Consumer attitudes and behaviors toward more sustainable diets: a scoping review

From Palm to Plate: Unveiling the Potential of Coconut as a Plant-Based Food Alternative

This review investigates coconut as a sustainable and nutrient-rich plant-based alternative to traditional animal-based food sources. We have explored the nutritional profile, culinary versatility, particularly focusing on the use of coconut meat, milk, cream, and oil in diverse dietary contexts when consumed in balance. Comparative analysis with animal-derived products reveals the high content of medium-chain triglycerides (MCTs), essential vitamins, and minerals in coconut, contrasted with its lower protein content. Researchers have underscored the environmental sustainability of coconut, advocating for its role in eco-friendly food production chains. We have also addressed challenges like potential allergies, nutritional balance, sensory attributes, and consumer motivations for coconut-based products, in terms of understanding the market dynamics. In conclusion, this review positions coconut as a promising candidate within sustainable diet frameworks, advocating for further research to augment its nutritional value, sensory characteristics, and product stability, thereby facilitating its integration into health-conscious and eco-centric dietary practices.

Multicriteria Measures to Assess the Sustainability of Diets: A Systematic Review

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.

Sustainability in the Public Healthcare Sector: Insights From an Analytical Hierarchy Process Analysis

Background This study aimed to identify sustainability priorities within Oman's healthcare sector using the analytical hierarchy process (AHP) methodology. Mainly, it focused on assessing the relative importance of economic, environmental, and social factors and their sub-elements in sustaining Oman's healthcare system. Methodology A semi-quantitative, cross-sectional design was employed to collect data from 23 Omani healthcare experts with at least 10 years of experience in five different public hospitals in Oman. The AHP methodology was used to analyze pairwise comparisons of sustainability factors and derive their priorities. The consistency ratio was calculated to ensure the reliability of the analysis, and the transitivity rule was applied to address inconsistencies in pairwise comparisons. Results The findings revealed a strong emphasis on environmental and social sustainability, with economic considerations ranking comparatively lower. Circular practices emerged as a key priority within the environmental domain, while patient satisfaction stood out within the social domain. The analysis showed the integration between healthcare, environmental health, and societal well-being, emphasizing the need for holistic approaches to sustainability. Conclusions This study contributes to the understanding of healthcare sustainability by providing empirical evidence of stakeholder preferences within Oman's healthcare system. By quantitatively assessing the relative importance of economic, environmental, and social factors, it informs decision-making and resource allocation toward sustainable healthcare development. The findings also support the argument for integrated approaches to healthcare sustainability that balance economic efficiency with environmental protection and social inclusion.

Toward Sustainable Diets-Interventions and Perceptions Among Adolescents: A Scoping Review

Adolescence is an important life stage during which shifts toward more healthy and sustainable diets can be promoted. Adolescents have increasing influence over their food choices, informed by their developing personal knowledge and values, affecting long-term dietary behaviors into adulthood. The recent literature regarding adolescents' (1) perceptions of environmentally sustainable diets and (2) interventions to support adolescents to eat sustainably was reviewed in this study. We reviewed published literature that focused on adolescent participants and their perceptions of, or interventions to support, sustainable dietary habits. Five electronic databases were searched to include studies published since 2012 that met the inclusion criteria, including reporting of participants aged between 11 and 18 years, reporting on adolescents' perceptions of sustainable diets or interventions implemented to improve the sustainability of adolescents' diets, and framed in the context of sustainability. Data were extracted, including study and participant characteristics, methodology, and results in relation to each of the 2 research focus areas. Twenty-eight articles were included in the review. Findings suggest that adolescents' understanding of what constitutes sustainable eating is poor. Adolescents who had previously received education regarding sustainable diets valued nature and health, or were from a rural or indigenous community, were more likely to value environmentally sustainable-food choices. Interventions which target adolescents' understanding of and aspiration to make sustainable-food choices appears to improve their attitudes toward sustainable food, whereas interventions to increase the availability of sustainable foods improved the environmental sustainability of adolescents' dietary intake. Multicomponent, tailored, and community-based interventions were most effective; however, the long-term effect of these interventions remains unclear. More research is needed in low- and middle-income countries, with consideration of adolescents' level of autonomy in food choice in local food environments and the long-term effectiveness of interventions. Systematic Review Registration: Open Science Framework identifier osf.io/h3jz6.

Food Choices, Sustainability and Australian Native Foods: Perceptions among University Students

(1) Background: Urgent changes in our food choices are needed for more sustainable, resilient and equitable food systems. Australian native plant-based foods have both environmental and health benefits. Including these foods in our diet may reduce both the risk of chronic diseases and the impact of climate change. This study explored the perceptions and attitudes towards food choices, sustainability and Australian native plant-based food among university students. (2) Methods: A cross-sectional online survey was completed by 212 university students in Australia from October to December 2022. Questions included information about sociodemographic characteristics, food choices, Australian native foods and the impact on sustainability. Logistic regression was used for analyses. (3) Results: Most participants recognised the impact of food choices on sustainability. There was a significant association between recognition of the impact of food choices on sustainability and the environmental and nutritional benefits of Australian native foods (OR = 2.89, 95% CI 1.29, 6.46, p = 0.010). Students who were familiar with or had tried Australian native plant-based foods were significantly more likely to recognise their environmental and nutritional benefits (p < 0.001). (4) Conclusions: Students who recognise the impact of food choices on sustainability and the benefits of Australian native foods are more likely to include native foods in their diet. More studies are needed to investigate the specific native foods consumed and the barriers and facilitators to the intake of these foods.

The Future of Plant-Based Diets: Aligning Healthy Marketplace Choices with Equitable, Resilient, and Sustainable Food Systems

The future of plant-based diets is a complex public health issue inextricably linked to planetary health. Shifting the world's population to consume nutrient-rich, plant-based diets is among the most impactful strategies to transition to sustainable food systems to feed 10 billion people by 2050. This review summarizes how international expert bodies define sustainable diets and food systems and describes types of sustainable dietary patterns. It also explores how the type and proportion of plant- versus animal-source foods and alternative proteins relate to sustainable diets to reduce diet-related morbidity and mortality. Thereafter, we synthesize evidence for current challenges and actions needed to achieve plant-based sustainable dietary patterns using a conceptual framework with principles to promote human health, ecological health, social equity, and economic prosperity. We recommend strategies for governments, businesses, and civil society to encourage marketplace choices that lead to plant-rich sustainable diets within healthy, equitable, and resilient agroecological food systems.

Nutritional Status, Intentions and Motivations towards Adopting a Planetary Health Diet-A Cross-Sectional Study

The planetary health diet is a proposition of a diet that is healthy for both people and the environment. The aim of this study was to investigate the nutritional behaviours among people who follow the planetary health diet and those who do not and assess the source of motivation that drives a willingness to follow sustainable diet guidelines. Using a self-administered questionnaire, data were collected from Polish adult volunteers. For analysis, respondents were divided into the following two groups: those following a planetary health diet (PD) and those who were not (O). Of the 216 respondents, 39.4% followed the PD. Non-adherence to the PD was linked to a higher prevalence of overweight and obesity. Taste was the most important factor for both groups during grocery shopping. However, sustainable agriculture and the health benefits of products were significantly more important for the PD followers. It can be concluded that adherence to the planetary diet is associated with lower body mass. This highlights the need for increased awareness and education about a diet's health benefits and environmental impact.

US Adults' Perceptions, Beliefs, and Behaviors towards Plant-Rich Dietary Patterns and Practices: International Food Information Council Food and Health Survey Insights, 2012-2022

Expert groups recommend that populations adopt dietary patterns higher in whole, plant-based foods and lower in red and processed meat as a high-impact climate action. Yet, there is limited understanding of populations' willingness to adopt plant-rich dietary patterns. This study examined United States (US) adults' perceptions, beliefs, and behaviors towards plant-rich dietary patterns and practices over a decade. Fifteen questions from the International Food Information Council's Food and Health Surveys (2012-2022) were analyzed across four sustainability domains (i.e., human health, environmental, social, and economic domains). Most respondents had favorable perceptions of environmentally sustainable food and beverages, but sustainability influenced less than half of consumers' purchase decisions. Plant-rich dietary pattern adherence increased across survey years (12.1% [2019] to 25.8% [2022], p < 0.001). One-quarter (28.1%) of Americans reported reducing their red meat intake over 12 months (2020-2022). Yet, another 15.5% reported greater red meat intake, and 18.8% reported greater plant-based meat alternative (PBMA) intake over 12 months. The percentage of respondents who reported greater red meat and PBMA consumption in the previous 12 months significantly increased across the years surveyed (2020-2022, p < 0.05). IFIC Survey findings highlight growing US consumer awareness of health, environmental, and social sustainability but low adoption of plant-rich dietary patterns and practices. Government leadership and coordinated actions by health professionals, civil society, and businesses are needed to educate and incentivize Americans to adopt plant-rich dietary behaviors, and greater industry transparency is needed to show how food and beverage products support human and planetary health.

Harnessing the power on our plates: sustainable dietary patterns for public and planetary health

Globally, diet quality is poor, with populations failing to achieve national dietary guidelines. Such failure has been consistently linked with malnutrition and poorer health outcomes. In addition to the impact of diet on health outcomes, it is now accepted that what we eat, and the resulting food system, has significant environmental or planetary health impacts. Changes are required to our food systems to reduce these impacts and mitigate the impact of climate change on our food supply. Given the complexity of the interactions between climate change, food and health, and the different actors and drivers that influence these, a systems-thinking approach to capture such complexity is essential. Such an approach will help address the challenges set by the UN 2030 Agenda for sustainable development in the form of the sustainable development goals (SDG). Progress against SDG has been challenging, with an ultimate target of 2030. While the scientific uncertainties regarding diet and public and planetary health need to be addressed, equal attention needs to be paid to the structures and systems, as there is a need for multi-level, coherent and sustained structural interventions and policies across the full food system/supply chain to effect behaviour change. Such systems-level change must always keep nutritional status, including impact on micronutrient status, in mind. However, benefits to both population and environmental health could be expected from achieving dietary behaviour change towards more sustainable diets.

Understanding nutrition students' knowledge, perceived barriers and their views on the future role of nutritionists regarding sustainable diets

Nutrition professionals are important stakeholders in sustainable food systems with skills to promote the connection between health, food production, environment, culture and economics. Higher education institutions are increasingly recognising the importance of teaching about sustainability, yet there exists a gap in the literature detailing the awareness of sustainability issues by nutrition students. This study aimed to ascertain the level of knowledge of sustainable diets (SDs), the perceived barriers to their adoption in their own diets, students' experience of university-based teaching about SDs and their views on the future role of the nutrition profession in relation to SD amongst nutrition students on Association for Nutrition (AfN)-accredited degrees. The study assessed environmental and sustainable food literacy (SFL) through an online questionnaire and explored the issues in more detail in virtual or face-to-face interviews in 2019. Quantitative data were analysed using descriptive statistics (Kruskal-Wallis, Jonckheere-Terpstra, independent t-test, Spearman, Pearson Correlations). Qualitative data were analysed using the Braun and Clark (2006) six-step approach to thematic analysis. The questionnaire responses (n = 51) represented 17 AfN-accredited undergraduate courses (35% of AfN-accredited universities in 2019). The majority (76%) of students had received an introduction, partaken in a module or received teaching on SDs throughout their whole degree. Students were predominantly environmentally literate, yet had a fragmented understanding of SDs, focusing on the environmental aspects of SDs. There was no correlation between SFL and reported sustainability content of university courses, highlighting a need for more effective teaching on sustainability topics. Additionally, no relationship between self-reported diet intake and SFL was found. Students identified a lack of knowledge and education as barriers preventing them from adopting sustainable practices in the present and future. To integrate sustainability into their future practice more consistently and effectively, nutrition students require more structured, holistic sustainability education and knowledge.