Wholesome Nutrition: an example for a sustainable diet

Mixed diets can meet nutrient requirements with lower carbon footprints

Achieving sustainable dietary change is essential for safeguarding human and environmental health. However, dietary recommendations based on broad food groups may not accurately reflect real-world realities because individuals select and consume dishes with multiple food items influenced by diverse context-specific factors. Therefore, here we explored the sustainability trade-offs of dietary choices at the dish level through an optimization modeling approach tested in Japan. We estimated the nutritional quality, price, and carbon footprint of major Japanese dishes and examined 16 dietary scenarios to identify options that meet the nutritional requirements and minimize carbon footprint. Overall, mixed diets contain more combinations of dishes that meet nutritional requirements with lower carbon footprints compared to more restrictive dietary scenarios. We argue that the approach developed here enables a better understanding of dietary trade-offs, complements existing methods, and helps identify sustainable diets by offering nuanced information at the national and sub-national levels.

The positive impact of mindfulness interventions on the explicit and implicit affective attitudes toward vegetarian foods

Objectives

The main goal of our intervention study was to investigate whether two conceptually different mindfulness interventions positively impacted the explicit and implicit affective evaluations of vegetarian foods. We included possible mediating variables (e.g., wellbeing) and related our results to the stage model of self-regulated behavioral change (SSBC).

Methods

We implemented a compassion and caring-based mental training (N = 31) and an adapted MBSR course (N = 34) as mindfulness interventions, and a stress-reduction course (N = 26) as the active control group. The curriculums consisted of 12 weekly group sessions á 75 min. All participants were tested pre- and post-intervention and 3 months after the last intervention session, answered questionnaires (mindfulness, compassion, wellbeing, items of the SSBC) and completed an explicit affective evaluation task and an affective priming task.

Results

There was an improvement in the explicit attitudes toward vegetarian foods regardless of the intervention group. In the SSBC, we found a link between the explicit attitudes toward vegetarian foods and the indicated stage in the model. Multiple regression analysis revealed social and personal norms and a vegetarian/vegan diet as the only significant predictors for goal intention in the SSBC.

Conclusion

The results of our study suggest that both conceptually different mindfulness interventions, as well as a stress-reduction program, have a positive impact on explicit affective attitudes toward vegetarian foods. We highlight the meaning of inner dimensions and transformation for change processes for a more sustainable diet and the role of social and personal norms.

Implementing micronutrient fortification programs as a potential practical contribution to achieving sustainable diets

Due to sustainability concerns related to current diets and environmental challenges, it is crucial to have sound policies to protect human and planetary health. It is proposed that sustainable diets will improve public health and food security and decrease the food system's effect on the environment. Micronutrient deficiencies are a well-known major public health concern. One-third to half of the world's population suffers from nutrient deficiencies, which have a negative impact on society in terms of unrealised potential and lost economic productivity. Large-scale fortification with different micronutrients has been found to be a useful strategy to improve public health. As a cost-effective strategy to improve micronutrient deficiency, this review explores the role of micronutrient fortification programmes in ensuring the nutritional quality (and affordability) of diets that are adjusted to help ensure environmental sustainability in the face of climate change, for example by replacing some animal-sourced foods with nutrient-dense, plant-sourced foods fortified with the micronutrients commonly supplied by animal-sourced foods. Additionally, micronutrient fortification considers food preferences based on the dimensions of a culturally sustainable diet. Thus, we conclude that investing in micronutrient fortification could play a significant role in preventing and controlling micronutrient deficiencies, improving diets and being environmentally, culturally and economically sustainable.

Sustainable transformation agenda for enhanced global food and nutrition security: a narrative review

The world's population is currently growing at an exponential rate, which is estimated to be over 8 billion inhabitants as reported by United Nations on November 15, 2022. According to FAO, 870 million people out of this population do not have enough food to eat, with the vast majority of hungry people (98%) living in developing countries, where almost 15% of the population is undernourished. Furthermore, the world's population is estimated to come to 9 billion by 2050, which would incur severe food scarcity and would seriously hamper global food security. Food losses, especially post-harvest loss as a result of poor agricultural practices have also been reported to greatly impact the economy, the environment, and the livelihoods of low and medium countries and Sub-Saharan-African. Therefore, realistic options should be established for promoting sustainable agriculture systems, improving nutrition, and achieving food security to end hunger in our nations. This paper elucidates the drivers of food insecurity including food losses, escalating population growth, hunger, and food production, among others, and provided some transformation approaches such as value addition through appropriate and emerging food processing and preservation techniques, application of biotechnological options through genetically modified foods and functional foods consumption and integration of indigenous underutilized nutrient-dense food crops which could serve as all-inclusive and sustainable transformation options for enhanced food and nutrition security, especially in developing countries, which is where the hunger burden and the prevalence of malnutrition and non-communicable diseases are high.

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

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

The Barriers to Sustainable Nutrition for Sustainable Health among Zayed University Students in the UAE

Unhealthy and unsustainable nutrition is a major concern globally, including in the United Arab Emirates. Although many education programs have been conducted, diet-related illnesses remain prevalent. This study aims to identify the barriers between knowledge and practice of sustainable healthy diets to achieve long-term health, among students of Zayed University in the United Arab Emirates. An online questionnaire was sent to Zayed University (ZU) students over 18 years of age, using snowball sampling. The participants achieved a mean score of 5.6 out of 11 in nutritional knowledge, and a mean score of 3.4 out of 6 in healthy habits. The only barrier that significantly affected dietary habits was not knowing how to plan a diet (p = 0.025). Accordingly, having good nutritional knowledge was significantly related to improved dietary habits (p < 0.001). In addition, school curriculums (p = 0.004), doing one’s own research (p < 0.001), and social media (p < 0.001) were significantly related to improved nutritional knowledge. The most commonly reported motivators for a healthier diet were “to keep their body healthy for a long time” and “to maintain a healthy weight” (72.6% and 70.1%, respectively). Overall, among ZU students the most significant barrier to achieving sustainable healthy nutrition was lack of knowledge. Education methods such as school curriculums, individual research, and social media were effective. Topics such as how to plan a diet, how to keep the body healthy, and how to maintain a healthy weight are of general interest.

Is high adaptation to the Mediterranean diet effective in increasing ecological footprint awareness? A cross-sectional study from Turkey

BACKGROUND

The effect of diet type on sustainable environment is known. It is important to understand the adaptation of individuals with high ecological footprint awareness to the Mediterranean type diet, especially under the assumption that the Mediterranean diet will reduce the ecological footprint. In the study, it is aimed to examine the relationship between the level of adherence to the Mediterranean diet and Ecological Footprint awareness of adults.

RESULTS

The sample of the study consisted of 395 individuals with a mean age of 26.2 ± 8.7 years: 293 females (74.2%) and 102 males (25.8%). As the Mediterranean Diet Adherence Scale (MDAS) score of individuals increased, the Ecological Footprint Awareness Scale score also increased. Similarly, a positive correlation was found between the participants' MDAS score and the awareness of food (r = 0.157; P = 0.002), energy (r = 0.133; P = 0.008), waste (r = 0.149; P = 0.003) and water consumption (r = 0.101; P = 0.045), which are sub-factors of the Ecological Footprint Awareness Scale.

CONCLUSION

As far as is known, this cross-sectional study is one of the first studies on compliance with the Mediterranean diet and awareness of the ecological footprint. The findings of the study show that as individuals' compliance with the Mediterranean diet increases, their awareness of their ecological footprint will also increase. To reach a conclusion on this issue, future studies should evaluate the relationship between adherence to the Mediterranean diet and awareness of food-environmental impact on different samples. © 2021 Society of Chemical Industry.

Health and Sustainable Nutritional Choices from Childhood: Dietary Pattern and Social Models

BACKGROUND

The role of diet in the pediatric age for optimal development, achievement, and maintenance of a healthy status is well recognized. Increasing attention is nowadays also paid to reducing the burden of human nutrition on the planet's health for present and future generations.

SUMMARY

Beyond environmental sustainability, the transition to diets rich in animal and processed foods contributes to an overall unhealthy nutritional status leading to an increased prevalence of obesity- and diet-related noncommunicable diseases. Childhood overweight and obesity are a growing public health crisis worldwide. The aim of this narrative review was to summarize evidence of the nutritional status and dietary habits in children and the link with environmental sustainability.

KEY MESSAGE

Optimizing nutrition in infancy and establishing healthy lifestyles from the preschool years might help to reduce the risk of overweight, and all the disorders related, respecting the sustainability dimension.

Dietary Patterns vs. Dietary Recommendations

Dietary Reference Values (DRVs) are important for developing labeling laws, identifying populations at risk of over- or under-consumption, and promoting public health interventions. However, the process of developing DRVs is quite complex, and they should not be viewed as recommendations ready to use or goals for individuals. Rather, they require interpretation by professionals and can form the basis of dietary advice. On the other hand, focusing on foods rather than macronutrients can assist individuals in understanding a healthy diet by taking into consideration many variables that may help compliance with a healthy dietary style. Evolution, tradition within specific geographical and historical contexts, taste, economic affordability, season-associated local dietary resources, and lifestyle may all explain the increasing popularity of dietary patterns that are highly successful today. Three models (the Mediterranean, New Nordic, and Japanese) have been recently characterized for geographical setting and food composition, as well as the associated lifestyle. Of note, all these three models rely on pyramids sharing a large basis made up of local vegetal resources and a top of red meats (allowed in many cases, but in limited amounts), thus allowing for the urgent demand of sustainability for the planet's health. This mini-review aimed to summarize the meaning of DRVs and to describe the dietary patterns that better contemplate health, diet diversity, and sustainability.

Development of the Cook-EdTM Matrix to Guide Food and Cooking Skill Selection in Culinary Education Programs That Target Diet Quality and Health

Culinary education programs are generally designed to improve participants’ food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills’ content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-Ed^TM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-Ed^TM matrix structure, skill focus points included, and their order. The final Cook-Ed^TM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-Ed^TM matrix to regional food-based dietary guidelines and food cultures.

Dietitians Australia position statement on healthy and sustainable diets

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet-related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective of natural resources and biodiversity, (iii) be culturally acceptable and (iv) be accessible, economically fair and affordable. Dietitians Australia acknowledges that it is critical to prioritise Indigenous knowledges in consultation, policy-making and implementation processes to achieve these recommendations. In facilitating the uptake of healthy and sustainable diets, dietitians are contributing to the transformation of our current food system that is urgently required to nourish present and future generations within planetary boundaries. In developing this position statement, opportunities for future research have been identified including those to advance the professions' capacity to improve environmental sustainability outcomes across all areas of practice. To achieve a population-level shift towards this diet, Dietitians Australia recommends: (i) the development of a National Food and Nutrition Strategy which honours Indigenous knowledges on food systems, (ii) the integration of sustainability principles in Australia's dietary guidelines, (iii) the reorientation of our food environment to prioritise access to healthy and sustainable foods, and (iv) investment in capacity building activities to equip the current and future nutrition and dietetics workforce.

Is Eating Less Meat Possible? Exploring the Willingness to Reduce Meat Consumption among Millennials Working in Polish Cities

Reducing the consumption of meat constitutes an important part of the global shift towards more sustainable food systems. At the same time, meat is firmly established in the food culture of most human beings, and better understanding of individual behaviors is essential to facilitate a durable change in contemporary eating patterns. To determine the level and nature of attachment to meat among consumers, the Meat Attachment Questionnaire (MAQ) in relation to the phases of behaviour change in the meat consumption reduction process was utilised. Data collected through a survey carried out among Poles aged 25–40 years living in cities were analysed with the use of Spearman’s correlations and one-way ANOVA with Tukey’s post-hoc tests. The biggest share of the studied group of millennials (N = 317) never considered reducing their meat consumption (Phase 1–41%) and was described by the highest level of MAQ score in all its categories: hedonism, affinity, dependence, and entitlement. More than half of the respondents in Phase 2 participants (“planners”) declared a willingness to cut down meat consumption but had not yet put their intentions into practice. Respondents qualified in Phase 3 declared the highest willingness to reduce meat consumption and were significantly less attached to meat regarding all MAQ categories than respondents in Phase 1. The 9% of the study participants (Phase 4) had already limited the frequency of their meat consumption to “several times a week”, this however still remains insufficient compared to the ambitious goals of sustainable healthy diets. Results indicated that meat attachment categories, especially hedonism and dependence, were identified as predictors of willingness to reduce meat consumption. Research exploring the determinants of change and possibilities of effective communication about meat reduction on an individual level in different cultural settings are needed.

Sustainability Recommendations and Practices in School Feeding: A Systematic Review

Considering the importance of schools for sustainable food offers and the formation of conscientious citizens on sustainability, this systematic review aimed to verify the recommendations on sustainability in school feeding policies and the sustainability practices adopted in schools. The research question that guided this study is “what are the recommendations on sustainability in school feeding policies and the sustainability practices adopted in schools?”. This systematic review was prepared according to PRISMA, and its checklist was registered in PROSPERO. Specific search strategies for Scopus, Web of Science, Pubmed, Lilacs, Google Scholar, and ProQuest Dissertations & Theses Global were developed. The included studies’ methodological quality was evaluated using the Meta-Analysis Statistical Assessment and Review Instrument (MASTARI). A total of 134 studies were selected for a full reading. Of these, 50 met the eligibility criteria and were included in the systematic review. Several sustainability practices were described. The most cited are school gardens and education activities for sustainability. However, actions carried out in food services were also mentioned, from the planning of menus and the purchase of raw materials (mainly local and organic foods, vegetarian/vegan menus) to the distribution of meals (reduction of organic and inorganic waste: composting, recycling, donating food, and portion sizes). Recommendations for purchasing sustainable food (organic, local, and seasonal), nutrition education focused on sustainability, and reducing food waste were frequent; this reinforces the need to stimulate managers’ view, in their most varied spheres, for the priority that should be given to this theme, so that education for sustainability is universally part of the curricula. The importance of education in enabling individuals to promote sustainable development is reaffirmed in Sustainable Development Goal 4 (SDG 4). The development of assessment instruments can help monitor the evolution of sustainable strategies at schools and the main barriers and potentialities related to their implementation.

Teach What You Eat: Student Biology Teachers' Intention to Teach Sustainable Nutrition

OBJECTIVE

To explain student biology teachers' intention to teach sustainable nutrition (SN) in classes using an extended model of the theory of planned behavior.

DESIGN

Germany-wide online questionnaire study in November/December 2019.

PARTICIPANTS

A total of 621 student biology teachers (mean age, 23.3 years; SD, 3.9 years; 77% female).

DEPENDENT VARIABLE

Intention to teach SN.

INDEPENDENT VARIABLES

Theory of planned behavior variables (attitudes toward teaching, subjective norms, self-efficacy), intention to eat sustainably, attitudes toward SN, knowledge about SN, prior university education for sustainable development experiences.

ANALYSES

Descriptive statistics, bivariate Spearman correlations, and a path model are reported.

RESULTS

The extended TPB model provided a moderate-to-high explanation of the intention to teach SN (R² = 0.50; P < 0.001). Respondents with a higher intention to eat sustainably in their daily lives reported more positive attitudes toward teaching, higher self-efficacy, and a higher teaching intention. Prior university education for sustainable development experiences also predicted the intention to teach. A higher level of knowledge about SN was only associated with higher self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Lectures and seminars on SN in biology teacher training may foster student (biology) teachers' self-efficacy in teaching SN and ensure that they understand the importance of their subject-specific commitment, involvement, and attitudes in implementing SN in schools.

Towards a More Sustainable Nutrition: Complementary Feeding and Early Taste Experiences as a Basis for Future Food Choices

The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the consumption of vegetable, organic and minimally processed foods, as well as regional, seasonal and Fair-Trade products, reducing the ecological impact of the production chain. These eating habits could be established starting from the prenatal period and from infancy during the complementary feeding stage, aiding children to accept of a more variable diet in terms of flavor, taste and texture. In particular, the positive parental role model is an effective method for improving a child’s diet and behaviors. Two healthy plates representing a sustainable diet in early infancy, at 6 and 24 months, are here proposed, in line with the “Planetary Health Diet” approved by the EAT-Lancet Commission. Our work aims to highlight how a sustainable diet is possible since infancy, since the introduction of solid foods.

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

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

Absence of symbolic and sustainable aspects in recommendations for healthy eating: a qualitative analysis of food-based dietary guidelines

ABSTRACT Objective Was analyzed the contents of the main messages of food-based dietary guidelines to promote healthy eating, identifying nutritional, symbolic, and sustainable recommendations. Methods Food-based dietary guidelines from 90 different countries were analyzed. These guidelines were selected from the United Nations Food and Agriculture Organization database. For data extraction, all messages were exported to the Nvivo software and, after repeated readings, were grouped into predefined categories and corresponding dimensions based on the literature. The categories were created according to the mixed model, that is, they were created before data analysis was performed, but modified if necessary. Results Was identified 1,982 messages grouped into the following dimensions: nutritional (n=73.9%); sustainable (3.2%); symbolic (3.3%), and others (19.7%). All food-based dietary guidelines addressed nutritional aspects, and the most frequent recommendation was regarding the consumption of fats, followed by the consumption of salt and vegetables and fruits, cited by at least 75 food-based dietary guidelines. Less than half (n=40) of the food-based dietary guidelines addressed sustainable or symbolic aspects of food and 13 of the food-based dietary guidelines addressed both aspects. However, these messages represented only 6.5% of the total messages in the documents. Conclusions The recommendations for healthy eating in the food-based dietary guidelines are incipient in terms of sustainable and symbolic issues. Recommendations for adopting healthy diets need to consider the completeness of the food and its various combinations, dietary patterns, and the factors associated with their consumption, as well as the individual’s relations with food, environment, and society.

Nutritional Sustainability Inside-Marketing Sustainability as an Inherent Ingredient

Current discussions about the concept of nutritional sustainability show a high complexity of this topic leading to many different definitions. Regarding communication issues of nutritional sustainability between actors of food chains this complexity should be reduced. One opportunity to tackle these challenges of reducing complexity might be the concept of ingredient branding. Therefore, the aim of this mini-review is the identification of conditions for ingredient branding application as a communication strategy for nutritional sustainability which might overcome challenges in communicating the complexity between the different stakeholders of supply chains. In doing so, the specific case of agrifood chains is discussed based on the selected characteristics of globalization, increasing consumer demands, foods incorporating credence attributes and price. Along the agrifood chain, a sourcing strategy reflecting nutritional and sustainable aspects might lead to an ingredient branding strategy implying a brand policy for a special ingredient within the final product which is an important component but cannot be clearly recognized by the user. A “nutritional sustainability inside” strategy should reflect the multifaceted information along the agrifood chain and should be based on standardized criteria for nutritional sustainability.

Do young adults value sustainable diet practices? Continuity in values from adolescence to adulthood and linkages to dietary behaviour

OBJECTIVE

To describe continuity over time in reports of valuing sustainable diet practices and investigate relationships between values, household meal behaviours and dietary intake.

DESIGN

Observational study. Participant ratings of how important it is for food to be produced as organic, not processed, locally grown and not GM were categorized to represent whether they valued (very/somewhat important) or did not value (a little/not at all important) each practice. Diet quality markers (e.g. fruit servings) were based on an FFQ.

SETTING

Mailed and online surveys.

PARTICIPANTS

Young adults (n 1620; 58 % female, mean age 31 (sd 1·6) years) who were participating in Project EAT (Eating and Activity among Teens and Young Adults) and responded to follow-up surveys in 2003-2004 and 2015-2016.

RESULTS

One-third (36·1 %) of participants reported valuing <2 practices at both assessments; 11·1 and 34·5 % respectively reported valuing ≥2 practices in 2003-2004 only and in 2015-2016 only; 18·3 % reported valuing ≥2 practices at both assessments. Regression models including demographics, parental status and vegetarian status showed that valuing ≥2 practices was associated with preparation of meals with vegetables at least a few times/week, less frequent purchase of family meals from fast-food restaurants, and higher diet quality in 2015-2016. For example, those who valued ≥2 practices consumed nearly one full vegetable serving more than other young adults on an average day and part of this difference was specifically associated with intake of dark green and red/orange vegetables.

CONCLUSIONS

Addressing the sustainability of food choices as part of public health messaging may be relevant for many young adults.

Do Europeans consider sustainability when making food choices? A survey of Polish city-dwellers

Objective

To obtain a better insight into the conceptualization of sustainable consumption among consumers with special focus on food choice determinants. Previous studies show that people present positive attitude towards sustainable diet while their everyday food choices do not follow sustainable diet rules.

Design

A structured questionnaire was designed and data were collected via computer-assisted telephone interview among a random group (n 600) of city-dwellers. Quota sampling was used in proportion to the city population. Cluster analysis (k-means method) was applied to identify consumer segments according to the determinants of food choices. Consumer segments were identified using one-way ANOVA with post hoc Duncan comparison of mean scores and cross-tabulation with χ². The Friedman test was applied to identify enablers and barriers of sustainable food choices.

Setting

Cities in Mazovia, the best developed, central region of Poland.

Participants

Adults (21–70 years old).

Results

Consumers are not familiar with the concept of sustainability and are not able to define it adequately. Only 6 % of the studied population indicated that sustainable consumption is connected with nutrition which has possibly less impact on the environment. Three segments of consumers were distinguished regarding their attitude to food choice determinants adequate to sustainable diet: Non-Adopters (17 %), Emergents (32 %), Adopters (51 %). Desire to improve health by decreasing body weight was the main driver for sustainable food choices, while prices were the main limitation.

Conclusions

Knowledge dissemination on sustainability issues is needed to empower consumers to make more sustainable food choices and to make public health and food policy measures more effective.

Historical Developments and Paradigm Shifts in Public Health Nutrition Science, Guidance and Policy Actions: A Narrative Review

Public health nutrition (PHN) seeks to protect and promote the nutrition-related health and wellbeing of populations. PHN science is dynamic and has evolved over time, helping to inform our understanding of the changing nature, scope, causes and solutions to PHN problems. This scientific basis has informed nutrition guidance and policy. Using a narrative synthesis method and guided by Kuhn's theory on the structure of scientific revolutions, this paper reviews the historical development of PHN, aiming to understand the emergence of major scientific paradigms, paradigm shifts and evidence-informed guidance and policy. We propose that the development of PHN is characterized by the successive layering of paradigms resulting from interactions between science, social change and policy-making. Four eras of PHN are evident: the foundation, nutrient deficiency, dietary excess and imbalances, and environmental sustainability (ES). Dominant paradigms have been communicated through nutrient reference standards, dietary goals and dietary guidelines. Transitions from one era to the next indicated new ways of thinking about PHN, amounting to a paradigm shift. The bidirectional relationship between nutrition and ES is the latest challenge confronting PHN. Investigating PHN paradigm transitions reveals how we have arrived at current guidance and policies, and how PHN might progress into the future.

Analysing the use of the Australian Health Star Rating system by level of food processing

BACKGROUND

The consumption of ultra-processed foods is associated with diminished dietary quality and adverse health outcomes. The Australian Health Star Rating (HSR) is a nutrient-based front-of-pack (FOP) labelling system that assesses the 'healthiness' of foods on a scale of 0.5 to 5 stars based on their content of 'risk' and 'positive' nutrients. This study aimed to analyse the use of health stars on new packaged food products entering the Australian marketplace by level of food processing.

METHODS

The Mintel Global New Product Database (GNPD) was searched to identify the number of stars displayed on the labels of all new packaged food products participating in the HSR system released into the Australian retail food supply between 27 June 2014 (the endorsement date) and 30 June 2017. Products were categorised by the four NOVA food processing categories: unprocessed and minimally processed (MP), processed culinary ingredients (PCI), processed (P), and ultra-processed (UP), and the distribution of the star ratings within each category was compared and analysed.

RESULTS

The majority of new food products displaying an HSR were UP (74.4%), followed by MP (12.5%), P (11.6%), and PCI (1.5%). The median HSR of MP products (4.5) was significantly higher than the median of P (4) and UP products (3.5) (all p < 0.05). In all NOVA categories HSR profiles were distributed towards higher star ratings, and the majority (77%) of UP products displayed an HSR ≥ 2.5.

CONCLUSIONS

The HSR is being displayed on a substantial proportion of newly released UP foods. Technical weaknesses, design flaws and governance limitations with the HSR system are resulting in 3 out of 4 instances of these UP foods displaying at least 2.5 so-called 'health' stars. These findings add further evidence to concerns that the HSR system, in its current form, is misrepresenting the healthiness of new packaged food products and creating a risk for behavioural nutrition.

Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Women's Cohort Study (UKWCS)

OBJECTIVES

Breast cancer is associated with overweight and obesity after menopause. However, clothing size as a proxy of adiposity in predicting postmenopausal breast cancer is not widely studied. We aimed to explore the relationships between postmenopausal breast cancer risk with adipose indicators (including clothing sizes) and weight change over adulthood.

DESIGN

Prospective cohort study.

SETTING

England, Wales and Scotland.

PARTICIPANTS

17 781 postmenopausal women from the UK Women's Cohort Study.

PRIMARY OUTCOME MEASURE

Incident cases of malignant breast cancers (International Classification of Diseases (ICD) 9 code 174 and ICD 10 code C50).

RESULTS

From 282 277 person-years follow-up, there were 946 incident breast cancer cases with an incidence rate of 3.35 per 1000 women. Body mass index (HR: 1.04; 95% CI: 1.02 to 1.07), blouse size (HR: 1.10; 1.03 to 1.18), waist circumference (HR: 1.07; 1.01 to 1.14) and skirt size (HR: 1.14;1.06 to 1.22) had positive associations with postmenopausal breast cancer after adjustment for potential confounders. Increased weight over adulthood (HR: 1.02; 1.01 to 1.03) was also associated with increased risk for postmenopausal breast cancer.

CONCLUSIONS

Blouse and skirt sizes can be used as adipose indicators in predicting postmenopausal breast cancer. Maintaining healthy body weight over adulthood is an effective measure in the prevention of postmenopausal breast cancer.

Balanced diets in food systems: Emerging trends and challenges for human health

Processed foods, generally known as modified raw foods produced by innovative processing technologies alters the food constituents such natural enzymes, fatty acids, micronutrients, macronutrients and vitamins. In contrast to fresh and unprocessed foods, processed foods are guaranteed to be safer, imperishable, long lasting and consist high level of nutrients bioactivity. Currently, the evolution in food processing technologies is necessary to face food security and safety, nutrition demand, its availability and also other global challenges in the food system. In this scenario, this review consists of information on two food processing technologies, which effects on processed foods before and after processing and the impact of food products on human health. It is also very well established that understanding the type and structure of foods to be processed can assist food processing industries towards advancement of novel food products. In connection with this fact, the present article also discusses the emerging trends and possible modifications in food processing technologies with the combination of conventional and modern techniques to get the suitable nutritional and safety qualities in food.