Carbon footprint of self-selected US diets: nutritional, demographic, and behavioral correlates

Comparing life cycle environmental impacts of food access and consumption pre- and during COVID 19 in New York State's Capital Region

The COVID-19 pandemic has significantly influenced household food shopping, food consumption, and food waste generation. However, the dietary environmental impacts for different income groups during COVID-19 remain unknown. To analyze dietary environmental impacts for various income groups, a process-based life cycle assessment (LCA) was conducted based on two electronic food access surveys implemented in the New York State's Capital Region during the COVID-19 pandemic and public and proprietary databases. We found that life cycle global warming potential, cumulative energy demand, acidification potential, and water resource depletion of per capital food consumption in the studied area tended to be lower during COVID-19 than pre-COVID-19. In contrast, life cycle eutrophication during COVID-19 was slightly higher than pre-COVID-19. The environmental impacts occurring at the food production stage were higher than those at the local transportation and waste disposal stages. The lowest income group had the lowest dietary environmental impacts due to their lowest food consumption of all the food categories. The second-highest income group had the highest dietary environmental impacts, since they consumed the most red meat which has a high impact intensity. This is the first study to our knowledge to investigate the differences in dietary environmental impacts among income groups during COVID-19.

Exploring dietary patterns and their association with environmental sustainability and body mass index in children and adolescents: Insights from the National Food, Nutrition and Physical Activity Survey 2015-2016

OBJECTIVE

To adapt four dietary patterns for children and adolescents, and study their associations with sustainability (greenhouse-gas emissions-GHGE and land use-LU), and health (body mass index-BMI) indicators.

RESEARCH METHODS & PROCEDURES

Dietary intake of children (3-9y) and adolescents (10-17y) from the National Food, Nutrition and Physical Activity Survey 2015-2016, Portugal (n = 1153) was assessed through two non-consecutive interviews: one-day food diaries (children), and 24-h recalls (adolescents), using an automated multiple-pass method, including a picture book for portion sizes estimation. Adherence to the Eat-Lancet and World Health Organization (WHO) recommendations, Mediterranean and Atlantic diets were evaluated using adapted versions for pediatrics of the World Index for Sustainability and Health (WISH), Diet Quality Index (DQI), Mediterranean Diet Score (MDS) and Southern-European Atlantic Diet (SEAD), respectively. Diet-related GHGE and LU were estimated using the SHARP-Indicators database. BMI (measured) z-scores were classified according to WHO criteria. A standardized weighted health-sustainability composite index was created (BMI + 0.5*GHGE+0.5*LU). Adjusted linear regression models were computed.

RESULTS

WISH, DQI, MDS, and SEAD had weighted mean scores (range) of 50 (0-130), 24 (9-36), 20 (8-32), and 17 (8-32), respectively. All dietary patterns were associated with lower environmental impact, particularly in children, but not with BMI. Only MDS explained both health and sustainability indicators in childhood (composite index: sd.β = -0·223,95%CI:-0·347,-0·072,R2 = 25.1 %), and adolescence (composite index: sd.β = -0·159,95%CI:-0·315,-0·003,R2 = 31.3 %).

CONCLUSION

The Mediterranean diet was the most related to (higher) environmental sustainability and (lower) BMI. However, in children (not adolescents), the WISH, DQI, and SEAD showed then same associations.

Environmental impact of the diet of young Portuguese and its relationship with adherence to the Mediterranean Diet

OBJECTIVE

To estimate, in a cohort of young Portuguese adults, the environmental impact (greenhouse gas (GHG) emissions, land use, energy used, acidification and potential eutrophication) of diet according to adherence to the Mediterranean Diet (MD).

METHODS

Data from 1554 participants of the Epidemiologic Health Investigation of Teenagers in Porto (EPITeen) were analysed. Food intake and MD adherence were determined using validated questionnaires. The environmental impact was evaluated with the EAT-Lancet Commission tables, and the link between MD adherence and environmental impact was calculated using adjusted multivariate linear regression models.

RESULTS

Higher adherence (high vs. low) to the MD was associated with lower environmental impact in terms of land use (7.8 vs. 8.5 m2, p = 0.002), potential acidification (57.8 vs. 62.4 g SO2-eq, p = 0.001) and eutrophication (21.7 vs. 23.5 g PO4-eq, p < 0.001). Energy use decreased only in the calorie-adjusted model (9689.5 vs. 10,265.9 kJ, p < 0.001), and GHG emissions were reduced only in a complementary model where fish consumption was eliminated (3035.3 vs. 3281.2 g CO2-eq, p < 0.001). Meat products had the greatest environmental impact for all five environmental factors analysed: 35.7% in GHG emissions, 60.9% in energy use, 72.8% in land use, 70% in acidification and 61.8% in eutrophication.

CONCLUSIONS

Higher adherence to the MD is associated with lower environmental impact, particularly in terms of acidification, eutrophication, and land use. Reducing meat consumption can contribute to greater environmental sustainability.

Heat/non-heat treatment alleviates β-conglycinin-triggered food allergy reactions by modulating the Th1/Th2 immune balance in a BALB/c mouse model

BACKGROUND

With the increasing popularity of plant protein-based diets, soy proteins are favored as the most important source of plant protein worldwide. However, potential food allergy risks limit their use in the food industry. This work aims to reveal the mechanism of β-conglycinin-induced food allergy, and to explore the regulatory mechanism of heat treatment and high hydrostatic pressure (HHP) treatment in a BALB/c mouse model.

RESULTS

Our results showed that oral administration of β-conglycinin induced severe allergic symptoms in BALB/c mice, but these symptoms were effectively alleviated through heat treatment and HHP treatment. Moreover, β-conglycinin stimulated lymphocyte proliferation and differentiation; a large number of cytokines interleukin (IL)-4, IL-5, IL-10, IL-12 and IL-13 were released and interferon γ secretion was inhibited, which disrupted the Th1/Th2 immune balance and promoted the differentiation and proliferation of naive T cells into Th2-type cells.

CONCLUSION

Heat/non-heat treatment altered the conformation of soybean protein, which significantly reduced allergic reactions in mice. This regulatory mechanism may be associated with Th1/Th2 immune balance. Our results provide data support for understanding the changes in allergenicity of soybean protein within the food industry. © 2024 Society of Chemical Industry.

Infectious disease responses to human climate change adaptations

Many recent studies have examined the impact of predicted changes in temperature and precipitation patterns on infectious diseases under different greenhouse gas emissions scenarios. But these emissions scenarios symbolize more than altered temperature and precipitation regimes; they also represent differing levels of change in energy, transportation, and food production at a global scale to reduce the effects of climate change. The ways humans respond to climate change, either through adaptation or mitigation, have underappreciated, yet hugely impactful effects on infectious disease transmission, often in complex and sometimes nonintuitive ways. Thus, in addition to investigating the direct effects of climate changes on infectious diseases, it is critical to consider how human preventative measures and adaptations to climate change will alter the environments and hosts that support pathogens. Here, we consider the ways that human responses to climate change will likely impact disease risk in both positive and negative ways. We evaluate the evidence for these impacts based on the available data, and identify research directions needed to address climate change while minimizing externalities associated with infectious disease, especially for vulnerable communities. We identify several different human adaptations to climate change that are likely to affect infectious disease risk independently of the effects of climate change itself. We categorize these changes into adaptation strategies to secure access to water, food, and shelter, and mitigation strategies to decrease greenhouse gas emissions. We recognize that adaptation strategies are more likely to have infectious disease consequences for under-resourced communities, and call attention to the need for socio-ecological studies to connect human behavioral responses to climate change and their impacts on infectious disease. Understanding these effects is crucial as climate change intensifies and the global community builds momentum to slow these changes and reduce their impacts on human health, economic productivity, and political stability.

Mexican national dietary guidelines promote less costly and environmentally sustainable diets

The 2023 Mexican Healthy and Sustainable Dietary Guidelines (HSDG 2023) were developed to include all dimensions of sustainability. Here we compare the environmental impact and cost of diets based on the HSDG 2023, current diets and the Mexican-adapted EAT healthy reference diet. Diets following HSDG 2023 are 21% less expensive, require 30% less land to be produced and have 34% less carbon emissions than current diets-particularly in Mexico City and other urban areas with higher prevalence of Westernized diets. This is driven by reduced animal-source food, especially red meat, and ultra-processed foods. In south-rural areas, the water footprint and cost of diets following HSDG 2023 were higher than those of current diets owing to increased intake of nuts, fruits and vegetables not offset by lower meat consumption (which is already close to recommendations). Diet environmental impact and cost could be further reduced with the Mexican-adapted EAT healthy reference diet compared with the HSDG 2023.

Augmenting the National Nutrition Data System to Promote Diet Sustainability Analyses

Research on sustainable diets has become an important and growing area of the nutrition field, but recent studies have pointed to a lack of sustainability metrics and methods that are hindering research and policy progress. To fill this gap, the White House National Strategy on Hunger, Nutrition, and Health calls for increased funding to improve metrics, data collection, and research to address all domains of sustainability, which include nutrition/health, economic, environmental, and social domains. Commodity recipe databases, such as the Food Commodity Intake Database (FCID), are important tools for conducting diet sustainability analyses because they translate mixed dishes from dietary surveys, such as the National Health and Nutrition Examination Survey (NHANES), into commodity ingredients. These ingredients have been linked to data on environmental impacts and economic costs from other databases, thus facilitating collaboration between nutrition researchers, environmental scientists, economists, and others. These linkages cannot be made with other components of the national nutrition data system, such as the Food Patterns Equivalents Database (FPED), because the disaggregated food groups from them are not relevant for examining environmental impacts. Although the NHANES is conducted on an ongoing basis, and FPED is continually updated, the FCID has not been officially updated since 2010. This severely limits advancements in sustainability research and related policy analyses. In this commentary, we argue that the federal government should promote this diet sustainability work by integrating a commodity recipe database into the national nutrition data system, and updating it on a regular basis, as it does with other component databases.

Dietary quality and dietary greenhouse gas emissions in the USA: a comparison of the planetary health diet index, healthy eating index-2015, and dietary approaches to stop hypertension

BACKGROUND

The Planetary Health Diet Index (PHDI) measures adherence to the dietary pattern presented by the EAT-Lancet Commission, which aligns health and sustainability targets. There is a need to understand how PHDI scores correlate with dietary greenhouse gas emissions (GHGE) and how this differs from the carbon footprints of scores on established dietary recommendations. The objectives of this study were to compare how the PHDI, Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to (a) dietary GHGE and (b) to examine the influence of PHDI food components on dietary GHGE.

METHODS

We used life cycle assessment data from the Database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies to calculate the mean dietary GHGE of 8,128 adult participants in the 2015-2016 and 2017-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Poisson regression was used to estimate the association of (a) quintiles of diet score and (b) standardized dietary index Z-scores with dietary GHGE for PHDI, HEI-2015, and DASH scores. In secondary analyses, we used Poisson regression to assess the influence of individual PHDI component scores on dietary GHGE.

RESULTS

We found that higher dietary quality on all three indices was correlated with lower dietary GHGE. The magnitude of the dietary quality-dietary GHGE relationship was larger for PHDI [-0.4, 95% CI (-0.5, -0.3) kg CO2 equivalents per one standard deviation change] and for DASH [-0.5, (-0.4, -0.6) kg CO2-equivalents] than for HEI-2015 [-0.2, (-0.2, -0.3) kg CO2-equivalents]. When examining PHDI component scores, we found that diet-related GHGE were driven largely by red and processed meat intake.

CONCLUSIONS

Improved dietary quality has the potential to lower the emissions impacts of US diets. Future efforts to promote healthy, sustainable diets could apply the recommendations of the established DASH guidelines as well as the new guidance provided by the PHDI to increase their environmental benefits.

Developing messages to encourage healthy, sustainable dietary substitutions: A qualitative study with US emerging adults

Prior research shows that adopting simple dietary substitutions (e.g., replacing beef with poultry or plant-based entrees) can improve dietary quality and reduce the negative environmental consequences of food production, but little is known about how to encourage people to adopt these substitutions. This study aimed to examine reactions to messages encouraging healthy, sustainable dietary substitutions among emerging adults ages 18-25. We conducted four online focus groups with a diverse sample of US emerging adults (n = 28; 61% female). Focus groups explored emerging adults' reactions to messages encouraging them to adopt three target dietary substitutions: replacing beef and pork with poultry and plant-based entrees; replacing juice with whole fruit; and replacing dairy milk with non-dairy milk. We transcribed discussions verbatim and adopted a thematic approach to analyzing the transcripts. Results showed that participants perceived messages to be most effective at encouraging the target dietary substitutions when the messages: encouraged specific, achievable dietary changes; linked these dietary changes to clear consequences; included personally relevant content; included statistics; were succinct; and used a positive tone. Across the target dietary substitutions, two message topics (small changes, big benefits, which emphasized how small dietary changes can have large positive health and environmental impacts, and warning, which discussed the negative health and environmental impacts of dietary choices) were generally perceived to be most effective. A few participants expressed doubt that the target dietary substitutions would have meaningful environmental impacts. Results suggest that campaign messages to encourage healthy, sustainable dietary substitutions may be more effective if the messages make the target dietary substitutions seem achievable and use statistics to clearly describe the positive impacts of making these changes.

Impact of consuming an environmentally protective diet on micronutrients: a systematic literature review

BACKGROUND

A global move toward consumption of diets from sustainable sources is required to protect planetary health. As this dietary transition will result in greater reliance on plant-based protein sources, the impact on micronutrient (MN) intakes and status is unknown.

OBJECTIVE

Evaluate the evidence of effects on intakes and status of selected MNs resulting from changes in dietary intakes to reduce environmental impact. Selected MNs of public health concern were vitamins A, D, and B12, folate, calcium, iron, iodine, and zinc.

METHODS

We systematically searched 7 databases from January 2011 to October 2022 and followed the PRISMA guidelines. Eligible studies had to report individual MN intake and/or status data collected in free-living individuals from the year 2000 onward and environmental outcomes.

RESULTS

From the 10,965 studies identified, 56 studies were included, mostly from high-income countries (n = 49). Iron (all 56) and iodine (n = 20) were the most and least reported MNs, respectively. There was one randomized controlled trial (RCT) that also provided the only biomarker data, 10 dietary intake studies, and 45 dietary modeling studies, including 29 diet optimization studies. Most studies sought to reduce greenhouse gas emissions or intake of animal-sourced foods. Most results suggested that intakes of zinc, calcium, iodine, and vitamins B12, A, and D would decrease, and total iron and folate would increase in a dietary transition to reduce environmental impacts. Risk of inadequate intakes of zinc, calcium, vitamins A, B12 and D were more likely to increase in the 10 studies that reported nutrient adequacy. Diet optimization (n = 29) demonstrated that meeting nutritional and environmental targets is technically feasible, although acceptability is not guaranteed.

CONCLUSIONS

Lower intakes and status of MNs of public health concern are a potential outcome of dietary changes to reduce environmental impacts. Adequate consideration of context and nutritional requirements is required to develop evidence-based recommendations. This study was registered prospectively with PROSPERO (CRD42021239713).

Commercial weight-loss diets, greenhouse gas emissions and freshwater consumption

BACKGROUND

Weight-loss attempts are widespread in the United States, with many using commercial weight-loss diet plans for guidance and support. Accordingly, dietary suggestions within these plans influence the nation's food-related environmental footprint.

METHODS

We modelled United States (US) per capita greenhouse gas emissions (GHGe) and water footprints associated with seven commercial weight-loss diets, the US baseline, and selected other dietary patterns. We characterised consumption in commercial weight-loss diets both via modelling from provided guidelines and based on specific foods in 1-week meal plans. Cradle-to-farmgate GHGe and water footprints were assessed using a previously developed model. GHGe results were compared to the EAT-Lancet 2050 target. Water footprints were compared to the US baseline.

RESULTS

Weight-loss diets had GHGe footprints on average 4.4 times the EAT-Lancet target recommended for planetary health (range: 2.4-8.5 times). Bovine meat was by far the largest contributor of GHGe in most diets that included it. Three commercial diets had water footprints above the US baseline. Low caloric intake in some diets compensated for the relative increases in GHGe- and water-intensive foods.

CONCLUSIONS

Dietary patterns suggested by marketing materials and guidelines from commercial weight-loss diets can have high GHGe and water footprints, particularly if caloric limits are exceeded. Commercial diet plan guidance can be altered to support planetary and individual health, including describing what dietary patterns can jointly support environmental sustainability and weight loss.

Cross-sectional measurement of adherence to a proposed sustainable and healthy dietary pattern among United States adults using the newly developed Planetary Health Diet Index for the United States

BACKGROUND

Dietary choices are an important avenue for improving food system sustainability. The Planetary Health Diet was proposed by the EAT-Lancet Commission as a reference healthy and sustainable dietary pattern.

OBJECTIVES

To assess adherence to the Planetary Health Diet among United States adults, this study developed and evaluated the Planetary Health Diet Index for the United States (PHDI-US), adapted from the original PHDI validated in the Brazilian population.

METHODS

The PHDI-US has 16 components with scores ranging between 0 and 150, and higher scores indicate better adherence to the Planetary Health Diet. Cross-sectional dietary data from 4741 participants of the National Health and Nutrition Examination Survey 2017-2018 were used to assess the validity and reliability of the PHDI-US.

RESULTS

Validity and reliability tests were acceptable overall: principal component analysis identified 6 components; total PHDI-US and Healthy Eating Index-2015 scores were positively associated (β = 0.67, standard error = 0.03, P <0.0001; R2 = 0.39); concurrent-criterion validity analyses identified significantly lower scores among males, everyday smokers, and younger adults; and the Cronbach's α value was 0.54. The average PHDI-US score was 46.7 out of 150, indicating that the diets of United States adults were far from meeting Planetary Health Diet recommendations. Based on component PHDI-US scores, many United States adults may be able to enhance the quality and sustainability of their diets by increasing intake of plant-based foods, including whole grains, nuts and peanuts, legumes, fruits, and vegetables, and reducing intake of animal-based foods, including red and processed meats.

CONCLUSIONS

The PHDI-US is a new tool that can assess adherence to the Planetary Health Diet and identify key aspects of United States adults' diets that could be altered to potentially improve dietary sustainability and quality.

Low Greenhouse Gas Emission Self-Selective Diets and Risk of Metabolic Syndrome in Adults 40 and Older: A Prospective Cohort Study in South Korea

BACKGROUND

The food system accounts for ∼ 40 % of human-generated greenhouse gas (GHG) emissions. Meanwhile, daily diet selection also impacts human nutrition status and health.

OBJECTIVES

This study aimed to use the alternate Mediterranean Diet (aMED) score to evaluate the quality of a low-GHG emission diet and the association with risk of developing metabolic syndrome (MetS).

METHODS

A total of 41,659 healthy participants without MetS 40 y of age or older were selected from the Health Examinees Study, an ongoing cohort study in South Korea from 2004. A dietary GHG emissions database was compiled following a national project and literature review. MetS was defined according to the Adult Treatment Panel III criteria of the National Cholesterol Education Program. The participants were grouped into quintiles based on 2,000  kcal -standardized daily diet-GHG emissions (Q1: the lowest energy-adjusted diet-GHG emissions). A multivariable logistic regression model was used to analyze the risk for MetS at follow-up. The aMED score was used to assess the diet quality of the different diet-related GHG emission groups.

RESULTS

Females with lower energy-adjusted diet-related GHG emissions had significantly lower risks of developing MetS (p = 0.0043 ) than those with the highest energy-adjusted diet-related GHG emissions. In addition, the Q1 group, in comparison with the other groups, had a higher aMED score (3.02 for males and 3.00 for females), which indicated that the participants in this group had a diet that more closely matched the Mediterranean diet.

DISCUSSION

These findings provide a reference for dietary guidance and other policies aimed toward improving dietary intake and reducing diet-related GHG emissions in South Korea and worldwide. https://doi.org/10.1289/EHP12727.

Simple dietary substitutions can reduce carbon footprints and improve dietary quality across diverse segments of the US population

Changing what foods we eat could reduce environmental harms and improve human health, but sweeping dietary change is challenging. We used dietary intake data from a nationally representative sample of 7,753 US children and adults to identify simple, actionable dietary substitutions from higher- to lower-carbon foods (for example, substituting chicken for beef in mixed dishes such as burritos, but making no other changes to the diet). We simulated the potential impact of these substitutions on dietary carbon emissions and dietary quality. If all consumers who ate the high-carbon foods instead consumed a lower-carbon substitute, the total dietary carbon footprint in the United States would be reduced by more than 35%. Moreover, if adopted, these substitutions would improve consumers' overall dietary quality by 4-10%, with benefits projected for all age, gender, and racial and ethnic groups. These results suggest that a 'small changes' approach could be a valuable starting point for addressing diet's impact on climate and health.

Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents

BACKGROUND

Interventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents' diet quality and reducing dGHGE.

OBJECTIVE

This study aimed to describe dGHGE in Swedish adolescents' diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality.

METHODS

Data come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11-12 y old), 8 (14-15 y old) and 11 (17-18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015).

RESULTS

dGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO2e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO2e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO2e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO2e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO2e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO2e/10MJ.

CONCLUSIONS

Food choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets.

Greater adherence to the Dietary Guidelines for Americans is associated with lower diet-related greenhouse gas emissions but higher costs

Introduction

Few studies have evaluated the sustainability of popular diet patterns in the US, which limits policy action and impedes consumer efficacy to make sustainable dietary changes. This study filled this gap by evaluating the relationship between diet quality, greenhouse gas emissions (GHGE), and diet cost for plant-based, restricted carbohydrate, low grain, low fat, and time restricted diet patterns.

Methods

Dietary data were retrieved from the National Health and Nutrition Examination Survey (2011-2018, n = 8,146) and linked with data on GHGE and food prices from publicly available databases. Diet quality was measured using the Healthy Eating Index-2015. The present study (1) compared the mean diet quality, GHGE, and diet cost between diet patterns, (2) evaluated the association of diet quality to GHGE and diet cost for each diet pattern, and (3) estimated the contribution of food sources to GHGE and diet cost for each diet pattern.

Results

Higher diet quality was associated with lower GHGE for the general population and for most diet patterns (p < 0.01) except for the plant-based and time restricted diet patterns (p > 0.05). Higher diet quality was associated with higher cost for the general population and for all dietary patterns (p < 0.01) except the time restricted diet pattern (p > 0.05). Protein foods, mostly beef, accounted for the largest share of GHGE (29-40%) and diet cost (28-47%) for all diet patterns except plant-based.

Discussion

Higher diet quality was associated with lower GHGE but was often accompanied by higher diet cost. These sustainability trade-offs can help inform major policy discussions in the US and shed light on further research needs in the area of food systems transformation.

Personal, behavioural and socio-environmental correlates of emerging adults' sustainable food consumption in a cross-sectional analysis

OBJECTIVE

Describe how dietary intake patterns of US young adults align with the EAT-Lancet Planetary Health Diet (PHD) sustainable diet goals and identify personal, behavioural, and socio-environmental correlates of sustainable intake.

DESIGN

Data on past-year dietary intake were captured using a FFQ. The PHD was applied to specific food groups, and a total PHD score was calculated. Linear regression models were used to identify associations between personal, behavioural and socio-environmental factors and PHD scores.

SETTING

This cross-sectional analysis uses data from the second wave of EAT 2010-2018 (Eating and Activity over Time), a population-based longitudinal study recruited in Minnesota.

PARTICIPANTS

Ethnically/racially diverse group of participants (n 1308) with a mean age of 22·1 (sd 2·0) years.

RESULTS

The mean PHD score was 4·1 (sd 1·4) on a scale of 0-14, with 14 representing the most sustainable. On average, participants consumed fewer whole grains, fish, legumes, soya, and nuts than ideal for a sustainable diet, and an excess of eggs, added sugar, and meat. The PHD score was higher for participants with higher socio-economic status (SES) and greater educational attainment. Higher home availability of healthy food (β = 0·24, P < 0·001) and less frequent fast-food consumption (β = -0·26, P < 0·001) were the strongest correlates of PHD scores.

CONCLUSIONS

Results suggest that a high percentage of participants may not be achieving the sustainable diet goals defined by the PHD. Reductions in meat consumption and increases in plant-based foods are necessary to increase the sustainability of US young adults' diets.

Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States

BACKGROUND

Major policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability.

OBJECTIVE

To evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low grain, restricted carbohydrate, low fat, and time restricted diet patterns on a daily per capita basis.

DESIGN

Dietary data from the National Health and Nutrition Examination Survey (2013-2016, n=4,025) were merged with data on greenhouse gas emissions (GHGE) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality.

RESULTS

The plant-based diet pattern had the lowest GHGE (3.5 kg CO2eq, 95% CI: 3.3, 3.8 kg CO2eq) and among the lowest diet cost ($11.51, 95% CI: $10.67, $12.41), but diet quality (45.8, 95% CI: 43.3, 48.5) was similar (P>0.005) to most other diet patterns. All of the sustainability impacts of the low grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46, 95% CI: $17.80, $19.13) but intermediate diet quality (46.8, 95% CI: 45.7, 47.9) and moderate-to-high GHGE (5.7 kg CO2eq, 95% CI: 5.4, 5.9 kg CO2eq). The low fat diet pattern had the highest diet quality (52.0, 95% CI: 50.8, 53.1) and intermediate GHGE (4.4 kg CO2eq, 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53, 95% CI: $13.73, $15.38). The time restricted diet pattern had among the lowest diet quality score (42.6, 95% CI: 40.8, 44.6), had GHGE similar to most other diet patterns (4.6 kg CO2eq, 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34, 95% CI: $11.38, $13.40).

CONCLUSIONS

Most diet patterns were associated with sustainability trade-offs. The nature of those trade-offs can help inform discussions on food and nutrition policy in the US, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.

Popular diets as selected by adults in the United States show wide variation in carbon footprints and diet quality

BACKGROUND

Carbon footprints of vegetarian, pescatarian, and other popular diets have been studied previously, but mostly as idealized versions modeled to meet dietary recommendations. Less is known about the footprints of popular diets as they are consumed by US adults, and thus the potential trade-offs with diet quality for free-living individuals.

OBJECTIVES

This study estimated the carbon footprint and diet quality of popular diets as selected by a nationally representative sample of US consumers, including the recently trending keto- and paleo-style diets.

METHODS

The 2005-2010 NHANES 24-h recall data were used to categorize individual adult diets (n = 16,412) into 6 types: vegan, vegetarian, pescatarian, paleo, keto, and all other diets, referred to here as omnivore diets. Average daily greenhouse gas emissions in kilograms of carbon dioxide equivalents per 1000 kcal (kg CO2-eq/1000 kcal) were calculated for each diet by matching our previously developed database to NHANES individual diet data. Diet quality was determined using the Healthy Eating Index (HEI) and the Alternate Healthy Eating Index. Survey-weighted ordinary least-squares regression was used to assess mean differences in diets.

RESULTS

The average carbon footprints of vegan (0.69 ± 0.05 kg CO2-eq/1000 kcal) and vegetarian (1.16 ± 0.02) diets were lower (P < 0.05) than those of the pescatarian (1.66 ± 0.04), omnivore (2.23 ± 0.01), paleo (2.62 ± 0.33), or keto (2.91 ± 0.27) diets. Mean HEI scores were highest for pescatarian diets (58.76 ± 0.79) and higher (P < 0.05) for vegetarian (51.89 ± 0.74) than for omnivore (48.92 ± 0.33) or keto (43.69 ± 1.61) diets.

CONCLUSIONS

Our results highlight the nuances when evaluating the nutritional quality of diets and their carbon footprints. On average, pescatarian diets may be the healthiest, but plant-based diets have lower carbon footprints than other popular diets, including keto- and paleo-style diets.

The Environmental Sustainability of Plant-Based Dietary Patterns: A Scoping Review

BACKGROUND

A large part of the existential threat associated with climate change is the result of current human feeding patterns. Over the last decade, research evaluating the diet-related environmental impacts of plant-based diets has emerged, and a synthesis of the available data is now due.

OBJECTIVES

The objectives of the study were as follows: 1) to compile and summarize the literature on diet-related environmental impacts of plant-based dietary patterns; 2) to assess the nature of the data on impacts of plant-based dietary patterns on both environmental parameters and health (e.g., if land use is reduced for a particular diet, is cancer risk also reduced?); and 3) to determine where sufficient data exist for meta-analyses, in addition to identifying gaps within the literature.

METHODS

Global peer-reviewed studies on the environmental impacts of plant-based diets were searched in Ovid MEDLINE, EMBASE, and Web of Science. After removing duplicates, the screening identified 1553 records. After 2 stages of independent review by 2 reviewers, 65 records met the inclusion criteria and were eligible to be used in synthesis.

RESULTS

Evidence suggests that plant-based diets may offer lower greenhouse gas emissions (GHGEs), land use, and biodiversity loss than offered by standard diets; however, the impact on water and energy use may depend on the types of plant-based foods consumed. Further, the studies were consistent in demonstrating that plant-based dietary patterns that reduce diet-related mortality also promote environmental sustainability.

CONCLUSIONS

Overall, there was agreement across the studies regarding the impact of plant-based dietary patterns on GHGE, land used, and biodiversity loss despite varied plant-based diets assessed.

Dietary modeling of greenhouse gases using OECD meat consumption/retail availability estimates

Research has demonstrated different carbon footprints, based on portion estimations. However, previous estimates are low and often omit the impact of food waste. For example, a high-level of daily meat consumption has been estimated at 100 g, which is less than a typical “quarter pounder” hamburger. We used the Organization for Economic Co-operation and Development (OECD) annual estimates of national retail availability, and applied a mathematical model to prorate other research results to determine a meat portion equal to current OECD statistics, and also projected the diets to 2500 and 3250 kcal, to include consumer and retail waste. Once prorated, the 14 national studies are contrasted and analyzed for reasonableness against OECD data pertaining to U.S., U.K., E.U., vegetarian and vegan diets. We quantify how previous studies underestimated greenhouse gas (GHG) emissions and show that previous GHG study results for the highest tier most accurately predict average national dietary consumption.

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

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

Dietary Environmental Footprints and Their Association with Socioeconomic Factors and Food Purchase Practices: BRAZUCA Natal Study

The analysis of dietary environmental impacts has proven to be an important tool for guiding the adoption of healthier and more sustainable diets. This study aimed to estimate the dietary carbon (CF), water (WF), and ecological (EF) footprints of residents in the city of Natal, Brazil; the study also aimed to verify their association with socioeconomic factors and food purchase practices. This is a cross-sectional study that used dietary data from 411 adults and elderlies, which was collected via a questionnaire that applied to the respondents. The results showed that the dietary CF was 1901.88 g CO2 eq/day/1000 kcal, the WF was 1834.03 L/day/1000 kcal, and the EF was 14.29 m2/day/1000 kcal. The highest environmental footprint values showed an association (p ≤ 0.05) with the factors of male sex, white ethnicity, and higher income and schooling, whereas the lowest environmental footprint values were associated with social vulnerability variables such as female sex, non-white ethnicity, and lower income and schooling (p ≤ 0.05). Moreover, people with lower environmental footprints consumed less fast food, had fewer meals at snack bars, and used food delivery services less often than those with higher footprints. The foods that most contributed to the CFs and WFs were beef and chicken, while fish and beef contribute the most to the EFs. The data in the present study show that a diet with a lower environmental impact is not always equal to a sustainable diet. This relationship is paradoxical and relates to food justice, as people with lower environmental footprint values are the same ones with worse socioeconomic conditions. In this sense, is it essential to consider the influence of the social context when assessing dietary environmental impacts and when assessing actions that promote healthier and more sustainable diets.

Does population aging reduce environmental pressures from urbanization in 156 countries?

Urbanization and population aging are key indicators of human-related social attributes. With economic progress and urban development, human living conditions and the level of medical and health care have been continuously improved. Population aging has become a global trend, which brings serious challenges to the world. Environmental sustainability is closely linked to both urbanization and aging. Most of the existing studies only focus on the linear relationship between urbanization and the environment, and the effect of aging on the ecological environment is also controversial. It is of great significance to conduct systematic research on urbanization-aging-environment. This paper aims to reconstruct the linear relationship between urbanization and the environment, investigating the nonlinear effect of population aging on the nexus of urbanization-environment in 156 countries. This paper focuses on exploring ways to improve environmental quality from the perspective of population aging. To this end, the panel threshold regression models of urbanization‑carbon emissions and urbanization-ecological footprint are developed respectively. In which, urbanization is set as the explanatory variable, carbon emissions and ecological footprint are set as the explained variables, and population aging is set as the threshold variable. This paper divides four income groups according to the income standard of the World Bank, and regresses the panel data of the global and four income groups respectively to reflect the comprehensiveness of this work. The results show that there is a threshold effect of population aging on the nexus of urbanization‑carbon emissions/ecological footprint both the global scale and different income groups. On a global scale, urbanization has a positive effect on carbon emissions and ecological footprint. When aging crosses the threshold in turn, the promotion effect of urbanization on carbon emissions gradually becomes smaller, and the influence coefficient of urbanization on the ecological footprint shows an inverted U-shaped change trend. Aging can reduce the environmental pressures related to urbanization. There is heterogeneity in the nonlinear regression results for different income groups. Population aging variable in high income group, upper middle income group helps to improve environmental quality. In lower middle income countries and low income countries, aging slightly increases the coefficients of urbanization and ecological footprint.

Low-carbohydrate vegan diets in diabetes for weight loss and sustainability: a randomized controlled trial

BACKGROUND

Low-carbohydrate, high animal fat and protein diets have been promoted for weight loss and diabetes treatment. We therefore tested the effect of a low-carbohydrate vegan diet in diabetes as a potentially healthier and more ecologically sustainable low-carbohydrate option.

OBJECTIVES

We sought to compare the effectiveness of a low-carbohydrate vegan diet with a moderate-carbohydrate vegetarian diet on weight loss and metabolic measures in diabetes.

METHODS

One hundred and sixty-four male and female participants with type 2 diabetes were randomly assigned to advice on either a low-carbohydrate vegan diet, high in canola oil and plant proteins, or a vegetarian therapeutic diet, for 3 mo, with both diets recommended at 60% of calorie requirements. Body weight, fasting blood, blood pressure, and 7-d food records, to estimate potential greenhouse gas emissions, were obtained throughout the study with tests of cholesterol absorption undertaken at baseline and end of study on 50 participants.

RESULTS

Both low-carbohydrate vegan and vegetarian diets similarly but markedly reduced body weight (-5.9 kg; 95% CI: -6.5, -5.28 kg; and -5.23 kg; 95% CI: -5.84, -4.62 kg), glycated hemoglobin (-0.99%; 95% CI: -1.07, -0.9%; and -0.88%; 95% CI: -0.97, -0.8%), systolic blood pressure (-4 mmHg; 95% CI: -7, -2 mmHg; and -6 mmHg; 95% CI: -8, -3 mmHg), and potential greenhouse gas emissions, but only for potential greenhouse gas emissions was there a significant treatment difference of -0.63 kgCO2/d (95% CI: -0.99, -0.27 kgCO2/d) favoring the low-carbohydrate vegan diet.

CONCLUSIONS

Low-carbohydrate vegan and vegetarian diets reduced body weight, improved glycemic control and blood pressure, but the more plant-based diet had greater potential reduction in greenhouse gas emissions.Trial registration number: clinicaltrials.gov identifier NCT02245399.

The Chilean Diet: Is It Sustainable?

Food systems are one of the main contributors to climate change. Sustainable diets are one strategy to mitigate climate change. Assessments and estimations at a national level are lacking, especially in the Global South, probably due to a lack of national surveys of food consumption and a limited interest in sustainable diets information. The objective of this study is to estimate and describe the carbon and water footprint of the Chilean population’s diet in an overall estimation desegregated by region, age, sex, socioeconomic level and their main characterizations. This study is based on a secondary data analysis from the National Survey of Food Consumption made in 2010. The carbon and water footprint of the food subgroups/person/day were estimated. The results are compared by sex, age group, socioeconomic level, and macro zone. A carbon footprint of 4.67 kg CO_2eq and a water footprint of 4177 L, both per person/day, were obtained. Animal-sourced foods, such as dairy and red meat, were responsible for 60.5% of the total carbon footprint and 52.6% of the water footprint. The highest values for both footprints were found in the following groups: men, adolescents, young adults, people with a higher socioeconomic level, and residents in the southern area of the country. The carbon footprint and water footprint values in Chile generated by food consumption would be above the world averages. Transforming the Chilean food system into a more sustainable one with changes in eating patterns is urgently required to attain this transformation.

Diet Sustainability Analyses Can Be Improved With Updates to the Food Commodity Intake Database

Diet sustainability analyses inform policymaking decisions and provide clinicians and consumers with evidence-based information to make dietary changes. In the United States, the Food Commodity Intake Database (FCID) provides a crosswalk for integrating nationally representative data on food intake from the National Health and Nutrition Examination Survey (NHANES) with data on sustainability outcomes from other publicly available databases. However, FCID has not been updated since 2010 and does not link with contemporary NHANES data, which limits further advancements in sustainability research. This study fills this research gap by establishing novel linkages between FCID and NHANES 2011-2018, comparing daily per capita food intake with and without these linkages, and making these data publicly available for use by other researchers. To update FCID, two investigators independently established novel data linkages, a third investigator resolved discrepancies, and a fourth investigator audited linkages for accuracy. Dietary data were acquired from nearly 45,000 adults from 2001 to 2018, and food intake was compared between updated vs. non-updated FCID versions. Total food intake from 2011 to 2018 was 5-23% higher using the updated FCID compared to the non-updated version, and intake was over 100% higher in some years for some food categories including poultry, eggs, legumes, starchy vegetables, and tropical oils (P < 0.001 for all comparisons). Further efforts may be needed to create new food composition data to reflect new products and reformulations that enter the food supply over time. This study removes a barrier to further diet sustainability analyses by establishing a data crosswalk between contemporary NHANES and other publicly available databases on agricultural resource use, environmental impacts, and consumer food expenditures.

Associations of Adherence to a Dietary Index Based on the EAT-Lancet Reference Diet with Nutritional, Anthropometric, and Ecological Sustainability Parameters: Results from the German DONALD Cohort Study

BACKGROUND

Validation of the EAT-Lancet reference diet (ELR-diet), recently proposed by the EAT-Lancet Commission, within the context of real-life studies is necessary to elucidate its feasibility, nutritional value, sustainability, and health effects.

OBJECTIVES

We aimed to develop a dietary index (DI) score to measure adherence to the ELR-diet. We further aimed to study the association between the DI score and 1) nutritional characteristics, 2) indicators of ecological sustainability, and 3) anthropometric markers and biomarkers for cardiometabolic health.

METHODS

A DI score was constructed by comparing the categories defined by the ELR-diet with the dietary data of 2-5 sets of 3-d weighed dietary records from DONALD (Dortmund Nutritional and Anthropometric Longitudinal Designed) study participants (n = 298; ≥15 y of age). Prospective associations between the DI score and risk markers (anthropometric and cardiometabolic) in young adulthood (≥18 y old) were investigated using multivariate linear regression.

RESULTS

Adherence to the DI score components was considerable (majority > 50%), but varied within the population (2%-100%). The highest tertile of the DI score was inversely associated with the intake of protein (tertile 3 compared with tertile 1: 13.5 compared with 14.5 energy %), added sugars (10.5 compared with 12.4 energy %), and cholesterol (100 compared with 116 mg/1000 kcal), but positively associated with fiber intake (10.0 compared with 8.82 g/1000 kcal) (all P < 0.05). The DI score was inversely associated with greenhouse-gas emissions (tertile 1 compared with tertile 3: 6.48 compared with 5.85 kg of carbon dioxide equivalents/2500 kcal; P < 0.001) and land use (8.24 compared with 7.16 m2 × y/2500 kcal; P < 0.001). Inverse associations between the DI score and anthropometric markers during young adulthood were observed (e.g., BMI: tertile 1 compared with tertile 3: 22.9 compared with 21.9 kg/m2; P = 0.03) (all P < 0.05). No associations between the DI score and cardiometabolic risk markers were found (all P ≥ 0.05).

CONCLUSIONS

Adherence to the ELR-diet was associated with favorable nutritional characteristics and reduced environmental impact. Adherence to the DI score in adolescence was also beneficial with respect to anthropometric markers in early adulthood, although not for further cardiometabolic risk markers.

Do diets with higher carbon footprints increase the risk of mortality? A population-based simulation study using self-selected diets from the USA

OBJECTIVE

Are diets with a greater environmental impact less healthy? This is a key question for nutrition policy, but previous research does not provide a clear answer. To address this, our objective here was to test whether American diets with the highest carbon footprints predicted greater population-level mortality from diet-related chronic disease than those with the lowest.

DESIGN

Baseline dietary recall data were combined with a database of greenhouse gases emitted in the production of foods to estimate a carbon footprint for each diet. Diets were ranked on their carbon footprints and those in the highest and lowest quintiles were studied here. Preventable Risk Integrated Model (PRIME), an epidemiological modelling software, was used to assess CVD and cancer mortality for a simulated dietary change from the highest to the lowest impact diets. The diet-mortality relationships used by PRIME came from published meta-analyses of randomised controlled trials and prospective cohort studies.

SETTING

USA.

PARTICIPANTS

Baseline diets came from adults (n 12 865) in the nationally representative 2005-2010 National Health and Nutrition Examination Survey.

RESULTS

A simulated change at the population level from the highest to the lowest carbon footprint diets resulted in 23 739 (95 % CI 20 349, 27 065) fewer annual deaths from CVD and cancer. This represents a 1·83 % (95 % CI 1·57 %, 2·08 %) decrease in total deaths. About 95 % of deaths averted were from CVD.

CONCLUSIONS

Diets with the highest carbon footprints were associated with a greater risk of mortality than the lowest, suggesting that dietary guidance could incorporate sustainability information to reinforce health messaging.

Single-item substitutions can substantially reduce the carbon and water scarcity footprints of US diets

BACKGROUND

Human food systems substantially affect the environment, but the impacts vary widely by food. Guidance to individuals to reduce their dietary impacts would benefit from easy advice, but little is known about the specific population impacts of simple changes on self-selected diets.

OBJECTIVES

The objective was to estimate the potential impact of a single dietary substitution on the carbon and water scarcity footprints of self-selected diets in the United States.

METHODS

This cross-sectional modeling study used 24-h dietary recall data from the 2005-2010 waves of the NHANES. Greenhouse gas emissions (GHGE) in the production of foods as well as irrigated water use, characterized by its relative scarcity at production locations, were matched to all foods in the recalls using previously developed databases. Impacts were summed to create carbon and water scarcity footprints for diets (n  = 16,800) of adults aged >18 y. Diet quality was assessed using the Healthy Eating Index (HEI). Foods with the highest impact on GHGE and selected additional foods were substituted for calorically equivalent, less impactful items. Footprints were calculated before and after these hypothetical substitutions.

RESULTS

The highest impact foods were all beef items, and 19.8% of individuals consumed them (n = 3320). After substitution of these items with poultry or pork, the mean carbon and water scarcity footprints among those with substitutions significantly decreased (P < 0.001) by 48.4 ± 0.6% and 29.9 ± 0.4%, respectively. Across the entire sample, these represented mean reductions of 9.6 ± 0.3% and 5.9 ± 0.2%, respectively. The mean HEI after substitutions was 3.6 ± 0.1% higher than before (P < 0.001). None of the selected additional foods had population impacts as large as the beef substitutions.

CONCLUSIONS

Simple substitutions can be made in individuals' diets to substantially reduce their carbon and water scarcity footprints without sacrificing dietary quality. Such substitutions may be easier to promote than complex dietary patterns.

Cooking at Home, Fast Food, Meat Consumption, and Dietary Carbon Footprint among US Adults

Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007-2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual's diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5-6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0-2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0-2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.

A Scoping Review of Indicators for Sustainable Healthy Diets

Introduction: Diets are currently unsustainable in many countries as evidenced by the growing burden of malnutrition, degradation of natural resources, contributions to climate change, and unaffordability of healthy diets. Agreement on what constitutes a healthy and sustainable diet has been debated. In 2019, FAO and WHO published the Sustainable Healthy Diets Guiding Principles, defining what qualifies as a sustainable healthy diet. While valuable, these principles require measurable indicators to support their operationalization. Our scoping review aims to describe how sustainable healthy diets have been assessed in the literature since 2010.

Methods: A search for English-language articles published in peer-reviewed journals was conducted from January 2010 through February 2020 across three databases. Out of the 504 articles initially identified, 103 articles were included. Metadata were extracted from each article on: publication year, country of study, study aims, methods, main data sources, indicators used to assess sustainable healthy diets, reported indicator strengths or limitations, and main study findings. A qualitative content analysis identified major conceptual themes across indicators and their frequency of use.

Findings: From the 103 empirical articles included in our review, 57.3% were published after 2017. Most studies were carried out in high-income countries (74%). Approximately 42% of the articles assessed the sustainability of diets using solely health and environmental indicators; &lt;25% assessed the sustainability of diets across health, environmental, and sociocultural aspects of sustainability. We found a substantial number of unique indicators used for assessing health (n = 82), environmental (n = 117), and sociocultural (n = 43) aspects of diets. These indicators covered concepts related to health outcomes, aspects of diet quality, natural resources, climate change, cultural acceptability, and cost of diets. The preponderance of indicators currently used in research likely poses challenges for stakeholders to identify the most appropriate measures.

Conclusion: Robust indicators for sustainable healthy diets are critical for understanding trends, setting targets, and monitoring progress across national and sub-national levels. Our review highlights the geographical imbalance, the narrow focus on health and environmental aspects, and the lack of common measures used in research. Measures registries could provide the decision-support needed by stakeholders to aid in the indicator selection process.

Variations in greenhouse gas emissions of individual diets: Associations between the greenhouse gas emissions and nutrient intake in the United Kingdom

BACKGROUND

Food production accounts for 30% of global greenhouse gas (GHG) emissions. Less environmentally sustainable diets are also often more processed, energy-dense and nutrient-poor. To date, the environmental impact of diets have mostly been based on a limited number of broad food groups.

OBJECTIVES

We link GHG emissions to over 3000 foods, assessing associations between individuals' GHG emissions, their nutrient requirements and their demographic characteristics. We also identify additional information required in dietary assessment to generate more accurate environmental impact data for individual-level diets.

METHODS

GHG emissions of individual foods, including process stages prior to retail, were added to the UK Composition Of Foods Integrated Dataset (COFID) composition tables and linked to automated online dietary assessment for 212 adults over three 24-hour periods. Variations in GHG emissions were explored by dietary pattern, demographic characteristics and World Health Organization Recommended Nutrient Intakes (RNIs).

RESULTS

GHG emissions estimates were linked to 98% (n = 3233) of food items. Meat explained 32% of diet-related GHG emissions; 15% from drinks; 14% from dairy; and 8% from cakes, biscuits and confectionery. Non-vegetarian diets had GHG emissions 59% (95% CI 18%, 115%) higher than vegetarian. Men had 41% (20%, 64%) higher GHG emissions than women. Individuals meeting RNIs for saturated fats, carbohydrates and sodium had lower GHG emissions compared to those exceeding the RNI.

DISCUSSION

Policies encouraging sustainable diets should focus on plant-based diets. Substituting tea, coffee and alcohol with more sustainable alternatives, whilst reducing less nutritious sweet snacks, presents further opportunities. Healthier diets had lower GHG emissions, demonstrating consistency between planetary and personal health. Further detail could be gained from incorporating brand, production methods, post-retail emissions, country of origin, and additional environmental impact indicators.

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.

Shifts towards healthy diets in the US can reduce environmental impacts but would be unaffordable for poorer minorities

Environmental implications of food choice are the focus of increasingly extensive research, but less is known about the impacts of dietary patterns of different socio-economic groups of a country, and the trade-offs between nutritional quality and environmental impacts of diet within those groups. We evaluate the impacts of US household dietary patterns on greenhouse gas emissions, blue water footprint, land use and energy consumption across supply chains using an environmentally extended input-output analysis. We compare the nutritional quality of these dietary patterns using healthy eating index scores across individuals' income and other socio-economic characteristics. Individuals with higher income or education levels are more likely to adopt healthier diets but are also responsible for larger environmental impacts of diet primarily due to a higher consumption of dairy and livestock products, seafood and items with lower energy density but higher nutrient density. Our optimization shows that a healthy diet with lower environmental impacts is achievable within current food budgets for almost 95% of people, and results in average decreases of 2% in food-related greenhouse gas emissions, 24% in land use and 4% in energy consumption, but a 28% increase in blue water consumption. However, such dietary patterns are unaffordable for 38% of Black and Hispanic individuals in the lowest income and education groups. Policies that affect income and food prices making nutritious food more affordable would be needed to achieve better nutrition and improved environmental outcomes simultaneously, particularly for more vulnerable socio-economic groups.

Data Integration for Diet Sustainability Analyses

Diet sustainability analyses are stronger when they incorporate multiple food systems domains, disciplines, scales, and time/space dimensions into a common modeling framework. Few analyses do this well: there are large gaps in food systems data in many regions, accessing private and some public data can be difficult, and there are analytical challenges, such as creating linkages across datasets and using complex analytical methods. This article summarizes key data sources across multiple domains of food system sustainability (nutrition, economic, environment) and describes methods and tools for integrating them into a common analytic framework. Our focus is the United States because of the large number of publicly available and highly disaggregated datasets. Thematically, we focus on linkages that exist between environmental and economic datasets to nutrition, which can be used to estimate the cost and agricultural resource use of food waste, interrelationships between healthy eating and climate impacts, diets optimized for cost, nutrition, and environmental impacts, and others. The limitations of these approaches and data sources are described next. By enhancing data integration across these fields, researchers can be better equipped to promote policy for sustainable diets.

Nutritional quality and carbon footprint of university students' diets: results from the EHU12/24 study

Objective:

To evaluate diets in terms of nutritional characteristics and quality from the perspectives of health, greenhouse gas emissions (GHGE) and possible associations with each other in a representative sample of students at a public university.

Design:

Cross-sectional. Dietary intake was evaluated with a validated FFQ, and diet quality was assessed through the Healthy Eating Index (HEI-2010) and MedDietScore (MDS). GHGE data were obtained from the literature. In addition, sex, socio-economic status (SES) and body fat (BF) status were analysed as covariates.

Setting:

Basque Autonomous Community, Spain.

Participants:

Totally, 26 165 healthy adults aged 18–28 years.

Results:

Student diets were characterised by low consumption of carbohydrates (38·72 % of total energy intake (TEI)) and a high intake of lipids (39·08 % of TEI). Over half of the participants had low dietary quality. The low-emitting diets were more likely to be consumed by subjects with low HEI-2010 scores (β: 0·039 kg eCO₂/1000 kcal/d) and high MDS scores (β: −0·023 kg eCO₂/1000 kcal/d), after controlling for sex, SES and BF status. Both the low-emitting and healthy diets were more likely to be consumed by women and by those with normal BF percentage.

Conclusions:

UPV/EHU university students’ diets were characterised by moderate quality from a nutritional perspective and moderate variation in the size of carbon footprints. In this population, diets of the highest quality were not always those with the lowest diet-related GHGE; this relationship depended in part on the constructs and scoring criteria of diet quality indices used.

Diets benefiting health and climate relate to longevity in northern Sweden

BACKGROUND

Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health.

OBJECTIVES

We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality.

METHODS

Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group).

RESULTS

NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim.

CONCLUSIONS

Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate perspective.

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.

Healthy diets can create environmental trade-offs, depending on how diet quality is measured

Background

There is an urgent need to assess the linkages between diet patterns and environmental sustainability in order to meet global targets for reducing premature mortality and improving sustainable management of natural resources. This study fills an important research gap by evaluating the relationship between incremental differences in diet quality and multiple environmental burdens, while also accounting for the separate contributions of retail losses, inedible portions, and consumer waste.

Methods

Cross sectional, nationally-representative data on food intake in the United States were acquired from the National Health and Nutrition Examination Survey (2005–2016), and were linked with nationally-representative data on food loss and waste from published literature. Survey-weighted procedures estimated daily per capita food retail loss, food waste, inedible portions, and consumed food, and were summed to represent Total Food Demand. Diet quality was measured using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. Data on food intake, loss, and waste were inputted into the US Foodprint Model to estimate the amount of agricultural land, fertilizer nutrients, pesticides, and irrigation water used to produce food.

Results

This study included dietary data from 50,014 individuals aged ≥2 y. Higher diet quality (HEI-2015 and AHEI-2010) was associated with greater per capita Total Food Demand, as well as greater retail loss, inedible portions, consumer waste, and consumed food (P < 0.001 for all comparisons). Consumed food accounted for 56–74% of agricultural resource use (land, fertilizer nutrients, pesticides, and irrigation water), retail loss accounted for 4–6%, inedible portions accounted for 2–15%, and consumer waste accounted for 20–23%. Higher diet quality was associated with lower use of agricultural land, but the relationship to other agricultural resources was dependent on the tool used to measure diet quality (HEI-2015 vs. AHEI-2010).

Conclusions

Over one-quarter of the agricultural inputs used to produce Total Food Demand were attributable to edible food that was not consumed. Importantly, this study also demonstrates that the relationship between diet quality and environmental sustainability depends on how diet quality is measured. These findings have implications for the development of sustainable dietary guidelines, which requires balancing population-level nutritional needs with the environmental impacts of food choices.

Association between diet-related greenhouse gas emissions and nutrient intake adequacy among Japanese adults

OBJECTIVES

A growing number of Western studies have been exploring sustainable and healthy dietary patterns that target to reduce diet-related greenhouse gas emissions (GHGE) and to achieve nutritional needs. However, research is limited among Asian populations, where food sources for diet-related GHGE differ from those in Western populations. This study aimed to investigate associations between diet-related GHGE and the prevalence of inadequate nutritional intake.

METHODS

A cross-sectional study was carried out among 392 healthy Japanese volunteers aged 20-69 years. Dietary intake was assessed by four-non-consecutive day diet record. Diet-related GHGE was estimated using the Global Link Input-Output model and adjusted for energy intake by residual method. Prevalence of inadequacy was defined as a percentage of participants with nutrient intake outside the Tentative Dietary Goal for Preventing Lifestyle-Related Disease or below the Estimated Average Requirement defined by the Dietary Reference Intakes (DRIs) for Japanese. The association between diet-related GHGE and the prevalence of inadequacy of the usual intake of each nutrient was examined using logistic regression models.

RESULTS

Participants with higher diet-related GHGE had overall better adherence to the DRIs. Intakes of all selected nutrients were positively associated with diet-related GHGE, except for carbohydrate, total fat, and saturated fat. With increasing quartile of diet-related GHGE, the prevalence of inadequacy decreased for protein, dietary fiber, potassium, vitamins A, B-6, and C, thiamin, riboflavin, calcium, magnesium, iron, and zinc, while that for sodium increased.

CONCLUSIONS

Diets with lower diet-related GHGE did not have better adherence to the DRIs compared to diets with higher diet-related GHGE among Japanese adults. Drastic dietary change or other strategies such as improving the food system would be needed to achieve a sustainable and healthy diet among Japanese.

Towards Win-Win Policies for Healthy and Sustainable Diets in Switzerland

The first Swiss national dietary survey (MenuCH) was used to screen disease burdens and greenhouse gas emissions (GHG) of Swiss diets (vegan, vegetarian, gluten-free, slimming), with a focus on gender and education level. The Health Nutritional Index (HENI), a novel disease burden-based nutritional index built on the Global Burden of Disease studies, was used to indicate healthiness using comparable, relative disease burden scores. Low whole grain consumption and high processed meat consumption are priority risk factors. Non-processed red meat and dairy make a nearly negligible contribution to disease burden scores, yet are key drivers of diet-related GHGs. Swiss diets, including vegetarian, ranged between 1.1–2.6 tons of CO₂e/person/year, above the Swiss federal recommendation 0.6 ton CO₂e/person/year for all consumption categories. This suggests that only changing food consumption practices will not suffice towards achieving carbon reduction targets: Systemic changes to food provisioning processes are also necessary. Finally, men with higher education had the highest dietary GHG emissions per gram of food, and the highest disease burden scores. Win–win policies to improve health and sustainability of Swiss diets would increase whole grain consumption for all, and decrease alcohol and processed meat consumption especially for men of higher education levels.

Nutritional Quality and Health Effects of Low Environmental Impact Diets: The "Seguimiento Universidad de Navarra" (SUN) Cohort

Current dietary patterns are negatively affecting both the environment and people's health. Healthy diets are generally more environmentally friendly. However, few studies have focused on the health consequences of diets with low environmental impact. We analyzed differences in the dietary composition (types of food, macro- and micro-nutrients) of those diets with high and low environmental impact, according to greenhouse gas emission and resources use (water, land and energy) using data from a Spanish cohort (17,387 participants), collected by means of a validated food frequency questionnaire. Cox analyses were used to assess the association of dietary environmental impact with total mortality risk. At a given level of energy intake, diets with lower environmental impact contained higher amounts of plant-based foods and lower levels of animal-derived products. Less polluting diets involved higher amounts of polyunsaturated fats and dietary fiber and lower amounts of saturated fats and sodium. However, diets associated with less environmental damage also contained more added sugars, but lower levels of vitamin B12, zinc and calcium. We did not detect any association between dietary environmental impact and risk of mortality. Diets should not only produce minimal environmental impact, but the maximum overall benefits for all key dimensions encompassed in sustainable diets.

Systematic Review of Dietary Patterns and Sustainability in the United States

Improving awareness and accessibility of healthy diets are key challenges for health professionals and policymakers alike. While the US government has been assessing and encouraging nutritious diets via the Dietary Guidelines for Americans (DGA) since 1980, the long-term sustainability, and thus availability, of those diets has received less attention. The 2015 Dietary Guidelines Advisory Committee (DGAC) examined the evidence on sustainable diets for the first time, but this topic was not included within the scope of work for the 2020 DGAC. The objective of this study was to systematically review the evidence on US dietary patterns and sustainability outcomes published from 2015 to 2019 replicating the 2015 DGAC methodology. The 22 studies meeting inclusion criteria reveal a rapid expansion of research on US dietary patterns and sustainability, including 8 studies comparing the sustainability of DGA-compliant dietary patterns with current US diets. Our results challenge prior findings that diets adhering to national dietary guidelines are more sustainable than current average diets and indicate that the Healthy US-style dietary pattern recommended by the DGA may lead to similar or increased greenhouse gas emissions, energy use, and water use compared with the current US diet. However, consistent with previous research, studies meeting inclusion criteria generally support the conclusion that, among healthy dietary patterns, those higher in plant-based foods and lower in animal-based foods would be beneficial for environmental sustainability. Additional research is needed to further evaluate ways to improve food system sustainability through both dietary shifts and agricultural practices in the United States.

Toward Healthy Diets from Sustainable Food Systems

This article is based on a session at ASN 2019 entitled "Addressing the Four Domains of Sustainable Food Systems Science (Health, Economics, Society and the Environment): What Will It Take to Harmonize the Evidence to Advance the Field?" A summary of presentations is included. The presentations addressed the 4 principal domains of sustainability defined as nutrition/health, economics, environment, and society and the ways in which they are represented in current research. The session also introduced metrics and measures that are specific to each domain. Participants discussed next steps to move toward consensus and collaboration among scientific communities, especially those of health/nutrition science and environmental science. Food systems may need to be restructured to ensure that the global food supply provides adequate calories and nutrients at an affordable cost. Finally, the session addressed strategies to implement research concepts and move toward policies that encourage consumers to choose healthy diets from sustainable food systems.

Daily cost of consumer food wasted, inedible, and consumed in the United States, 2001-2016

BACKGROUND

Consumer food waste in the United States represents substantial amounts of wasted nutrients, as well as needless environmental impact from wasted agricultural inputs, energy use, and greenhouse gas emissions. Efforts to reduce food waste at the consumer level are urgently needed to address the most prominent nutrition and environmental sustainability issues we now face. Importantly, individuals report that saving money is a salient motivator for reducing food waste, yet contemporary evidence on the consumer cost of wasted food is lacking. The objectives of this study are to 1) estimate the daily per capita cost of food wasted, inedible, and consumed 2) at home and away from home, and 3) by food group.

METHODS

This study utilizes cross-sectional, nationally-representative data on food intake from the National Health and Nutrition Examination Survey (2001-2016), linked with nationally representative data on food waste from published literature, as well as data on food prices and food price inflation from multiple publicly-available sources. Survey-weighted procedures estimated daily per capita expenditure on food waste for 39,758 adults aged ≥20 y.

RESULTS

Total daily per capita food expenditure was $13.27, representing 27% wasted, 14% inedible, and 59% consumed. The greatest daily food waste expenditures were observed for meat and seafood purchased for consumption outside of the home ($0.94, 95% CI: $0.90-0.99), and fruits and vegetables purchased for consumption in the home ($0.68, $0.63-0.73).

CONCLUSIONS

The most cost-effective ways to reduce food waste at the consumer level are to focus waste reduction efforts on meat and seafood purchased for consumption outside of the home and fruits and vegetables purchased for consumption in the home. A number of strategies are available to help consumers reduce their food waste, which can increase their financial flexibility to purchase more healthy foods while simultaneously reducing environmental impact.

The role of dairy foods in lower greenhouse gas emission and higher diet quality dietary patterns

PURPOSE

There is conflicting advice about the inclusion of dairy foods in a lower greenhouse gas (GHG) emission dietary pattern. Our purpose was to assess the prevalence of dairy food intake among higher diet quality and lower GHG emission diets in Australia and within these diets assess the association between level of dairy food intake and adequate intake of a broad range of nutrients.

METHODS

Dietary intake data collected using a 24-h recall process were sourced from the most recent Australian Health Survey. Diet quality was assessed by level of compliance with the food group-based Australian Dietary Guidelines. A subgroup of 1732 adult (19 years and above) daily diets was identified having higher diet quality score and lower GHG emissions (HQLE). Intake of core dairy foods (milk, cheese, yoghurt) was assessed and nutrient profiling was undertaken for 42 macro- and micronutrients.

RESULTS

The HQLE subgroup had 37% higher diet quality score and 43% lower GHG emissions than the average Australian adult diet (P < 0.05). Intake of dairy foods was very common (90% of HQLE diets) and greatly exceeded the intake of non-dairy alternatives (1.53 serves compared to 0.04 serves). HQLE daily diets in the highest tertile of dairy food intake were more likely to achieve the recommended intake of a wide range of nutrients, including calcium, protein, riboflavin, vitamin B12, folate, phosphorous, magnesium, iodine and potassium compared to other HQLE daily diets.

CONCLUSION

Core dairy foods have an important role for achieving adequate nutrient intakes in a healthy and lower GHG emission dietary pattern in Australia.

Addressing the carbon footprint, healthfulness, and costs of self-selected diets in the USA: a population-based cross-sectional study

BACKGROUND

The role of diet in health is well established and, in the past decade, more attention has been given to the role of food choices in the environment. The agricultural sector produces about a quarter of the world's greenhouse gas emissions (GHGE), and meat production, especially beef, is an important contributor to global GHGE. Our study aimed to address a fundamental gap in the diet-climate literature: identifying consumers who are receptive to making dietary changes, and the effect of their potential changes on GHGE, diet healthfulness, and diet costs.

METHODS

Dietary data on US individuals from a nationally representative survey were linked to food-related GHGE. We identified individuals receptive to changing their diets (potential changers) as those who reported trying US dietary guidance and were likely to agree that humans contribute to climate change. We assessed GHGE, diet healthfulness measured by the Healthy Eating Index (HEI), and diet costs before and after hypothetical changes replacing either beef or meats with poultry or plant-protein foods.

FINDINGS

Our sample comprised 7188 individuals, of whom 16% were potential changers. These were disproportionately women, highly educated, or had higher income compared with individuals deemed not likely to change. Replacing 100% of beef intake in potential changers with poultry reduced mean dietary GHGE by 1·38 kg CO₂-equivalents per person per day (95% CI 1·19-1·58), a 35·7% decrease. This replacement also increased mean HEI by 1·7% and reduced mean diet costs by 1·7%. We observed the largest changes when replacing all beef, pork, or poultry intake with plant-protein foods (GHGE decreased by 49·6%, mean HEI increased by 8·7%, and dietary costs decreased by 10·5%). Hypothetical replacements in the potential changers alone resulted in whole population reductions in 1-day dietary GHGE of 1·2% to 6·7%, equivalent to 22-126 million fewer passenger vehicle km.

INTERPRETATION

Individual-level diet studies that include a variation in response by consumers can improve our understanding of the effects of climate policies such as those that include sustainability information in national dietary guidance. In our study, we found that changes by a small percentage of motivated individuals can modestly reduce the national dietary GHGE. Moreover, these substitutions can modestly improve diet healthfulness and reduce diet costs for individuals who make these changes.

FUNDING

Wellcome Trust.

Changes in dietary carbon footprint over ten years relative to individual characteristics and food intake in the Västerbotten Intervention Programme

The objective was to examine 10-year changes in dietary carbon footprint relative to individual characteristics and food intake in the unique longitudinal Västerbotten Intervention Programme, Sweden. Here, 14 591 women and 13 347 men had been followed over time. Food intake was assessed via multiple two study visits 1996–2016, using a 64-item food frequency questionnaire. Greenhouse gas emissions (GHGE) related to food intake, expressed as kg carbon dioxide equivalents/1000 kcal and day, were estimated. Participants were classified into GHGE quintiles within sex and 10-year age group strata at both visits. Women and men changing from lowest to highest GHGE quintile exhibited highest body mass index within their quintiles at first visit, and the largest increase in intake of meat, minced meat, chicken, fish and butter and the largest decrease in intake of potatoes, rice and pasta. Women and men changing from highest to lowest GHGE quintile exhibited basically lowest rates of university degree and marriage and highest rates of smoking within their quintiles at first visit. Among these, both sexes reported the largest decrease in intake of meat, minced meat and milk, and the largest increase in intake of snacks and, for women, sweets. More research is needed on how to motivate dietary modifications to reduce climate impact and support public health.