Dietary recommendations in Spain -affordability and environmental sustainability?

Traditional Atlantic Diet and Its Effect on Health and the Environment: A Secondary Analysis of the GALIAT Cluster Randomized Clinical Trial

Importance

The universal call to action for healthier and more sustainable dietary choices is the framework of the United Nations's Sustainable Development Goals. The Atlantic diet, originating from the northwest of the Iberian Peninsula, represents an example of a traditional diet that aligns with these principles.

Objective

To explore a 6-month intervention based on the Atlantic diet's effects on metabolic and environmental health, assessing metabolic syndrome (MetS) incidence and the carbon footprint.

Design, Setting, and Participants

The Galician Atlantic Diet study was a 6-month randomized clinical trial designed to assess the effects of this regional traditional diet on families' eating habits. The study was conducted from March 3, 2014, to May 29, 2015, at a local primary health care center in the rural town of A Estrada in northwestern Spain and involved a multisectoral collaboration. Families were randomly selected from National Health System records and randomized 1:1 to an intervention or control group. This secondary analysis of the trial findings was performed between March 24, 2021, and November 7, 2023.

Interventions

Over 6 months, families in the intervention group received educational sessions, cooking classes, written supporting material, and foods characteristic of the Atlantic diet, whereas those randomized to the control group continued with their habitual lifestyle.

Main Outcomes and Measures

The main outcomes were MetS incidence, defined per National Cholesterol Education Program Adult Treatment Panel III guidelines, and carbon footprint emissions as an environmental metric using life cycle assessment with daily dietary intake as the functional unit.

Results

Initially, 250 families were randomized (574 participants; mean [SD] age, 46.8 [15.7] years; 231 males [40.2%] and 343 females [59.8%]). The intervention group included 126 families (287 participants) and the control group, 124 families (287 participants). Ultimately, 231 families completed the trial. The intervention significantly reduced the risk of incident cases of MetS (rate ratio, 0.32; 95% CI, 0.13-0.79) and had fewer MetS components (proportional odds ratio, 0.58; 95% CI, 0.42-0.82) compared with the control condition. The intervention group did not have a significantly reduced environmental impact in terms of carbon footprint emissions compared with the control group (-0.17 [95% CI, -0.46 to 0.12] kg CO2 equivalents/person/d).

Conclusions and Relevance

These findings provide important evidence that a family-focused dietary intervention based on a traditional diet can reduce the risk of incident MetS. Further research is needed to understand the underlying mechanisms and determine the generalizability to other populations, taking into account regional cultural and dietary variations.

Trial Registration

ClinicalTrials.gov Identifier: NCT02391701.

Sustainability analysis of the Mediterranean diet: results from the French NutriNet-Santé study

The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: -35 %, greenhouse gas emissions: -40 % and cumulative energy demand: -17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.

Process Evaluation of Food Game: A Gamified School-Based Intervention to Promote Healthier and More Sustainable Dietary Choices

Food Game is a gamified school-based intervention that aims to promote healthier dietary choices (i.e., adherence to the Mediterranean diet) and more sustainable behaviors among high school students in an urban area in Northern Italy. The program consists of an offline and online competition in which groups of students participate in peer-led activities to design and communicate products promoting health and sustainability. This study aimed to examine how the program works in practice, understand its mechanisms of change and assess any variation in student outcomes. A mixed methods process evaluation was conducted. Students completed a three-wave longitudinal survey and participated in focus groups. Program staff and teachers were also interviewed. Qualitative and quantitative data analyses indicate that Food Game?s gamification strategy was successful in engaging students, who felt stimulated by the game, its embedded competition and the self-organized group work. Although no significant change in adherence to the Mediterranean diet was found, pro-environmental behaviors, attitudes and perceived peer approval on healthy eating increased over time. Findings provide preliminary support for Food Game as an acceptable and engaging intervention though there is yet not sufficient evidence that it is also promotes healthier and more sustainable behaviors. The results contribute to the limited evidence base for offline gamified school-based interventions and offer insight into the applicability of the gamification approach as a key motivational strategy in other prevention settings and contexts. Suggestions on how to strengthen the program include dosage increase and addition of activities to promote change on relevant school and community factors.

Insights into the Nitrogen Footprint of food consumption in Spain: Age and gender impacts on product choices and sustainability

The reactive nitrogen released to the environment caused by food consumption can be quantified through the Nitrogen Footprint (NF). Spain has been traditionally regarded to follow the worldwide recognized healthy Mediterranean diet. However, dietary changes among the population have started to shift from the traditional Spanish food consumption. Based on the established method for quantifying the NF from the consumer perspective, this study aimed to estimate the NF from food consumption in Spain, distinguishing between different age groups and gender. The results show that the food NF in Spain was 12.78 kg of N/cap/year and 601 Gg N/year in total. The main food contributors to the overall food NF in Spain were cereals, beef, and pork, while the food products oilseeds and oil, fruits, and legumes presented a lower contribution to the Spanish food NF. Additionally, differences in the food NF among the Spanish population were also observed. Younger age groups (<10 years) and the elderly (>65 years) presented lower food NF per capita than the rest of the population. In relation to gender, it was observed that women have a food NF slightly lower than men. It was seen that food production NF contributes 91 % to the overall food NF in Spain compared to the total food consumption NF. Key strategies based on improving the N use efficiency of crops and livestock, recycling and avoiding food waste, and implementing more sustainable eating patterns can be applied to reduce the food NF in Spain.

The Environmental Sustainability of Plant-Based Dietary Patterns: A Scoping Review

BACKGROUND

A large part of the existential threat associated with climate change is the result of current human feeding patterns. Over the last decade, research evaluating the diet-related environmental impacts of plant-based diets has emerged, and a synthesis of the available data is now due.

OBJECTIVES

The objectives of the study were as follows: 1) to compile and summarize the literature on diet-related environmental impacts of plant-based dietary patterns; 2) to assess the nature of the data on impacts of plant-based dietary patterns on both environmental parameters and health (e.g., if land use is reduced for a particular diet, is cancer risk also reduced?); and 3) to determine where sufficient data exist for meta-analyses, in addition to identifying gaps within the literature.

METHODS

Global peer-reviewed studies on the environmental impacts of plant-based diets were searched in Ovid MEDLINE, EMBASE, and Web of Science. After removing duplicates, the screening identified 1553 records. After 2 stages of independent review by 2 reviewers, 65 records met the inclusion criteria and were eligible to be used in synthesis.

RESULTS

Evidence suggests that plant-based diets may offer lower greenhouse gas emissions (GHGEs), land use, and biodiversity loss than offered by standard diets; however, the impact on water and energy use may depend on the types of plant-based foods consumed. Further, the studies were consistent in demonstrating that plant-based dietary patterns that reduce diet-related mortality also promote environmental sustainability.

CONCLUSIONS

Overall, there was agreement across the studies regarding the impact of plant-based dietary patterns on GHGE, land used, and biodiversity loss despite varied plant-based diets assessed.

Nutrition and its footprints: Using environmental indicators to assess the nexus between sustainability and food

Current food systems are associated with the unsustainable use of natural resources; therefore, rethinking current models is urgent and is part of a global agenda to reach sustainable development. Sustainable diets encompass health, society, economy, culture as well as the environment, in addition to considering all the stages that make up the food production chain. This study aimed to perform a review on the importance of using environmental footprints (EnF) as a way of assessing the environmental impacts of food systems. The most used EnF to assess impacts related to the food system was the carbon footprint, followed by the water footprint, and the land use footprint. These EnF usually measured the impacts mainly of the current diet and theoretical diets. Animal-source foods were the ones that most contribute to the environmental impact, with incentives to reduce consumption. However, changing dietary patterns should not be restricted to changing behavior only, but should also involve all stakeholders in the functioning of food systems. We conclude that EnF are excellent tools to evaluate and guide the adoption of more sustainable diets, and can be applied in different contexts of food systems, such as food consumption analysis, menu analysis, food waste, and inclusion of EnF information on food labels.

Nutritionally adequate and environmentally respectful diets are possible for different diet groups: an optimized study from the NutriNet-Santé cohort

BACKGROUND

Research has shown that vegetarian diets have a low environmental impact, but few studies have examined the environmental impacts and nutritional adequacy of these diets together, even though vegetarian diets can lead to nutritional issues.

OBJECTIVES

Our objective was to optimize and compare 6 types of diets with varying degrees of plant foods (lacto-, ovolacto-, and pescovegetarian diets and diets with low, medium, and high meat content) under nutritional constraints.

METHODS

Consumption data in 30,000 participants were derived from the French NutriNet-Santé cohort using an FFQ. Diets were optimized by a nonlinear algorithm minimizing the diet deviation while meeting multiple constraints at both the individual and population levels: nonincrease of the cost and environmental impacts (as partial ReCiPe accounting for greenhouse gas emissions, cumulative energy demand, and land occupation, distinguishing production methods: organic and conventional), under epidemiologic, nutritional (based on nutrient reference values), and acceptability (according to the diet type) constraints.

RESULTS

Optimized diets were successfully identified for each diet type, except that it was impossible to meet the EPA (20:5n-3) + DHA (22:6n-3) requirements in lacto- and ovolactovegetarians. In all cases, meat consumption was redistributed or reduced and the consumption of legumes (including soy-based products), whole grains, and vegetables were increased, whereas some food groups, such as potatoes, fruit juices, and alcoholic beverages, were entirely removed from the diets. The lower environmental impacts (as well as individual indicators) observed for vegetarians could be attained even when nutritional references were reached except for long-chain n-3 (omega-3) fatty acids.

CONCLUSIONS

A low-meat diet could be considered as a target for the general population in the context of sustainable transitions, although all diets tested can be overall nutritionally adequate (except for n-3 fatty acids) when planned appropriately.This trial was registered at clinicaltrials.gov as NCT03335644.

Feeding children with environmentally based dietary guidelines: The Nitrogen Footprint of school lunch menus adhering to the Spanish dietary guidelines

It is at an early development stage the best opportunity for a society to learn the concepts of sustainable production and consumption. Schools can serve as effective and efficient ways for this purpose. This work quantifies the Nitrogen Footprint (NF) of twelve school menus developed following the Spanish dietary guidelines. The analysis considers six fall school menus and six spring school menus for 7 to 12 years old children. Fall menus present higher NF than spring menus, being on average 23 g N and 19 g N, respectively. This is mainly due to the presence of beef dishes in fall menus, which significantly increase the production NF. Menus including non-meat protein sources, such as legumes, exhibit the lowest N pollution. Menus with beef dishes remain the most intensive menus for fall and spring in terms of N pollution and energy intake, being 0.04 g N/kcal. The highest contributing stage to the total NF is the production (92.6 %), followed by consumption (5.8 %), while the distribution and cooking stages present lower contributions. In order to improve the overall NF, some reduction strategies are: (1) substitution of beef with other animal meat sources, (2) substitution of beef with non-meat sources, (3) improvement of wastewater treatment efficiency, and (4) recycling non-edible food. Substituting beef with non-meat sources achieves the highest reduction (76 %) compared to the total NF of the school menus. It is recommendable to include environmental aspects related to N emissions within the school guidelines in order to provide practical information to policymakers and guide-users.

Blue carbon accounting as metrics to be taken into account towards the target of GHG emissions mitigation in fisheries

The adoption of the 2030 Agenda for Sustainable Development must address the balance between sustainable growth and tackling climate change. In this context, forests can help to reduce greenhouse gas (GHG) emissions, unfortunately, equivalent solutions in the ocean are often overlooked. Moreover, the complexity in determining the real impact of fishing on the environment is not a trivial issue. Thus, the aim of this study is to broaden the scope and analyse, for the first time, the entire carbon cycle associated with the life cycle of a fish: Scomber scombrus from a fishery located in the Cantabrian Sea (Spain). From this carbon cycle assessment, it is estimated that fishing activity has prevented 871.7 t of carbon (in terms of blue carbon) from being sequestered each year. This value comes from the fraction of fish that would have died of natural causes if they had not been caught, reaching the seabed, and undergoing remineralisation processes of the carbon content of their bodies. Beyond these results, it is vital to implement a series of actions with the aim of counteracting the amount of carbon that could have been sequestered on the seabed by the natural death of the fishes if they had not been caught. To this end, it is shown that the implementation of technical improvements to the vessels, the replacement of the current fuel used and the rearrangement of shipping routes in combination with an extension in the closed fishing season and a commitment to an omnivorous diet, allows for a reduction in carbon flow of almost 90 % of the blue carbon that has been prevented from being sequestered by fisheries. A consequential approach can then identify the influence of the proposed changes on their corresponding carbon flows for use as decision criteria in regulating fisheries and environmental management policies.

A Comparison of the Mediterranean Diet and Current Food Patterns in Italy: A Life Cycle Thinking Approach for a Sustainable Consumption

The transition toward more sustainable food systems, which already represents a central element of the European Farm to Fork and Green Deal strategies, could be an effective measure to contribute to global decarbonization and greenhouse gas (GHGs) reduction goals; concurrently, it could improve the health status and nutrition of the global population. In this context, the Mediterranean diet (MD) could play a considerable role, as it is generally recognized as a more balanced, healthy, and sustainable eating pattern than Western consumption patterns, which are characterized by excess food and high energy content, thus causing undesirable effects on both human health and the environment. Although traditionally linked to MD, Italy sees relatively moderate adherence by its citizens, as they consume about +75% of the daily caloric intake recommended by MD. Therefore, this study aims to quantitatively assess the potential environmental, economic, and health impacts of this lower adherence to MD by Italians. Current Italian Food Patterns (CIFP) in 2019 were analyzed and compared to the MD recommended amounts through a Life Cycle Thinking (LCT) approach (LCA) and carbon footprint (CF) analysis. The results show that CIFP, compared to MD, has +133% greater impacts on the environmental macro-area, +100% greater impacts on the human health macro-area, and +59% greater impacts on the economic macro-area (with annual fossil and mineral resource savings of $53.35 per person, $3.2 billion per year). The analysis also shows that CIFP has a CF of 6.54 × 101 kg CO2 eq, +142% over MD (2.7 × 101 kg CO2 eq), resulting in a lower environmental impact of the Mediterranean diet.

Co-benefits of the EAT-Lancet diet for environmental protection in the framework of the Spanish dietary pattern

The immediate need to build resilient food systems with lower greenhouse gas (GHG) emissions and protection of water resources is a global challenge. To address this, the EAT-Lancet Commission described the global reference diet with principles of nutritional quality and environmental sustainability. With this in mind, the carbon and water footprints of the current Spanish dietary pattern have been compared with the EAT-Lancet global dietary recommendations, taking into account deviations in food intake. To provide additional context, differences between the average Spanish dietary pattern and dietary guidelines applied in other countries in Europe (Italy, the Netherlands and the Mediterranean region) and America have also been analyzed and discussed from a sustainability approach. We found that the EAT-Lancet diet requires less water resources (3056 L·person^-1·day^-1) and lower level of GHG emissions (2.13 kgCO₂eq·person^-1·day^-1) in comparison with the Spanish dietary pattern (3732 L·person^-1·day^-1 and 3.62 kgCO₂eq·person^-1·day^-1, respectively). Starch-based products and oils and fats were identified as largest contributors to both environmental indicators in the EAT-Lancet diet. On the other hand, meat and dairy were the environmental hotspots in the Spanish dietary pattern. Comparison with other food-based dietary patterns also raises environmental concerns about the high meat consumption in Spain. Overall, this analysis suggests that reducing the consumption of beef meat and dairy to a level in line with the global environmental targets set by the EAT-Lancet Commission would ensure a shift in Spanish dietary habits towards more environmentally sustainable food consumption patterns.

Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care

Background

Depression symptoms are prevalent in the general population, and their onset and continuation may be related to biological and psychosocial factors, many of which are related to lifestyle aspects. Health promotion and lifestyle modification programmes (LMPs) may be effective on reducing the symptoms. The objective of this study was to analyse the clinical effectiveness of a LMP and a LMP plus Information and Communication Technologies, when compared to Treatment as Usual (TAU) over 6 months. The interventions were offered as an adjuvant treatment delivered in Primary Healthcare Centers (PHCs) for people with depression symptoms.

Methods

We conducted an open-label, multicentre, pragmatic, randomized clinical trial. Participants were recruited from several PHCs. Those participants visiting general practitioner for any reason, who also met the inclusion criteria (scoring 10 to 30 points on the Beck II Self-Applied Depression Inventory) were invited to take part in the study. TAU+LMP consisted of six weekly 90-min group sessions focused on improving lifestyle. TAU+LMP + ICTs replicated the TAU+LMP format, plus the addition of a wearable smartwatch to measure daily minutes walked and sleep patterns. A total of 188 participants consented to participate in the study and were randomized. We used linear mixed models, with a random intercept and an unstructured covariance to evaluate the impact of the interventions compared to TAU.

Results

Both interventions showed a statistically significant reduction on depressive symptoms compared to TAU (TAU+LMP vs. TAU slope difference, b = −3.38, 95% CI= [−5.286, −1.474] p = 0.001 and TAU+LMP+ICTs vs. TAU slope difference, b = −4.05, 95% CI = [−5.919, −2.197], p < 0.001). These reductions imply a moderate effect size. In the TAU+LMP+ICTs there was a significant increase regarding minutes walking per week (b = 99.77) and adherence to Mediterranean diet (b = 0.702). In the TAU+LMP there was a significant decrease regarding bad sleep quality (b = −1.24).

Conclusion

TAU+LMPs administered in PHCs to people experiencing depression symptoms were effective on reducing these symptoms compared to TAU. They also have a positive impact on changing several lifestyle factors. These findings indicate that these interventions can be promising strategies for PHCs.

Sustainability Dimensions of the Mediterranean Diet: A Systematic Review of the Indicators Used and Its Results

The concern about sustainability is growing and the Mediterranean diet has been extensively identified as a promising model, with benefits for human and environmental health. This systematic review aims to identify and describe the indicators that have been used to evaluate the sustainability of the Mediterranean diet and the results from their application. A methodology using PRISMA guidelines was followed, and searches were performed in Web of Science, PubMed, Scopus, and GreenFile. A total of 32 studies assessing the sustainability of the Mediterranean diet were identified. Twenty-five of these studies quantified the environmental impact, 7 studies evaluated the nutritional quality, and 12 studies assessed the daily cost of this dietary pattern. A total of 33 distinct indicators were identified, of which 10 were used to assess the environmental dimension (mainly, carbon, water, and ecological footprint), 8 were used to assess the nutritional dimension (mainly Health score and Nutrient Rich Food Index), 1 was used to assess the economic dimension (dietary cost), and 8 used combined indicators. The remaining 6 indicators for the assessment of sociocultural dimension were only identified in 1 study but were not measured. The Mediterranean diet had a lower environmental impact than Western diets and showed a carbon footprint between 0.9 and 6.88 kg CO2/d per capita, a water footprint between 600 and 5280 m3/d per capita, and an ecological footprint between 2.8 and 53.42 m2/d per capita. With regard to the nutritional dimension, the Mediterranean diet had a high nutritional quality and obtained 122 points on the Health score and ranged between 12.95 and 90.6 points on the Nutrient Rich Food Index. The cost of the Mediterranean diet is similar to other diets and varied between 3.33 and 14.42€/d per capita. These findings show that no uniformity in assessing the MDiet's sustainability exists.

Epigenetic Effects of Healthy Foods and Lifestyle Habits from the Southern European Atlantic Diet Pattern: A Narrative Review

Recent scientific evidence has shown the importance of diet and lifestyle habits for the proper functioning of the human body. A balanced and healthy diet, physical activity, and psychological well-being have a direct beneficial effect on health and can have a crucial role in the development and prognosis of certain diseases. The Southern European Atlantic diet, also named the Atlantic diet, is a unique dietary pattern that occurs in regions that present higher life expectancy, suggesting that this specific dietary pattern is associated with positive health effects. In fact, it is enriched with nutrients of high biological value, which, together with its cooking methods, physical activity promotion, reduction in carbon footprint, and promoting of family meals, promote these positive effects on health. The latest scientific advances in the field of nutri-epigenetics have revealed that epigenetic markers associated with food or nutrients and environmental factors modulate gene expression and, therefore, are involved with both health and disease. Thus, in this review, we evaluated the main aspects that define the Southern European Atlantic diet and the potential epigenetic changes associated with them based on recent studies regarding the main components of these dietary patterns. In conclusion, based on the information existing in the literature, we postulate that the Southern European Atlantic diet could promote healthy aging by means of epigenetic mechanisms. This review highlights the necessity of performing longitudinal studies to demonstrate this proposal.

Organizational Behavior in Green Supply Chain Integration: Nexus Between Information Technology Capability, Green Innovation, and Organizational Performance

Stakeholder pressure and public awareness of environmental protection drive organizations to improve environmental practices in the supply chain (SC), such as green supply chain integration (GSCI) and green innovation (GI). The use of information technology (IT) is crucial to manufacturing organizations' GSCI and performance. However, the research on the relationship between IT capabilities, GSCI, GI and organizational performance is still limited. Therefore, empirical research is needed on the cognitive thinking of employees using IT capabilities to improve GSCI and organizational performance. The data for this study comes from SC personnel in manufacturing organizations through a structured questionnaires and was analyzed by employing structural equation modeling. Based on the results, this paper concludes that organizational IT capabilities positively affect the GSCI and improve organizational performance (environmental and operational performance). Furthermore, the study discovered that GI increases organizational performance and acts as a positive mediator in the link between GSCI and performance. The findings contribute to existing GSCI and GI knowledge, which can provide a bird's eye-view to develop an organization's IT capabilities to achieve competitive performance goals.

Whether Green Finance Can Effectively Moderate the Green Technology Innovation Effect of Heterogeneous Environmental Regulation

As an essential way to promote ecological civilization, green finance is attracting wide attention. However, whether green finance can successfully regulate the green technology innovation effect of heterogeneous environmental regulations and boost green technology innovation in coordination with heterogeneous environmental regulations remains unclear. Based on the re-measurement of the green finance development index of various provinces and cities in China, this study uses the spatial Durbin model to test the above problems empirically. The results show that green finance and "market incentive" environmental regulations can promote regional green technology innovation, while "command and control" environmental regulations inhibit regional green technology innovation. Green finance plays a negative regulatory role in the mechanism of heterogeneous environmental regulations affecting green technology innovation. Green finance alleviates the negative impact of "command and control" environmental regulations on green technology innovation and weakens the positive impact of "market-incentive" environmental regulations on green technology innovation. In terms of spillover effects, green finance can effectively promote green technology innovation in neighboring regions, while heterogeneous environmental regulations have a crowding-out effect on green technology innovation in neighboring regions.

Diffusion Path Identification of Public Opinion Involving Enterprise Green Technology Adoption: An Interpretive-Structural-Modeling-Based Approach

With the increasing information transparency of business operations' environmental influences, public opinion plays an important role in the green technology adoption of enterprises. Identifying the diffusion path of public opinion involving the process of enterprise green technology adoption is a significant task to verify the triggering mechanisms among the external factors and internal ones. An appropriate framework may help to clarify how the sustainability elements of public opinion are introduced to green technology adoption. Therefore, an interpretive structural-modeling (ISM)-based approach was applied to explore the basic transmission process and path of public opinion involving green technology adoption in enterprise practices. From the pressure of public opinion to the stakeholders involved, as well as the corresponding operational environmental activities, this study explored the psychological behavior of internal and external stakeholders and tried to clarify what the driving elements of green technology adoption are and how they relate to each other. Based on the field data collected from practitioners with Chinese contextual experience, the driving elements of the enablers of green technology adoption by enterprises were identified, and the fundamental triggering mechanisms of the public opinion pressure among them were analyzed. Thereafter, the influence of internal and external stakeholders involving green technology adoption and their corresponding behaviors under the pressure of public opinion were determined and expounded comprehensively, which illustrates the diffusion path of how public opinion influences the operational green technology adoption. This may narrow the gap between public environmental expectation and business operations. Finally, the managerial implications and the limitations of this study were concluded. The explanatory corresponding ISM model established in this study enriches the literature on the theoretical research of the mechanisms of green technology adoption.

Driving commitment to sustainable food policies within the framework of American and European dietary guidelines

Diet and nutrition are essential factors in promoting good health throughout life. Their role as determinants of chronic non-communicable diseases is widely recognized. Additionally, the demand for food involves relevant environmental burdens that have to be taken into account on the way to achieving the Sustainable Development Goals. As an important part of nutrition policy, food-based dietary guidelines (FBDGs) have been revised. The key question is: Are environmental considerations being incorporated into them? To address this issue, we modeled and compared both the main environmental indicators in terms of carbon footprint (CF) and water footprint (WF), and nutritional quality (according to the Nutrient Rich Diet index, NRD9.3 and a health gain score) of dietary guidelines from Northern and Southern Europe and America. Particularly, the FBDGs compared were Dutch Dietary Guidelines (DDG), New Nordic Diet (NND), Spanish Strategy for Nutrition, Physical Activity and Obesity Prevention (NAOS), Mediterranean Diet (MD), Italian Dietary Guidelines (IDG) and American Dietary Guidelines (DGA). The IDG and MD offered the best profiles from a climate change perspective (2.04 and 2.21 kgCO₂eq·day^-1). Overall, DGA had the highest CF (2.98 kgCO₂eq·day^-1). WF presented greater fluctuations, not only due to daily-recommended amounts, but also because of different climate conditions and production systems of the reference countries. Hence, WF ranged from 1760 L·person^-1·day^-1 in IDG to 3181 L·person^-1·day^-1 in NAOS. Finally, the nutritional value of MD, which had the highest NRD9.3 (477) and health gain score (178), has been demonstrated when the comparison was made with DDG, the one with the lowest health gain score (97) and DGA, the worst in terms of NRD9.3 (391). To go ahead of the FBDGs that bet on all dimensions of sustainability, multi-criteria analysis is needed. Nutrition and environmental performance are not the only aspects of the problem; economy and sociocultural variables should be considered.

Assessment of the Methodology That Is Used to Determine the Nutritional Sustainability of the Mediterranean Diet-A Scoping Review

Mediterranean diet (MedDiet) is often used as an example of a sustainable diet that promotes a sustainable food system. MedDiet presents low environmental impacts, is characterized by high sociocultural food values, allows for positive local economic returns, and presents major health and nutrition benefits. Previous studies have not systematically examined the methodological assessment of MedDiet nutritional sustainability. In our study, we review the methodological assessment of nutritional sustainability, filling a crucial gap in the literature that can inform the state of the art regarding the cross-disciplinary assessment of MedDiet nutritional sustainability. Through a systematic search on PubMed and Scopus, we identified 28 studies, published between 2013 and 2021, that dealt with the MedDiet nutritional sustainability. Studies that assessed the sustainability of MedDiet based on dietary consumption data, studies that explored the MedDiet sustainability resorting to dietary scenarios, and studies with a mixed approach (dietary consumption and dietary scenarios) and proposals of methodological approaches to assess the MedDiet nutritional sustainability were summarized. We identified 24 studies exploring the dimensions of nutritional sustainability of the MedDiet, and 4 proposing the methodological approaches to assess the MedDiet nutritional sustainability or the sustainability of MedDiet typical agro-foods. From the 24 studies exploring the sustainability of MedDiet, none fully addressed the complexity of the four dimensions of nutritional sustainability (environmental, economic, socio-cultural, and health-nutrition). One of the methodological proposals to assess the MedDiet nutritional sustainability contemplated on the four dimensions of nutritional sustainability, as well as one of the methodological proposals to assess the sustainability of typical agro-foods of MedDiet. Environmental sustainability was the most well-studied dimension, while no study focuses on the socio-cultural dimension of sustainability. Our study reviewed for the first time the assessment of nutritional sustainability of MedDiet. To the best of our knowledge, no research has been made assessing MedDiet in all the dimensions of the complex concept, that is nutritional sustainability. Integrating health and nutrition, environmental, economic, and socio-cultural considerations across scales and contexts can offer a more complete understanding of the opportunities and barriers to achieving nutritional sustainability not only in MedDiet but also in other dietary patterns and food products.

Changes in Dietary Patterns through a Nutritional Intervention with a Traditional Atlantic Diet: The Galiat Randomized Controlled Trial

Unhealthy dietary patterns (DPs) can lead to cardiovascular and other chronic diseases. We assessed the effects of a community-focused intervention with a traditional Atlantic diet on changes in DPs in families and the associations of these changes with weight loss. The Galiat study is a randomized, controlled trial conducted in 250 families (720 adults and children) and performed at a primary care setting with the cooperation of multiple society sectors. Over 6 months, families randomized to the intervention group received educational sessions, cooking classes, written supporting material, and foods that form part of the Atlantic diet, whereas those randomized to the control group followed their habitual lifestyle. At baseline, five DPs that explained 30.1% of variance were identified: “Caloric”, “Frieds”, “Fruits, vegetables, and dairy products”, “Alcohol”, and “Fish and boiled meals.” Compared to the controls, the intervention group showed significant improvements in “Fruits, vegetables, and dairy products” and “Fish and boiled meals” and reductions in the “Caloric” and “Frieds”. Changes in bodyweight per unit increment of “Frieds” and “Fruits, vegetables, and dairy products” scores were 0.240 kg (95% CI, 0.050–0.429) and −0.184 kg (95% CI, −0.379–0.012), respectively. We found that a culturally appropriate diet improved DPs associated with weight loss.

Assessment of environmental and economic aspects of household food waste using a new Environmental-Economic Footprint (EN-EC) index: A case study of Daegu, South Korea

While the global food demand has continued to increase, the enormous natural resources required for its production are limited, in addition to the accompanying environmental degradation. Despite all these, food waste generation continues unabated, especially at the household level, further compounding the environmental impacts, economic cost, and food security issues. In this study, granular primary data of edible household food waste using direct-weighing from 218 households in Daegu, South Korea was used to assess the environmental (carbon footprint, and water footprint) and economic (wasted cost) impacts associated with their wastage. For the first time, the Environmental-Economic (EN-EC) Footprint index is proposed as a single indicator for environmental and economic impacts to assess the hotspot food waste products among the selected 42 major food waste items. This study presents that the selected food products had a significant contribution to an average edible food waste generation of 0.73 ± 0.06 kg (per household/day), 0.71 ± 0.05 kg CO₂eq of GHG emissions, 0.46 ± 0.04 m³ of water footprint, and 3855.93 ± 527.27 won of economic loss, respectively. Based on the newly developed EN-EC Footprint index, we found that wasted animal-based food products had relatively high environmental and economic losses compared to non-animal-based food products. The findings of this study presented a novel method of estimating combined environmental and economic impacts associated with household food waste, which may further act as convenient guides for the waste management authorities and policymakers in addressing the mitigation of household food waste impacts.

Exploring Sustainable Food Choices Factors and Purchasing Behavior in the Sustainable Development Goals Era in Spain

The aim of the present study was (1) to investigate what consumers include within the concept of food sustainability and its link with sustainable consumption, by identifying meaningful consumer typologies from the concept of food sustainability and food choice factors framed by SDG 12, and (2) to know how different farm systems attributes affecting purchase behavior are associated with such typologies. Consumers from two Spanish regions (n = 403) answered a paper questionnaire to know their degree of knowledge of sustainability, and beliefs, behavior, attitudes and preferences towards food sustainability, and the importance given to product characteristics and shopping practices. A principal component analysis was conducted to identify groups with similar answers, to average some of the questions before the final analysis of variance, which includes demographic classes as fixed effects. A cluster analysis using the most representative questions identified two clusters. cluster 1 (68.4%) responded to more sustainability-related attributes, and cluster 2 (31.5%) presented a less-expanded concept of sustainability. The origin of the product and quality certification (local, organic) was important for food purchase practices. The place of residence and gender differences of the consumers were the most influential factors. In the conjoint study, regarding the purchase of Iberian pork, cluster 1 remained unwilling to sacrifice outdoor systems and local breed at the expense of the price, in the case of the Iberian pig production. The most important demographic differentiator was the region of residence of the consumer. In conclusion, consumers are not aware of the wider aspects included in the sustainability concept. Moreover, the concept of sustainability elicits different meanings to the segments of the consumers identified.

Environmental assessment of menus for toddlers serviced at nursery canteen following the Atlantic diet recommendations

Menus served at public services can be considered as a good opportunity for consumers to demand a service that ensures healthy and environmentally friendly food. It is especially in the sector of nurseries and schools, where these demands make the most sense since they call for the protection of particularly vulnerable population: children. The purpose of this study is to analyze the biweekly menus served at a public Spanish nursery canteen considering the link with the two most recognized environmental indicators: the consumptive water footprint (WF) and the carbon footprint (CF). The WF and CF of the menus vary considerably between menus (619-1359 L·menu^-1 and 0.75-2.95 kg CO₂eq·menu^-1). The assessment has identified non-dairy sources of protein and dairy-based products as the key food categories in all menus. Menus with more meat (mostly beef) and dairy products (mainly cheese) were associated with higher impacts. That is, the average impact of menus with beef is about 2 times greater than the one of all other menus. The distribution and cooking stages presented negligible contributions in terms of greenhouse gases emissions, mainly due to the consumption of local/regional products and low-energy intensive cooking techniques. The most important strategy for reducing environmental impacts is based on reducing the frequency of consumption of beef, so that poultry and lean pork are consumed alternately. This reduction should not compromise the necessary protein intake for toddlers. Attention should also be paid to afternoon snacks that are rich in cold meat and dairy products. Considering these issues, significant reductions in WF and CF indicators could be achieved, up to 550 L·menu^-1 and 0.70 kg CO₂eq·menu^-1. Since eating habits introduced at an early stage are more likely to develop into adult behaviour, children canteen services are an excellent opportunity to promote healthy eating habits in children and their families.

Effects of a Community-Based Behavioral Intervention with a Traditional Atlantic Diet on Cardiometabolic Risk Markers: A Cluster Randomized Controlled Trial ("The GALIAT Study")

The Atlantic diet, the traditional dietary pattern in northern Portugal and northwest Spain, has been related to metabolic health and low ischemic heart disease mortality. The Galiat Study is a randomized controlled trial aimed to assess the effects of the Atlantic diet on anthropometric variables, metabolic profile, and nutritional habits. The dietary intervention was conducted in 250 families (720 adults and children) and performed at a primary care center. Over six months, families randomized to the intervention group received educational sessions, cooking classes, written supporting material, and foods that form part of the Atlantic diet, whereas those randomized to the control group followed their habitual lifestyle. 213 families (92.4%) completed the trial. Adults in the intervention group lost weight as opposed to controls who gained weight (adjusted mean difference -1.1 kg, p < 0.001) and total serum cholesterol (adjusted mean difference -5.2 mg/dL, p = 0.004). Significant differences in favor of the intervention were found in other anthropometric variables and low-density lipoprotein cholesterol, but changes in triglycerides, high-density lipoprotein cholesterol, inflammation markers, blood pressure, and glucose metabolism were not observed. A family-based nutritional intervention based on the Atlantic diet showed beneficial effects on adiposity and the lipid profile.

Tracking the environmental footprints of institutional restaurant service in nursery schools

When dietary habits are analyzed in the framework of school catering services, nutritional indicators are essential criteria in the definition of menus, but attention should also be paid to the associated environmental impacts. It is especially relevant to assess food patterns in nursery schools when consumption habits are most strongly implemented, and they must be healthy and sustainable. With the aim of evaluating the main environmental indicators: Carbon and water footprints (CF and WF), ten menus consisting of lunch and afternoon snack were evaluated, which comprise a wide range of food categories (fruits and vegetables, starch-based products, milk and milk products, non-dairy sources of protein, and others). The CF of the menus varied considerably according to their composition, with beef-rich menus having the worst profile (up to 2.24 kg CO₂/menu and 0.39 kg CO₂/100 kcal). Regarding the WF, meals rich on animal-based products also entailed water implications and mainly associated with the consumption of beef. Green WF and blue WF are responsible for 88% of the contributions to this indicator, on average. The WF indicator reaches up to 1271 L·menu^-1 and 223 L/100 kcal for a menu containing beef meat. This study confirms the effect on CF and WF from animal-based products, specifically beef meat and dairy products. The findings of the study can be useful to make recommendations not only to consumers on reducing the environmental impacts from food production and consumption, but also to design balanced menus with better environmental scores based on the combination of low and high footprint food products, always providing the necessary energy and nutrients, an unquestionable issue in toddlers and pre-school children whose need to follow balanced and healthy diets, being meat an important foodstuff.

Reshaping the Traditional Pattern of Food Consumption in Romania through the Integration of Sustainable Diet Principles. A Qualitative Study

The Romanian traditional pattern of food consumption as a whole is no longer a reference point in shaping a healthy and sustainable food behavior due to the growing discrepancies between the return to traditions and the constraints of sustainable development, so the aim of this study is to provide solutions for reshaping the food pattern by incorporating the principles of sustainable diet. The research conducted is based on qualitative data and the semi-structured interview was used as method of data collection from a sample of 21 Romanians traditional food consumers. The study led to a typology of respondents that combines two consumption orientations, “healthy” and “convenience”, with two attitudes towards traditional diet, “hedonism” and “conformism”. Although respondents do not completely reject the idea of flexitarianism, they showed the tendency for overconsumption of meat-based traditional foods and a weak concern for environmental sustainability. For these reasons, a set of recommendations for a new model of sustainable diet for Romanian population, focused on the relationship between traditionality, sustainability, and health, was put forward. The research findings show the need for supporting nutritional education programs and extensive information campaigns targeted at Romanian consumers to encourage the adoption of flexitarian style and the switch to a more sustainable diet in the near future.