Five priorities to operationalize the EAT–Lancet Commission report

Developing a novel optimisation approach for keeping heterogeneous diets healthy and within planetary boundaries for climate change

BACKGROUND AND OBJECTIVES

Current dietary habits have substantial negative impacts on the health of people and the planet. This study aimed to develop a novel approach for achieving health-promoting and climate-friendly dietary recommendations for a broad range of consumers.

SUBJECTS AND METHODS

Hierarchical clustering analysis was combined with linear programming to design nutritionally adequate, health-promoting, climate-friendly and culturally acceptable diets using Swedish national dietary data (n = 1797). Diets were optimised for the average consumption of the total population as well as for the dietary clusters.

RESULTS

Three dietary clusters were identified. All optimised diets had lower shares of animal-source foods and contained higher amounts of plant-based foods. These dietary shifts reduced climate impacts by up to 53% while leaving much of the diet unchanged. The optimised diets of the three clusters differed from the optimised diet of the total population. All optimised diets differed considerably from the food-group pattern of the EAT-Lancet diet.

CONCLUSIONS

The novel cluster-based optimisation approach was able to generate alternatives that may be more acceptable and realistic for a sustainable diet across different groups in the population.

Global trends and research hotspots of EAT-Lancet diet: a bibliometric analysis

The EAT-Lancet diet is a groundbreaking and comprehensive dietary framework that has garnered significant attention in the fields of nutrition, sustainability, and public health. We aimed to conduct a bibliometric study to investigate current status and hotspots in the field of EAT-Lancet diet based on the Web of Science Core Collection (WOSCC) database, and the documents of EAT-Lancet diet published from Jan 1, 2019 to Sep 1.2023 were extracted. The bibliometric and visualized analysis were performed by VOSviewer 1.6.16 and WOSCC Online Analysis Platform. In total, 155 documents from 62 journals were included, and 735 authors from 389 institutions and 53 countries/regions contributed to the field of EAT-Lancet diet. The most productive countries/regions, institutions, authors, and journals were the USA, Wageningen University & Research, Johan Rockström, and Nutrients, respectively. The first high-cited document was published in Lancet and authored by Willett et al. in 2019. This is also the first study about EAT-Lancet diet. The article firstly proposed the "EAT-Lancet Diet" emphasizing balanced, plant-based eating to improve human health while addressing environmental concerns. In conclusion, in the field of EAT-Lancet diet, the main research hotspots and frontiers are the adaptation of EAT-Lancet diet, the composition of EAT-Lancet diet, and the benefits of EAT-Lancet diet for human health. The number of research on the EAT-Lancet diet is currently limited. There is a pressing need for further studies to broaden our understanding of the EAT-Lancet diet and its potential to enhance human health.

Perseverance, partnerships and passion: ingredients for successful local government policy to promote healthy and sustainable diets

BACKGROUND

Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia.

METHODS

Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method.

RESULTS

Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect.

CONCLUSIONS

Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach.

The negative impact of vegetarian and vegan labels: Results from randomized controlled experiments with US consumers

Reducing consumption of animal products is a critically important challenge in efforts to mitigate the climate crisis. Despite this, meals containing animal products are often presented as the default versus more environmentally sustainable vegetarian or vegan options. We tested whether vegetarian and vegan labels on menu items negatively impact the likelihood of US consumers choosing these items by using a between-subjects experimental design, where participants chose a preference between two items. Menu items were presented with titles and descriptions typical at restaurants, and a random group saw "vegan" or "vegetarian" labels in the titles of one of the two items. Two field studies were conducted at a US academic institution, where people selected what to eat via event registration forms. The methodology was extended to an online study, where US consumers selected what to hypothetically eat in a series of choice questions. Overall, results showed the menu items were significantly less likely to be chosen when they were labeled, with much larger effects in the field studies, where choice was not hypothetical. In addition, the online study showed male participants had a significantly higher preference for options containing meat versus other participants. Results did not indicate the impact of labels differed by gender. Furthermore, this study did not find that vegetarians and vegans were more likely to choose items with meat when the labels were removed, indicating that removing labels did not negatively impact them. The results suggest removing vegetarian and vegan labels from menus could help guide US consumers towards reduced consumption of animal products.

Interpreting alignment to the EAT-Lancet diet using dietary intakes of lactating mothers in rural Western Kenya

The EAT-Lancet reference diet intends to be good for planetary and human health. We compared single multiple pass method 24-h dietary intake of mothers (n = 242) from a cross-sectional study in Western Kenya to the recommended range of intake of 11 EAT-Lancet food groups (e.g., 0-100 g/day legumes; maximum score 11), defining alignment two ways: daily intake among food groups where a minimum intake of 0 g was either acceptable or unacceptable. Ordinal logistic regression models assessed associations between alignment and body mass index (BMI). Cost of mothers' diets and hypothetical diets within recommended ranges (lower bounds >0 g) were estimated using food price data from markets within the mothers' locality. Mean energy intake was 1827 (95% confidence interval [CI]: 1731-1924) kcal/day. Relative to the EAT-Lancet diet, mothers' diets were on average higher for grains; within recommendations for tubers, fish, beef and dairy; closer to lower bounds for chicken, eggs, legumes and nuts; and lower for fruits and vegetables. Mean (95% CI) alignment scores were 8.2 (8.0-8.3) when 0 g intakes were acceptable and 1.7 (1.6-1.9) otherwise. No significant associations were found between alignment and BMI. Mothers' diets and hypothetical diets within recommended ranges averaged 184.6 KES (1.6 USD) and 357.5 KES (3.0 USD)/person/day, respectively. Lactating mothers' diets were not diverse and diverged from the reference diet when an intake of 0 g was considered unacceptable. Lower bound intakes of 0 g for micronutrient-dense food groups are inappropriate in food-insecure populations. It would likely cost more than mothers currently spend to tailor their diets to the EAT-Lancet reference diet.

How the EAT-Lancet Commission on food in the Anthropocene influenced discourse and research on food systems: a systematic review covering the first 2 years post-publication

In 2019, the EAT-Lancet Commission's report on food in the Anthropocene presented a planetary heath diet to improve health while reducing the environmental effect of food systems globally. We assessed EAT-Lancet's immediate influence on academic research and debate by conducting a systematic review of articles citing the Commission and others published from January, 2019, to April, 2021. The Commission influenced methods, results, or discourse for 192 (7·5%) of 2560 citing articles, stimulating cross-disciplinary research and debate across life sciences (47%), health and medical sciences (42%), and social sciences (11%). Sentiment analysis of 76 critiquing articles indicated that opinions were, on average, more positive than negative. Positive sentiments centred on benefits for informing policy, public health, and raising public awareness. Negative sentiments included insufficient attention to socioeconomic dimensions, feasibility, and environmental effects other than emissions. Empirical articles predominantly evaluated the effects of changed diets or food production on the environment and wellbeing (29%), compared current diets with EAT-Lancet recommendations (12%), or informed future policy and research agendas (20%). Despite limitations in EAT-Lancet's method, scope, and implementation feasibility, the academic community supported these recommendations. A broad suite of research needs was identified focusing on the effects of food processing, socioeconomic and political drivers of diet and health, and optimising consumption or production for environment and health.

Seafood consumption changes and COVID-19 impact index in West Nusa Tenggara, Indonesia

This empirical study examines seafood consumption patterns in the province of West Nusa Tenggara, Indonesia at the regency level, and analyzes changes in consumption patterns during the COVID-19 (SARS-CoV-2) virus outbreak. We used a stratified semi-random general population survey administered online through mobile devices from November 24th-December 31st 2020 for rapid assessment and dissemination, which received 1518 respondents. Our findings enabled us to generate a COVID-19 impact index at the regency level, indicating an urban-to-rural gradient in the degree of change in seafood consumption patterns, with rural areas incurring more changes. During COVID-19, 61% of respondents ate less seafood than normal, 66% stated seafood was more expensive, and 37% stated that the seafood they normally buy was not available. Respondents also bought 5% less fresh or raw seafood, and 4.3% more pre-cooked seafood products during the pandemic. Traditional markets, mobile vendors, and food stands remain the most frequent access points for seafood, although access decreased during the pandemic for all, with mini- and supermarket access slightly increasing. Raw and fresh seafood purchases from travelling merchants decreased 12.5% during the pandemic. A larger percentage of women (~10% more than men) eat fish at least once per week, and women eat a larger diversity of seafood products. However, men classified themselves on average in a higher income class than women both before and during the pandemic, and men were significantly more likely to agree that they had enough money to buy the food they wanted during the pandemic. Overall, respondents who indicated eating a higher frequency of fish per week, were significantly more likely to agree that they ate less fish during the pandemic. Respondents on Sumbawa island were significantly more likely to agree that the fisheries products were not available during the pandemic.

Measuring sustainable consumer food purchasing and behavior

Consumer food purchasing and willingness to adopt a sustainable healthy diet (SHD) is a key factor affecting the sustainability of the entire food system. Studies have developed scales to measure consumer preferences for particular consumption patterns, while others have sought to empirically define the multiple dimensions of a sustainable food system (environmental, social, economic, etc.). This paper builds on these literatures by tracking consumers' SHD behaviors using a large-scale, longitudinal survey of adults in the United States and mapping them onto multiple systems-level indicators. We wanted to know whether consumers interact with the sustainability of their food along the same principles developed by experts. Our study defines 18 food purchasing behaviors that support the sustainability goals of leading scientific institutions, uses factor analysis to identify the unobserved drivers behind these behaviors, and creates SHD scores to investigate their correlations with other consumer characteristics and behaviors. Factor analysis results show consumer food purchasing is motivated by three underlying sustainability dimensions-Economic Security, Socio-Environment, and Nutrition-which are fewer constructs than often defined by academic researchers. SHD scores reveal higher adoption of behaviors that fall under Economic Security relative to the other two dimensions. All three sustainability constructs are impacted by socio-economic and demographic characteristics.

Healthy and sustainable diets from today to 2050—The role of international trade

The connection between international trade and food systems (un)sustainability is both contentious and critical for policy work supporting progress towards achieving the twin goals of hunger alleviation and dietary health while improving the overall sustainability of development. We characterize the food system using a set of metrics based upon the EAT-Lancet commission dietary guidelines for both over- and under-consumption of different foods to assess country-level dietary health and sustainability in tandem. Using a partial equilibrium model of agricultural production and trade, we then project the functioning of the global agricultural system to 2050 and calculate the metrics for that year. For most regions we find increased overconsumption above the expert-defined healthy and sustainable diet thresholds, with more limited progress towards closing dietary health and sustainability gaps where they currently exist. Trade influences this dynamic into the future under certain socioeconomic conditions, and we find that under a “business as usual” trade environment, future agricultural import profiles continue to be misaligned with dietary health and sustainability outcomes, suggesting the potential for early intervention in trade policy as a means to positively influence food system outcomes.

From Golden Rice to Golden Diets: How to turn its recent approval into practice

Following its approval in the Philippines in July 2021, provitamin A-rich "Golden Rice" is set to become the worlds' first commercialized genetically modified crop with direct consumer benefits. Despite supplementation and fortification programs, the burden of micronutrient deficiencies remains high. For Golden Rice to be successful in reducing vitamin A deficiency, it needs to be taken up by food systems and integrated into consumer diets. Despite negative information often being associated with genetic engineering, evidence suggests that consumers react positively to Golden Rice. Thus, it offers policy makers and public health stakeholders a new, powerful option to address micronutrient malnutrition that they can integrate as a cost-effective component in broader nutrition strategies and tailor it to consumers' heterogeneous socio-economic contexts and needs to promote "Golden Diets". For this to happen, the right framing of the pathway from policy to consumption is crucial.

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.

Compliance with EAT-Lancet dietary guidelines would reduce global water footprint but increase it for 40% of the world population

The EAT-Lancet Commission has proposed a global benchmark diet to guide the shift towards healthy and sustainable dietary patterns. Yet it is unclear whether consumers' choices are convergent with those guidelines. Applying an advanced statistical analysis, we mapped the diet gap of 15 essential foods in 172 countries from 1961 to 2018. We found that countries at the highest level of development have an above-optimal consumption of animal products, fats and sugars but a sub-optimal consumption of legumes, nuts and fruits. Countries suffering from limited socio-economic progress primarily rely on carbohydrates and starchy roots. Globally, a gradual change towards healthy and sustainable dietary targets can be observed for seafood, milk products, poultry and vegetable oils. We show that if all countries adopted the EAT-Lancet diet, the water footprint would fall by 12% at a global level but increase for nearly 40% of the world's population.

Local urban government policies to facilitate healthy and environmentally sustainable diet-related practices: a scoping review

OBJECTIVE

This scoping review sought to describe the policy actions that urban local governments globally have implemented to facilitate healthy and environmentally sustainable diet-related practices.

SETTING

Urban local government authorities.

DESIGN

Five databases were searched to identify publications which cited policies being implemented by local governments within the 199 signatory cities of the Milan Urban Food Policy Pact (MUFPP) that targeted at least one healthy and sustainable diet-related practice. Grey literature was then searched to retrieve associated policy documentation. Data from both sources were charted against the MUFPP's monitoring framework to analyse the policy actions included in each overarching policy.

RESULTS

From 2624 screened peer-reviewed studies, 27 met inclusion criteria and cited 36 relevant policies amongst signatory cities to the MUFPP. Most were from high income countries (n 29; 81 %), considered health (n 31; 86 %), equity (n 29; 81 %) and the broader food system beyond dietary consumption (n 34; 94 %). Of the 66 policy actions described, the most common involved food procurement within public facilities (n 16; 44 %) and establishing guidelines for school-feeding programs (n 12; 33 %).

CONCLUSIONS

This review has demonstrated that urban local government authorities are implementing policies that consider multiple phases of the food supply chain to facilitate population-wide uptake of healthy and sustainable diet-related practices. Opportunities exist for local governments to leverage the dual benefits to human and planetary health of policy actions, such as those which discourage the overconsumption of food including less meat consumption and the regulation of ultra-processed foods.

From Diospyros kaki L. (Persimmon) Phytochemical Profile and Health Impact to New Product Perspectives and Waste Valorization

Persimmon (Diospyros kaki L.) fruit's phytochemical profile includes carotenoids, proanthocyanidins, and gallic acid among other phenolic compounds and vitamins. A huge antioxidant potential is present given this richness in antioxidant compounds. These bioactive compounds impact on health benefits. The intersection of nutrition and sustainability, the key idea behind the EAT-Lancet Commission, which could improve human health and decrease the global impact of food-related health conditions such as cancer, heart disease, diabetes, and obesity, bring the discussion regarding persimmon beyond the health effects from its consumption, but also on the valorization of a very perishable food that spoils quickly. A broad option of edible products with better storage stability or solutions that apply persimmon and its byproducts in the reinvention of old products or even creating new products, or with new and better packaging for the preservation of food products with postharvest technologies to preserve and extend the shelf-life of persimmon food products. Facing a global food crisis and the climate emergency, new and better day-to-day solutions are needed right now. Therefore, the use of persimmon waste has also been discussed as a good solution to produce biofuel, eco-friendly alternative reductants for fabric dyes, green plant growth regulator, biodegradable and edible films for vegetable packaging, antimicrobial activity against foodborne methicillin-resistant Staphylococcus aureus found in retail pork, anti-Helicobacter pylori agents from pedicel extracts, and persimmon pectin-based emulsifiers to prevent lipid peroxidation, among other solutions presented in the revised literature. It has become clear that the uses for persimmon go far beyond the kitchen table and the health impact consumption demonstrated over the years. The desired sustainable transition is already in progress, however, mechanistic studies and clinical trials are essential and scaling-up is fundamental to the future.

Sustainable Agri-Food Systems: Environment, Economy, Society, and Policy

Agri-food systems (AFS) have been central in the debate on sustainable development. Despite this growing interest in AFS, comprehensive analyses of the scholarly literature are hard to find. Therefore, the present systematic review delineated the contours of this growing research strand and analyzed how it relates to sustainability. A search performed on the Web of Science in January 2020 yielded 1389 documents, and 1289 were selected and underwent bibliometric and topical analyses. The topical analysis was informed by the SAFA (Sustainability Assessment of Food and Agriculture systems) approach of FAO and structured along four dimensions viz. environment, economy, society and culture, and policy and governance. The review shows an increasing interest in AFS with an exponential increase in publications number. However, the study field is north-biased and dominated by researchers and organizations from developed countries. Moreover, the analysis suggests that while environmental aspects are sufficiently addressed, social, economic, and political ones are generally overlooked. The paper ends by providing directions for future research and listing some topics to be integrated into a comprehensive, multidisciplinary agenda addressing the multifaceted (un)sustainability of AFS. It makes the case for adopting a holistic, 4-P (planet, people, profit, policy) approach in agri-food system studies.

The importance of food systems and the environment for nutrition

Global and local food system transformation is necessary in order to ensure the delivery of healthy, safe, and nutritious foods in both sustainable and equitable ways. Food systems are complex entities that affect diets, human health, and a range of other outcomes including economic growth, natural resource and environmental resiliency, and sociocultural factors. However, food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability. Although there has been increased focus on this topic in recent years, many gaps in our knowledge persist on the relation between environmental factors, food systems, and nutritional outcomes. In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation.