse gas emissions, freshwater use, cropland use, and fertiliser application. For comparison, the impacts of adopting the global dietary recommendations of the World Health Organization and the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems were also analysed. Each guideline's health and sustainability implications were assessed by modelling its adoption at both the national level and globally, and comparing the impacts to global health and environmental targets, including the Action Agenda on Non-Communicable Diseases, the Paris Climate Agreement, the Aichi biodiversity targets related to land use, and the sustainable development goals and planetary boundaries related to freshwater use and fertiliser application.

RESULTS

Adoption of national FBDGs was associated with reductions in premature mortality of 15% on average (95% uncertainty interval 13% to 16%) and mixed changes in environmental resource demand, including a reduction in greenhouse gas emissions of 13% on average (regional range -34% to 35%). When universally adopted globally, most of the national guidelines (83, 98%) were not compatible with at least one of the global health and environmental targets. About a third of the FBDGs (29, 34%) were incompatible with the agenda on non-communicable diseases, and most (57 to 74, 67% to 87%) were incompatible with the Paris Climate Agreement and other environmental targets. In comparison, adoption of the WHO recommendations was associated with similar health and environmental changes, whereas adoption of the EAT-Lancet recommendations was associated with 34% greater reductions in premature mortality, more than three times greater reductions in greenhouse gas emissions, and general attainment of the global health and environmental targets. As an example, the FBDGs of the UK, US, and China were incompatible with the climate change, land use, freshwater, and nitrogen targets, and adopting guidelines in line with the EAT-Lancet recommendation could increase the number of avoided deaths from 78 000 (74 000 to 81 000) to 104 000 (96 000 to 112 000) in the UK, from 480 000 (445 000 to 516 000) to 585 000 (523 000 to 646 000) in the USA, and from 1 149 000 (1 095 000 to 1 204 000) to 1 802 000 (1 664 000 to 1 941 000) in China.

CONCLUSIONS

This analysis suggests that national guidelines could be both healthier and more sustainable. Providing clearer advice on limiting in most contexts the consumption of animal source foods, in particular beef and dairy, was found to have the greatest potential for increasing the environmental sustainability of dietary guidelines, whereas increasing the intake of whole grains, fruits and vegetables, nuts and seeds, and legumes, reducing the intake of red and processed meat, and highlighting the importance of attaining balanced energy intake and weight levels were associated with most of the additional health benefits. The health results were based on observational data and assuming a causal relation between dietary risk factors and health outcomes. The certainty of evidence for these relations is mostly graded as moderate in existing meta-analyses.