Integration of various dimensions in food-based dietary guidelines via mathematical approaches: report of a DGE/FENS Workshop in Bonn, Germany, 23-24 September 2019

The planet on our plates: approaches to incorporate environmental sustainability within food-based dietary guidelines

For many decades, food-based dietary guidelines (FBDGs) were only health-oriented. This changed post-2009 when gradually, an increasing number of countries began to include environmental sustainability considerations in their guidelines. International organisations such as the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) have stated that governments should include environmental sustainability in future FBDGs. However, methodologies on how this should be done are lacking. Therefore, through workshops and discussions with experts, we analysed a selection of methodologies and classified them into six groups: (1) health first; (2) additional advice; (3) demonstrating synergies; (4) modelling impact; (5) combining strategies; (6) systems first. We then assessed how innovative each approach was and their potential for transformative impact. Of the 6 approaches investigated, only approaches 5 and 6 could be considered as disruptive innovations and leading to major changes. Adding environmental sustainability into FBDGs is a policy innovation and has become a debate between old and new multi-criteria guidelines for eating. With the addition of environmental sustainability in FBDGS, a new or emerging set of multi-criteria guidelines for judging food are being proposed that challenges past norms and governance. Today, there is growing scientific consensus that diets that are good for human health are also good for the environment. There is also a growing recognition that food system change is inevitable and desirable. We see this as a positive opportunity to collaborate on FBDGs that are more appropriate for the 21st century and ambitious enough to meet the environmental challenges at hand.

Planet-based diets: improving environmental sustainability of healthy diets

The focus of nutritionists is on improvement of the health impact of current diets. Therefore, it is important to ask the question whether healthy diets are more sustainable. This review provides an overview on the research on synergies between health and sustainability. Synergies are found from shifts from animal-based to plant-based diets, from ultra-processed foods to fresh and whole foods and from reduction of food waste. The importance of looking at sustainability of the present diets has led to steps made in Europe to incorporate sustainability into food-based dietary guidelines. Examples from UK, Nordics, Belgium and the Netherlands are given. World Wildlife Fund has summarised the insides in a future-proof diet: the planet-based diet within planetary boundaries.

Developing feasible healthy diets for Ethiopian women of reproductive age: a linear goal programming approach

OBJECTIVE

To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference.

DESIGN

Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet.

SETTINGS

Five regions are included in the urban and rural areas of Ethiopia.

PARTICIPANTS

Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019.

RESULTS

Women's mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet's cost.

CONCLUSION

The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.

Avoidable diet-related deaths and cost-of-illness with culturally optimized modifications in diet: The case of Brazil

BACKGROUND

Dietary risk factors have an important impact on premature deaths and disabilities due to non-communicable diseases. In this study, we perform diet optimization to design different dietary scenarios taking into account food prices and preferences and evaluate the number of deaths that would be prevented as well as the economic burden and costs from the health system that would be saved in Brazil.

METHODS

We used dietary intake and food prices data from the nationwide Household Budget Survey (HBS) and the National Dietary Survey (NDS) 2017-2018. Linear programming models were performed to design five scenarios which different sets of key diet modifications at the least deviation from the baseline consumption. Comparative risk assessment models were used to estimate the health impacts of optimized dietary changes on mortality and the economic impacts on morbidity (hospitalizations) and premature deaths.

RESULTS

The optimized diets were, on average, more expensive than the baseline diets, varying from Int$ (international dollar) 0.02/day to 0.52/day/adult. The number of deaths prevented or postponed varied from 12,750 (10,178-15,225) to 57,341 (48,573-66,298) according to the different scenarios. The diet modifications would save from 50 to 219 million in hospitalizations and from 239 to 804 million yearly in productivity losses with the reduction of premature deaths.

CONCLUSION

A substantial number of deaths and costs due to hospitalization and productivity losses would be avoidable even with small changes in diets. However, even the cheapest intervention might be prohibitive for deprived families, yet subsidies and social policies could contribute to improving diets.

Automation, Climate Change, and the Future of Farm Work: Cross-Disciplinary Lessons for Studying Dynamic Changes in Agricultural Health and Safety

In this review, we first assess the state of agricultural health and safety research as it pertains to the dynamic challenges facing automating agriculture on a warming planet. Then, we turn to social science fields such as rural sociology, science and technology studies, and environmental studies to leverage relevant insights on the introduction of new technologies, environmental risks, and associated workplace hazards. Increased rates of automation in agriculture alongside new risks associated with climate change create the need for anticipatory governance and adaptive research to study novel mechanisms of worker health and safety. The use of the PRISMA framework led to the 137 articles for our review. We identify three themes in the literature on agricultural health and safety: (1) adoption outcomes, (2) discrete cases of health risks, and (3) an emphasis on care and wellbeing in literature on dairy automation Our review led to the identification of research gaps, noting that current research (a) tends to examine these forces separately, instead of together, (b) has not made robust examination of these forces as socially embedded, and (c) has hesitated to examine the broad, transferable themes for how these forces work across industries. In response to these gaps, we suggest that attention to outside disciplines may provide agricultural health and safety research with a toolset to examine needed inquiry into the multiplicity of experiences of rural stakeholders, the industry specific problems arising from automation and climate change, and the socially embedded aspects of agricultural work in the future.

Climate-friendly, health-promoting, and culturally acceptable diets for German adult omnivores, pescatarians, vegetarians, and vegans - a linear programming approach

OBJECTIVES

A frequently suggested approach to reduce greenhouse gas emissions (GHGEs) caused by food production is to reduce the intake of animal products, which can create nutritional deficiencies. This study aimed to identify culturally acceptable nutritional solutions for German adults that are both climate friendly and health promoting.

METHODS

Linear programming was applied to optimize the food supply for omnivores, pescatarians, vegetarians, and vegans considering nutritional adequacy, health promotion, GHGEs, affordability, and cultural acceptability by approaching German national food consumption.

RESULTS

Implementing dietary reference values and omitting meat (products) reduced the GHGEs by ≤52%. The vegan diet was alone in staying below the Intergovernmental Panel on Climate Change (IPCC) threshold of 1.6 kg carbon dioxide equivalents per person per day. The optimized omnivorous diet constrained to meet this goal maintained ≥50% of each baseline food and, on average, deviated from baseline by 36% for women and 64% for men. Butter, milk, meat products, and cheese were reduced by half for both sexes, whereas bread, bakery goods, milk, and meat were reduced mainly for men. The intake of vegetables, cereals, pulses, mushrooms, and fish increased by between 63% and 260% for the omnivores, compared with baseline. Besides the vegan dietary pattern, all optimized diets cost less than the baseline diet.

CONCLUSIONS

A linear programming approach for optimizing the German habitual diet to be healthy, affordable, and meet the IPCC GHGE threshold was possible for several dietary patterns and appears to be a feasible way forward toward including climate goals into food-based dietary guidelines.

Approximately Half of Total Protein Intake by Adults Must be Animal-Based to Meet Nonprotein, Nutrient-Based Recommendations, With Variations Due to Age and Sex

BACKGROUND

Shifting towards a more plant-based diet, as promoted in Western countries, will reduce the animal protein contribution to total proteins. Such a reduction may not only impair protein adequacy, but also the adequacy in other nutrients.

OBJECTIVES

We determined, for different adult subpopulations, the minimum total protein levels and the minimum animal protein contributions to total proteins that are compatible with the fulfillment of all nonprotein nutrient-based recommendations.

METHODS

Mean nutritional contents and mean diet costs were estimated using a French, cross-sectional, representative survey for 5 French subpopulations: 1) women < 50 y; 2) women 50-64 y; 3) women ≥ 65 y; 4) men < 65 y; and 5) men ≥ 65 y. For each subpopulation, linear programming optimization was used to assess the minimum protein level (model set #1) and the minimum animal protein contribution to total proteins (model set #2) that are compatible with the fulfillment of all nutrient-based recommendations (except proteins, for which levels were analyzed as outputs). Total diet costs were not allowed to increase. Eating habits were considered in model set #2 only.

RESULTS

The minimum amount of protein that was theoretically compatible with the fulfillment of nutrient-based recommendations (model set #1) was below the minimum recommended protein intake for all subpopulations except women < 50 y. In model set #2, for women and men ≥ 65 y, decreasing animal protein contributions to total proteins below 55% and 60%, respectively, led to protein levels below recommended levels. For the other subpopulations (women < 50 y, women 50-64 y, and men < 65 y), the lowest animal protein contributions to total proteins compatible with a nutritionally adequate diet (including protein adequacy) were 55%, 50%, and 45%, respectively.

CONCLUSIONS

This study provides factual information about the animal protein contributions to total proteins compatible with meeting all nutrient-based recommendations at no additional cost, and shows that they vary between 45% and 60% depending on the group of adults considered.

Additional costs of lactose-reduced diets: lactose-free dairy product substitutes are a cost-effective alternative for people with lactose intolerance

OBJECTIVE

People with lactose intolerance have to limit their consumption of lactose-containing dairy products which are a main source of Ca. In particular, for low-income people it is of interest which alternative diet form rich in Ca leads to the lowest additional costs. This study aims to calculate the additional costs of lactose-reduced diets and to show which of different options represent the most cost-effective alternative within a lactose-reduced diet.

DESIGN

Using linear programming, food baskets with different lactose contents were calculated and were compared to a basic model, reflecting a normal diet without a limitation of lactose. By comparing the costs and the composition of the food baskets, recommendations for a lactose-reduced diet were derived.

SETTING

Germany.

PARTICIPANTS

A consumer panel dataset representative for Germany is used for the calculations. Information on prices and nutrients is derived from the 9429 adult households without children, and information on consumed food quantities from the 3046 single households.

RESULTS

The minimum additional food costs depend on the severity of lactose intolerance and range from 0·2 % to 6·1 % per month. It was found that the greatest adjustments due to lactose reduction could be observed within the dairy product group. In this group, with a rising lactose limit, normal milk was increasingly replaced by lactose-free milk.

CONCLUSION

It was shown that a lactose-reduced diet is generally associated with higher food costs. When suffering from lactose intolerance, switching to lactose-free milk seems to be the most cost-effective way to cover nutrient requirements.