Co-benefits from sustainable dietary shifts for population and environmental health: an assessment from a large European cohort study

Co-creating innovative and accepted legume-based dishes for school canteens with adolescents in a low socioeconomic area

The promotion of sustainable diets, that valorise and give stage to plant-based foods, is beneficial for both human and environmental health. Adolescence is crucial to support healthy and sustainable eating. Despite this, adolescents remain an understudied group, especially those with a lower economic status. This study aimed to develop innovative, sustainable and healthy legume-based dishes for school canteens through co-creation with adolescents in a low socioeconomic status area with high immigration rate. Nineteen adolescents and four chefs participated in iterative sessions of focus group discussions using a combination of methods (Jobs-To-Be-Done, free association tasks, SCAMPER (Substitute-Combine-Adapt-Modify-Purpose-Eliminate-Rearrange) technique) to identify ideas of new legume-based dishes. Subsequently, 91 adolescents rated their willingness-to-try 28 dish concepts based on these ideas. Six concepts were selected and translated into prototypes that underwent further evaluation by 138 adolescents who assessed their liking, sensory and emotional responses. Results showed that all dishes were well-received, with lower acceptance among high-neophobic adolescents, yet none of the selected dishes were rejected. Exploring individual differences in liking identified two clusters with different hedonic patterns. Emotional characterization of dishes showed those that elicit positive emotional responses high in arousal and novelty in all adolescents, independently from food neophobia, increasing their likelihood of acceptance. The study shows that co-creation with adolescents, in combination with understanding individual differences, are promising strategies to develop innovative, healthy and well-received legume-based dishes for school canteens.

Examining the link between adherence to the planetary health diet pattern and mortality in the us: a prospective cohort study

BACKGROUND

Though the Planetary Health Diet (PHD) is designed to enhance both human and environmental health, there is limited understanding of how adherence to PHD influences the risk of mortality in the general US adult population. This study aimed to evaluate the relationship between the Planetary Health Diet Index for the United States (PHDI-US) and mortality among adults in the overall population of the United States.

METHODS

The PHDI-US comprises 16 components, assigned scores ranging from 0 to 150, with higher scores signifying a greater level of adherence to the PHD. Data were obtained from the National Health and Nutrition Examination Survey spanning 2005 to 2018, with mortality data linked through December 2019.

RESULTS

This study encompassed 30,521 participants (mean [SD] age, 47.02 [17.01] years; 14,817 males [48.0%]). Over an average follow-up period of 8.50 years, there were 3,706 recorded deaths. In the adjusted multivariable model, individuals in the highest quintile of PHDI-US exhibited a reduced risk of all-cause mortality (hazard ratio [HR], 0.64; 95% CI, 0.54-0.75), cardiovascular disease mortality (HR, 0.73; 95% CI, 0.55-0.97), cancer mortality (HR, 0.68; 95% CI, 0.52-0.89), and other-cause mortality (HR, 0.58; 95% CI, 0.46-0.72) compared to those in the lowest quintile.

CONCLUSION

Adherence to a PHD pattern was associated with lower mortality risk in the general US adult population.

The climate emergency for rheumatologists: where do we stand?

Climate change and pollution are a major existential threat. Healthcare contributes a noteworthy 4-6% to the total carbon footprint and 5-7% of the total greenhouse gas (GHG) emissions. Environmental pollution and modern lifestyles are also contributing to the increased prevalence of autoimmune and lifestyle-related rheumatic disease. In this review, we assess both the effects of rheumatological practice on climate change and the potential impact of climate change on rheumatological diseases. Preliminary evidence suggests that climate change is linked with the inception or exacerbation of some of the autoimmune and inflammatory rheumatic diseases (AIRDs) like rheumatoid arthritis, lupus, systemic sclerosis, and reactive arthritis. Furthermore, with rampant industrialization and pollution, emerging infections such as Dengue, Zika virus, and chikungunya have emerged as triggers of inflammatory arthritis. Strategies at different levels are proposed to mitigate the effect of the healthcare industry and the community on the environment. The rheumatology community can acknowledge and begin to address the challenges of climate change and health.

How Sustainable Are Hospital Menus in the United Kingdom? Identifying Untapped Potential Based on a Novel Scoring System for Plant-Based Provisions

BACKGROUND

Adopting plant-forward diets is essential for achieving climate targets. As the second-largest provider of public sector meals in the UK, the National Health Service (NHS) can significantly reduce its environmental impact by transitioning to plant-forward menus, contributing to its goal of being a net-zero healthcare service by 2045. This study evaluates the extent to which NHS hospitals currently align with sustainable practices by assessing the plant-forward nature of in-patient menus.

METHODS

Green Plans from 40 hospital trusts were analysed to assess commitment to plant-forward, lower-emission menus. Freedom of Information requests were sent to 50 NHS trusts, and 36 menus from the spring/summer season of 2024 were analysed. A novel scoring system was developed to assess the hospital menus, with subscores reflecting the availability of plant-based meals, ruminant-meat meals, and menu strategies to encourage plant-forward choices.

RESULTS

Green Plans showed limited commitment to increasing plant-based food options. Hospital menus scored poorly overall (average score of 20/100, range: 9-38). The lowest subscores were observed in the provision of fully plant-based meals and nudging techniques. The provision of ruminant meat varied (subscore range: 0-100) and all hospitals included processed meat on their menu. Hospitals with outsourced catering scored higher than those with in-house catering.

CONCLUSION

Despite national recommendations to shift towards plant-forward diets, NHS hospitals currently show little commitment and provide limited offerings in this regard. The novel scoring system offers a practical framework for monitoring progress and guiding hospitals towards environmentally sustainable, plant-forward menus.

Association between the EAT-Lancet Diet, Incidence of Cardiovascular Events, and All-Cause Mortality: Results from a Swiss Cohort

BACKGROUND

An unhealthy diet is a major contributor to several noncommunicable diseases, including cardiovascular diseases, the leading cause of death worldwide. Additionally, our food system has significant impacts on the environment. The EAT-Lancet Commission has recommended a healthy diet that preserves global environmental resources.

OBJECTIVES

This prospective study aimed to evaluate the associations between adherence to the EAT-Lancet diet and the incidence of cardiovascular events and all-cause mortality in a Swiss cohort.

METHODS

We analyzed data from the CoLaus/PsyCoLaus cohort study (N = 3866). Dietary intake was assessed using a semiquantitative food frequency questionnaire. The EAT-Lancet adherence score was calculated based on the recommended intake and reference intervals of 12 food components, ranging from 0 to 39 points. Participants were categorized into low-, medium-, and high-adherence groups according to score tertiles. We used Cox Proportional Hazards regressions to assess the association among diet adherence, incident cardiovascular events, and all-cause mortality.

RESULTS

During a mean follow-up of 7.9 y (SD: ±2.0 y), 294 individuals (7.6%) from our initial sample experienced a first cardiovascular event, and 264 (6.8%) died. Compared with the low-adherence group, the adjusted hazard ratios for all-cause mortality were 0.88 (95% CI: 0.66, 1.17) and 0.70 (95% CI: 0.49, 0.98) for the medium-adherence and high-adherence groups, respectively (P-trend = 0.04). We observed no association between adherence groups and cardiovascular events.

CONCLUSIONS

In a Swiss cohort, high adherence to the EAT-Lancet diet is associated with a potential 30% lower risk of overall mortality. However, it is not associated with cardiovascular events.

Food groups, macronutrient intake and objective measures of total carotenoids and fatty acids in 16-to-24-year-olds following different plant-based diets compared to an omnivorous diet

BACKGROUND

Knowledge about the diet quality among youth who follow different types of plant-based diets is essential to understand whether support is required to ensure a well-planned diet that meets their nutritional needs. This study aimed to investigate how food groups, macronutrient intake, and objective blood measures varied between Norwegian youth following different plant-based diets compared to omnivorous diet.

METHODS

Cross-sectional design, with healthy 16-to-24-year-olds (n = 165) recruited from the Agder area in Norway, following a vegan, lacto-ovo-vegetarian, pescatarian, flexitarian or omnivore diet. Participants completed an electronic questionnaire, a dietary screener, 24-hour dietary recalls and provided dried blood samples for analysis of carotenoids and fatty acids.

RESULTS

Vegans reported the highest mean intake (g/d, g/MJ) of vegetables, legumes, nuts and seeds and substitutes to dairy and meat (compared to all, p<0.001), fruit and berries (compared to omnivores, p = 0.004 and pescatarians, p = 0.007), and vegetable oil (compared to omnivores, p<0.001, pescatarians, p = 0.003 and flexitarians, p = 0.004) and vegetable products (compared to omnivores, p = 0.007). No difference was found between groups in mean intake (g/d, g/MJ) of any of the confectionary foods or sweet pastries, beverages (sugar-sweetened, non-sugary, alcoholic), or salted snacks, neither in g/MJ of convenience foods. The energy percentage (E%) of protein, carbohydrates and total fat were within the Nordic Nutrition Recommendations 2023 across groups. However, all groups, except vegans, exceeded the E% for saturated fatty acids. All groups exceeded recommendations for added and free sugar. Furthermore, all groups consumed <25g/d of dietary fibre, except vegans and pescatarians. For omega-3, lacto-ovo-vegetarians had intakes below recommendations. Blood marker of total carotenoids did not differ between groups, neither did the reported mean intake (g/MJ) of carotenoid-rich foods. Vegans showed the lowest blood level of palmitic acid compared to all (p<0.001), but highest level of linoleic acid (compared to flexitarians, p = 0.022, and omnivores, p<0.001). The lowest blood levels of eicosapentaenoic acid and docosahexaenoic acid were found in vegans and lacto-ovo-vegetarians.

CONCLUSIONS

Our findings suggest that all groups had risk of dietary shortcomings. However, vegans consumed the most favorable diet. All groups should increase their consumption of vegetables, fruits and berries, and reduce their total sugar intake.

Body composition and CO2 dietary emissions

Background

The amount and quality of foods consumed not only impact on individual health, as reflected in body composition, but they could influence on greenhouse gas emissions and then, on environment.

Aim

This study aims to assess the relationship between the body composition and the CO2 emissions resulting from the dietary choices of an adult population.

Design

A cross-sectional study on baseline data from 778 participants aged 55-75 years old, with metabolic syndrome (MetS) as part of the PREDIMED-Plus study.

Methods

Food intake was registered using a validated semi quantitative 143-item food frequency questionnaire. The amount of CO2 emitted was calculated using data from the Agribalyse® 3.0.1 database. Anthropometry (body weight, height, and waist, and hip circumference, and body mass index) was determined by usual measurements, and body composition (fat mass, visceral fat, muscular mass, fat free mass, and total body water) were assessed by bioimpedance.

Results

CO2 emissions were linearly and positively associated with weight, waist circumference, visceral fat, fat free mass, total body water and energy intake.

Conclusion

Body composition is associated with dietary CO2 emissions. The higher total body water, fat free mass, and body weight, the higher the dietary CO2 emissions were, following a linear relationship.

Clinical trial registration

http://www.isrctn.com/ISRCTN89898870, ISRCTN89898870.

Dynamic Trends in Aquatic Product Supply and Consumption in China: Implications for Sustainable Diets and Environmental Impact Reduction

Aquatic foods play a pivotal role in transforming food systems. As the world's leading producer, consumer, and trader of aquatic products, China's potential for sustainable supply and consumption is critical to understand. The aim of this study was to depict the dynamic trends of aquatic products and the consequences of sustainable diets and environmental impacts. A panel dataset about Chinese aquatic products covering the period from 1952 to 2023 was drawn for analysis. Diet sustainability was assessed with the deviation from the Dietary Guidelines for Chinese Residents (2022) and EAT-Lancet recommendations. The environmental impacts of aquatic products' supply and consumption were assessed using carbon footprints and water footprints. The findings reveal that aquatic products' supply increased from 4.65 million tons to 71.16 million tons from 1978 to 2023, and annual aquatic food consumption per capita increased from 3.50 kg in 1978 to 15.20 kg. While overall supply meets consumption needs, structural imbalances persist at the provincial level. Over time, the influence of marine fishery products has declined from 1.06 million tons (63.63%) in 1952 to 35.85 million tons (50.38%) in 2023, whereas offshore aquaculture shows promising potential for meeting future supply demands (23.96 million tons in 2023, accounting for 66.82% of marine fishery production). To align with healthy dietary goals and environmentally sustainable food systems, provincial aquatic food demand across China was adjusted. The carbon footprints and water footprints of both current and adjusted consumption patterns were also assessed. The results indicate that adjusting consumption based on the Dietary Guidelines for Chinese Residents (2022) and EAT-Lancet recommendations could reduce environmental impacts to different degrees. The findings could offer valuable references and insights into developing sustainable strategies in aquatic product management and advancing food system transformation.

Modelling the cost differential between current and healthy diets according to household education level in Belgium

This study aims to estimate the cost differential between current and healthy diets, overall and by household education level. Data from the 2014-2015 Belgian National Food Consumption Survey and food prices from the 2014 GfK ConsumerScan panel were linked. The DIETCOST programme was used to model healthy, isocaloric healthy and current diets. For the reference household, the average daily diet cost was 20.1€ (95%CI: 19.9-20.4) for current diets, 20.9€ (95%CI: 20.6-21.2) for healthy isocaloric diets (+3.9% vs. the current diets) and 22.5€ (95%CI: 22.3-22.8) for healthy diets (+12.0%). In low-educated households, the cost of current and of healthy isocaloric diets was similar (19.2€ (95%CI: 19.0-19.5) vs. 19.3€ (95%CI: 19.0-19.6)), whereas in high-educated households, the cost of healthy isocaloric diets (22.0€; 95%CI: 21.8-22.3) was higher than the cost of current diets (21.2€; 95%CI: 20.9-21.4)). Though needing validation, this finding is valuable for interventions aimed at improving dietary habits in disadvantaged populations.

Integration of Multiple Climate Change Mitigation Actions and Health Co-Benefits: A Framework Using the Global Calculator

BACKGROUND

The Global Calculator is an open-source model of the world's energy, land, and food systems. It is a pioneering online calculator to project the impact of interventions to mitigate climate change on global temperature. A few studies have been conducted to evaluate the health co-benefits of climate change mitigation, though they are still fragmentary.

OBJECTIVES

Our objectives are to identify which sectors could yield the greatest results in terms of climate change mitigation and suggest whether existing evidence could be used to weight mitigation actions based on their ancillary impacts on human health or health co-benefits.

METHODS

Using the International Energy Agency (IEA) 4DS scenario as a referent (i.e., the "4-degree Celsius increase scenario"), we simulated changes in different policy "levers" (encompassing 43 potential technological and behavioral interventions, grouped by 14 sectors) and assessed the relative importance of each lever in terms of changes in annual greenhouse gas emissions in 2050 and cumulative emissions by 2100. In addition, we examined existing estimates for the health co-benefits associated with different interventions, using evidence from the Lancet Pathfinder and four other tools.

DISCUSSION

Our simulations suggest that-after accounting for demographic change-transition from fossil fuels to renewables and changes in agriculture, forestry, land use, and food production are key sectors for climate change mitigation. The role of interventions in other sectors, like carbon capture and storage (CCS) or nuclear power, is more modest. Our work also identifies mitigation actions that are likely to have large health co-benefits, including shifts to renewable energy and changes in land use as well as dietary and travel behaviors. In conclusion, some of the sectors/interventions which have been at the center of policy debate (e.g., CCS or nuclear power) are likely to be far less important than changes in areas such as dietary habits or forestry practices by 2050. https://doi.org/10.1289/EHP14906.

Emerging EAT-Lancet planetary health diet is associated with major cardiovascular diseases and all-cause mortality: A global systematic review and meta-analysis

BACKGROUND & AIMS

In 2019, the EAT-Lancet Commission promoted a plant-based diet, emphasizing its potential to enhance human health and environmental sustainability. Nevertheless, a thorough evaluation of health benefits associated with EAT-Lancet diet requires robust statistical backing. This synthesis seeks to compile evidence related to the effects of the EAT-Lancet diet on major cardiovascular disease (CVD) and mortality.

METHODS

A systematic review and meta-analysis were conducted utilizing data from MEDLINE, EMBASE, PubMed, Web of Science, and medRxiv, covering the period from January 2019 to October 8, 2024. We included all cohort and case-control studies that investigated the association between the emerging EAT-Lancet diet and outcomes such as diabetes, CVD, all-cause mortality, and cancer. Summary effect size estimates are presented as hazard ratios (HRs) and were analyzed using random-effects models. Study heterogeneity was assessed with the Q statistic and I2 statistic. Subgroup analyses were performed to identify potential sources of variability, while publication bias was evaluated using Begg's and Egger's tests. Additionally, sensitivity analyses were conducted to assess the robustness of the results.

RESULTS

We identified 28 publications that included a total of over 2.21 million participants. Adhering to the EAT-Lancet dietary patterns was negatively associated with diabetes, CVD (mortality), all-cause mortality, and cancer (mortality), with HRs of 0.78 (95 % CI: 0.65-0.92), 0.84 (95 % CI: 0.81-0.87), 0.83 (95 % CI: 0.78-0.89), and 0.86 (95 % CI: 0.80-0.92), respectively. Significant heterogeneity was observed for diabetes (I2 = 94.0 %), all-cause mortality (I2 = 85.5 %), and cancer incidence (I2 = 79.3 %). Importantly, no evidence of publication bias was found for any of the clinical outcomes analyzed. Sensitivity analyses confirmed the robustness of the results across various dietary scoring systems for CVD mortality, all-cause mortality, and cancer.

CONCLUSION

Following the EAT-Lancet diet was significantly associated with reduced odds of diabetes, CVD, cancer and mortality. These findings are clinically important, highlighting the beneficial effects of the recent EAT-Lancet diet on various health outcomes.

Alignment between greenhouse gas emissions reduction and adherence the EAT-Lancet diet: A modeling study based on the NutriNet-Santé cohort

The potential of the EAT-Lancet reference diet, which promotes a healthy diet within planetary limits, to reduce greenhouse gas emissions (GHGe) remains understudied. This study examines the role of nutritional and acceptability constraints in reducing GHGe through diet optimization, and tests the alignment between GHGe reduction and the EAT-Lancet score. The study used data from 29,413 NutriNet-Santé participants to model French diets and evaluate their environmental, nutritional, economic, and health impact. The Organic Food Frequency Questionnaire was used to assess organic and conventional food consumed, and the Dialecte database was used to estimate the diet environmental impacts. Quality of diets were also evaluated based using the PNNS-GS2 (Programme National Nutrition-Santé 2 guidelines score). When testing minimizing GHGe under strict nutritional and acceptability constraints, it was possible to reduce GHGe up to 67 % (from 4.34 in the observed diet to GHGe = 1.45 kgeqCO2/d) while improving the EAT score by 103 % with 91 % of the food as organic. Greater reductions required relaxation of some constraints. When testing maximizing EAT score under gradual reduction in GHGe, the adherence to the EAT-Lancet diet was not significantly affected by the gradual reduction in GHGe. To maximize EAT score with 75 % reduction in GHGe (1.09 kgeqCO2/d), less strict constraints on the bioavailability of iron and zinc are necessary. The EAT score improved by 141 %, while land occupation decreased by 57 %, compared to the observed value. The diet contained 94 % of organic foods. There was some alignment between the degree of adherence to the EAT-Lancet diet and the reduction in GHGe, but other diets may also lead to a strong reduction in GHGe. Thus, GHGe can be greatly reduced by dietary choices, but require profound reshaping of diets which must be coupled with changes in other areas of the food chain.

Association of the EAT-Lancet diet, serial measures of serum proteome and gut microbiome, and cardiometabolic health: a prospective study of Chinese middle-aged and elderly adults

BACKGROUND

The EAT-Lancet diet was reported to be mutually beneficial for the human cardiometabolic system and planetary health. However, mechanistic evidence linking the EAT-Lancet diet and human cardiometabolic health is lacking.

OBJECTIVES

We aimed to investigate the role of blood proteins in the association between the EAT-Lancet diet and cardiometabolic health and explore the underlying gut microbiota-blood protein interplay.

METHODS

Our study was based on a prospective cohort including 3742 Chinese participants enrolled from 2008-2013 with serum proteome data repeatedly measured ≤3 times (Nproteome = 7514) and 1195 with gut metagenomic data measured ≤2 times over 9 y (Nmicrobiota = 1695). Least absolute shrinkage and selection operator and multivariable linear regression were used to explore the associations of the EAT-Lancet diet (assessed by semi-quantitative food frequency questionnaire) with serum proteins and gut microbes. Linear mixed-effect model and logistic regression were used to examine the associations of selected proteins with 11 cardiometabolic risk factors and 4 cardiometabolic diseases, respectively. Mediation analysis was used to identify potential mediation effects. Multiple comparisons were adjusted using the Benjamini-Hochberg method.

RESULTS

The mean (standard deviation) age of enrolled participants was 58.4 (6.1) y (31.6% men). The EAT-Lancet diet was prospectively associated with 4 core proteins, including α-2-macroglobulin (A2M) (pooled β: 0.12; 95% confidence interval [CI]: 0.05, 0.2), retinol-binding protein 4 (pooled β: -0.14; 95% CI: -0.24, -0.04), TBC1 domain family member 31 (pooled β: -0.11; 95% CI: -0.22, 0), and adenylate kinase 4 (pooled β: -0.19; 95% CI: -0.3, -0.08). The identified proteins were prospectively associated with cardiometabolic diseases (pooled odds ratio ranged from 0.8-1.18) and risk factors (pooled β ranged from -0.1 to 0.12), mediating the association between the EAT-Lancet diet and blood triglycerides. We then identified 5 gut microbial biomarkers of the EAT-Lancet diet, and discovered a potential gut microbiota-blood protein interplay (EAT-Lancet diet→Rothia mucilaginosa→A2M) underlying the EAT-Lancet diet-cardiometabolic health association.

CONCLUSIONS

Our study presents key molecular evidence to support the role of EAT-Lancet diet adherence in promoting cardiometabolic health.

Association between Diet-Related Greenhouse Gas Emissions and Mortality among Japanese Adults: The Japan Collaborative Cohort Study

BACKGROUND

Planetary and human health are highly intertwined; our current food system is associated with high greenhouse gas emissions (GHGE) and burden of disease.

OBJECTIVE

The aim of this study was to investigate the associations of diet-related GHGE with all-cause and cause-specific mortality in Japan.

METHODS

This study included 58,031 Japanese adults (35,078 women and 22,953 men) 40-79 y of age who participated in the Japan Collaborative Cohort Study during the period 1988-1990. Diet-related GHGE was calculated from dietary intake estimated by a validated food frequency questionnaire and previously developed GHGE tables of each food and beverage. Participants were classified into quintiles of diet-related GHGE per kg food/d. Hazard ratios (HRs) of all-cause and cause-specific mortality were calculated using the Cox proportional hazard and restricted cubic spline models.

RESULTS

The average diet-related GHGE was 1,522   g - CO 2 -eq / kg  food / d . Over a period of 19.3 y (955,819 person-years) of median follow-up, 11,508 deaths were documented. After adjusting for lifestyle and medical history, in comparison with the fourth quintiles of diet-related GHGE, the first and fifth quintiles were associated with a higher risk of all-cause mortality: multivariable HR of all-cause mortality was 1.11 [95% confidence interval (CI): 1.05, 1.18] and 1.09 (95% CI: 1.03, 1.17) for the lowest and highest GHGE, respectively; those of cardiovascular disease mortality were 1.23 (95% CI: 1.10, 1.38) and 1.22 (95% CI: 1.08, 1.37), respectively. The diet-related GHGE range with the lowest HR of all-cause mortality was 1,400 - 1,600   g - CO 2 eq / kg food/d (p for nonlinearity < 0.001 ). Replacing one serving of red meat with one serving of pulses was inversely associated with all-cause mortality (HR = 0.96 ; 95% CI: 0.93, 0.99) and GHGE (mean change, - 347   g - CO 2 -eq / kg / d ; 95% CI: - 353 , - 342 ).

DISCUSSION

Diet-related GHGE was associated with all-cause and cardiovascular disease mortality in a U-shaped fashion. This finding could be useful for creating a policy for sustainable shifts in dietary habits that will benefit the population and environmental health. https://doi.org/10.1289/EHP14935.

Cost-effectiveness of tax policies on promoting sustainable diets in Iran: a modeling study

Background

Implementation of food taxes may promote sustainable diets in a society. This study estimates the potential short-term impacts of taxes on sugar and sweets (SAS), sugar sweetened beverages (SSB) and hydrogenated oil and animal fats (HOAF) in Iran through a social cost-effectiveness analysis.

Methods

In this study, three tax scenarios were evaluated, including a 25% tax on SASs, a 30% tax on SSBs, and a 30% tax on HOAFs. The data from Iran's 2019-2020 Household Income and Expenditure Survey (HIES) were utilized, and a simulated population of 1 million individuals aged over 25 years was analyzed. Population impact fraction (PIF) was calculated to estimate the averted number of cases and Disability-Adjusted Life Years (DALYs) under each policy scenario. Additionally, the study assessed water and carbon footprints, as well as all associated costs. Cost-effectiveness was evaluated through incremental cost-effectiveness ratios (ICER) and comparison with WHO-recommended thresholds.

Results

Implementation of taxes on SASs and HOAFs resulted in reductions of 1.09 and 1.08% in water footprint, as well as 0.47 and 1.05% in carbon footprint, respectively. In terms of population health, the interventions resulted in averting 343.92 DALYs (95% UI = 318.62-369.36) for the SSB tax and 1219.01 DALYs (95% UI = 1123.05-1315.77) for the tax on HOAFs. Additionally, the tax on SASs averted 1028.09 DALYs (95% UI = 947.16-1,109). All scenarios were deemed cost-effective based on the WHO threshold for ICER, with values of 0.26 billion Rials/DALY, 0.54 billion Rials/DALY, and 0.17 billion Rials/DALY, respectively.

Conclusion

The studied tax scenarios could generate substantial health gains and be cost-effective in Iran. It is recommended that policymakers consider implementing such price policies to promote healthy and sustainable diets.

An Innovative One Health Approach: BIOQUALIM, a Transdisciplinary Research Action Protocol-From Cultivated Biodiversity to Human Health Prevention

BACKGROUND/OBJECTIVES

The "One Health" approach underscores the connection between human, animal, and environmental health, promoting solutions to global challenges like climate change and biodiversity loss. The Planetary Health Diet (PHD) promotes a plant-based diet with organically grown plants to reduce the environmental impact of meat production and decrease the risk of non-communicable diseases (NCDs). The BIOQUALIM project will evaluate the PHD's effectiveness in preventing NCDs like periodontal diseases and cancers through four inter-related studies.

METHODS

The clinical study will involve volunteers reducing their meat consumption and incorporating einkorn into their diet, allow for analysis of their interdental microbiota, oral health, general health, and quality of life. The chemical analysis will study nutrients and anti-cancer compounds in einkorn and common wheat varieties. The behavioral study will explore PHD knowledge, attitudes, and behaviors related to PHD. The psycho-social study will evaluate the impact of peer-support workshops on plant-based dietary cooking among post-therapy cancer patients.

RESULTS

The results are expected to demonstrate that einkorn varieties possess nutritional properties that, when incorporated into the PHD enriched with einkorn, can enhance health markers. This study will identify barriers to and facilitators of PHD adoption and highlight how peer-support workshops can improve dietary adherence.

CONCLUSIONS

BIOQUALIM's transdisciplinary approach will demonstrate the PHD's role in preventing NCDs.

Adherence to the EAT-Lancet sustainable diet and ultra-processed food consumption: findings from a nationwide population-based study in Brazil

OBJECTIVE

To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population.

DESIGN

The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively.

SETTING

Nationally representative sample of the Brazilian population.

PARTICIPANTS

The study included 46 164 Brazilians ≥ 10 years old.

RESULTS

The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods.

CONCLUSIONS

Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

Environmental impact of dietary patterns in 10 European countries; a cross-sectional analysis of nationally representative dietary surveys

BACKGROUND

Changing dietary patterns is essential to reducing the substantial environment impact of agriculture and food production systems. We performed a cross-country comparison of dietary patterns and their associated environmental impact in Europe, including by sociodemographic factors.

METHODS

We analyzed pooled cross-sectional dietary records collected during 2010-18 from 10 European countries using the European Food Safety Authority (EFSA) Comprehensive European Food Database (16 508 adults; aged 18-79 years). Each food consumed was mapped to the corresponding environmental impact data using the SHARP Indicators Database, which provides greenhouse gas emission (GHGE) and land use (LU) values of approximately 900 foods. Total diet-associated environmental impact was calculated for each person and averaged across multiple days. Multivariable linear regression models were used to compare diet-associated GHGE and LU between population subgroups (gender, age, education and diet type) with country-level fixed effects.

RESULTS

The mean dietary GHGE and LU per capita ranged from 4.0 kgCO2/day and 5.0 m2*year/day in Spain to 6.5 kgCO2eq/day and 8.2 m2*year/day in France. Diet-related GHGE and LU (per kg/food) were lower among females (2.6 kgCO2eq/day, B = -0.08, P < 0.01; 3.2 m2*year/day, B = -0.11, P < 0.01), older population aged 66-79 (2.6 kgCO2eq/day, B = -0.03, P < 0.01; 3.4 m2*year/day, B = -0.4, P < 0.01), people following vegetarian diets (1.7 kgCO2eq/day, B = -0.07, P < 0.01; 2.0 m2*year/day, B = -0.07, P < 0.01), and higher among individuals with secondary education (2.7 kgCO2eq/day, B = 0.05, P < 0.01; 3.6 m2*year/day, B = -0.05, P < 0.01).

CONCLUSIONS

Environmental footprints vary substantially across countries, dietary patterns and between different sociodemographic groups in Europe. These findings are crucial for the development of country-specific food policies aimed at promoting environmentally sustainable diets.

Validity and reliability of the Sustainable HEalthy Diet (SHED) index by comparison with EAT-Lancet diet, Mediterranean diet in Turkish adults

Background

Food consumption and diet are strongly associated with sustainability. The Sustainable HEalthy Diet index was developed to measure the nutritional, environmental, and sociocultural components of sustainable diets and healthy eating patterns. However, a methodological approach has yet to be proposed for Turkish adults. This study aimed to determine the validity and reliability of the SHED index in Turkish adults.

Methods

Data were collected from 558 healthy adults using a web-based questionnaire. Internal consistency reliability was evaluated using Cronbach's alpha coefficient, and repeatability was evaluated using the test-retest method. Construct validity was investigated using the EAT-Lancet diet and the Mediterranean Diet Adherence Screener (MEDAS), and the adapted SHED index structures' accordance was evaluated with confirmatory factor analysis.

Results

Good reliability and repeatability were found (r = 0.758 and 0.795, respectively). A higher SHED index score was related to a greater intake of grains, fruits, and vegetables and a lower intake of meat, eggs, and dairy compared to EAT-Lancet diet food groups. A higher SHED index score was associated with a lower saturated fat and added sugar intake. While the SHED index was associated with greater adherence to the Mediterranean diet (r = 0.334, p < 0.001), it was negatively associated with non-alcoholic and diet non-alcoholic beverage consumption (r = -0.257 and -0.264, respectively; p < 0.001).

Conclusion

The SHED index showed good validity and reliability in Turkish adults. Our results suggest that the SHED index can be used in epidemiological and intervention studies because it allows the measurement of diets in terms of health and sustainability to propose adaptations accordingly.

Association Between Adherence to EAT-Lancet Diet and Risk of Hypertension: An 18-Year National Cohort Study in China

OBJECTIVE

The EAT-Lancet Commission has proposed an EAT-Lancet diet (ELD), also known as a planetary health diet (PHD), which is environmentally sustainable and promotes human health. However, the association between this diet and the risk of hypertension remains unclear. This study aimed to determine whether adherence to ELD was associated with a lower risk of hypertension.

METHODS

11,402 adults without hypertension at baseline from the China Health and Nutrition Survey were included. The PHD score was used to evaluate ELD adherence, with higher scores reflecting better compliance. Cox proportional hazards regression analysis was utilized to estimate the hazard ratio (HR) with a 95% confidence interval (CI). Additionally, a subgroup analysis was performed to identify the possible effect modifiers, and a mediation analysis was conducted to explore the mediation effects of anthropometric measurements on the association between ELD and hypertension.

RESULTS

A total of 3993 participants (35%) developed hypertension during 93,058 person-years of follow-up. In the covariate-adjusted model, hypertension risk was reduced in the highest quartile participants compared to the lowest quartile of the PHD score (adjusted HR: 0.79, 95%CI: 0.71-0.87; P-trend < 0.001), which remained significant after sensitivity analysis. Notably, the association was also observed in isolated systolic hypertension, isolated diastolic hypertension, and systolic-diastolic hypertension. Subgroup analysis revealed that the inverse association between the PHD score and hypertension risk was more pronounced in nonsmokers and high-sodium intake consumers than in smokers and low-sodium consumers (P-interaction < 0.05). Additionally, mediation analysis revealed that 23.3% of the association between the PHD score and hypertension risk was mediated by the waist-to-height ratio.

CONCLUSION

Our findings suggest that a higher adherence to ELD is associated with a lower risk of hypertension. These results emphasize that ELD may serve as a potential strategy to prevent hypertension.

Planetary health diet and cardiovascular disease: results from three large prospective cohort studies in the USA

BACKGROUND

In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease.

METHODS

We included women from the Nurses' Health Study (NHS I; 1986-2016), women from the Nurses' Health Study II (NHS II; 1991-2017), and men from the Health Professionals Follow-up Study (HPFS; 1986-2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0-140. Higher scores indicated greater adherence to the PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.

FINDINGS

Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78-0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74-0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78-0·95]; p-trend=0·0004) compared with the lowest quintile.

INTERPRETATION

We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations support the Planetary Health Diet as a promising strategy to promote both human and planetary health.

FUNDING

National Institutes of Health.

Changing the availability and positioning of more vs. less environmentally sustainable products: A randomised controlled trial in an online experimental supermarket

Food purchasing behaviours are shaped by the choices available to shoppers and the way they are offered for sale. This study tested whether prominent positioning of more sustainable food items online and increasing their relative availability might reduce the environmental impact of foods selected in a 2x2 (availability x position) factorial randomised controlled trial. Participants (n = 1179) selected items in a shopping task in an experimental online supermarket. The availability intervention added lower-impact products to the regular range. The positioning intervention biased product order to give prominence to lower-impact products. The primary outcome was the environmental impact score (ranging from 1 "least impact" to 5 "most impact", of each item in shopping baskets) analysed using Welch's ANOVA. Secondary outcomes included interactions (analysed via linear regression) by gender, age group, education, income and meat consumption and we assessed intervention acceptability (using different frames) in a post-experiment questionnaire. Compared to control (mean = 21.6), mean eco quintile score was significantly reduced when availability & order was altered (-2.30; 95%CI: 3.04; -1.56) and when order only was changed (-1.67; 95%CI: 2.42; -0.92). No significant difference between availability only (-0.02; 95%CI: 0.73; 0.69) and control was found. There were no significant interactions between interventions or by demographic characteristics. Both interventions were acceptable under certain frames (positioning emphasising lower-impact products: 70.3% support; increasing lower-impact items: 74.3% support). Prominent positioning of more sustainable products may be an effective strategy to encourage more sustainable food purchasing. Increasing availability of more sustainable products alone did not significantly alter the environment impact of products selected.

Evaluation of the Climate Impact and Nutritional Quality of Menus in an Italian Long-Term Care Facility

Global warming poses a significant threat to our planet, with the food sector contributing up to 37% of total greenhouse gas emissions. This study aimed to assess the climate change impact and healthiness of menus in a long-term care facility in Italy. We analyzed two 28-day cyclical menus using the carbon footprint (CF) and the Modified EAT-Lancet Diet Score (MELDS) to evaluate adherence to the Planetary Health Diet (PHD). Monte Carlo simulations were employed to explore 20,000 daily menu permutations. Results showed that the mean GHGEs of spring/summer and autumn/winter daily menus were 2.64 and 2.82 kg of CO2eq, respectively, with 99% of menus exceeding the 2.03 kg of CO2eq benchmark. Only 22% of menus were adherent to the PHD, with MELDSs ranging from 12 to 29. A strong inverse association between the CF and adherence to the PHD was observed. These findings suggest significant potential for reducing the CFs of meals served in nursing homes while promoting adherence to a planetary diet, presenting an opportunity to set new standards in caregiving and environmental sustainability.

Plant-based and planetary-health diets, environmental burden, and risk of mortality: a prospective cohort study of middle-aged and older adults in China

BACKGROUND

Plant-based diets (PBDs) and planetary-health diets (PHDs) are recommended for their potential health and environmental benefits, but population-based evidence in diverse cultures is scarce.

METHODS

We included 9364 adults aged 45 years and older (52·3% female, 47·7% male) from the open cohort of the China Health and Nutrition Survey. Dietary intake was assessed using 3-day 24 h dietary recalls combined with weighing methods from 1997 to 2011, and mortality was documented from 1997 to 2015. We calculated the overall PBD index (PDI), healthful PBD index (hPDI), and unhealthful PBD index (uPDI; ranges 18-90), and the PHD score (range 0-140). We also estimated the related greenhouse gas emissions, land appropriation, and total water footprint and examined their associations with mortality.

FINDINGS

PBD indices were inversely related to greenhouse gas emissions, land appropriation, and total water footprint, whereas higher PHD score was related to higher environmental burdens (p<0·0001). During follow-up (mean 9·2 years), 792 (8·5%) death cases were documented. PDI (HR 1·08 [95% CI 0·88-1·32]) and hPDI (0·98 [0·80-1·21]) were not significantly associated with mortality, whereas higher uPDI was related to a higher mortality risk (1·55 [1·26-1·91]). In contrast, higher PHD score was associated with lower mortality risk (0·79 [0·63-0·99]).

INTERPRETATION

The PBDs showed environmental benefits, but are not necessarily associated with lower mortality risk. The PHD, developed mainly in western populations, was related to lower mortality risk but higher environmental burdens in the Chinese population.

FUNDING

Fundamental Research Funds for the Central Universities, Zhejiang University Global Partnership Fund, and National Natural Science Foundation of China.

Adherence to the EAT-Lancet diet and incident depression and anxiety

High-quality diets have been increasingly acknowledged as a promising candidate to counter the growing prevalence of mental health disorders. This study aims to investigate the prospective associations of adhering to the EAT-Lancet reference diet with incident depression, anxiety and their co-occurrence in 180,446 UK Biobank participants. Degrees of adherence to the EAT-Lancet diet were translated into three different diet scores. Over 11.62 years of follow-up, participants in the highest adherence group of the Knuppel EAT-Lancet index showed lower risks of depression (hazard ratio: 0.806, 95% CI: 0.730-0.890), anxiety (0.818, 0.751-0.892) and their co-occurrence (0.756, 0.624-0.914), compared to the lowest adherence group. The corresponding hazard ratios (95% CIs) were 0.711 (0.627-0.806), 0.765 (0.687-0.852) and 0.659 (0.516-0.841) for the Stubbendorff EAT-Lancet index, and 0.844 (0.768-0.928), 0.825 (0.759-0.896) and 0.818 (0.682-0.981) for the Kesse-Guyot EAT-Lancet diet index. Our findings suggest that higher adherence to the EAT-Lancet diet is associated with lower risks of incident depression, anxiety and their co-occurrence.

The co-benefits of climate change mitigation strategies on cardiovascular health: a systematic review

Background

Climate change is a significant threat to global human health and a leading cause of premature death. Global warming, leading to more extreme weather (in particular extreme heat events), and air pollution has been associated with increased cardiovascular disease (CVD) morbidity and mortality. According to the Global Burden of Disease Study 2019, 62% of the deaths attributable to climate change were from CVD. Climate change mitigation is a slow, steady process, and the concept of co-benefits has arisen to promote climate action. This systematic review examines how numerous mitigation strategies, such as plant-based diets, increasing green spaces, increasing active transport, using renewable energy sources, and smoking cessation, may have the co-benefit of reducing CVD.

Methods

A mixed methods systematic review with narrative synthesis was conducted on four databases, according to the PRISMA guidelines. The articles retrieved (published between 2012 and 2022) had a mitigation strategy as the exposure, and CVD related morbidity or mortality reduction as an outcome.

Findings

The review found that renewable energy has a stronger association with cardiovascular co-benefits compared to emission reduction targets. Multimodal transport is more beneficial for both the climate and cardiac health than zero emission vehicles. Diet modification, such as Mediterranean and plant-based-diets, is positively associated with CVD reduction. Proximity to green spaces and reducing urbanisation may also improve cardiac health.

Interpretation

This systematic review demonstrates that implementing four mitigation strategies - increasing renewable energy use, active transport, green spaces, and plant-based diets; could lead to the co-benefit of reducing CVD morbidity and mortality. Furthermore, it illustrates the importance of plant-based diets and active transport to improve cardiovascular health.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

A systematic evaluation of seven different scores representing the EAT-Lancet reference diet and mortality, stroke, and greenhouse gas emissions in three cohorts

Different approaches have been used for translation of the EAT-Lancet reference diet into dietary scores that can be used to assess health and environmental impact. Our aim was to compare the different EAT-Lancet diet scores, and to estimate their associations with all-cause mortality, stroke incidence, and greenhouse gas emissions. We did a systematic review (PROSPERO, CRD42021286597) to identify different scores representing adherence to the EAT-Lancet reference diet. We then qualitatively compared the diet adherence scores, including their ability to group individuals according the EAT-Lancet reference diet recommendations, and quantitatively assessed the associations of the diet scores with health and environmental outcome data in three diverse cohorts: the Danish Diet, Cancer and Health Cohort (DCH; n=52 452), the Swedish Malmö Diet and Cancer Cohort (MDC; n=20 973), and the Mexican Teachers' Cohort (MTC; n=30 151). The DCH and MTC used food frequency questionnaires and the MDC used a modified diet history method to assess dietary intake, which we used to compute EAT-Lancet diet scores and evaluate the associations of scores with hazard of all-cause mortality and stroke. In the MDC, dietary greenhouse gas emission values were summarised for every participant, which we used to predict greenhouse gas emissions associated with varying diet adherence scores on each scoring system. In our review, seven diet scores were identified (Knuppel et al, 2019; Trijsburg et al, 2020; Cacau et al, 2021; Hanley-Cook et al, 2021; Kesse-Guyot et al, 2021; Stubbendorff et al, 2022; and Colizzi et al, 2023). Two of the seven scores (Stubbendorff and Colizzi) were among the most consistent in grouping participants according to the EAT-Lancet reference diet recommendations across cohorts, and higher scores (greater diet adherence) were associated with decreased risk of mortality (in the DCH and MDC), decreased risk of incident stroke (in the DCH and MDC for the Stubbendorff score; and in the DCH for the Colizzi score), and decreased predicted greenhouse gas emissions in the MDC. We conclude that the seven different scores representing the EAT-Lancet reference diet had differences in construction, interpretation, and relation to disease and climate-related outcomes. Two scores generally performed well in our evaluation. Future studies should carefully consider which diet score to use and preferably use multiple scores to assess the robustness of estimations, given that public health and environmental policy rely on these estimates.

The Society of Behavioral Medicine urges passage of the PLANT (Peas, Legumes, And Nuts Today) Act

Current US diets negatively impact human health and the environment, while shifting toward increased intake of plant-based foods could mitigate these issues. Current food policies exacerbate these problems, necessitating a reevaluation and the implementation of new policies. The Society of Behavioral Medicine urges legislators to support the PLANT Act (H.R.5023), which would enhance production, research, and development of plant-based foods and address both health and environmental concerns.

[Health issues related to the environment and the role of caregivers]

The healthcare system and the practice of health care have unprecedented impacts on our environment. High carbon footprint, pollution and its consequences on health, the picture is not glorious. Even if they rarely identify themselves as such, healthcare professionals are key actors in the drive towards more sustainable practices. Their numbers, skills and activities give them privileged access to the population, communities and individuals of all ages and backgrounds. Thanks to their increasingly specialized training, they are in a position to accompany people on their health journey, prevent illness and promote healthy behaviours. These aspects are central to sustainability in healthcare.

The co-benefits of biodiversity citizen science for well-being and nature relatedness

Human well-being is dependent on the health of our planet. Biodiversity-related citizen science supports conservation research, and there is increasing interest in its potential as a health co-benefits intervention. This randomized controlled study investigates the health co-benefits of biodiversity citizen science participation. Seventy participants were randomly assigned to a citizen science project or control group for an 8-month period. Both groups completed pre- and post-intervention surveys, evaluating nature relatedness, self-efficacy related to biodiversity loss, subjective well-being, and climate change anxiety. A subset (N = 13) of participants engaged in the citizen science project also took part in focus group discussions. The intervention group reported a significant increase in nature relatedness and self-efficacy to help address issues of biodiversity loss. Although no significant changes were observed for other well-being or anxiety scales, most participants reported positive outcomes related to mental or physical well-being in focus groups. There were stronger positive effects for participants without previous environmental volunteering experience. These results suggest that citizen science participation has the potential to contribute to Planetary Health goals, with sustained co-benefits for well-being and nature relatedness. Future interventions evaluating co-benefits should consider previous environmental volunteering experience and focus on participants with little experience to maximize health outcomes.

Are the 2019 Canada's Food Guide Recommendations on Healthy Food Choices Consistent with the EAT-Lancet Reference Diet from Sustainable Food Systems?

BACKGROUND

The diet proposed by the EAT-Lancet Commission, which supports both health and environmental sustainability, provides an opportunity to assess the sustainability of food-based dietary guidelines.

OBJECTIVES

The primary objective was to assess the alignment of the 2019 Canada's Food Guide (CFG) with the EAT-Lancet diet. To do so, an index assessing adherence to the EAT-Lancet diet was developed and evaluated.

METHODS

Data from 1147 adults were used from the cross-sectional PRÉDicteurs Individuals, Sociaux et Environnementaux (PREDISE) study conducted between 2015 and 2017 in the province of Québec. The EAT-Lancet Dietary Index (EAT-I) was developed to evaluate adherence to the EAT-Lancet diet. Adherence to the 2019 CFG was assessed using the Healthy Eating Food Index (HEFI)-2019. Associations between the HEFI-2019 score and component scores and the EAT-I score were examined using linear regression models.

RESULTS

The mean EAT-I score (/80) in this population was 33.4 points [95% confidence interval (CI): 32.2, 34.6]. EAT-I scores were consistent with expected differences in diet quality between females and males (+6.9 points, 95% CI: 4.8, 9.0) and between adults aged 50-65 y and 18-34 y (+4.3 points, 95% CI: 1.6, 7.0). The mean HEFI-2019 (/80) score was 44.9 points (95% CI: 44.1, 45.7). The HEFI-2019 was strongly associated with the EAT-I (ß = 0.76, 95% CI: 0.72, 0.80). Among the 10 components of the HEFI-2019, components such as the whole-grain foods (ß =4.01, 95% CI: 3.49, 4.52), grain foods ratio (ß =3.65, 95% CI: 3.24, 4.07), plant-based protein foods (ß =2.41, 95% CI: 2.03, 2.78), and fatty acids ratio (ß =3.12, 95% CI: 2.72, 3.51) showed the strongest associations with the EAT-I.

CONCLUSIONS

These results suggest that recommendations in the 2019 CFG are largely coherent with the EAT-Lancet diet underscoring the complementarity and compatibility of the 2019 CFG for sustainability and health promotion purposes.

Exploring Australian News Media Portrayals of Sustainable and Plant-Based Diets

(1) Background: Dietary behaviour transformation is imperative for the attainment of more sustainable food systems, including an increased intake of plant-based foods and lower consumption of red meat and highly processed foods. The influence of news media coverage on public opinion regarding dietary behaviours is significant. Therefore, this study aimed to explore how sustainable/plant-based diets have been portrayed in Australian news media. (2) Methods: The Factiva global news database was used to search news articles published in Australia between 2018 and 2020. Relevant news articles were selected if they included keywords relating to sustainable diets, plant-based diets, and meat alternatives. We used a coding protocol to extract key information, such as date of publication, article topic, and any health, environmental and economic impacts. Then, we performed a framing and thematic analysis of the data. (3) Results: From 357 included articles, more than half of the articles encouraged increasing the intake of plant-based foods (53.5%) and reducing animal-derived food intake (55.2%). Several reasons for such shift from animal protein centric Australian diets were identified throughout the articles such as health benefits (15.4%), environmental impacts (11.2%), animal welfare (4.8%), seasonality and local food intake (5.3%), avoiding overconsumption (4.5%) and food wastage (4.5%). (4) Conclusions: The predominant frame in Australian news coverage about sustainable diets has been about consumption, more plant- and less animal-based products, with little nuance about the complex interplay of diet quality and environment in influencing food choices. Australian news media should broaden its coverage of sustainable diets to include health, environmental, and economic factors to improve public understanding and facilitate informed and sustainable food choices. Further research is needed to enhance comprehension of how the audience perceives media coverage on this topic, which will provide a more thorough understanding.

Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study

BACKGROUND

The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents.

METHODS

Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5-7) and non-ideal (0-4).

RESULTS

A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]).

CONCLUSION

Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.

Sustainability benefits of transitioning from current diets to plant-based alternatives or whole-food diets in Sweden

Plant-based alternatives (PBAs) are increasingly becoming part of diets. Here, we investigate the environmental, nutritional, and economic implications of replacing animal-source foods (ASFs) with PBAs or whole foods (WFs) in the Swedish diet. Utilising two functional units (mass and energy), we model vegan, vegetarian, and flexitarian scenarios, each based on PBAs or WFs. Our results demonstrate that PBA-rich diets substantially reduce greenhouse gas emissions (30-52%), land use (20-45%), and freshwater use (14-27%), with the vegan diet showing the highest reduction potential. We observe comparable environmental benefits when ASFs are replaced with WFs, underscoring the need to reduce ASF consumption. PBA scenarios meet most Nordic Nutrition Recommendations, except for vitamin B12, vitamin D and selenium, while enhancing iron, magnesium, folate, and fibre supply and decreasing saturated fat. Daily food expenditure slightly increases in the PBA scenarios (3-5%) and decreases in the WF scenarios (4-17%), with PBA diets being 10-20% more expensive than WF diets. Here we show, that replacing ASFs with PBAs can reduce the environmental impact of current Swedish diets while meeting most nutritional recommendations, but slightly increases food expenditure. We recommend prioritising ASF reduction and diversifying WFs and healthier PBAs to accommodate diverse consumer preferences during dietary transitions.

Diet-Attributable Greenhouse Gas Emissions and Acute Myocardial Infarction in Costa Rica Heart Study

Adopting sustainable dietary patterns is essential for planetary and human health. As data to address this issue are lacking in Latino populations, this study examined the association between diet-attributable greenhouse gas emissions (GHGEs) and myocardial infarction (MI) in a Costa Rica Heart Study. This analysis included 1817 cases of a first non-fatal acute MI during hospitalization and their matched population-based controls, by age, sex, and area of residence. A validated food frequency questionnaire was used to quantify habitual dietary intake and diet-attributable GHGEs (kg CO2 equivalent (eq.)/year). Due to the matching design, conditional logistic regression was used. Red meat consumption contributed approximately 50% to the total diet-attributable GHGEs among both cases and controls. Higher diet-attributable GHGEs were associated with increased odds of acute MI. The odds of MI were 63% higher (OR = 1.63; 95% CI 1.20-2.21) among participants in the highest quintile (median diet-attributable GHGEs = 6247 kg CO2 eq./year) compared to the lowest quintile (median diet-attributable GHGEs = 2065 kg CO2 eq./year). An increasing linear trend in the odds of acute MI and diet-attributable GHGEs was detected (p-trend 0.0012). These findings highlight the importance of reducing red meat consumption to sustainably mitigate the incidence of MI and improve planetary health.

Improving the nutrient quality of foods and beverages using product specific standards for positive nutrients and ingredients will help to increase mean population intakes toward dietary guidelines

Background

A shift toward more sustainable diets, rich in plant-based foods and with fewer animal-derived foods, is needed and will lead to improved health and environmental benefits. Food industry needs to play a part and broaden the scope of product reformulation beyond the reduction of nutrients to limit to increasing ingredients and nutrients in line with dietary recommendations for a healthy sustainable diet.

Methods

The Positive Nutrition Standards (PNS) were defined to increase the consumption of recommended ingredients and nutrients. The PNS were set by translating WHO and Codex guidance into product group standards, considering the role of the product group in the diet. The potential impact of the PNS for vegetables, wholegrain and fibre was modeled using data from the US NHANES 2017-2018 survey, assuming that, foods consumed would be reformulated to meet the standards where relevant.

Results

The modeling showed that application of the PNS could increase mean population intakes by 30% for fibre, by more than 50% for vegetables and even double the intake of wholegrain. However, reformulation alone would not be sufficient to reach recommended intake levels.

Conclusion

The PNS described in this paper can help to increase intakes of relevant positive nutrients and ingredients. However, a multistakeholder approach is needed to encourage consumers to make additionally required dietary shifts to meet the recommendations for positive nutrients and ingredients.

Environmental and nutritional assessment of young children's diets in Norway: comparing the current diet with national dietary guidelines and the EAT-Lancet reference diet

PURPOSE

Introducing healthy and sustainable diets early in life can promote lifelong healthy dietary patterns with a low environmental impact. Therefore, we aimed to estimate the environmental and nutritional consequences of a dietary change for 2-year-old children in Norway towards healthier dietary patterns.

METHODS

Environmental impacts of the current habitual diet among 2-year-olds (n = 1413) were estimated for six impact categories and compared with scenario diets based on the Norwegian food-based dietary guidelines (FBDG) and the EAT-Lancet Commission reference diet. Last, we evaluated the nutritional adequacy of the diets against the Norwegian nutrition recommendations for children aged 2-5 years. The current diet was assessed by an FFQ.

RESULTS

Environmental impacts of the current habitual diet were up to two times higher than those of the scenario diets. Compared with the current diet, impacts from the FBDG scenario diet were reduced by 35% for water use and 18% for terrestrial acidification, whereas impacts from the EAT-Lancet scenario diet were reduced by 51% for water use, 57% for terrestrial acidification, 36% for global warming potential and 27% for freshwater eutrophication. Milk and dairy products were the main contributors to environmental impacts in both the current diet and the FBDG scenario diet. The scenario diets were nutritionally adequate and improved the dietary quality among Norwegian 2-year-olds.

CONCLUSION

Compared to current diets among young children, more plant-based dietary patterns in line with national FBDG or the EAT-Lancet Commission reference diet can improve the nutritional adequacy of diets and simultaneously reduce environmental impacts.

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.

Aligning Environmental Sustainability, Health Outcomes, and Affordability in Diet Quality: A Systematic Review

Improving diet quality while simultaneously maintaining planetary health is of critical interest globally. Despite the shared motivation, advancement remains slow, and the research community continues to operate in silos, focusing on certain pairings (diet-climate), or with a discipline-specific lens of a sustainable diet, rather than examining their totality. This review aimed to summarize the literature on adherence to a priori defined dietary patterns in consideration of diet quality, metabolic risk factors for noncommunicable diseases (NCDs), environmental impacts, and affordability. A methodology using PRISMA guidelines was followed, and searches were performed in 7 databases as of October 2022. The Appraisal tool for Cross-Sectional Studies (AXIS) and the National Institutes of Health (NIH) quality assessment tool for observational cohort studies were employed for quality appraisal. The evidence was narratively synthesized according to the characteristics of the diet quality metrics. The review includes 24 studies published between 2017-2023. Thirteen distinct diet quality scores were identified, with those measuring adherence to national dietary guidelines the most reported. Thirteen distinct environmental impact indicators were identified, with greenhouse gas emissions (n=23) reported most. All studies reported on body mass index, and 7 studies assessed the cost of adherence. Our results are consistent with previous findings that healthier diets can reduce environmental impacts; however, incongruities between population and planetary health can occur. Hence, the "sustainability" of dietary patterns is dependent on the choice of indicators selected. Further, healthy, lower impact diets can increase financial cost, but may also provide a protective role against the risk of obesity. Given the Global Syndemic, strategies to reduce obesity prevalence should emphasize the win-win opportunities for population and planetary health through dietary change. Research should identify diets that address multiple environmental concerns to curtail burdens potentially transferring, and harmonize this with sociocultural and equity dimensions. This review was registered at PROSPERO as CRD42021238055.

Compliance with the EAT-Lancet diet and risk of colorectal cancer: a prospective cohort study in 98,415 American adults

Background

The EAT-Lancet diet (ELD) is a recommended dietary pattern for achieving simultaneous improvements in both individual health and environmental sustainability. While research on the association between ELD and colorectal cancer (CRC) remains scarce, the potential impact of nutrition on CRC prevention and progression is a topic of growing interest. This study aims to investigate the relationship between adherence to the ELD and the risk of CRC, shedding light on the role of nutrition in CRC prevention.

Methods

A total of 98,415 participants were included. A Diet History Questionnaire (DHQ) was used to collect dietary information, and an ELD score was used to assess adherence to ELD. Higher scores indicated greater adherence. Cox hazard regression analyses were conducted to examine whether there were associations between the ELD score and CRC risk. The restricted cubic spline (RCS) model was used to further explore the dose-response association between the ELD score and CRC incidence. Subgroup analyses were conducted to identify potential modifiers that interacted with ELD on CRC incidence, and sensitivity analyses were performed to evaluate the robustness of the established association.

Results

During a mean follow-up of 8.82 years, a total of 1,054 CRC cases were documented. We found a statistically significant correlation between the ELD score and CRC risk (Q4 vs. Q1: HR 0.81, 95% CI 0.67-0.98; P for trend = 0.034) after adjusting for potential confounders. No statistically significant associations were discovered between ELD adherence and CRC by anatomical site. Subgroup analyses found no interactional factor, sensitivity analyses, and the RCS model showed a robustness and linearity association (P-linearity >0.05).

Conclusion

We concluded that adherence to ELD contributes to the prevention of CRC.

Adherence to a Planetary Health Diet, Environmental Impacts, and Mortality in Chinese Adults

Importance

Although the EAT-Lancet Commission has recently proposed a planetary health diet (PHD) to promote human and environmental health, little is known about how PHD affects environment and mortality risk among an Asian population.

Objective

To investigate whether a PHD score is associated with environmental impacts and mortality outcomes in a Chinese cohort living in Singapore.

Design, Setting, and Participants

This cohort study used data from the Singapore Chinese Health Study. Eligible participants were without known cardiovascular disease and cancer at baseline; they were recruited between 1993 and 1998 and followed up using record linkage data until 2020. Data were analyzed from September 2022 to April 2023.

Exposures

PHD score was calculated based on the reference consumption of 14 dietary components in PHD and individual energy intake assessed using a validated food frequency questionnaire in this cohort.

Main Outcomes and Measures

Diet-related environmental impacts were estimated using a food frequency questionnaire. Mortality outcomes (all-cause, cardiovascular disease, cancer, and respiratory disease) were identified via linkage with a nationwide registry.

Results

A total of 57 078 participants were included in this study (mean [SD] age, 56.1 (7.9) years; 31 958 women [56.0%]). During a median (IQR) follow-up of 23.4 (18.7-26.2) years, 22 599 deaths occurred. Comparing the highest and lowest quintiles, higher PHD scores were associated with lower greenhouse gas emissions (β = -0.13 kg CO2 equivalent; 95% CI, -0.14 to -0.12 kg CO2 equivalent), but with higher total water footprint (β = 0.12 m3; 95% CI, 0.11-0.13 m3) and land use (β = 0.29 m2; 95% CI, 0.28-0.31 m2). In the adjusted multivariable model, compared with the lowest quintile, participants in the highest quintile of PHD score had lower risk of all-cause mortality (hazard ratio [HR], 0.85; 95% CI, 0.81-0.89), cardiovascular disease mortality (HR, 0.79; 95% CI, 0.73-0.85), cancer mortality (HR, 0.93; 95% CI, 0.86-1.00), and respiratory disease mortality (HR, 0.81; 95% CI, 0.74-0.89).

Conclusions and Relevance

In this study of Singapore Chinese adults, higher adherence to PHD was associated with reduced risk of chronic disease mortality. However, environmental impacts were uncertain, as higher adherence was associated with lower greenhouse gas emissions but higher total water footprint and land use.

Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study

PURPOSE

The EAT-Lancet Commission proposed an evidence-based global reference diet to improve human health within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was developed based on the EAT-Lancet recommendations and validated among Brazilian adults. However, the relative validity of the PHDI in adolescents has yet to be assessed. Thus, we aimed to evaluate the relative validity of the PHDI in European adolescents.

METHODS

We used cross-sectional data from 1804 adolescents (12.5-17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The PHDI (0-150 points) was calculated based on dietary intake data from two non-consecutive 24-h dietary recalls. Associations between the PHDI and usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet were evaluated using multivariable-adjusted mixed-effects linear regression models.

RESULTS

Higher PHDI score was associated with greater intakes of nutrients predominantly from plant-source foods, such as vegetable protein, vitamin E, and folate and with lower intake of nutrients predominately from animal-source foods, such as total and saturated fat, cholesterol, and animal protein. Furthermore, a higher PHDI score was also positively associated with plasma β-carotene, vitamin C, vitamin D, folate, and ferritin concentrations, while negatively associated with trans-fatty acids concentration. Moreover, higher PHDI was related to a greater adherence to the Mediterranean dietary pattern.

CONCLUSIONS

The PHDI showed good relative validity among adolescents in the HELENA study. Hence, future research should assess adherence to the PHDI and long-term health outcomes.

Exploring healthy and climate-friendly diets for Danish adults: an optimization study using quadratic programming

Background

A transition to healthy and sustainable diets has the potential to improve human and planetary health but diets need to meet requirements for nutritional adequacy, health, environmental targets, and be acceptable to consumers.

Objective

The objective of this study was to derive a nutritionally adequate and healthy diet that has the least deviation possible from the average observed diet of Danish adults while aiming for a greenhouse gas emission (GHGE) reduction of 31%, corresponding to the GHGE level of the Danish plant-rich diet, which lays the foundation for the current healthy and sustainable food-based dietary guidelines (FBDGs) in Denmark.

Methods

With an objective function minimizing the departure from the average observed diet of Danish adults, four diet optimizations were run using quadratic programming, with different combinations of diet constraints: (1) nutrients only (Nutri), (2) nutrients and health-based targets for food amounts (NutriHealth), (3) GHGE only (GHGE), and finally, (4) combined nutrient, health and GHGE constraints (NutriHealthGHGE).

Results

The GHGE of the four optimized diets were 3.93 kg CO₂-eq (Nutri), 3.77 kg CO₂-eq (NutriHealth) and 3.01 kg CO₂-eq (GHGE and NutriHealthGHGE), compared to 4.37 kg CO₂-eq in the observed diet. The proportion of energy from animal-based foods was 21%-25% in the optimized diets compared to 34% in the observed diet and 18% in the Danish plant-rich diet. Moreover, compared to the average Danish diet, the NutriHealthGHGE diet contained more grains and starches (44 E% vs. 28 E%), nuts (+230%), fatty fish (+89%), eggs (+47%); less cheese (-73%), animal-based fats (-76%), total meat (-42%); and very limited amounts of ruminant meat, soft drinks, and alcoholic beverages (all-90%), while the amounts of legumes and seeds were unchanged. On average, the mathematically optimized NutriHealthGHGE diet showed a smaller deviation from the average Danish diet compared to the Danish plant-rich diet (38% vs. 169%, respectively).

Conclusion

The final optimized diet presented in this study represents an alternative way of composing a nutritionally adequate and healthy diet that has the same estimated GHGE as a diet consistent with the climate-friendly FBDGs in Denmark. As this optimized diet may be more acceptable for some consumers, it might help to facilitate the transition toward more healthy and sustainable diets in the Danish population.

Economic, social and environmental spillovers decrease the benefits of a global dietary shift

Dietary shifts are key for enhancing the sustainability of current food systems but need to account for potential economic, social and environmental indirect effects as well. By tracing physical quantities of biomass along supply chains in a global economic model, we investigate the benefits of adopting the EAT-Lancet diet and other social, economic and environmental spillovers in the wider economy. We find that decreased global food demand reduces global biomass production, food prices, trade, land use and food loss and waste but also reduces food affordability for low-income agricultural households. In sub-Saharan Africa, increased food demand and higher prices decrease food affordability also for non-agricultural households. Economic spillovers into non-food sectors limit agricultural land and greenhouse gas reductions as cheaper biomass is demanded more for non-food use. From an environmental perspective, economy-wide greenhouse gas emissions increase as lower global food demand at lower prices frees income subsequently spent on non-food items.

Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders

Climate change will be a major challenge for the world's health systems in the coming decades. Elevated temperatures and increasing frequencies of heat waves, wildfires, heavy precipitation and other weather extremes can affect health in many ways, especially if chronic diseases are already present. Impaired responses to heat stress, including compromised vasodilation and sweating, diabetes-related comorbidities, insulin resistance and chronic low-grade inflammation make people with diabetes particularly vulnerable to environmental risk factors, such as extreme weather events and air pollution. Additionally, multiple pathogens show an increased rate of transmission under conditions of climate change and people with diabetes have an altered immune system, which increases the risk for a worse course of infectious diseases. In this review, we summarise recent studies on the impact of climate-change-associated risk for people with diabetes and discuss which individuals may be specifically prone to these risk conditions due to their clinical features. Knowledge of such high-risk groups will help to develop and implement tailored prevention and management strategies to mitigate the detrimental effect of climate change on the health of people with diabetes.

Associations between measures of socio-economic position and sustainable dietary patterns in the NutriNet-Santé study

OBJECTIVE

We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns.

DESIGN

Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively.

SETTING

France.

PARTICIPANTS

29 119 NutriNet-Santé participants.

RESULTS

Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (βprimary v. postgraduate = -0·62, 95 % CI (-0·72, -0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (βmanual workers v. intermediate professionals = -0·43, 95 % CI (-0·52, -0·33) and βemployees v. intermediate professionals = -0·56, 95 % CI (-0·64, -0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status.

CONCLUSIONS

Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.

EAT-Lancet Healthy Reference Diet score and diabetes incidence in a cohort of Mexican women

To improve the health of our planet and develop sustainable food policies, it is important to understand the health impact of a diet pattern that considers planetary and population health. We used data from the Mexican Teachers' Cohort (MTC) to estimate the association between the EAT-Lancet healthy reference diet (EAT-HRD) and type 2 diabetes (T2D) incidence. We included 74,671 women aged ≥25 years, free of T2D at baseline. A validated food frequency questionnaire (FFQ) was used to assess dietary intake. We created an EAT-HRD score based on 15 food groups recommended by the EAT-Lancet Commission (range from 0 to 15). T2D cases were identified through self-report and cross-linkage with clinical and administrative databases. We used Cox proportional hazards models to estimate the association between categories of the EAT-HRD score with T2D incidence. During a median follow-up of 2.16 y (IQR 1.8-4.3 y), we identified 3241 T2D incident cases. The median EAT-HRD score was 6 (IQR 5-7). In multivariable analyses, when comparing extreme categories, higher adherence to the EAT-HRD score was associated with lower T2D incidence (HR 0.90; 95% CI 0.75, 1.10), yet, the estimation was imprecise. Compared to those who did not meet the EAT-HRD recommendations, adhering to the red meat, legumes, and fish recommendations was associated with lower T2D incidence. Meeting the recommendation of dairy and added sugars was associated with an increased incidence of T2D. Higher adherence to a diet designed to promote environmental and human health may help prevent T2D incidence among women in a middle-income country.

Public perceptions of responsibility for recommended food policies in seven countries

BACKGROUND

Food policy is important to promote healthy and sustainable diets. However, who is responsible for developing and implementing food policy remains contentious. Therefore, this study aimed to investigate how the public attributes responsibility for food policy to governments, individuals and the private sector.

METHODS

A total of 7559 respondents from seven countries [Australia (n = 1033), Canada (n = 1079), China (n = 1099), India (n = 1086), New Zealand (n = 1090), the UK (n = 1079) and the USA (n = 1093)] completed an online survey assessing perceived responsibility for 11 recommended food policies.

RESULTS

Overall, preferred responsibility for the assessed food policies was primarily attributed to governments (62%), followed by the private sector (49%) and individuals (31%). Respondents from New Zealand expressed the highest support for government responsibility (70%) and those from the USA the lowest (50%). Respondents from the USA and India were most likely to nominate individuals as responsible (both 37%), while those from China were least likely (23%). The private sector had the highest attributed responsibility in New Zealand (55%) and the lowest in China and the USA (both 47%). Support for government responsibility declined with age and was higher among those on higher incomes, with a university degree, and who perceived themselves to consume a healthy diet or be in poor health.

CONCLUSIONS

Across seven diverse countries, results indicate the public considers government should take primary responsibility for the assessed food policies, with modest contribution from the private sector and minority support for individual responsibility.