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Leonard UM, Kiely ME. Can micronutrient requirements be met by diets from sustainable sources: outcomes of dietary modelling studies using diet optimization. Ann Med 2024; 56:2389295. [PMID: 39129219 PMCID: PMC11321105 DOI: 10.1080/07853890.2024.2389295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Consumption of diets from sustainable sources is required for planetary health, however, large sections of the population, including females of reproductive age and children, will be at risk of not meeting their micronutrient (MN) requirements in a complete transition to plant-based foods. Constrained diet optimization methods use mathematical programming to construct diets that meet predefined parameters and may contribute towards modelling dietary solutions that meet nutritional and planetary targets. OBJECTIVE Review the evidence from diet optimization studies proposing solutions to ensure MN availability in the context of a transition to diets from sustainable sources. APPROACH Narrative review focusing on literature published over the last five years. RESULTS Dietary modelling using diet optimization can design a range of omnivorous and plant-based diets that meet individual MN requirements, have reduced environmental impacts, and minimize deviation from culturally acceptable dietary practices. Using data from large-scale dietary surveys, diet optimization can support development of food-based dietary guidelines; identify limiting MNs in a particular context or a conflict between constraints e.g. nutrition and environment; explore food-based strategies to increase nutrient supply, such as fortification; and support trial design. Methods used and outcomes reported are sources of variability. Individual-level dietary data and MN requirements for population sub-groups such as females of reproductive age and children are important requirements. Although maintaining iron and zinc intakes are regularly reported to present challenges in diets from sustainable sources, few studies have considered bioavailability, which reduces with increased dietary phytate. These and other data gaps including acceptability and affordability must be addressed to improve the applicability of modelling outcomes in population recommendations. CONCLUSIONS Dietary modelling using diet optimization can be useful in the design of more sustainable diets that meet MN requirements, however, translation of outcomes into dietary intervention studies is required to test real-world application and adoption into dietary guidelines.
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Affiliation(s)
- Ursula M. Leonard
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Mairead E. Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, Ireland, University College Cork, Cork, Ireland
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Mazac R, Hyyrynen M, Kaartinen NE, Männistö S, Irz X, Hyytiäinen K, Tuomisto HL, Lombardini C. Exploring tradeoffs among diet quality and environmental impacts in self-selected diets: a population-based study. Eur J Nutr 2024; 63:1663-1678. [PMID: 38584247 PMCID: PMC11329690 DOI: 10.1007/s00394-024-03366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/01/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Proposed sustainable diets often deviate dramatically from currently consumed diets, excluding or drastically reducing entire food groups. Moreover, their environmental sustainability tends to be measured only in terms of greenhouse gases emissions. The aim of this study was to overcome these limitations and identify a cluster of already adopted, relatively healthy diets with substantially lower environmental impacts than the average diet. We also aimed to estimate the reduction in multiple environmental impacts that could be achieved by shifting to this diet cluster and highlight possible tradeoffs among environmental impacts. METHODS The diet clusters were identified by applying energy-adjusted multiple factor analysis and hierarchical clustering to the dietary data of the National FinHealth 2017 Study (n = 5125) harmonized with life cycle assessment data on food products from Agribalyse 3.0 and Agri-Footprint using nutrient intakes and global warming potential, land use, and eutrophication of marine and freshwater systems as the active variables. RESULTS We identified five diet clusters, none of which had the highest overall diet quality and lowest impact for all four environmental indicators. One cluster, including twenty percent of the individuals in the sample was identified as a "best compromise" diet with the highest diet quality and the second lowest environmental impacts of all clusters, except for freshwater eutrophication. The cluster did not exclude any food groups, but included more fruits, vegetables, and fish and less of all other animal-source foods than average. Shifting to this cluster diet could raise diet quality while achieving significant reductions in most but not all environmental impacts. CONCLUSION There are tradeoffs among the environmental impacts of diets. Thus, future dietary analyses should consider multiple sustainability indicators simultaneously. Cluster analysis is a useful tool to help design tailored, socio-culturally acceptable dietary transition paths towards high diet quality and lower environmental impact.
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Affiliation(s)
- Rachel Mazac
- Faculty of Agriculture and Forestry, Department of Agricultural Sciences and Helsinki Institute of Sustainability Science, University of Helsinki, Helsinki, Finland.
| | - Matti Hyyrynen
- Natural Resource Institute of Finland, Helsinki, Finland
| | | | - Satu Männistö
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Xavier Irz
- Faculty of Agriculture and Forestry, Department of Economics and Management and Helsinki Institute of Sustainability Science, University of Helsinki, Helsinki, Finland
| | - Kari Hyytiäinen
- Faculty of Agriculture and Forestry, Department of Economics and Management and Helsinki Institute of Sustainability Science, University of Helsinki, Helsinki, Finland
| | - Hanna L Tuomisto
- Faculty of Agriculture and Forestry, Department of Agricultural Sciences and Helsinki Institute of Sustainability Science, Natural Resources Institute Finland (Luke), University of Helsinki, Helsinki, Finland
| | - Chiara Lombardini
- Faculty of Agriculture and Forestry, Department of Economics and Management and Helsinki Institute of Sustainability Science, University of Helsinki, Helsinki, Finland
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Rei M, Costa A, Sosa S, da Costa S, Torres D, Sage C, Rodrigues S. Multicriteria Measures to Assess the Sustainability of Diets: A Systematic Review. Nutr Rev 2024:nuae081. [PMID: 38942740 DOI: 10.1093/nutrit/nuae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
CONTEXT Assessing the overall sustainability of a diet is a challenging undertaking requiring a holistic approach capable of addressing the multicriteria nature of this concept. OBJECTIVE The aim was to identify and summarize the multicriteria measures used to assess the sustainability characteristics of diets reported at the individual level by healthy adults. DATA SOURCES Articles were identified via PubMed, Scopus, and Web of Science. The search strategy consisted of key words and MeSH terms, and was concluded in September 2022, covering references in English, Spanish, and Portuguese. DATA EXTRACTION This systematic review followed the PRISMA guidelines. The search identified 5663 references, from which 1794 were duplicates. Two reviewers independently screened the titles and abstracts of each of the 3869 records and the full-text of the 144 references selected. Of these, 7 studies met the inclusion criteria. DATA ANALYSIS A total of 6 multicriteria measures were identified: 3 different Sustainable Diet Indices, the Quality Environmental Costs of Diet, the Quality Financial Costs of Diet, and the Environmental Impact of Diet. All of these incorporated a health/nutrition dimension, while the environmental and economic dimensions were the second and the third most integrated, respectively. A sociocultural sustainability dimension was included in only 1 of the measures. CONCLUSION Despite some methodological concerns in the development and validation process of the identified measures, their inclusion is considered indispensable in assessing the transition towards sustainable diets in future studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022358824.
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Affiliation(s)
- Mariana Rei
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Alexandra Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Sofia Sosa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Sofia da Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Duarte Torres
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal
| | - Colin Sage
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
| | - Sara Rodrigues
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal
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Leonard UM, Leydon CL, Arranz E, Kiely ME. Impact of consuming an environmentally protective diet on micronutrients: a systematic literature review. Am J Clin Nutr 2024; 119:927-948. [PMID: 38569787 DOI: 10.1016/j.ajcnut.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 04/05/2024] Open
Abstract
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).
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Affiliation(s)
- Ursula M Leonard
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Clarissa L Leydon
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland; Department of Agrifood Business and Spatial Analysis, Teagasc Food Research Centre, Ashtown, Dublin, Ireland
| | - Elena Arranz
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland; Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
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Irz X, Tapanainen H, Saarinen M, Salminen J, Sares-Jäske L, Valsta LM. Reducing the carbon footprint of diets across socio-demographic groups in Finland: a mathematical optimisation study. Public Health Nutr 2024; 27:e98. [PMID: 38436089 PMCID: PMC10993064 DOI: 10.1017/s1368980024000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To characterise nutritionally adequate, climate-friendly diets that are culturally acceptable across socio-demographic groups. To identify potential equity issues linked to more climate-friendly and nutritionally adequate dietary changes. DESIGN An optimisation model minimises distance from observed diets subject to nutritional, greenhouse gas emissions (GHGE) and food-habit constraints. It is calibrated to socio-demographic groups differentiated by sex, education and income levels using dietary intake data. The environmental coefficients are derived from life cycle analysis and an environmentally extended input-output model. SETTING Finland. PARTICIPANTS Adult population. RESULTS Across all population groups, we find large synergies between improvements in nutritional adequacy and reductions in GHGE, set at one-third or half of the current level. Those reductions result mainly from the substitution of meat with cereals, potatoes and roots and the intra-category substitution of foods, such as beef with poultry in the meat category. The simulated more climate-friendly diets are thus flexitarian. Moving towards reduced-impact diets would not create major inadequacies related to protein and fatty acid intakes, but Fe could be an issue for pre-menopausal females. The initial socio-economic gradient in the GHGE of diets is small, and the patterns of adjustments to more climate-friendly diets are similar across socio-demographic groups. CONCLUSIONS A one-third reduction in GHGE of diets is achievable through moderate behavioural adjustments, but achieving larger reductions may be difficult. The required changes are similar across socio-demographic groups and do not raise equity issues. A population-wide policy to promote behavioural change for diet sustainability would be appropriate.
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Affiliation(s)
- Xavier Irz
- Department of Economics and Management, University of
Helsinki, Latokartanonkaari 5, Helsinki,
Finland
- Bioeconomy Policies and Markets Group, Natural Resources
Institute Finland, Latokartanonkaari 9, PL 2, Helsinki,
Finland
| | - Heli Tapanainen
- Department of Public Health and Welfare, Finnish Institute
for Health and Welfare, Helsinki, Finland
| | - Merja Saarinen
- Sustainability Science and Indicators Group, Natural
Resources Institute Finland, Latokartanonkaari 9, PL 2,
Helsinki, Finland
| | - Jani Salminen
- Finnish Environment Institute, Latokartanonkaari 11,
Helsinki, Finland
| | - Laura Sares-Jäske
- Department of Public Health and Welfare, Finnish Institute
for Health and Welfare, Helsinki, Finland
| | - Liisa M Valsta
- Department of Public Health and Welfare, Finnish Institute
for Health and Welfare, Helsinki, Finland
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Kenny TA, Woodside JV, Perry IJ, Harrington JM. Consumer attitudes and behaviors toward more sustainable diets: a scoping review. Nutr Rev 2023; 81:1665-1679. [PMID: 37014671 PMCID: PMC10639109 DOI: 10.1093/nutrit/nuad033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
There is an urgent need to move toward more sustainable diets. Although this will require radical and systemic changes across food systems, altering consumer ideologies and practices is essential to garner support for such actions. In this scoping review, the evidence on consumers' attitudes and behaviors toward more sustainable diets is synthesized and a range of factors, considerations, and proposed strategies are presented that can contribute to building the societal-level support for urgent and systems-level changes. The findings suggest that consumers, insofar as they are interested in sustainability and have the capacity to engage with the concept, primarily approach the concept of sustainable diet from a human health perspective. However, the interconnectedness of human health and well-being with environmental health is poorly understood and under-researched in the context of consumer behaviors and attitudes toward sustainable diets. This highlights the need for (1) sustained efforts from public health professionals to encourage a realignment of the term sustainable diet with its multidimensional meaning by championing an ecological public health approach in all efforts aimed at promoting more sustainable consumption, from awareness raising to policy development; (2) a broader research lens focused on the multidimensional concept of sustainability in the literature exploring consumer attitudes and behaviors; and (3) the development of multidisciplinary, clear, and evidence-based sustainable-eating messages, including holistic sustainable dietary guidance, to address knowledge gaps, minimize conflicting narratives, and build consumer agency. The findings contribute to understanding how support can be generated for the necessary structural and system-level changes required to support behavior change.
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Affiliation(s)
- Tara A Kenny
- Centre for Health & Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Jayne V Woodside
- Centre for Public Health, Queens University Belfast, Belfast, United Kingdom
| | - Ivan J Perry
- Centre for Health & Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Janas M Harrington
- Centre for Health & Diet Research, School of Public Health, University College Cork, Cork, Ireland
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Viroli G, Kalmpourtzidou A, Cena H. Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability. Nutrients 2023; 15:4723. [PMID: 38004117 PMCID: PMC10675717 DOI: 10.3390/nu15224723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.
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Affiliation(s)
- Giulia Viroli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
| | - Aliki Kalmpourtzidou
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
- Clinical Nutrition Unit, General Medicine, ICS Maugeri IRCCS, 27100 Pavia, Italy
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Lindroos AK, Hallström E, Moraeus L, Strid A, Winkvist A. Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents. Am J Clin Nutr 2023; 118:956-965. [PMID: 37678640 DOI: 10.1016/j.ajcnut.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/25/2023] [Accepted: 09/02/2023] [Indexed: 09/09/2023] Open
Abstract
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.
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Affiliation(s)
- Anna Karin Lindroos
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Elinor Hallström
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Institutes of Sweden (RISE), Department of Food and Agriculture, Lund, Sweden
| | - Lotta Moraeus
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Anna Strid
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Braga Tibaes JR, Barreto Silva MI, Makarowski A, Cervantes PB, Richard C. The nutrition and immunity (nutrIMM) study: protocol for a non-randomized, four-arm parallel-group, controlled feeding trial investigating immune function in obesity and type 2 diabetes. Front Nutr 2023; 10:1243359. [PMID: 37727636 PMCID: PMC10505731 DOI: 10.3389/fnut.2023.1243359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Individuals with obesity and/or type 2 diabetes are at higher risk of infection and have worse prognoses compared to healthy individuals. Several factors may influence immune responses in this population, including high adiposity, hyperglycemia, and unhealthy dietary habits. However, there is insufficient data on the independent or clustered contribution of these factors to obesity-related immune dysfunction, especially accounting for dietary intake. This study aims to establish the independent contribution of obesity and hyperglycemia to immune dysfunction independent of diet in adults with and without obesity with or without type 2 diabetes. Methods The Nutrition and Immunity (nutrIMM) study is a single-centre, non-randomized, four-arm, parallel-group, controlled feeding trial. It will enroll adults without obesity (Lean-NG) and with obesity and three metabolic phenotypes of normoglycemia, glucose intolerance, and type 2 diabetes. Participants will be assigned to one of four groups and will consume a standard North American-type diet for 4 weeks. The primary outcomes are plasma concentration of C-reactive protein and concentration of ex-vivo interleukin-2 secreted upon stimulation of T cells with phytohemagglutinin. Discussion This will be the first controlled feeding study examining the contribution of obesity, hyperglycemia, and diet on systemic inflammation, immune cell phenotype, and function in adults of both sexes. Results of this clinical trial can ultimately be used to develop personalized dietary strategies to optimize immune function in individuals with obesity with different immune and metabolic profiles. Clinical trial registration ClinicalTrials.gov, identifier NCT04291391.
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Affiliation(s)
| | - Maria Inês Barreto Silva
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
- Department of Applied Nutrition, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Alexander Makarowski
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Paulina Blanco Cervantes
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Caroline Richard
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
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Nordman M, Lassen AD, Stockmarr A, van ‘t Veer P, Biesbroek S, Trolle E. Exploring healthy and climate-friendly diets for Danish adults: an optimization study using quadratic programming. Front Nutr 2023; 10:1158257. [PMID: 37396137 PMCID: PMC10307962 DOI: 10.3389/fnut.2023.1158257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background A transition to healthy and sustainable diets has the potential to improve human and planetary health but diets need to meet requirements for nutritional adequacy, health, environmental targets, and be acceptable to consumers. Objective The objective of this study was to derive a nutritionally adequate and healthy diet that has the least deviation possible from the average observed diet of Danish adults while aiming for a greenhouse gas emission (GHGE) reduction of 31%, corresponding to the GHGE level of the Danish plant-rich diet, which lays the foundation for the current healthy and sustainable food-based dietary guidelines (FBDGs) in Denmark. Methods With an objective function minimizing the departure from the average observed diet of Danish adults, four diet optimizations were run using quadratic programming, with different combinations of diet constraints: (1) nutrients only (Nutri), (2) nutrients and health-based targets for food amounts (NutriHealth), (3) GHGE only (GHGE), and finally, (4) combined nutrient, health and GHGE constraints (NutriHealthGHGE). Results The GHGE of the four optimized diets were 3.93 kg CO2-eq (Nutri), 3.77 kg CO2-eq (NutriHealth) and 3.01 kg CO2-eq (GHGE and NutriHealthGHGE), compared to 4.37 kg CO2-eq in the observed diet. The proportion of energy from animal-based foods was 21%-25% in the optimized diets compared to 34% in the observed diet and 18% in the Danish plant-rich diet. Moreover, compared to the average Danish diet, the NutriHealthGHGE diet contained more grains and starches (44 E% vs. 28 E%), nuts (+230%), fatty fish (+89%), eggs (+47%); less cheese (-73%), animal-based fats (-76%), total meat (-42%); and very limited amounts of ruminant meat, soft drinks, and alcoholic beverages (all-90%), while the amounts of legumes and seeds were unchanged. On average, the mathematically optimized NutriHealthGHGE diet showed a smaller deviation from the average Danish diet compared to the Danish plant-rich diet (38% vs. 169%, respectively). Conclusion The final optimized diet presented in this study represents an alternative way of composing a nutritionally adequate and healthy diet that has the same estimated GHGE as a diet consistent with the climate-friendly FBDGs in Denmark. As this optimized diet may be more acceptable for some consumers, it might help to facilitate the transition toward more healthy and sustainable diets in the Danish population.
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Affiliation(s)
- Matilda Nordman
- National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Dahl Lassen
- National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Pieter van ‘t Veer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Sander Biesbroek
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Ellen Trolle
- National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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Rossi L, Ferrari M, Ghiselli A. The Alignment of Recommendations of Dietary Guidelines with Sustainability Aspects: Lessons Learned from Italy's Example and Proposals for Future Development. Nutrients 2023; 15:nu15030542. [PMID: 36771249 PMCID: PMC9921064 DOI: 10.3390/nu15030542] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
The main objective of this paper is to describe the process of the inclusion of sustainability in the Italian Dietary Guidelines (IDGs). In the IDGs' sustainability chapter, particular emphasis was put on the selection of foods, recommending a plant-based diet with a large quota of vegetable proteins. Advice was also given on the selection of local seasonal products, with low growth input, such as fertilizers, artificial light and heating. Reduction of animal food was recommended, to be substituted with lower impact foods (poultry, milk, eggs and Mediterranean fish including aquaculture). Food waste was largely addressed. Recommendations were made for food purchase planning, food storage and the reuse of leftovers as strategies to reduce waste and save money. The IDGs sustainability recommendations were related to the 16 guiding principles of a sustainable healthy diet and their contribution to the achievement of the Sustainable Developing Goals was provided. The inclusion of sustainability in dietary guidelines requires a multidisciplinary approach to cover the wide range of aspects of a sustainable diet. In the IDGs, it was possible to show that practical recommendations for improving sustainability behavior can be passed on to consumers. Methodological aspects for developing recommendations are not definitive.
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Affiliation(s)
- Laura Rossi
- Council for Agricultural Research and Economics—Research Centre for Food and Nutrition (CREA–Food and Nutrition), Via Ardeatina 546, 00178 Rome, Italy
- Correspondence:
| | - Marika Ferrari
- Council for Agricultural Research and Economics—Research Centre for Food and Nutrition (CREA–Food and Nutrition), Via Ardeatina 546, 00178 Rome, Italy
| | - Andrea Ghiselli
- Italian Society of Food Science and Nutrition, Via Bu Meliana, 00195 Rome, Italy
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de Freitas NPA, Carvalho TR, Gonçalves CCRA, da Silva PHA, de Melo Romão LG, Kwak-Kim J, Cavalcante MB. The Dietary Inflammatory Index as a predictor of pregnancy outcomes: Systematic review and meta-analysis. J Reprod Immunol 2022; 152:103651. [DOI: 10.1016/j.jri.2022.103651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
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