Toward a life cycle-based, diet-level framework for food environmental impact and nutritional quality assessment: a critical review

Regional food consumption in Italy, a life cycle analysis

Urbanization and globalization have led to an increasing concern and focus on the sustainability of the food sector, particularly in discussing the composition of consumers' diets. This study examines Italian consumption habits, categorizing them into four macro-geographical areas (North-West, North-East, Center, South, and Islands), utilizing public data obtained from surveys including 3323 individuals, and assesses their environmental impacts through the application of the Life Cycle Assessment methodology. The findings unveil distinct dietary patterns across Italian macro-regions, indicative of cultural disparities, and present avenues for promoting environmentally sustainable dietary choices. The study identifies meat consumption as the primary environmental concern across all macro-regions, with fish emerging as a secondary contributor to particulate matter formation. Pork and poultry exhibit notable impacts within toxicity-related categories. Additionally, the research underscores challenges in data collection, notably the absence of a site-specific Italian database, and underscores the necessity for more recent consumption data to accurately capture contemporary Italian dietary habits. Finally, the study demonstrates that addressing the issue from a macro-regional perspective allows for more targeted and dedicated cultural interventions.

Environmental and Health Sustainability of the Mediterranean Diet: A Systematic Review

The Mediterranean diet (MD) has been shown to be a healthy dietary pattern (DP), and lately it is increasingly being studied as a sustainable DP. The aim of this study is to analyze whether the MD is a sustainable and healthy DP accounting for its carbon footprint, water footprint (WF), land use (LU), and/or energy use, based on the existing scientific literature. We conducted a systematic review following PRISMA guidelines and registered in PROSPERO (CRD42022309916). We included 35 studies: 25 modeling studies, 7 cross-sectional, and 3 longitudinal. Twenty-four studies compared the sustainability of the MD with that of other DPs; 21 assessed the sustainability of the MD compared with dietary consumption data; and 9 evaluated the MD's adherence and its environmental impacts. A total of 29 studies analyzed the carbon footprint, 11 the LU, 20 the WF, and 7 the energy use of the MD. Six articles assessed the health aspect of the diet apart from the environmental impact. The MD showed high nutritional quality, ranging between 122 and 178 points on the health score and between 13.51 and 90.6 points on the nutrient-rich food index. Using the results for environmental footprints in the same measurement units, we were able to quantitatively compare the most frequently assessed diets with MD. When compared with other diets, 91% of the studies referred to the MD as a sustainable DP, and most of the articles in which its adherence was assessed obtained an inverse correlation with the environmental footprints. Environmental footprints of the MD ranged from 1.03 to 5.08 kg CO2-eq/person-day for greenhouse gas emissions, 257.2-2735.2 L/person-day for WF, and 4-14.8 m2/person-day and 2.85-3.32 m2∗year/d for LU. In summary, the available evidence suggests that, in general, the MD is a sustainable and healthy DP, which aligns with planetary health.

An unbiased, sustainable, evidence-informed Universal Food Guide: a timely template for national food guides

BACKGROUND

Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public.

METHODS

To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides' utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics.

RESULTS

The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to 'best' evidence-based practice, and human and animal welfare.

CONCLUSION

The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices.

A multi-dimensional Sustainable Diet Index (SDI) for Ghanaian adults under transition: the RODAM Study

BACKGROUND

The sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability.

METHODS

We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25-70 years). For the SDI construct (0-16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors.

RESULTS

The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors.

CONCLUSION

The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.

Review of Diet Quality Indices that can be Applied to the Environmental Assessment of Foods and Diets

PURPOSE OF REVIEW

The aim was to identify indices of diet quality and health that could be applied to the environmental assessment of foods in order to provide metrics that collectively assess nutritional, health and environmental dimensions.

RECENT FINDINGS

The review identified five major groups of indices: nutrient-food quantity-based; guideline-based; diversity-based; nutrient quality-based; health-based. Nutrient-food quantity-based and guideline type indices were the most frequently used to evaluate diet quality. Scaled assessment using a nutritional functional unit is the most common integration of diet quality with the environmental analysis of foods. There are fewer indices that measure the heath impacts of foods, but epidemiological dietary risk factors seem a promising approach to integrate diet and health impacts into the environmental assessment of foods. Five groups of nutritional and health indices were identified that can be applied when performing an environmental assessment of foods. This review proposes different methodological insights when doing such assessments to ensure transparency and comparability of the results.

Switches in food and beverage product purchases can reduce greenhouse gas emissions in Australia

Switching between similar food and beverage products may reduce greenhouse gas emissions (GHGe). Here, using consumer data linked to 23,550 product-specific GHGe values, we estimated annual GHGe attributable to product purchases consumed at home in Australia and calculated reductions from specific switches. Potential changes to mean Health Star Rating, mean energy density and the proportion of ultraprocessed foods purchased were assessed. Approximately 31 million tonnes of GHGe were attributable to products consumed at home in 2019, the three highest contributors of GHGe being 'meat and meat products' (49%), 'dairy' (17%) and 'non-alcoholic beverages' (16%). Switching higher-emission products for 'very similar' lower-emission products could reduce total emissions by 26%. Switches to 'less similar' lower-emission products could lead to a 71% reduction. Switches had little impact on the average Health Star Rating, energy density of purchases and proportion of ultraprocessed foods purchased. Directing manufacturing and marketing towards lower-environmental-impact products and signposting such options to consumers are key.

Mediterranean diet: a potential player in the link between oral microbiome and oral diseases

Background

The oral microbiome is a complex and dynamic assemblage of microorganisms that colonize different sites of the oral cavity maintaining both oral and systemic health. Therefore, when its composition is altered, oral diseases occur. Among oral inflammatory pathologies, periodontal diseases affect the tissues surrounding the teeth, representing the main cause of tooth loss and one of the most important threats to the oral health. Lifestyle and eating habits influence the composition of the human oral microbiota and the development and progression of oral diseases. In this context, the Mediterranean Diet (MD) model, comprising both healthy dietary choices and lifestyle, is linked to the prevention of several metabolic and chronic-degenerative pathological processes, including oral diseases. Indeed, the MD is a plant-based diet, enriched of anti-inflammatory and antioxidant nutrients, which may induce beneficial effects against dental caries and periodontal diseases.

Aim

This review summarizes the role of the oral microbiome in the development of the oral diseases and the potential of MD in modulating the oral microbiome leading to implications for oral health.

Conclusions

The data collected highlight the need to promote the MD pattern along with the correct hygiene habits to prevent the development of oral diseases.

Quantification and environmental impact of slaughter waste during its life cycle

Considering the lack of an in-depth and comprehensive study on slaughter waste quantification and its management, despite the growing demand for meat this study aims to quantify the slaughter waste generated in Mumbra, Thane, India, from the meat retail stores. The study also endeavors to find the composition of slaughter waste in municipal solid waste by employing the questionnaire survey method. The literature reviewed the published studies on the life cycle analysis of food products for global warming potential values for meat and vegetable products along with the vegetarian and non-vegetarian dietary patterns. In this study, it was observed that 55.93% of the population were non-vegetarian consumers and the composition of slaughter waste was 7% of total municipal solid waste disposed of in disposal sites resulting in greenhouse gas emission of 0.11 Gg CO2 Eq./year. The study presents the implementation of a biomethanation plant as a mitigation measure, along with an evaluation of the theoretical biogas potential and electricity generation capacity derived from slaughter waste, considering it as a potential feedstock. The outcomes of this study also highlight the necessity for further focused research in this specific area, aiming to increase consumer knowledge regarding the environmental impacts of meat-based diets. The finding of this study will help researchers and assists policymakers in facilitating effective management and understanding the scale of the emissions resulting from meat products and slaughter waste and identifying suitable mitigation approaches, and actively contributing to reducing the environmental footprint.

Sustainable healthy diet modeling for a plant-based dietary transitioning in the United States

The potential environmental and nutritional benefits of plant-based dietary shifts require thorough investigation to outline suitable routes to achieve these benefits. Whereas dietary consumption is usually in composite forms, sustainable healthy diet assessments have not adequately addressed composite diets. In this study, we build on available data in the Food4HealthyLife calculator to develop 3 dietary concepts (M) containing 24 model composite diet scenarios (S) assessed for their environmental and nutritional performances. The Health Nutritional Index (HENI) and Food Compass scoring systems were used for nutritional quality profiling and estimates of environmental impact were derived from previously reported midpoint impact values for foods listed in the What We Eat in America database. The diets were ranked using the Kruskal‒Wallis nonparametric test, and a dual-scale data chart was employed for a trade-off analysis to identify the optimal composite diet scenario. The results showcased a distinct variation in ranks for each scenario on the environment and nutrition scales, describing an inherent nonlinear relationship between environmental and nutritional performances. However, trade-off analysis revealed a diet with 10% legumes, 0.11% red meat, 0.28% processed meat and 2.81% white meat could reduce global warming by 54.72% while yielding a diet quality of 74.13 on the Food Compass Scoring system. These observations provide an interesting forecast of the benefits of transitioning to an optimal plant- and animal-based dieting pattern, which advances global nutritional needs and environmental stewardship among consumers.

Insight into the Sustainability of the Mediterranean Diet: The Water Footprint of the Recommended Italian Diet

At present, as we face climate change and natural resource scarcity, one of the major challenges linking humans and the environment is to ensure sufficient, nutritious, safe, and affordable food for a rapidly growing world population. In a nutshell, "feed the world without destroying it". The water footprint (WF), i.e., the withdrawals of fresh water necessary to produce one kilogram of food product, is one of the key indicators of the environmental impact of diets. In this work, the WF of the food patterns suggested by the Italian Food Based Dietary Guidelines, considered a model of the Mediterranean Diet, was evaluated for the first time. The data reported here clearly demonstrate that the suggested Italian dietary patterns have a low WF, the reduction of which by replacing animal foods with plant foods is limited because the suggested consumption of meat is already low. Consumer choice in the consumption of specific products within a food group could further reduce the WF of the diet, underlining the need to provide correct information not only to consumers but also to farmers and producers to encourage them to make water-saving choices.

Inappropriate dietary habits in tobacco smokers as a potential risk factor for lung cancer: Pomeranian cohort study

OBJECTIVE

Little is known whether diet quality modulates lung cancer risk in smokers. The aim of the study was to assess the dietary habits of a large group of volunteers participating in the lung cancer screening program.

METHODS

The 62-item food frequency questionaire was completed by 5997 participants, 127 of whom (2.1%) were later diagnosed with lung cancer. Two approaches were applied to identify dietary habits. The non-healthy diet index was calculated, and a direct analysis of the frequency of consumption was used. A logistic regression analysis was performed to estimate the association between food product intake and the risk of lung cancer.

RESULTS

The study population did not follow the Polish nutritional recommendations. They consumed fruits and vegetables too rarely and far too often ate non-recommended foods, such as processed meat, refined products, sugar, sweets, and salty snacks. Participants diagnosed with lung cancer more often consumed low-quality processed meat, red meat, fats, and refined bread and less often whole-grain products, tropical fruits, milk, fermented unsweetened milk drinks, nuts, honey, and wine. The non-healthy diet index score was significantly higher in those with cancer diagnosis compared with those without lung cancer (11.9 ± 5.2 versus 10.9 ± 5.3; P < 0.001).

CONCLUSIONS

The surveyed population of smokers did not follow dietary recommendations; there was a particularly high index of an unhealthy diet in by people diagnosed with lung cancer. Prevention programs should be based on encouraging smoking cessation, lifestyle modification, and methods of early detection of lung cancer. Lifestyle modification should include changing eating habits based on a healthy diet, which may be an additional factor in reducing the risk of developing cancer.

Modeling a localized metropolitan food system in the Midwest USA: Life cycle impacts of scenarios for Des Moines, Iowa

Food systems are energy-intensive, causing ≈25 % of anthropogenic global warming potential (GWP) and contributing to challenges across the food-energy-water nexus. The state of Iowa, USA, is of particular interest as a rainfed agricultural region of the upper Midwest; despite its highly productive landscape, a large proportion of food consumed by Iowa residents is imported. This study focused on the Des Moines Metropolitan Statistical Area (DM-MSA), a six-county area in central Iowa with a 2020 population of ≈700,000. A life cycle assessment approach was used to quantify environmental impacts (GWP, fossil energy and water consumption, land use); scenarios modeled provision and consumption of 50 % of nutritional requirements for the current DM-MSA population by food group (e.g., grains, proteins, vegetables). The four DM-MSA food system scenarios were: 1) current conditions (baseline), 2) local production for 50 % of food, 3) consumption changed to follow USA dietary guidelines, and 4) combined changes to production and consumption. Localizing food production reduced all environmental impacts more than following USA dietary guidelines. Compared to the baseline, 50 % local production scenarios reduced GWP and energy consumption (18-24 %) and water use (35-41 %) annually. Decreases by food group were least for protein (-10 % GWP) and greatest for fruits and vegetables (-58-62 % GWP). Local scenario alternatives could further reduce some environmental impacts if paired with a nutritionally- and environmentally-optimized diet (EAT-Lancet) providing the greatest change (-30-38 % for GWP and energy use) compared to the local scenario. A 50 % local production scenario for the DM-MSA could decrease GWP by 102 million CO_2eq yr^-1 and water use by 44 billion L yr^-1. However, this would require dietary changes based on seasonal food availability. Further development and co-simulation with other metropolitan-scale biophysical and social models will enhance understanding of food system drivers and support effective decision-making for urban food system improvements in the Midwest.

Protein quality as a complementary functional unit in life cycle assessment (LCA)

Goal and theoretical commentary

A number of recent life cycle assessment (LCA) studies have concluded that animal-sourced foods should be restricted-or even avoided-within the human diet due to their relatively high environmental impacts (particularly those from ruminants) compared with other protein-rich foods (mainly protein-rich plant foods). From a nutritional point of view, however, issues such as broad nutrient bioavailability, amino acid balances, digestibility and even non-protein nutrient density (e.g., micronutrients) need to be accounted for before making such recommendations to the global population. This is especially important given the contribution of animal sourced foods to nutrient adequacy in the global South and vulnerable populations of high-income countries (e.g., children, women of reproductive age and elderly). Often, however, LCAs simplify this reality by using 'protein' as a functional unit in their models and basing their analyses on generic nutritional requirements. Even if a 'nutritional functional unit' (nFU) is utilised, it is unlikely to consider the complexities of amino acid composition and subsequent protein accretion. The discussion herein focuses on nutritional LCA (nLCA), particularly on the usefulness of nFUs such as 'protein,' and whether protein quality should be considered when adopting the nutrient as an (n)FU. Further, a novel and informative case study is provided to demonstrate the strengths and weaknesses of protein-quality adjustment.

Case study methods

To complement current discussions, we present an exploratory virtual experiment to determine how Digestible Indispensable Amino Acid Scores (DIAAS) might play a role in nLCA development by correcting for amino acid quality and digestibility. DIAAS is a scoring mechanism which considers the limiting indispensable amino acids (IAAs) within an IAA balance of a given food (or meal) and provides a percentage contribution relative to recommended daily intakes for IAA and subsequent protein anabolism; for clarity, we focus only on single food items (4 × animal-based products and 4 × plant-based products) in the current case exemplar. Further, we take beef as a sensitivity analysis example (which we particularly recommend when considering IAA complementarity at the meal-level) to elucidate how various cuts of the same intermediary product could affect the interpretation of nLCA results of the end-product(s).

Recommendations

First, we provide a list of suggestions which are intended to (a) assist with deciding whether protein-quality correction is necessary for a specific research question and (b) acknowledge additional uncertainties by providing mitigating opportunities to avoid misinterpretation (or worse, dis-interpretation) of protein-focused nLCA studies. We conclude that as relevant (primary) data availability from supply chain 'gatekeepers' (e.g., international agri-food distributors and processors) becomes more prevalent, detailed consideration of IAA provision of contrasting protein sources needs to be acknowledged-ideally quantitatively with DIAAS being one example-in nLCA studies utilising protein as a nFU. We also contend that future nLCA studies should discuss the complementarity of amino acid balances at the meal-level, as a minimum, rather than the product level when assessing protein metabolic responses of consumers. Additionally, a broader set of nutrients should ideally be included when evaluating "protein-rich foods" which provide nutrients that extend beyond amino acids, which is of particular importance when exploring dietary-level nLCA.

Changes in terms of risks/benefits of shifting diets towards healthier and more sustainable dietary models

Food production and therefore human diet are identified as important sources of environmental impact. Unhealthy and unsustainable diets with high intake of meat and low intake of plant-based products are predominant worldwide. On the other hand, a balance between health and sustainability is necessary, since diets that are environmentally sustainable could lack essential macro- and micronutrients and result in nutrient deficiencies, non-communicable diseases and malnutrition. The aim of this project was to investigate the nutritional adequacy and environmental impact of adults' diet by comparing current dietary habits and new alternative dietary scenarios. First, a systematic review was conducted following PRISMA guidelines to assess the environmental impact of current diets and sustainable dietary scenarios such as vegan, vegetarian, pescatarian, omnivorous and optimised dietary patterns worldwide. In the second part of the project, an optimisation study was conducted, based on a multi-objective optimisation approach, with the purpose of creating the optimal diet based on nutritional and environmental constraints for the adult Italian population. The dietary scenarios of the optimised models were developed in accordance with the Italian food-based dietary guidelines. Food consumption data was extracted from the INHES study and used as baseline diet. A clear evaluation of the current environmental impact because of diet and potential sustainable dietary scenarios globally is challenging. Finally, national food-based guidelines should be adjusted by suggesting healthy and sustainable dietary recommendations in line with traditional eating habits and local food availability in order the desirable dietary shifts towards sustainability to be feasible.

Formulation, pilot-scale preparation, physicochemical characterization and digestibility of a lentil protein-based model infant formula powder

BACKGROUND

Infant formula is a human milk substitute for consumption during the first months of life. The protein component of such products is generally of dairy origin. Alternative sources of protein, such as those of plant origin, are of interest due to dairy allergies, intolerances, and ethical and environmental considerations. Lentils have high levels of protein (20-30%) with a good amino acid profile and functional properties. In this study, a model lentil protein-based formula (LF), in powder format, was produced and compared to two commercial plant-based infant formulae (i.e., soy; SF and rice; RF) in terms of physicochemical properties and digestibility.

RESULTS

The macronutrient composition was similar between all the samples; however, RF and SF had larger volume-weighted mean particle diameters (D[4,3] of 121-134 μm) than LF (31.9 μm), which was confirmed using scanning electron and confocal laser microscopy. The larger particle sizes of the commercial powders were attributed to their agglomeration during the drying process. Regarding functional properties, the LF showed higher D[4,3] values (17.8 μm) after 18 h reconstitution in water, compared with the SF and RF (5.82 and 4.55 μm, respectively), which could be partially attributed to hydrophobic protein-protein interactions. Regarding viscosity at 95 °C and physical stability, LF was more stable than RF. The digestibility analysis showed LF to have similar values (P < 0.05) to the standard SF.

CONCLUSION

These results demonstrated that, from the nutritional and physicochemical perspectives, lentil proteins represent a good alternative to other sources of plant proteins (e.g., soy and rice) in infant nutritional products. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Carbon Footprint of Alternative Grocery Shopping and Transportation Options from Retail Distribution Centers to Customer

The COVID-19 pandemic has accelerated the growth of e-commerce and automated warehouses, vehicles, and robots and has created new options for grocery supply chains. We report and compare the greenhouse gas (GHG) emissions for a 36-item grocery basket transported along 72 unique paths from a centralized warehouse to the customer, including impacts of micro-fulfillment centers, refrigeration, vehicle automation, and last-mile transportation. Our base case is in-store shopping with last-mile transportation using an internal combustion engine (ICE) SUV (6.0 kg CO₂e). The results indicate that emissions reductions could be achieved by e-commerce with micro-fulfillment centers (16-54%), customer vehicle electrification (18-42%), or grocery delivery (22-65%) compared to the base case. In-store shopping with an ICE pick-up truck has the highest emissions of all paths investigated (6.9 kg CO₂e) while delivery using a sidewalk automated robot has the least (1.0 kg CO₂e). Shopping frequency is an important factor for households to consider, e.g. halving shopping frequency can reduce GHG emissions by 44%. Trip chaining also offers an opportunity to reduce emissions with approximately 50% savings compared to the base case. Opportunities for grocers and households to reduce grocery supply chain carbon footprints are identified and discussed.

An integrated assessment of environmental sustainability and nutrient availability of food consumption patterns in Latin America and the Caribbean

BACKGROUND

In Latin America and the Caribbean, historical shifts away from traditional, plant-sourced food production and consumption patterns may undermine both nutritional status and environmental sustainability. Although agricultural intensification and increasingly animal-centric dietary preferences in the region are well-documented, their influence on environmental degradation remains unknown.

OBJECTIVE

This study aimed to 1) characterize the environmental impacts of current food consumption patterns in South America, Central America, and the Caribbean and 2) identify food groups that minimize impact while maintaining adequate nutrient availability.

DESIGN

Apparent regional food consumption was derived using data from the Food and Agriculture Organization's Food Balance Sheets on per capita food availability and levels of imported vs. local food production. Region-specific life cycle assessment data on greenhouse gas emissions, land use, and freshwater consumption were leveraged to estimate total, food group-level, and nutrient-specific environmental impacts.

RESULTS

Annual overall emissions were highest in Caribbean food consumption patterns (2521.2 kg/capita), largely derived from meat (26.7%) and fruit (23.8%) production. Land use (1941.0 m2/capita) and water consumption (2060.8 m3/capita), in contrast, were highest for the South American pattern, due to high consumption of meat and dairy. Across the regions, meat constituted 7.5-12.7% of food consumption yet accounted for as much as 73.1% of greenhouse gas emissions, 56.6% of land use, and 54.2% of water consumption. In contrast, legumes and seeds, cereals, roots, and vegetables demonstrated overall low environmental impacts, particularly relative to their contributions to dietary protein, iron, and zinc availability.

CONCLUSIONS

Findings point to the capacity of plant-sourced food consumption to minimize environmental harm without necessarily jeopardizing nutrient availability in Latin America and the Caribbean. Local agriculture can contribute to food system sustainability by producing diversified plant-sourced foods, cornerstones of many traditional food customs, and mitigating the impacts of industrialized livestock operations and imported, animal-centric dietary habits.

Life Cycle Assessment on Agricultural Production: A Mini Review on Methodology, Application, and Challenges

Agricultural Life Cycle Assessment (LCA) is an effective tool for the quantitative evaluation and analysis of agricultural materials production and operation activities in various stages of the agricultural system. Based on the concept of life cycle, it comprehensively summarizes the impact of agriculture on the environment, which is an effective tool to promote the sustainability and green development of agriculture. In recent years, agricultural LCA has been widely used in the agroecosystem for resource and environmental impacts analysis. However, some challenges still exist in agricultural LCA, i.e., the environmental impact assessment index system needs to be improved; its application in different production mode is limited; and combination research with other models needs more attention. This paper discusses the above-mentioned challenges and recommends research priorities for both scientific development and improvements in practical implementation. In summary, further research is needed to construct a regional heterogeneity database and develop innovated methodologies to develop more meaningful functional units for agricultural products to complement LCA by other models. These efforts will make agricultural LCA more robust and effective in environmental impacts assessment to support decision making from individual farm to regional or (inter)national for the sustainable future of agriculture.

Integrating Dietary Impacts in Food Life Cycle Assessment

Food production and food consumption have been too long studied separately. This paper therefore reviews progresses in assessment methods and identifies how nutrition effects on human health and environmental impacts of the entire food production and consumption can and should be consistently and systematically assessed, on a life cycle-based and a health-based perspective. Main observations include: (a) The strong activity in the Life Cycle Assessment (LCA) of a large range of agriculture production, covering beyond carbon footprint the biodiversity and health impacts of land, water, fertilizers, and pesticide use. (b) The multi-functionality of all foods and the need to compare a wide range of possible alternative including comparing serving size, meal alternatives and diets. (c) The availability of epidemiological dietary risk factors expressed in DALYs, enabling the creation of an additional LCA nutritional impact category and providing much broader flexibility in the choice of the functional unit and the kind of valid comparison LCA can address. (d) The need to use Big Data and machine learning method to better understand interactions and propose healthy and sustainable food baskets. As illustrated by the fruit yogurt example, dietary impacts on human health often dominate the life cycle impacts on human health and it is strongly recommended to consider them in the life cycle inventory and impact assessment of all commodities and foods that will eventually be consumed.

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

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

Ten-Year Changes in Global Warming Potential of Dietary Patterns Based on Food Consumption in Ontario, Canada

Many studies have evaluated the life cycle environmental impacts of diets based on a single period, but few studies have considered how environmental impacts of diets change over time, even though dietary patterns (DPs) change due to policy and socio-demographic factors. This study evaluated changes in the global warming potential (GWP) of DPs in the province of Ontario, Canada, using a life cycle assessment. We quantified the farm-to-fork GWP of six DPs (Omnivorous, No Pork, No Beef, No Red Meat, Pescatarian, and Vegetarian), using dietary intake data from a 2014 and 2015 survey. Throughout this period, the biggest decrease in GWP was for DPs containing beef, even though these DPs still have the highest GWP (3203 and 2308 kg CO2e, respectively, based on the annual energy intake of one individual). Across all DPs, plant-based proteins contributed less than 5% to GWP, while meat and fish contributed up to 62% of the total GWP. Ten-year GWP reductions are insufficient to meet climate change and other sustainability goals, and major dietary shifts are needed, particularly substituting animal-based proteins with plant-based proteins. To design effective interventions for shifting towards sustainable diets, research is needed to understand how socio-demographic and regional differences influence individuals’ food choices.

The Environmental Footprint Associated With the Mediterranean Diet, EAT-Lancet Diet, and the Sustainable Healthy Diet Index: A Population-Based Study

Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020.

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

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

Greenhouse Gas Emissions Associated With the Mexican Diet: Identifying Social Groups With the Largest Carbon Footprint

Background

Most studies of the climate footprint of diets have been conducted in countries in the global north, but the majority of the world population lives in global south countries. We estimated total dietary greenhouse gas emissions (GHGE) in Mexico, examined the contribution of major food and beverage groups, and assessed variation across social groups.

Methods

We linked individual-level dietary data from the Mexican National Health and Nutrition Survey 2018 to the SHARP Indicators Database, containing GHGE estimates for 182 primary food and beverages.

Results

Mean dietary GHGE was 3.9 kg of carbon dioxide equivalent per person per day. Dietary GHGE is highest among those in young adulthood and middle age versus adolescents and older adults, and among males, those with higher educational attainment, higher socioeconomic status, that do not speak an indigenous language, and that live in urban areas.

Conclusion

The Mexican diet has a much lower carbon footprint than diets in other Latin American countries for which such estimates are available. In contrast to patterns observed in Argentina and Brazil, dietary GHGE was lowest in those in lower socioeconomic and educational strata and in rural areas. A better understanding of the differences in diet sustainability between and within countries will be needed for developing global and local strategies that meet the environmental sustainability goals.

Dietary Patterns at the Individual Level through a Nutritional and Environmental Approach: The Case Study of a School Canteen

The public catering sector has important responsibilities in seeking a change toward more sustainable choices for many aspects related to the environmental impacts of their services. The environmental impact of production processes can be studied through life cycle assessment (LCA), which allows a greater awareness of choices and has rarely been applied to catering. In this work, we studied the impacts of two dishes (braised meat and cauliflower meatballs) in a school canteen, their impacts were studied using the daily energy requirement (expressed in kcal) as a functional unit. Global warming potential (GWP) and nonrenewable energy (NRE) were calculated starting from the supply of raw materials up to distribution. Electricity and the act of cooking the meatballs accounted for more than 60% of the measured impact in terms of GWP, whereas, less markedly, they dominated in terms of nonrenewable energy used. In the case of braised meat, the total impact was, however, attributable to the life cycle of the meat (between 60% and 76%) and the consumption of electricity (between 19% and 27%), whereas for all other factors, the contribution was never particularly high. Additionally, a discussion on the correct functional unit to be used proposed the environmental impact of different recipes as an additional criterion for nutritionists during the composition of the menu. An integrated system appears important for changing policies and behaviors and the application of LCA can be a tool capable of contributing to the construction of a holistic instrument of sustainability.

Alternatives to Cow’s Milk-Based Infant Formulas in the Prevention and Management of Cow’s Milk Allergy

Cow’s milk-based infant formulas are the most common substitute to mother’s milk in infancy when breastfeeding is impossible or insufficient, as cow’s milk is a globally available source of mammalian proteins with high nutritional value. However, cow’s milk allergy (CMA) is the most prevalent type of food allergy among infants, affecting up to 3.8% of small children. Hypoallergenic infant formulas based on hydrolysed cow’s milk proteins are commercially available for the management of CMA. Yet, there is a growing demand for more options for infant feeding, both in general but especially for the prevention and management of CMA. Milk from other mammalian sources than the cow, such as goat, sheep, camel, donkey, and horse, has received some attention in the last decade due to the different protein composition profile and protein amino acid sequences, resulting in a potentially low cross-reactivity with cow’s milk proteins. Recently, proteins from plant sources, such as potato, lentil, chickpeas, quinoa, in addition to soy and rice, have gained increased interest due to their climate friendly and vegan status as well as potential lower allergenicity. In this review, we provide an overview of current and potential future infant formulas and their relevance in CMA prevention and management.

Changing dietary patterns is necessary to improve the sustainability of Western diets from a One Health perspective

Western diets are associated with multiple environmental impacts and risks to human health. European countries are gradually taking action towards the Farm to Fork Strategy, embracing a Life Cycle Assessment (LCA) perspective to promote the sustainability of food production and consumption. Although LCA enables the comprehensive assessment of environmental impacts, diet-related human health and animal welfare impacts are often underrepresented. This study proposes integrating additional indicators into LCA to evaluate the sustainability of diets under the One Health (OH) approach, which holistically considers interlinked complex health issues between humans, animals and the environment. Human health loss is estimated according to risk factors for non-communicable diseases; while animal welfare is measured as animal life years suffered, loss of animal lives and loss of morally-adjusted animal lives. The extended LCA framework is applied to men and women's reference diets in the German federal state of North Rhine-Westphalia (NRW); compared to three optimized dietary scenarios under nutritional constraints: 1) the national dietary guidelines, 2) a vegan diet (VD) and 3) a Mediterranean diet (MD). Men's reference diet causes greater impacts than women's across OH dimensions due to the higher food consumption, especially of ready-to-eat meals, sausages, meat, and sweetened and alcoholic beverages. Both reference diets are associated with risk factors for cardiovascular diseases, diabetes, stroke and neoplasms. Besides meat, consumption of honey, fish and seafood has the greatest impact on animal welfare, because of the high number of individuals involved. Alternative diets improve the sustainability of food consumption in NRW, although trade-offs arise: MD worsens animal suffering due to the higher fish intake; water use increases in both VD and MD due the higher intake of nuts and vegetables. Results highlight the importance of including animal welfare and human health indicators in LCA to better elucidate the potential impacts of diets characterized by the high intake of animal products, from a OH perspective.

Life cycle assessment of plant cell cultures

A novel food such as plant cell culture (PCC) is an important complementary asset for traditional agriculture to tackle global food insecurity. To evaluate environmental impacts of PCC, a life cycle assessment was applied to tobacco bright yellow-2 and cloudberry PCCs. Global warming potential (GWP), freshwater eutrophication potential (FEUP), marine eutrophication potential, terrestrial acidification potential (TAP), stratospheric ozone depletion, water consumption and land use were assessed. The results showed particularly high contributions (82-93%) of electricity consumption to GWP, FEUP and TAP. Sensitivity analysis indicated that using wind energy instead of the average Finnish electricity mix reduced the environmental impacts by 34-81%. Enhancement in the energy efficiency of bioreactor mixing processes and reduction in cultivation time also effectively improved the environmental performance (4-47% reduction of impacts). In comparison with other novel foods, the environmental impacts of the PCC products studied were mostly comparable to those of microalgae products but higher than those of microbial protein products produced by autotrophic hydrogen-oxidizing bacteria. Assayed fresh PCC products were similar or close to GWP of conventionally grown food products and, with technological advancements, can be highly competitive.

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

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

Carbon footprint of the Brazilian diet

OBJECTIVE

To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population.

METHODS

Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata.

RESULTS

The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region.

CONCLUSION

The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.

Mediterranean diet quality index is associated with better cardiorespiratory fitness and reduced systolic blood pressure in adults: A cross-sectional study

BACKGROUND

Literature suggests higher cardiorespiratory fitness (CRF) is inversely related to chronic diseases such as metabolic syndrome and cardiovascular disease and hypertension. The aim of this study was to assess the association of Mediterranean dietary quality index (Med-DQI) with CRF and hypertension in a sample of Iranian adults.

METHODS

This was a cross-sectional study on 270 healthy men and women, aged 18-45 years. Dietary intake and physical activity level were assessed through a validated food frequency questionnaire (FFQ); and the International Physical Activity Questionnaires (IPAQ), respectively. Cardiorespiratory fitness was assessed by using a graded exercise treadmill test. The association between Med-DQI and CRF was investigated using multiple regression models.

RESULTS

Participants in the top tertiles of Med-DQI, had higher VO2 max (mL/kg/min) (p = 0.02) and lower SBP (p = 0.01). When we controlled for age, sex, weight, smoking, physical activity and energy intake, the significant results were remained. Results of unadjusted linear regression shows that CRF was positively associated with cholesterol (p < 0.001) and fish (p < 0.001). Also, CRF was positively associated with vegetables and fruits (p < 0.001) and olive oil (p = 0.05). After adjustments for confounders, the significant associations of olive oil and cholesterol with CRF were disappeared while vegetables and fruits and total score of Med-DQI remained significant. There were no significant relations between saturated fatty acids meat, and cereals with Med-DQI.

CONCLUSIONS

Our results demonstrated that Med-DQI was associated with better CRF in Iranian adults and SBP. Further studies with interventional approaches are needed to better clarify the causal inference of these associations.

Analysis of the Cultured Meat Production System in Function of Its Environmental Footprint: Current Status, Gaps and Recommendations

Cultured meat has been presented as an environmentally friendlier option to conventional meat, but due to the limited data, the studies related to its performance are scarce and based on hypothetical production processes. This work provides a short literature review of the published environmental assessments of cultured meat. The main findings of this critical analysis showed that the lack of real data related to cultured meat decreased the level of accuracy of each study. The missing environmental profile of the process itself, including the proliferation and differentiation phases in bioreactors, along with key ingredients such as growth factors and other recombinant proteins, increase the difficulty of achieving reliable conclusions. In order to bridge the highlighted gaps, a complete production system is modelled and analysed from an engineering and life-cycle perspective. Furthermore, an overview of the supply chains of different products used in the process is provided, together with recommendations on how they should be considered in future life-cycle assessments. In essence, this work provides a structured pathway for upcoming consistent environmental assessments in this field, with the objective of setting the basis to understand the potential of cultured meat.

Large-Scale Microanalysis of U.S. Household Food Carbon Footprints and Reduction Potentials

Promoting sustainable food consumption is critical to meet the United Nation's Sustainable Development Goals. The existing research using average diets and the individual one-day diet recall data to obtain insights into food carbon footprints (CFs) may neglect the diverse food purchasing patterns in different households (HHs). In this paper, we analyzed detailed grocery shopping records of 57,578 U.S. HHs to evaluate the associated food CFs. The cradle-to-farm-gate CFs of 83 food items were calculated using a process-based life cycle assessment model adapted to the U.S. condition. Using the CF of a healthy and sustainable diet as the benchmark, we quantified the CF reduction potentials for each HH. Our results suggest three key strategies to reduce HH food CFs: (1) lowering the over-purchasing in small (one- or two-person) HHs can achieve two-thirds of the recognized carbon emission reduction potentials; (2) reducing the intake of snacks, ready-made food, and drinks leads to as much as, if not more, carbon emission reduction than changing diets; and (3) more attention needs to be paid to reduce the carbon intensity of food items with large purchased volume.

Sustainable food profiling models to inform the development of food labels that account for nutrition and the environment: a systematic review

Sustainable food profiling models (SFPMs) are the scientific basis for the labelling of food products according to their environmental and nutritional impact, allowing consumers to make informed choices. We identified ten SFPMs that score individual foods according to at least two environmental indicators, with the most common being greenhouse gas emissions (n=10) and water use (n=8). Six models additionally assessed the nutritional quality of foods and presented different methods to combine nutritional and environmental indicators. Key advantages of identified models include a wide range in system boundaries, reference units, approaches for defining cutoff values, design proposals for food labelling schemes, and the comprehensive geographical scope of the lifecycle inventory databases used in the development phase of the model. Key disadvantages of identified models include inconsistent methods for food classification and poor replicability due to unclear methods, unavailable code for environmental and nutritional impact calculation, and unclear cutoff values. We found that few SFPMs to date account for at least two environmental impact factors, and even fewer include nutritional values or other dimensions of sustainability. This systematic review highlights the need to use consistent components and to develop national and international reference values for the classification of sustainable food to enable standardised food labelling.

A Life Cycle Assessment Approach for Vegetables in Large-, Mid-, and Small-Scale Food Systems in the Midwest US

Although vegetables are important for healthy diets, there are concerns about the sustainability of food systems that provide them. For example, half of fresh-market vegetables sold in the United States (US) are produced in California, leading to negative impacts associated with transportation. In Iowa, the focus of this study, 90% of food is imported from outside the state. Previous life cycle assessment (LCA) studies indicate that food consumption patterns affect global warming potential (GWP), with animal products having more negative impacts than vegetables. However, studies focused on how GWP, energy, and water use vary between food systems and vegetable types are less common. The purpose of this study was to examine these environmental impacts to inform decisions to buy locally or grow vegetables in the Midwest. We used a life cycle approach to examine three food systems (large-, mid-, and small-scale) and 18 vegetables commonly grown in/near Des Moines, Iowa. We found differences in GWP, energy, and water use (p ≤ 0.001 for each) for the three food systems with the large-scale scenario producing more emissions. There were also differences among vegetables, with the highest GWP for romaine lettuce (1.92 CO2eq/kg vegetable) approximately three times that of leaf lettuce (0.65 CO2eq/kg vegetable) at the large scale. Hotspots and tradeoffs between GWP, energy, and water use were also identified and could inform vegetable production/consumption based on carbon and water use footprints for the US Midwest.

Toward a Healthy and Environmentally Sustainable Campus Food Environment: A Scoping Review of Postsecondary Food Interventions

Interventions are urgently needed to transform the food system and shift population eating patterns toward those consistent with human health and environmental sustainability. Postsecondary campuses offer a naturalistic setting to trial interventions to improve the health of students and provide insight into interventions that could be scaled up in other settings. However, the current state of the evidence on interventions to support healthy and environmentally sustainable eating within postsecondary settings is not well understood. A scoping review of food- and nutrition-related interventions implemented and evaluated on postsecondary campuses was conducted to determine the extent to which they integrate considerations related to human health and/or environmental sustainability, as well as to synthesize the nature and effectiveness of interventions and to identify knowledge gaps in the literature. MEDLINE (via PubMed), CINAHL, Scopus, and ERIC were searched to identify articles describing naturalistic campus food interventions published in English from January 2015 to December 2019. Data were extracted from 38 peer-reviewed articles, representing 37 unique interventions, and synthesized according to policy domains within the World Cancer Research Foundation's NOURISHING framework. Most interventions were focused on supporting human health, whereas considerations related to environmental sustainability were minimal. Interventions to support human health primarily sought to increase nutrition knowledge or to make complementary shifts in food environments, such as through nutrition labeling at point of purchase. Interventions to support environmental sustainability often focused on reducing food waste and few emphasized consumption patterns with lower environmental impacts. The implementation of integrated approaches considering the complexity and interconnectivity of human and planetary health is needed. Such approaches must go beyond the individual to alter the structural determinants that shape our food system and eating patterns.

Dietary Risk-Related Colorectal Cancer Burden: Estimates From 1990 to 2019

Background: Colorectal cancer remains a public health problem worldwide. Dietary risk factors play a key role in the carcinogenesis and progression of colorectal cancer. This study aimed to explore the geographical and temporal trends in various dietary factor-related colorectal cancers.

Methods: Data were extracted from the Global Burden of Disease (GBD) 2019 study, including the deaths, disability-adjusted life-years (DALYs), age-standardized rate (ASR), and summary exposure value (SEV) among 4 world regions, 11 age groups, 21 regions, and 204 countries and territories between 1990 and 2019. The estimated annual percentage changes (EAPCs) were calculated to evaluate the variation trend of ASR.

Results: Dietary factors were the leading cause of colorectal cancer death and DALY rate, regardless of age. Dietary factor-related deaths and DALYs accounted for 32 and 34% of global colorectal cancer, respectively. Further analysis showed that low whole grain intake remained the leading cause of cancer death and DALY rate, followed by milk and calcium. Diets that were low in whole grains, milk, and calcium accounted for 81.61% of deaths and 81.64% of DALYs. Deaths and DALYs of dietary factors related to colorectal cancer grew by half from 1990 to 2019. All ASRs remained higher for men than women. Asia carried the highest colorectal cancer burden attributed to dietary risks, especially for East Asia [age-standardized death rate (ASDR): EAPC = 1.15, 95% CI:0.88–1.42; DALY: EAPC = 1.08, 95% CI:0.82–1.34]. The heavy burden also existed in high-middle and middle socio-demographic index (SDI) quintiles. China has always had the highest deaths and DALYs of colorectal cancer attributable to dietary risks, followed by the USA, India, and Japan.

Conclusions: Large variations existed in the dietary risk-related colorectal cancer burdens among sexes, regions, and countries. More targeted interventions to address modifiable dietary risk factors would save 32% of deaths and 34% of DALYs for colorectal cancer.

Which diet has the lower water footprint in Mediterranean countries?

The Mediterranean region is increasingly water scarce, with the food system being the largest driver of water use. We calculate the water resources related to food consumption in nine major Mediterranean countries, by means of the water footprint (WF), for the existing situation (period 2011-2013) as well as the Mediterranean and EAT-Lancet diets. We account for different food intake requirements according to gender and six age groups. These nine countries - Spain, France, Italy, Greece, Turkey, Egypt, Tunisia, Algeria and Morocco - represent 88% of the population of all countries bordering the Mediterranean. As first major observation, we find that the EAT-Lancet diet, a scientifically optimised diet for both nutrition and certain environmental indicators, requires less water resources than the Mediterranean diet, a culturally accepted diet within the region. In terms of water resources use, adherence to the former is thus more beneficial than adherence to the latter. As second major observation, we find that the EAT-Lancet diet reduces the current WF for all nations consistently, within the range -17% to -48%, whereas the Mediterranean diet reduces the WF of the European countries, Turkey, Egypt and Morocco within the range of -4% to -35%. For the Maghreb countries Tunisia and Algeria, the Mediterranean diet WF is slightly higher compared to the current WF and the proportions of food product groups differ. Such dietary shifts would be important parts of the solution to obtain the sustainable use of water resources in Mediterranean countries.

Small targeted dietary changes can yield substantial gains for human health and the environment

To identify environmentally sustainable foods that promote health, we combined nutritional health-based and 18 environmental indicators to evaluate, classify and prioritize individual foods. Specifically for nutrition, we developed the Health Nutritional Index to quantify marginal health effects in minutes of healthy life gained or lost of 5,853 foods in the US diet, ranging from 74 min lost to 80 min gained per serving. Environmental impacts showed large variations and were found to be correlated with global warming, except those related to water use. Our analysis also indicated that substituting only 10% of daily caloric intake from beef and processed meat for fruits, vegetables, nuts, legumes and selected seafood could offer substantial health improvements of 48 min gained per person per day and a 33% reduction in dietary carbon footprint.

Deconstructing the Supermarket: Systematic Ingredient Disaggregation and the Association between Ingredient Usage and Product Health Indicators for 24,229 Australian Foods and Beverages

Unhealthy diets are underpinned by the over-consumption of packaged products. Data describing the ingredient composition of these products is limited. We sought to define the ingredients used in Australian packaged foods and beverages and assess associations between the number of ingredients and existing health indicators. Statements of ingredients were disaggregated, creating separate fields for each ingredient and sub-ingredient. Ingredients were categorised and the average number of ingredients per product was calculated. Associations between number of ingredients and both the nutrient-based Health Star Rating (HSR) and the NOVA level-of-processing classification were assessed. A total of 24,229 products, listing 233,113 ingredients, were included. Products had between 1 and 62 ingredients (median (Interquartile range (IQR)): 8 (3–14)). We identified 915 unique ingredients, which we organised into 17 major and 138 minor categories. ‘Additives’ were contained in the largest proportion of products (64.6%, (15,652/24,229)). The median number of ingredients per product was significantly lower in products with the optimum 5-star HSR (when compared to all other HSR score groups, p-value < 0.001) and significantly higher in products classified as ultra-processed (when compared to all other NOVA classification groups, p-value < 0.001). There is a strong relationship between the number of ingredients in a product and indicators of nutritional quality and level of processing.

Perspective: Defining Carbohydrate Quality for Human Health and Environmental Sustainability

Plant foods are universally promoted for their links to improved human health, yet carbohydrate-containing foods are often maligned based on isolated, reductionist methods that fail to assess carbohydrate foods as a matrix of nutrients and food components. Currently accepted positive carbohydrate quality indices include plant food, whole-grain content, and dietary fiber, while negative health outcomes are linked to high intakes of added sugar and high glycemic index. More recently, negative health aspects have been linked to ultra-processed foods, which are often high in carbohydrates. Yet, carbohydrate staples such as grains and dairy products are both enriched and fortified, resulting in these carbohydrate foods containing important nutrients of concern such as dietary fiber, potassium, vitamin D, and calcium. This Perspective analyzes carbohydrate metrics used in dietary guidance and labeling and finds limitations in accepted indices included in standardized quality carbohydrate definitions and also proposes additional indices to benefit both human and environmental health. As nutrition recommendations shift away from a single-nutrient focus to a more holistic dietary pattern approach that is flexible and adaptable for each individual, it is necessary to determine the quality components that make up these patterns. This review concludes that current approaches that demonize staple carbohydrate foods do little to promote the recommended patterns of foods known to improve health status and reduce disease risk.

Lifetime climate impacts of diet transitions: a novel climate change accounting perspective

Dietary transitions, such as eliminating meat consumption, have been proposed as one way to reduce the climate impact of the global and regional food systems. However, it should be ensured that replacement diets are indeed nutritious and that climate benefits are accurately accounted for. This study uses New Zealand food consumption as a case study for exploring the cumulative climate impact of adopting the national dietary guidelines and the substitution of meat from hypothetical diets. The new GWP* metric is used as it was designed to better reflect the climate impacts of the release of methane than the de facto standard 100-year Global Warming Potential metric (GWP100). A transition at age 25 to the hypothetical dietary guideline diet reduces cumulative warming associated with diet by 7 to 9% at the 100th year compared with consuming the average New Zealand diet. The reduction in diet-related cumulative warming from the transition to a hypothetical meat-substituted diet varied between 12 and 15%. This is equivalent to reducing an average individual's lifetime warming contribution by 2 to 4%. General improvements are achieved for nutrient intakes by adopting the dietary guidelines compared with the average New Zealand diet; however, the substitution of meat items results in characteristic nutrient differences, and these differences must be considered alongside changes in emission profiles.

An explorative assessment of environmental and nutritional benefits of introducing low-carbon meals to Barcelona schools

Shifting to plant-based and low-carbon diets is a key measure for climate change mitigation. In this regard, national and local governments are setting goals and actions to tackle this issue. The municipality of Barcelona has set an intervention for the academic year 2020-21: introducing low-carbon meals in public schools. This study assesses the environmental and nutritional benefits of this intervention by applying the Life Cycle Assessment (LCA) methodology, with an energy and nutritional functional unit; and combined it with the Water-Energy-Food (WEF) nexus approach, by considering three WEF resources-based impacts (Blue Water Footprint (BWF), Primary Energy Demand (PED) and Land Use (LU)) and the Global Warming Potential (GWP). The transition to a low-carbon meal would reduce between 46 and 60% the environmental impacts. These benefits could even be higher when extra interventions within the school boundaries are applied. More research in behavioural change is needed in order to evaluate both: the acceptance of the new menus by scholars and the adaptation of the school kitchen staff to the new menu. Finally, it is suggested to monitor the environmental and nutritional changes of the introduction of low-carbon meals within the school menus in an integrated way.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

BACKGROUND

Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets.

OBJECTIVE

To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns.

METHODS

We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it.

CONCLUSIONS

The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Multi-Objective Optimization of Nutritional, Environmental and Economic Aspects of Diets Applied to the Spanish Context

Current food consumption patterns must be revised in order to improve their sustainability. The nutritional, environmental, and economic consequences of these dietary patterns must be taken into consideration when diet guidelines are proposed. This study applied a systematic optimization methodology to define sustainable dietary patterns complying with nutritional, environmental, and economic issues. The methodology was based on a multi-objective optimization model that considered a distance-to-target approach. Although the three simultaneous objectives (maximal nutritional contribution, minimal greenhouse gas emissions, and minimal costs) could be divergent, the proposed model identified the optimal intake of each food product to achieve the maximal level of nutritional, environmental, and economic diets. This model was applied to six different eating patterns within the Spanish context: one based on current food consumption and five alternative diets. The results revealed that dietary patterns with improved nutritional profiles and reduced environmental impacts could be defined without additional costs just by increasing the consumption of vegetables, fruits, and legumes, while reducing the intake of meat and fish.

Mediterranean diet and breast cancer risk: a narrative review

Breast cancer is the second most frequent type of cancer worldwide and the most commonly occurring malignancy in women, and its incidence is increasing in most developed and developing countries. There is growing evidence that lifestyle factors, in particular diet may be associated with higher breast cancer risk. Some evidence exists regarding the benefit of Mediterranean diet on reduced risk of breast cancer in premenopausal and postmenopausal women. The protective effect of the Mediterranean diet against the risk of breast cancer, is primarily due to principal foods of this nutritional pattern. The principal components of the Mediterranean diet, such as fruits and vegetables, olive oil, fish and red wine have important antioxidants properties due to their high content of substances like polyphenols, flavonoids, carotenoids and fibers, along with a favorable fatty acid profile, that in turn could reduce the risk of breast cancer. Considering the severity of breast cancer and the increasing incidence in the world, there is an increasing interest in promoting prevention strategies in order to reduce the incidence. The aim of this paper is to provide a general overview of the current evidence on the relationship between breast cancer and Mediterranean diet, in premenopausal and postmenopausal women, and to emphasize the potential role of Mediterranean Diet as an effective tool in primary prevention. The possible molecular mechanisms underlying this association will be also pointed out.

Nutrition-Oriented Reformulation of Extruded Cereals and Associated Environmental Footprint: A Case Study

The global food system faces a dual challenge for the decades ahead: to (re)formulate foods capable to feed a growing population while reducing their environmental footprint. In this analysis, nutritional composition, recipe, and sourcing data were analyzed alongside five environmental indicators: climate change (CC), freshwater consumption scarcity (FWCS), abiotic resource depletion (ARD), land use impacts on biodiversity (LUIB), and impacts on ecosphere/ecosystems quality (IEEQ) to assess improvement after three reformulation cycles (2003, 2010, 2018) in three extruded breakfast cereals. A life cycle assessment (LCA) was performed using life cycle inventory (LCI) composed by both primary data from the manufacturer and secondary data from usual third-party LCI datasets. Reformulation led to improved nutritional quality for all three products. In terms of environmental impact, improvements were observed for the CC, ARD, and IEEQ indicators, with average reductions of 12%, 14%, and 2% between 2003 and 2018, respectively. Conversely, the FWCS and LUIB indicators were increased by 57% and 70%, respectively. For all indicators but ARD, ingredients contributed most to the environmental impact. This study highlights the need for further focus on the selection of less demanding ingredients and improvements in agricultural practices in order to achieve environmental and nutritional improvements.