Choosing a healthy and sustainable diet: A three-level approach for understanding the drivers of the Italians' dietary regime over time

Which messages about healthy and sustainable eating resonate best with consumers with low socio-economic status?

Consumers with low socioeconomic status (SES) eat less healthy and sustainable diets than consumers with higher status. This is attributed, at least in part, to inequalities in health communication. An online survey with 134 socioeconomically disadvantaged consumers in Italy was conducted to test the effectiveness of tailor-made communication material (infographics) about healthy and sustainable eating (HSE). Participants were recruited at two social supermarkets by a social service organisation as well as via a crowdsourcing platform. Participants found information about HSE delivered through infographics moderately effective in increasing motivation, capability, and opportunity for HSE, and moderately useful and likely to impact their behaviour. Certain messages were more effective than others for native consumers, while migrants showed more indifferent responses to the various messages and manifested lower motivation to shift towards HSE, limited access to and seeking of nutrition-related information, and lower trust in information sources. Selecting which messages to deliver strategically, while also considering differences between segments of the target audience and their preferred sources and channels for communication, is promising; yet, structural changes related to food's affordability and availability are also needed to facilitate an effective communication.

What factors influence sustainable and healthy diet consumption? A review and synthesis of literature within the university setting and beyond

Globally, typical dietary patterns are neither healthy nor sustainable. Recognizing the key role of dietary change in reducing noncommunicable disease risk and addressing environmental degradation, it is crucial to understand how to shift individuals toward a sustainable and healthy diet (SHD). In this literature review, we introduced the concept of a SHD and outlined the dietary behaviors necessary to transition toward SHD consumption; we reviewed the literature on factors that may influence sustainable (and unsustainable) dietary behaviors in adults; and we developed a novel scoring system to rank factors by priority for targeting in future research. Given the significant potential to promote a sustainable and healthy dietary transition on the university campus-where factors that may impact dietary behaviors can be targeted at all levels of influence (i.e., individual, interpersonal, environmental, policy)-we narrowed our focus to this setting throughout. Aided by our novel scoring system, we identified conscious habitual eating, product price, food availability/accessibility, product convenience, self-regulation skills, knowledge of animal ethics/welfare, food promotion, and eating norms as important modifiable factors that may influence university students' dietary behaviors. When scored without consideration for the university population, these factors were also ranked as highest priority, as was modified portion sizes. Our findings offer insight into factors that may warrant attention in future research aimed at promoting SHDs. In particular, the high-priority factors identified from our synthesis of the literature could help guide the development of more personalized dietary behavioral interventions within the university setting and beyond.

Sociodemographic Trends in Planetary Health Diets among Nutrition Students in Türkiye: Bridging Classroom to Kitchen

This study aimed to investigate the effects of sociodemographic parameters on healthy and sustainable nutrition in nutrition students. This cross-sectional study was conducted with 601 students. Researchers administered questionnaire forms to gather sociodemographic information such as age, gender, geographical region, residence area, accommodation, BMI, and income level. Participants' 24 h dietary records were used to evaluate Healthy Eating Index-2020 (HEI-2020) and Planetary Health Diet Index (PHDI). The mean PHDI scores of the Marmara (53.4 ± 14.9), Aegean (58.2 ± 18.3), Mediterranean (55.3 ± 15.5), and Black Sea (55.5 ± 15.7) regions, which are the coastal regions of Türkiye, were significantly higher than for the Central Anatolia region (46.7 ± 15.1). The PHDI and HEI-2020 score means of students living in metropolitan cities and rural areas were significantly higher than those living in urban areas (p < 0.05). Being in the 20-25 years age group increased the probability of being in a lower PHDI group (AOR 1.82; 95% CI 1.07:3.12; p = 0.028). While a similar result was found in the 20-25 years age group for HEI-2020, income level and gender did not have a statistically significant effect on these scores. Since students' ages, geographical regions, and residence areas affect PHDI and HEI-2020, it is considered important to take these sociodemographic variables into consideration in guidelines and studies.

Adherence to Mediterranean Diet in Individuals on Renal Replacement Therapy

Patients on renal replacement therapy are typically subject to several dietary restrictions; however, this approach has been questioned in recent years, with some suggesting that the Mediterranean diet might be beneficial. Data on the adherence to this diet and factors that influence it are scarce. We conducted a web survey among individuals on renal replacement therapy (dialysis or kidney transplant, KT) using the MEDI-LITE questionnaire to assess adherence to the Mediterranean diet and dietary habits in this population. Adherence to the Mediterranean diet was generally low, and significantly lower among participants on dialysis versus KT recipients (19.4% vs. 44.7%, p < 0.001). Being on dialysis, adopting fluid restrictions, and having a basic level of education were predictors of low adherence to the Mediterranean diet. Consumption of foods typically included in the Mediterranean diet, including fruit, legumes, fish, and vegetables, was generally low, particularly among those on dialysis. There is a need for strategies to improve both the adherence to and the quality of the diet among individuals on renal replacement therapy. This should be a shared responsibility between registered dietitians, physicians, and the patient.

Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review

Background. Climate change and global health are inextricably linked. Thus, health systems and their professionals must adapt and evolve without losing quality of care. Aim(s). To identify health and environmental co-benefits derived from a sustainable diet and promotion strategies that favor its implementation. Methods. A systematic search for articles published on sustainable diets and human/planetary health published between 2013 and 2020 was conducted on the databases PubMed, Cinahl, Scopus and Trip from 4 to 7 May 2020 in accordance with the PRISMA guideline. Results. A total of 201 articles was retrieved, but only 21 were included. A calorie-balanced diet mainly based on food of plant origin that would allow the attainment of 60% of daily caloric requirements and a low protein intake from animal foods (focusing in fish and poultry) could significantly reduce global morbi-mortality and the dietary environmental impact maintaining a framework of sustainability conditioned by the consumption of fresh, seasonal, locally produced and minimally packaged products. Discussion. The implementation of sustainable diets requires working on the triangulation of concepts of food–health–environment from schools and that is permanently reinforced during all stages of the life by healthcare workers, who should establish the appropriate modifications according to the age, gender and health situation.

The Economic Perspective of Food Poverty and (In)security: An Analytical Approach to Measuring and Estimation in Italy

The UN Sustainable Development Goals have set clear targets on global poverty, hunger and malnutrition to be achieved by 2030, which have prompted academics and policymakers to identify useful strategies and drivers. Moreover, the COVID19 pandemic has exacerbated inequalities at national and sub-national levels thus hampering the achievement of these goals. On considering the multifaceted nature of poverty, a recent research strand focuses on food poverty and insecurity issues in terms of economic access to food and healthy diet consumption, with moderate and extreme food insecurity affecting almost 9% of the population in Europe and North America. This paper aims to analyse food poverty and insecurity at regional level in Italy. Using micro-data from the Italian Household Budget Survey carried out by ISTAT, an analytical approach was proposed to define and measure the different degree of food poverty and insecurity. Moreover, to obtain insights into whether food poverty and insecurity can afford population healthy nutrition, inequality of the distributions of food expenditure categories are estimated. The results provided us with information on other important aspects of the poverty. Indeed, in Italy individuals who are at-risk-of-food-poverty or food insecure amount to 22.3% of the entire population. Furthermore, the at-risk-of-food-poverty-rate varies at regional level from 14.6% (Umbria) to 29.6% (Abruzzo), with high levels of food consumption inequalities observed above all for vegetables, meat and fish. All these issues could help policy makers to define economic intervention policies aimed at reducing social exclusion and achieving more equitable and sustainable living conditions for the entire population.

Combined innovations in public policy, the private sector and culture can drive sustainability transitions in food systems

Global food system analyses call for an urgent transition to sustainable human diets but how this might be achieved within the current global food regime is poorly explored. Here we examine the factors that have fostered major dietary shifts across eight countries in the past 70 years. Guided by transition and food-regime theories, we draw on data from diverse disciplines, reviewing post-World War 2 shifts in consumption of three food commodities: farmed tilapia, milk and chicken. We show that large-scale shifts in commodity systems and diets have taken place when public-funded technological innovation is scaled-up by the private sector under supportive state and international policy regimes, highlighting pathways between commodity systems transformation and food-system transitions. Our analysis suggests that the desired sustainability transition will require public policy leadership and private-sector technological innovation alongside consumers who culturally value and can afford healthy, sustainable diets.

Exploring External Factors Affecting the Intention-Behavior Gap When Trying to Adopt a Sustainable Diet: A Think Aloud Study

Not least from an ecological and health perspective, it can be posited that a broader part of consumers should practice sustainable diets. People who are already willing to do so are often confronted with the intention-behavior gap, caused by a range of internal and external factors. To eliminate these barriers requires a deeper and more comprehensive understanding of these factors and their interplay. Therefore, a think aloud study with 20 adult German participants was conducted to explore the four chosen external factors of availability, education, advertising and price. Furthermore, questionnaires for all four factors were handed out and a follow-up interview was conducted to gain additional qualitative data. Results show that these four external factors seem to have a major impact on the intention-behavior relation. According to the participants all factors interact in some way with other internal and external factors, making practicing sustainable diets a complex activity. In conclusion, the four external factors availability, education, advertising and price need to be addressed by various stakeholders within our food systems in order to move forward in the process of making sustainable diets practicable and sustainable food systems firmly established.

Sub-Saharan Africa's food nitrogen and phosphorus footprints: A scenario analysis for 2050

The current study presents the first nitrogen (N) and phosphorus (P) footprints calculator for Sub-Saharan Africa during 1961-2017 using an adjusted N-Calculator model, by calculating two sets of virtual N factors (VNFs) or virtual P factors (VPFs): one for fertilized farms and one for unfertilized farms. We furthermore calculated the future food footprints of N (NF) and P (PF) under five scenarios include: 1) business as usual [BAU], 2) achieve an equitable diet (EqD) while the plant N and P uptake and all other food losses would be constant at 2017 level [S1], 3) follow the EqD without any changes in plant N and P uptake, but the current ratio of other food losses would increase by 50% [S2], 4) follow the EqD with a 5% less in plant N and P uptake than the current ratio, and the current ratio of other food losses would increase by 50% [S3], and 5) follow the EqD with a 10% greater in plant N and P uptake than the current ratio, while the current ratio of other food losses would decrease by 50% [S4]. NF (kg N cap^-1 yr^-1) and PF (kg P cap^-1 yr^-1) increased from 6.7 and 1.1 to 8.3 and 1.5 during 1961-2017, respectively. The national NF (Tg N yr^-1) and PF (Tg P yr^-1) increased from 1.6 and 0.26 to 7.7 and 1.4, respectively. In 2050, NF would be 9.7, 21.7, 24.1, 27.7, and 15.5 kg N cap^-1 yr^-1 for the BAU, S1, S2, S3, and S4 scenarios, respectively. While, PF would be 1.8, 5.1, 5.6, 7.3, and 3.0 kg P cap^-1 yr^-1, respectively. S4 scenario results in much less NF and PF. We suggest applying the S4 scenario with a change of dietary style by reducing the foods consumption with high VNFs and VPFs by 2050.

The affordability of a healthy and sustainable diet: an Australian case study

BACKGROUND/AIMS

EAT-Lancet Commission's Planetary Health Diet proposed a diet that integrates nutrition and sustainability considerations, however its affordability is unknown in many country-specific contexts, including Australia. The aim of this study is to develop a healthy and sustainable food basket modelled on the Planetary Health Diet to determine the affordability of the Planetary Health Diet basket across various socio-economic groups, and compare this affordability with a food basket modelled on the typical current diet, in an Australian setting.

METHODS

An Australian-specific Planetary Health Diet basket was developed for a reference household (2 adults and 2 children) modelled on the Planetary Health Diet reference diet, and compared to a previously-developed Typical Australian Diet basket. The cost of each food basket was determined by online supermarket shopping surveys in low, medium and high socio-economic areas in each Australian state. Basket affordability was determined for the reference household by comparing the basket cost to disposable income in each socio-economic group in each state. Mann-Whitney U tests then determined if there were significant differences between the median costs and the median affordability of both baskets.

RESULTS

The Planetary Health Diet basket was shown to be less expensive and more affordable than the Typical Australian Diet basket nationally, in all metropolitan areas, in all socio-economic groups across Australia (median cost: Planetary Health Diet = AUD$188.21, Typical Australian Diet = AUD$224.36; median affordability: Planetary Health Diet = 13%, Typical Australian Diet = 16%; p = < 0.05).

CONCLUSIONS

This study showed the Planetary Health Diet to be more affordable than the Typical Australian Diet for metropolitan-dwelling Australians.

IMPLICATIONS

These results can help to inform public health and food policy aimed at achieving a healthy and sustainable future for all Australians, including reductions in overweight/obesity rates and increased food security.

Perception of Older Adults about Health-Related Functionality of Foods Compared with Other Age Groups

The proportion of older adults in the population is significantly growing in the EU, therefore, wellbeing of the older population has become a social challenge. Functional foodstuffs are food products with nutritional composition that may reduce the risk of diet-related diseases or enhance physiological functions. Therefore, they could play an important role in prevention and mitigation of health-related problems, and in promotion of healthy ageing. The aim of this study is to present the impact of age on consumer preferences about functionality of foods, covering attitude aspects, nutrition claims, possible carriers, some particular health problems and expectations about sustainable production. The results are based on a representative quantitative survey. Findings highlight statistically significant (p < 0.05) differences in preferences of older adults compared to other age segments. They generally accept functional foods, especially when functionality is attached to increased vitamin, protein, and fiber content. Older adults also prefer products with lower salt and sugar content, which were less relevant for other age groups. Products of fruit and vegetable origin are distinguished as carriers of functional traits. Compared to other segments, older adults accept products of animal origin (especially milk products) and even breakfast products on a higher level. The paper provides details about particular health issues that could be addressed by functional foods based on actual consumer concerns.

Adherence to the Mediterranean diet pattern among university staff: a cross-sectional web-based epidemiological study in Southern Italy

In this cross-sectional web-survey, carried out in 340 employees (24-67 years) among university staff of Southern Italy, we assessed the adherence to the Mediterranean Diet (MD). Using an online questionnaire based on validated 14-point MD Adherence Screener (MEDAS), the mean of the score was 7.34 (±1.9) for total population independently of sex. In population divided by the cut-off age of 45 years, MD adherence resulted significantly lower in younger respect to older group (p = .003). In multiple regression analyses we observed the direct association between MEDAS score and older age group also after adjustments. Importantly, in all sample the percentage of adherers to recommendations for fruits, nuts and fish resulted outside dietary guidelines. The present findings underscore the need to develop healthy education programmes aimed to improve the consumption of several components of the MD, particularly among young adults, in order to prevent the early onset of chronic non-transmittable diseases.

Review of Methodologies for Assessing Sustainable Diets and Potential for Development of Harmonised Indicators

The underlying values and priorities that drive policy responses depend largely on the constructs that researchers and decision makers select to measure and the metrics used. Despite much recent attention being given to sustainable diets and food systems and to the importance of clearly measuring sustainability to meet targets, to achieve goals, and to appraise dietary and environmental policies, it is not commonly agreed how the different indicators of sustainable diets are assessed. The evidence base for assessment of these indicators are frequently weak, fragmented, and arbitrary. The aim of this paper was to compare a range of published methods and indicators for assessing sustainable diets and food systems in order to harmonise them. Keyword and reference searches were performed in PubMed, Scopus, CAB Abstracts, and Web of Knowledge. Fifty-two studies (21 proposed methods and 31 used methods) that combined environment, nutrition and health, and socioeconomic aspects of sustainable diets were reviewed. The majority (over 90%) of the studies focused on high-income countries. Twenty-eight studies assessed the environmental effects of different dietary practices, eight of the studies examined the nutrition and health indicators used for assessing sustainable food systems, and seven studies assessed the social and economic costs of diets. A classification of the elements was developed, and common elements are proposed for standardizing. These elements were categorized into nutrition and health indicators, environment indicators, and socioeconomic indicators. Standardized or harmonized indicators can be used for consistency and applicability purposes and to support, implement, and monitor relevant policies.

Mediterranean diet is associated with bone mineral density and muscle mass in postmenopausal women

PURPOSE

This study aimed to investigate the association between the Mediterranean diet (MD), body composition, and bone mineral density (BMD) in postmenopausal women.

METHODS

In this cross-sectional study, 105 apparently healthy postmenopausal women aged between 45 and 65 years were included. BMD, percentage body fat, and appendicular lean mass index (ALMI, appendicular lean mass/height squared) were assessed by dual-energy X-ray absorptiometry. Dietary intake was assessed by a validated food frequency questionnaire. Assessment of MD adherence was based on intake of cereals, vegetables, fruits, meats, dairy products, fish, red wine, and olive oil, and expressed as the Mediterranean diet score (MDS).

RESULTS

Women with higher adherence to the MD had higher ALMI (6.6 ± 0.8 kg/m² vs. 6.3 ± 0.7 kg/m²; p = 0.039) and lumbar spine BMD (1.076 ± 0.149 vs. 0.997 ± 0.143 g/cm²; p = 0.007) compared to those with lower MDS. Linear regression analysis adjusted for previous hormone therapy, previous smoking behavior, and habitual physical activity showed an independent positive contribution of MDS to lumbar spine BMD (mean difference 0.088 g/cm², 95% confidence interval 0.028-0.147; p = 0.004) and ALMI (mean difference 0.296 kg/m², 95% confidence interval 0.020-0.591; p = 0.049).

CONCLUSION

Bone mineral density at the lumbar spine and ALMI were positively associated with the MDS in a sample of postmenopausal women from a non-Mediterranean region.