Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets

Trajectories of Nutritional Quality, Diet-Related Environmental Impact, and Diet Cost in China: How Much Does Ultra-Processed Food and Drink Consumption Matter?

BACKGROUND

Rapid socio-economic developments confront China with a rising consumption of ultra-processed foods (UPFs) and ultra-processed drinks (UPDs). This study aims to evaluate their potential impact on diet transformation towards sustainability including nutrition, environmental sustainability, and diet-related cost.

METHODS

Dietary intake was assessed by 24 h recalls in 27,311 participants (age: 40.5 ± 19.7; female, 51.1%) in the China Health and Nutrition Survey 1997-2011. The nutrient quality, environmental sustainability (greenhouse gas emission (GHGE), total water use (TWU), land use (LU), and diet cost were assessed as diet-related sustainability indicators. Foods and drinks were classified according to the degree of processing based on NOVA. Two-level mixed effects models were applied to explore the secular trends of the sustainability indicators being nested within random effect (individual level).

RESULTS

UPFs and UPDs are less nutrient-dense, containing more energy, sodium, and added sugar compared to unprocessed or minimally processed foods and drinks (MPFs and MPDs). UPFs and UPDs were higher for GHGE and TWU but lower for LU. Costs of UPDs tripled those of MPDs. In the period of 1997-2011, the percentage of UPFs and UPDs per 2000 kcal increased for both sexes. The increase in UPFs and UPDs was associated with a lower nutrient quality but a higher environmental impact and diet cost.

CONCLUSIONS

From 1997 to 2011, there was a significant increase in the consumption of UPFs and UPDs in China. This trend had negative impacts on both the nutrient quality and environmental impact; meanwhile, it led to increased diet costs. Policies to reduce the production and consumption of UPFs and UPDs should be reinforced by making alternatives for ultra-processed breakfast cereals, snacks, and alcoholic beverages available and acceptable. Additionally, instead of only focusing on high-UPFD consumers, attention is needed on the currently low-UPFD consumers as their consumption has been growing rapidly in the last decades.

Are healthier diets more sustainable? A cross-sectional assessment of 8 diet quality indexes and 7 sustainability metrics

BACKGROUND

A comparison of commonly used diet quality indexes (DQIs) and their association with multiple indicators of sustainability has not been performed, which limits policy action.

OBJECTIVES

To evaluate the associations between 8 DQIs and 7 sustainability indicators in a nationally representative sample in the United States.

METHODS

In this cross-sectional analysis, dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 18,522 ≥20 y) were merged with data on greenhouse gas emissions (GHGE), cumulative energy demand (CED), water scarcity footprint (WSF), land, fertilizer nutrients, pesticides, and food prices from multiple publicly available databases. Diet quality was measured using the Healthy Eating Index-2020 (HEI-2020), Alternate Healthy Eating Index-2010 (aHEI-2010), Mediterranean Diet Score (Med), Alternate Mediterranean Diet Score (aMed), Healthful Plant-Based Diet Index (hPDI), Planetary Health Diet Index (PHDI) for the United States, Dietary Approaches to Stop Hypertension Index (DASH), and Nutrient-Rich Foods Index 9.3 (NRF9.3). The relationship between each DQI and sustainability indicator was assessed using linear regression.

RESULTS

Greater scores on most or all DQIs were associated with lower daily per capita GHGE (β = -0.908 to -0.250 carbon dioxide equivalents per 1 unit increment in diet quality z-score), CED (β = -2.699 to 0.202 MJ), land (β = -0.002 to <-0.001 ha), and fertilizer nutrients (β= -0.026 to 0.007 kg). By contrast, greater scores on most or all DQIs were associated with greater WSF (β = 343-649 L equivalents) and diet cost (β = 0.037-1.125 US$), and had mixed associations with pesticide use (β = -0.001 to <-0.001 kg). Greater scores on aHEI-2010 and hPDI were associated with the greatest ratio of favorable-to-unfavorable sustainability outcomes (5:2 each), followed by PHDI (4:1), Med and aMed (4:2 each), HEI-2020 and DASH (3:2 each), and NRF9.3 (3:4).

CONCLUSIONS

All DQIs had sustainability trade-offs, but those that emphasized plant-based foods, rather than nutrients or animal-based foods, were associated with more favorable sustainability outcomes.

Modelling the cost differential between current and healthy diets according to household education level in Belgium

This study aims to estimate the cost differential between current and healthy diets, overall and by household education level. Data from the 2014-2015 Belgian National Food Consumption Survey and food prices from the 2014 GfK ConsumerScan panel were linked. The DIETCOST programme was used to model healthy, isocaloric healthy and current diets. For the reference household, the average daily diet cost was 20.1€ (95%CI: 19.9-20.4) for current diets, 20.9€ (95%CI: 20.6-21.2) for healthy isocaloric diets (+3.9% vs. the current diets) and 22.5€ (95%CI: 22.3-22.8) for healthy diets (+12.0%). In low-educated households, the cost of current and of healthy isocaloric diets was similar (19.2€ (95%CI: 19.0-19.5) vs. 19.3€ (95%CI: 19.0-19.6)), whereas in high-educated households, the cost of healthy isocaloric diets (22.0€; 95%CI: 21.8-22.3) was higher than the cost of current diets (21.2€; 95%CI: 20.9-21.4)). Though needing validation, this finding is valuable for interventions aimed at improving dietary habits in disadvantaged populations.

Evaluating the effectiveness of a food literacy pilot program for university students: using a mixed-methods research approach

BACKGROUND/OBJECTIVES

As awareness of climate change increases, the relevance of environmental education in dietary choices gains prominence. Although diversely defined, food literacy (FL) is increasingly recognized as the ability to make food choices with an awareness of environmental sustainability. This study aims to conduct a pilot implementation and assess the effectiveness of a program developed to improve FL among university students.

SUBJECTS/METHODS

The study spanned from August 2022 to February 2023, involving 92 participants (42 in the intervention group and 50 in the control group). Over 11 weeks, the program included cooking classes, local farm visits, and environmental impact lectures developed through extensive literature reviews and interviews with students and experts. FL was measured using a 33-item survey along with basic sociodemographic factors. After the intervention, both groups participated in qualitative interviews. All statistical analyses were carried out in Stata/SE version 17.0, and interview data were analyzed in Microsoft Excel using the framework analysis method.

RESULTS

The FL scores of the intervention group improved significantly from an average of 65.8 to 69.6 points (P = 0.015), with notable gains in the socio-ecological domain in FL from 65.3 to 71.5 points (P < 0.001). A linear regression analysis comparing FL between the intervention and control groups found that only the knowledge items were marginally significant (P = 0.054), with no statistically significant difference in the practice aspect before and after the intervention (P = 0.657). The interviews revealed that the intervention group experienced broadened perspectives and heightened environmental consciousness, although translating these into practice was challenged by unchanged daily routines.

CONCLUSION

This pilot program effectively enhanced some aspects of FL-related knowledge of participants. High satisfaction among participants and no dropouts indicated its potential for scaling. Future programs will benefit from strategies that facilitate the transition from educational improvement to practical application.

Low-carbon diets across diverse dietary patterns: Addressing population heterogeneity under constrained optimization

Mathematical optimization is a useful tool for modeling diets that fulfill requirements for health and environmental sustainability, however, population-based optimization approaches fail to account for underlying dietary diversity in populations. This study proposes a methodological approach to consider diverse dietary intake patterns in mathematical optimization of nutritionally adequate low-carbon diets and investigates the differences between different population groups, along with trade-offs between greenhouse gas emission (GHGE) reduction and the inconvenience of dietary changes required to achieve optimized diets. A k-means clustering analysis was applied to individual dietary intake data from Denmark, which resulted in four clusters with different dietary patterns. This was followed by quadratic programming, wherein the total dietary changes required from the observed diet within each cluster were used as a proxy for consumer inconvenience (i.e., "inconvenience index") and were minimized while fulfilling nutrient constraints and incrementally tightened GHGE constraints. Across clusters, a steep increase of the inconvenience index was observed at GHGE levels below approximately 3 kg CO2e/10 MJ, corresponding to GHGE reductions of 24-36 % in different clusters. In all clusters, the optimized diets with nutritional and GHGE constraints showed common traits of increased content of cereals and starches, eggs, and fish and decreased amounts of beef and lamb, cheese, animal-based fats, and alcoholic beverages, but differences across clusters were also observed, maintaining characteristics of the clusters' baselines. When additional health-based targets for food amounts were applied as constraints, the optimized diets converged towards the same type of diet. The total inconvenience of dietary changes required to fulfill constraints differed between clusters, indicating that specific sub-populations may be more effective targets for dietary transition. The method has potential for future integration of more sustainability aspects and different consumer preferences.

Foodprint 2.0: A computational simulation model that estimates the agricultural resource requirements of diet patterns

Reducing the environmental pressures stemming from food production is central to meeting global sustainability targets. Shifting diets represents one lever for improving food system sustainability, and identifying sustainable diet opportunities requires computational models to represent complex systems and allow users to evaluate counterfactual scenarios. Despite an increase in the number of food system sustainability models, there remains a lack of transparency of data inputs and mathematical formulas to facilitate replication by researchers and application by diverse stakeholders. Further, many models lack the ability to model multiple geographic scales. The present study introduces Foodprint 2.0, which fills both gaps. Foodprint 2.0 is an updated biophysical simulation model that estimates the agricultural resource requirements of diet patterns and can be adapted to suit a variety of research purposes. The objectives of this study are to: 1) describe the new features of Foodprint 2.0, and 2) demonstrate model performance by estimating the agricultural resource requirements of food demand in the United States (US) using nationally representative dietary data from the National Health and Nutrition Examination Survey from 2009-2018. New features of the model include embedded functions to integrate individual-level dietary data that allow for variance estimation; new data and calculations to account for the resource requirements of food trade and farmed aquatic food; updated user interface; expanded output data for over 200 foods that include the use of fertilizer nutrients, pesticides, and irrigation water; supplementary files that include input data for all parameters on an annual basis from 1999-2018; sample programming code; and step-by-step instructions for users. This study demonstrates that animal-sourced foods consumed in the US accounted for the greatest share of total land use, fertilizer nutrient use, pesticide use, and irrigation water use, followed by grains, fruits, and vegetables. Greater adherence to the Dietary Guidelines for Americans was associated with lower use of land and fertilizer nutrients, and greater use of pesticides and irrigation water. Foodprint 2.0 is a highly modifiable model that can be a useful resource for informing sustainable diet policy discussions.

Diet affordability: a key dimension in the assessment of sustainable food systems and healthy diets

A promulgated global shift toward a plant-based diet is largely in response to a perceived negative environmental impact of animal food production, but the nutritional adequacy and economic implications of plant-sourced sustainable healthy dietary patterns need to be considered. This paper reviews recent modeling studies using Linear Programming to determine the respective roles of animal- and plant-sourced foods in developing a least-cost diet in the United States and New Zealand. In both economies, least-cost diets were found to include animal-based foods, such as milk, eggs, fish, and seafood, to meet the energy and nutrient requirements of healthy adults at the lowest retail cost. To model a solely plant-based least-cost diet, the prevailing costs of all animal-sourced foods had to be increased by 1.1 to 11.5 times their original retail prices. This led to the inclusion of fortified plant-based foods, such as fortified soymilk, and a plant-based diet that was considerably (34-45%) more costly. The first-limiting essential nutrients were mostly the vitamins and minerals, with special focus on pantothenic acid, zinc, and vitamin B-12, when transitioning from an animal- and plant-containing least-cost diet to a plant-only based least-cost diet. Modeled least-cost diets based on contemporary food costs include animal-sourced foods, at least for developed high-income US and NZ food economies, and potentially for developing low- and middle-income countries, such as Indonesia. Modeling of least-cost diets that consist exclusively of plant-based foods is feasible, but at a higher daily diet cost, and these diets are often close to limiting for several key nutrients. Diet affordability, as a key dimension of sustainable healthy diets, and the respective economic roles of animal- and plant-sourced foods need to be considered.

Green hospitals: Mitigating water footprint and greenhouse gas emissions through sustainable menu planning in Turkish state university hospitals

Considering the importance of sustainable nutrition, it is important that hospitals' meal menus are planned to ensure the lowest possible environmental footprint. In this study, we aimed to evaluate the environmental effects of hospital menus and the changes that may occur when these menus are planned according to the Turkey Dietary Guidelines and Mediterranean diet recommendations. In this context, first, the yearly environmental footprints of the standard meal menus of the state university hospitals in Turkey (n = 42), including water footprint (WF) and greenhouse gas emission (GHGE) values, were determined. Second, changes in the environmental footprint as a result of arranging the standard meal menus of state university hospitals according to the Turkey Dietary Guidelines and Mediterranean nutritional models were evaluated. It was determined that the average WF and GHGE values of hospital menus were 137,280 ± 18537.2 L/month and 140.0 ± 18.4 kg CO2-eq/month, respectively. Adjusting state university hospitals' standard meal menus according to Turkey Dietary Guidelines and Mediterranean nutritional models reduced WF by 24.8% to 103206.7 L/month and 37.8% to 85420.5 L/month, and GHGEs by 31.7% to 95.5 kg CO2-eq/month and 49% to 71.3 kg CO2-eq/month, respectively. In addition, it was determined that hospital meal menus planned according to the Turkey Dietary Guidelines and the Mediterranean nutritional model contained lower saturated fat and cholesterol and higher dietary fiber. In conclusion, planning hospital menus according to the Turkey Dietary Guidelines and Mediterranean nutritional recommendations can reduce the environmental footprint of hospital food services.

Environmental sustainability of diets among children and adolescents in the German DONALD cohort study: age and time trends, and nutrient adequacy

BACKGROUND

Identifying diets beneficial for both human and planetary health has become increasingly important. However, to date, there is limited research on sustainable diets for children and adolescents, a vulnerable population group with specific nutritional needs.

OBJECTIVES

We aimed to identify 1) the main determinants; 2) age and time trends of greenhouse gas emissions (GHGE), land use (LU), and water use (WU) of diets of children and adolescents; and 3) analyze the associations of dietary GHGE, LU, and WU with nutrient adequacy.

METHODS

A total of 5510 3-d-weighted dietary records (n = 856; 6-17 y; 48% ♀) of the DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study between 2000 and 2021 were analyzed. Values of GHGE (kgCO2eq), LU (m2 × year), and WU (L) determined by life cycle assessment were assigned to all recorded foods. For nutrient adequacy, the mean adequacy ratio (MAR = ∑(nutrient intake / recommended intake) / number of nutrients) was used. Data were analyzed using polynomial mixed-effects regression models.

RESULTS

The main contributors to GHGE and LU were meat products (GHGE: 25.6%; LU: 32.8%), dairy products (22.2%; 17.7%), and sweets and pastries (14.0%; 14.3%); to WU, nonalcoholic beverages (24.3%), meat products (18.9%), and vegetables and fruits (17.7%). GHGE, LU, and WU per 1000 kcal increased with age (P < 0.01). GHGE and LU per 1000 kcal increased between 2000 and 2010 and decreased after that in females (P < 0.01) and males (GHGE only: P = 0.02). No significant time trend was found for WU (P > 0.05). A higher MAR was directly associated with GHGE/1000 kcal (MAR: β: 0.011, 95% CI: 0.008, 0.013, P < 0.0001), LU/1000 kcal (MAR: β: 0.009, 95%CI: 0.005, 0.013, P < 0.0001), and WU/1000 kcal (MAR: β: 0.429, 95% CI: 0.325, 0.533, P < 0.0001).

CONCLUSIONS

Our findings underscore the further need and the capacity for change toward more environmentally sustainable diets. Yet, the tradeoff between environmental sustainability and nutrient adequacy in the diets of children and adolescents requires specific attention to dietary composition.

Environmental impact of Norwegian self-selected diets: comparing current intake with national dietary guidelines and EAT-Lancet targets

OBJECTIVES

Dietary environmental impact in a Norwegian adult population was estimated for six environmental impact categories. Moreover, environmental benefits of scenario diets complying with the Norwegian Food-Based Dietary Guidelines (FBDG) and the EAT-Lancet reference diet were assessed.

DESIGN

The current diet of Norwegian adults was estimated according to 24-h dietary recall data from a national dietary surveillance survey (Norkost 3). Scenario diets were modelled to represent the Norwegian FBDG and the EAT-Lancet healthy reference diet. Dietary environmental impact in terms of global warming potential, freshwater and marine eutrophication, terrestrial acidification, water use and transformation and use of land was estimated for the current and scenario diets using environmental impact data representative of the Norwegian market. Significant associations between impact and gender/educational attainment were assessed at P < 0·05.

SETTING

Norway.

PARTICIPANTS

Adults (n=1787) aged 18-70 years who participated in the Norkost 3 survey (2010-2011).

RESULTS

Environmental impact varied significantly by gender and educational attainment. The food groups contributing most to environmental impact of Norwegian diets were meat, dairy, beverages, grains and composite dishes. Compared with the current Norwegian diet, the FBDG scenario reduced impacts from 2 % (freshwater eutrophication) to 32 % (water use), while the EAT-Lancet scenario reduced impacts from 7 % (marine eutrophication) to 61 % (land use). The EAT-Lancet scenario resulted in 3-48 % larger reductions in impact than the FBDG scenario.

CONCLUSIONS

The Norwegian FBDG, while not as environmentally friendly as the EAT-Lancet reference diet, can still be an important tool in lessening environmental burden of Norwegian diets.

Climate Change and Children's Health: Building a Healthy Future for Every Child

Observed changes in temperature, precipitation patterns, sea level, and extreme weather are destabilizing major determinants of human health. Children are at higher risk of climate-related health burdens than adults because of their unique behavior patterns; developing organ systems and physiology; greater exposure to air, food, and water contaminants per unit of body weight; and dependence on caregivers. Climate change harms children through numerous pathways, including air pollution, heat exposure, floods and hurricanes, food insecurity and nutrition, changing epidemiology of infections, and mental health harms. As the planet continues to warm, climate change's impacts will worsen, threatening to define the health and welfare of children at every stage of their lives. Children who already bear higher burden of disease because of living in low-wealth households and communities, lack of access to high quality education, and experiencing racism and other forms of unjust discrimination bear greater risk of suffering from climate change hazards. Climate change solutions, advanced through collaborative work of pediatricians, health systems, communities, corporations, and governments lead to immediate gains in child health and equity and build a foundation for generations of children to thrive. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.

Consistency of the Initial and Updated Version of the Nutri-Score with Food-Based Dietary Guidelines: A French Perspective

BACKGROUND

To help consumers to make healthier food choices, 7 European countries have implemented the front-of-pack nutrition label Nutri-Score. The algorithm was updated in 2022-2023 by the Nutri-Score European scientific committee, based on the current scientific knowledge.

OBJECTIVES

The aim of this study was to investigate the consistency of the newly internationally developed algorithm with the French food-based dietary guidelines (FBDG) and compare the respective performances of the initial and updated algorithm.

METHODS

Three complementary French food composition databases were used to access extensive coverage of the food supply in France (n = 46,752): the Oqali, OpenFoodFacts, and CIQUAL databases. Based on the French FBDG, a list of 41 criteria was defined by which the consistency between French FBDG and the Nutri-Score was assessed (eg, consumption of fresh vegetables is promoted in FBDG, thus the Nutri-Score should rate favorably such products).

RESULTS

Of all criteria, the initial algorithm met 63% (26/41) of them, whereas the revised algorithm met 85% (35/41) of them. Improvements achieved by the updated version of the Nutri-Score in alignment with the FBDG were particularly observed for high-fat products (ie, fatty fish, nuts, and seeds), sweet products (ie, ice creams and sweet spreads), salty products (ie, savory snacks and salted nuts), dairy beverages, and beverages with artificial sweeteners.

CONCLUSIONS

The Nutri-Score's updated nutrient profiling system appears to rate foods more consistently regarding the French dietary guidelines and improved the currently existing system. This work supports the implementation of the updated nutrient profiling system underlying Nutri-Score.

The association between consideration of future consequences and food intake is mediated by food choice motives in a French adult population

OBJECTIVES

Consideration of future consequences (CFC) distinguishes individuals who adopt behaviours based on immediate needs and concerns from individuals who consider the future consequences of their behaviours. We aimed to assess the association between CFC and diet, and testing the mediating role of food choice motives on this relationship.

DESIGN

Individuals (aged ≥ 18 years) completed the CFC-12 questionnaire in 2014, at least three 24-h dietary records, and a food choice motive questionnaire. A multiple mediator analysis allowed to assess the mediating effect of food choice motives on the cross-sectional association between CFC and diet, adjusted for socio-demographic factors.

SETTING

Data from the NutriNet-Santé cohort study.

PARTICIPANTS

27 330 participants.

RESULTS

CFC was associated with all food choice motives (P < 0·001), with the strongest positive associations for avoidance for environmental reasons, absence of contaminants and health motives and the strongest negative associations for innovation and convenience. Positive total effects were found between CFC and the consumption of healthy food groups (fruits and vegetables, whole-grain foods, legumes), and negative total effects for alcohol, meat and poultry and processed meat (P < 0·001). CFC was positively associated with diet quality (P < 0·001). Across food groups, major mediators of these relationships were higher health (8·4-32·6%), higher environmental (13·7-22·1 %) and lower innovation (7·3-25·1 %) concerns.

CONCLUSIONS

CFC was associated with healthier dietary intake, essentially mediated by a greater motivation of future-oriented participants for self-centred and altruistic outcomes, including health and environment. Focusing on the awareness of future benefits in public health interventions might lead to healthier dietary behaviours.

Relationships Between Three Eating Behaviors and Nine Motives for Food Choices Among Brazilian Adults: A Structural Equation Model

We examined the relationships between three eating behaviors and nine motives underlying food choices made by Brazilian adults. Using participant responses to the short version of the Three-Factor Eating Questionnaire and the Food Choice Questionnaire, we investigated eating behaviors (cognitive restriction, uncontrolled eating, and emotional eating) and motives for food choices (health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern). We used a structural equation model to test relationship pathways (β), with eating behaviors as independent variables and motives for food choices as dependent variables. Participants were 1297 individuals (69.5% female) with a mean age of 25.0 years (SD = 5.8). We confirmed the validity and reliability of the questionnaires in this sample. Restrictive eating behavior was significantly related to motives of health (β = .415), mood (β = .127), natural content (β = .364), weight control (β = .681), and ethical concern (β = .161). Emotional eating behavior was related to motives of mood (β = .277), health (β = -.137), and natural content (β = -.136). Uncontrolled eating behavior was related to motives of convenience (β = .226), sensory appeal (β = .121), price (β = .153), and familiarity (β = .090). We believe these findings can now help design future research and clinical interventions for managing people's risky eating behaviors and promoting beneficial food choices.

Environmental pressures and pesticide exposure associated with an increase in the share of plant-based foods in the diet

Diets rich in plant-based foods are encouraged for human health and to preserve resources and the environment but the nutritional quality and safety of such diets is debated. This study aimed to model nutritionally adequate diets with increasing plant food content and to characterise the derived diets using a multicriteria approach including, nutrients intake, environmental pressures and exposure to pesticides. Using data of the NutriNet-Santé cohort (N = 29,413), we implemented stepwise optimization models to identified maximum plant-food content under nutritional constraints. Environmental indicators at the production level were derived from the DIALECTE database, and exposure to pesticide residues from plant food consumption was estimated using a contamination database. Plant-based foods contributed to 64.3% (SD = 10.6%) of energy intake in observed diets and may reach up to 95% in modelled diets without jeopardizing nutritional status. Compared to the observed situation, an increase in plant-based foods in the diets led to increases in soy-based products (+ 480%), dried fruits (+ 370%), legumes (+ 317%), whole grains (+ 251%), oils (+ 144%) and vegetables (+ 93%). Animal products decreased progressively until total eviction, except for beef (- 98%). Dietary quality (estimated using the Diet Quality Index Based on the Probability of Adequate Nutrient Intake) was improved (up to 17%) as well as GHGe (up to - 65%), energy demand (up to - 48%), and land occupation (- 56%) for production. Exposures to pesticides from plant-based foods were increased by 100% conventional production and to a much lesser extent by 100% organic production. This study shows that shifting to nutritionally-adequate plant-based diets requires an in-depth rearrangement of food groups' consumption but allows a drastic reduction environmental impact. Increase exposure to pesticide residues and related risks can be mitigated by consuming foods produced with low pesticide input.

Aligning Environmental Sustainability, Health Outcomes, and Affordability in Diet Quality: A Systematic Review

Improving diet quality while simultaneously maintaining planetary health is of critical interest globally. Despite the shared motivation, advancement remains slow, and the research community continues to operate in silos, focusing on certain pairings (diet-climate), or with a discipline-specific lens of a sustainable diet, rather than examining their totality. This review aimed to summarize the literature on adherence to a priori defined dietary patterns in consideration of diet quality, metabolic risk factors for noncommunicable diseases (NCDs), environmental impacts, and affordability. A methodology using PRISMA guidelines was followed, and searches were performed in 7 databases as of October 2022. The Appraisal tool for Cross-Sectional Studies (AXIS) and the National Institutes of Health (NIH) quality assessment tool for observational cohort studies were employed for quality appraisal. The evidence was narratively synthesized according to the characteristics of the diet quality metrics. The review includes 24 studies published between 2017-2023. Thirteen distinct diet quality scores were identified, with those measuring adherence to national dietary guidelines the most reported. Thirteen distinct environmental impact indicators were identified, with greenhouse gas emissions (n=23) reported most. All studies reported on body mass index, and 7 studies assessed the cost of adherence. Our results are consistent with previous findings that healthier diets can reduce environmental impacts; however, incongruities between population and planetary health can occur. Hence, the "sustainability" of dietary patterns is dependent on the choice of indicators selected. Further, healthy, lower impact diets can increase financial cost, but may also provide a protective role against the risk of obesity. Given the Global Syndemic, strategies to reduce obesity prevalence should emphasize the win-win opportunities for population and planetary health through dietary change. Research should identify diets that address multiple environmental concerns to curtail burdens potentially transferring, and harmonize this with sociocultural and equity dimensions. This review was registered at PROSPERO as CRD42021238055.

Decreasing consumption of sugar-sweetened beverages and Raising tap water consumption through Interventions based on Nutrition and sustainability for Kids: study protocol of the "DRINK" cluster randomised controlled trial

BACKGROUND

Effectiveness of actions to reduce sugar-sweetened beverage (SB) consumption in children still needs to be improved. Furthermore, the growing concern about sustainable food systems encourages to develop sustainability-based interventions. The objective of this cluster randomised controlled trial is to evaluate the long-term effectiveness of nutrition- and environmental sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 3rd to 6th grade primary school children (8 to 11 years of age).

METHODS

Forty-eight French-speaking Belgian primary schools (equivalent to around 3500 pupils involved in the evaluation) are randomised using a factorial plan: (i) control, (ii) nutrition-based intervention, (iii) sustainability-based intervention, and (iv) both. The interventions (encouragement of water breaks; provision of posters, leaflets, reusable cups, and glass bottles; website; meetings at school) were undertaken from February 2022 to June 2023. Evaluation includes questionnaires for the children and their parents on various determinants of dietary behaviour, a 4-day diary to collect information on the child's beverage consumption, and audits at schools. The first evaluation was conducted in Spring 2021 before any intervention, with the two post-intervention evaluations being held in 2022 and 2023. The main quantitative judgement criterion will be the change over time in the mean SB consumption (in ml/day) in the intervention groups compared with the control group. Given the context of the research (school), the safety of the intervention, and the content of data collection, a consent was acknowledged as unnecessary by the Ethical Committee of the Faculty of Psychology (ULB; n°073/2021), but children and parents are explicitly informed of their right to refuse to fill in the questionnaires.

DISCUSSION

Multicomponent interventions based on nutrition and on environmental sustainability, alone or mixed, will provide an original and topical insight into health promotion at school around dietary behaviours. The dissemination plan will enable to widely inform stakeholders, school staff, and families, in addition to the scientific community through the usual medium (articles, conferences), about the research findings in 2024-2025.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN99843102. Retrospectively registered on 25 May 2021.

Sustainability Perception of Italian Consumers: Is it Possible to Replace Meat, and What Is the Best Alternative?

Growing worldwide food demand with its environmental impacts requires a reshaping of food consumption. This study aims to evaluate the degree of Italian consumers' awareness of sustainability and whether protein alternatives to meat could be accepted. A cross-sectional survey was carried out on a group of 815 respondents, representative of the Italian adult population for geography, gender, and age, using multivariate analysis together with cluster analysis. Lack of awareness of the consequences of food choices on the environment was found in 45% of respondents, and 51% reduced their consumption of meat. Typical foods of the Mediterranean diet (84% legumes 82% eggs, and 77% fish) were selected as the preferred sources of protein to replace meat, while insects and insect-based products were less accepted (67%). The importance of meat is the latent factor that explains more than 50% of the common variance observed in the factor analysis. The cluster analysis confirmed the importance of meat for Italian consumers, emphasizing other aspects of the sustainability of food choices. Cluster 1 (25.6%) considered meat very important. Two out of five clusters (clusters 2 and 3, 38%) considered meat replaceable in the diet, and cluster 4 (31.3%) included meat consumers that were willing to be sustainable. Cluster 5 identifies the "unsustainable consumers" (5.7%). In conclusion, besides the perceived importance of meat, there is room for recommendations for its reduction by proposing alternative foods already present in the Mediterranean diet.

Metabolic syndrome criteria and severity and carbon dioxide (CO2) emissions in an adult population

BACKGROUND

Metabolic syndrome (MetS) has become a growing risk factor of some non-communicable diseases. Increase of greenhouse gas emissions affects the planet.

AIMS

To assess the association between MetS severity and amount of carbon dioxide (CO₂) emitted in an adult population.

DESIGN

Cross-sectional study (n = 6646; 55-76-year-old-men; 60-75-year-old-women with MetS).

METHODS

Dietary habits were assessed using a pre-validated semi quantitative 143-item food frequency questionnaire. The amount of CO₂ emitted due to the production of food consumed by person and day was calculated using a European database, and the severity of the MetS was calculated with the MetS Severity Score.

RESULTS

Higher glycaemia levels were found in people with higher CO₂ emissions. The risk of having high severe MetS was related to high CO₂ emissions.

CONCLUSIONS

Low CO₂ emissions diet would help to reduce MetS severity. Advantages for both health and the environment were found following a more sustainable diet.

TRIAL REGISTRATION

ISRCTN, ISRCTN89898870 . Registered 05 September 2013.

Meat Consumption and Availability for Its Reduction by Health and Environmental Concerns: A Pilot Study

(1) Background: Excessive meat consumption has raised multiple health and environmental concerns; however, there are no data on the population's willingness to reduce its intake for these reasons. The current study aims to assess the frequency of meat intake and readiness to limit consumption due to concern about the impact on health and the environment in residents of the Lisbon metropolitan region. (2) Methods: This analytical cross-sectional observational study was carried out in 197 residents in the metropolitan region of Lisbon. The participants were divided into two groups by age (GI: 20-29 years; GII: 40-64 years). Meat consumption and willingness to reduce it were assessed through a questionnaire. (3) Results: Most participants (67%) reported not having knowledge about the ecological footprint of meat. Being a less frequent meat consumer (<1 time per day) is associated with a willingness 3.6 times higher (p < 0.001) to reduce meat consumption due to sensitivity to the impact on health and 4.0 times higher (p < 0.001) due to environmental reasons. (4) Conclusions: Lower meat consumption frequency was associated with reductions in this consumption for environmental and health reasons.

Exploring healthy and climate-friendly diets for Danish adults: an optimization study using quadratic programming

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.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Associations between measures of socio-economic position and sustainable dietary patterns in the NutriNet-Santé study

OBJECTIVE

We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns.

DESIGN

Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively.

SETTING

France.

PARTICIPANTS

29 119 NutriNet-Santé participants.

RESULTS

Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (βprimary v. postgraduate = -0·62, 95 % CI (-0·72, -0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (βmanual workers v. intermediate professionals = -0·43, 95 % CI (-0·52, -0·33) and βemployees v. intermediate professionals = -0·56, 95 % CI (-0·64, -0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status.

CONCLUSIONS

Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.

Higher adherence to the EAT-Lancet reference diet is associated with higher nutrient adequacy in the NutriNet-Santé cohort : a cross-sectional study

BACKGROUND

In 2019, the EAT-Lancet Commission proposed a planetary and healthy reference diet; however, its nutritional quality has been rarely evaluated.

OBJECTIVE

Across different adherence levels to the EAT-Lancet reference diet, the following were our objectives:1) describe the food and nutritional intakes of the French population, 2) to evaluate the nutrient quality and, 3) investigate the consistency between the French national recommendations and the EAT-Lancet reference diet.

DESIGN

This cross-sectional study was conducted among participants of the NutriNet-Santé cohort and the sample was weighted on the characteristics of the general French population. Adherence to the EAT-Lancet reference diet was estimated using the EAT-Lancet Diet Index (ELD-I). Usual nutrient intakes were obtained using the variance reduction method. We used the estimated average requirements cut-point method to estimate the proportion of participants who meet their respective nutritional requirements. Furthermore, the adequacy of the French food-based dietary recommendations (Programme National Nutrition Santé [PNNS]) according to adherence to the EAT-Lancet reference diet was studied.

RESULTS

The weighted sample was composed of 98,465 participants. Except for bioavailable zinc and vitamin B12, we observed a decrease in the nutrient inadequacy prevalence when the adherence to the EAT-Lancet reference diet increased, particularly for vitamin B9 (Q1=37.8% vs. Q5=5.5%, p=<0.0001) and vitamin C (Q1=59.0% vs. Q5=10.8 %, p=<0.0001). However, inadequacy prevalence remained high in all ELD-I quintiles, particularly for fiber (95.9%), vitamin B1 (70.8%), iodine (48.4%), and magnesium (76.8%). Higher ELD-I score was associated with higher adherence for most components of the PNNS, except for food groups that are not specifically included in the EAT-Lancet reference diet and are typical of the French diet, including alcohol, processed meat, and salt.

CONCLUSION

In the French context, although issues with the intake of certain nutrients may occur, a diet that remains within the planetary limits as the EAT-Lancet reference diet allows a favorable nutritional quality.

TRIAL REGISTRATION NUMBER

NCT03335644.

Global Scientific Trends on Healthy Eating from 2002 to 2021: A Bibliometric and Visualized Analysis

Diet has been recognized as a vital risk factor for non-communicable diseases (NCDs), climate changes, and increasing population, which has been reflected by a rapidly growing body of the literature related to healthy eating. To reveal a panorama of the topics related to healthy eating, this study aimed to characterize and visualize the knowledge structure, hotspots, and trends in this field over the past two decades through bibliometric analyses. Publications related to healthy eating between 1 January 2002 and 31 December 2021 were retrieved and extracted from the Web of Science database. The characteristics of articles including publication years, journals, authors, institutions, countries/regions, references, and keywords were assessed. The analyses on co-authorship, co-occurrence, and co-citation were performed and network visualization maps were constructed by VOSviewer. Major subdomains identified by bibliometrics were further discussed and analyzed. A total of 12,442 articles on healthy eating were identified. Over the past two decades, the annual global publications increased from 71 to 1764, showing a nearly 25-fold growth. The journal Nutrients published the most articles and The American Journal of Clinical Nutrition possessed the highest citations. The United States, Harvard University, and Hu, Frank B. were identified as the most productive and influential country, institution, and author, respectively. The co-occurrence cluster analysis of the top 100 keywords formed four clusters: (1) the food insecurity environment for youths highlighting the necessity and significance of implementing healthy eating in early life; (2) sustainable advantages of the Mediterranean diet; (3) the importance of an overall healthy lifestyle optimization leveraged by eHealth; (4) the challenges during the course of healthy eating against obesity, which are prominent in reflecting the knowledge structure, hotspots, and trends. Moreover, COVID-19, orthorexia nervosa, sustainability, microbiota, food insecurity, and e-health are identified keywords that represented the latest high-frequency keywords and indicated the emerging frontiers of healthy eating. This study indicates that the number of publications on healthy eating will increase in the future and that healthy dietary patterns and clinical applications of healthy eating will be the next hotspots in this research field.

Assessing the interlinkage between biodiversity and diet through the Mediterranean diet case

The adoption of healthy and sustainable diets, and the transition to sustainable food systems is of principal importance in order to counteract the double burden of climate change and non-communicable diseases. The Mediterranean diet (MD) has been widely recognized as a biodiversity and healthy nutrition resource to support sustainable development and food security. This study explored biodiversity in terms of food plants species, subspecies, varieties and races, and also addressed food-plant diversity differences between the MD and western-type consumption patterns. It was funded by the EU BioValue Project, aiming to promote the integration of underutilized crops into the food value chains. Using a two-stage scheme, data were selected from MEDUSA and Euro+Med databases (including 449 species, 2,366 subspecies, varieties, and races). Furthermore, 12 countries from North Africa and Europe were classified in two groups according to their sub-regional attributes and their traditionally most prevalent dietary pattern (MD or western-type diets). Statistical analysis showed that the mean of the majorly cultivated food plants in the MD was significantly higher than its counterpart in the Western-diet. Furthermore, no statistical difference was detected in the averages of native food plants between the MD group and the Western diet group, implying that the higher diversity in food plants observed in the MD seems to be attributed to crop utilization rather than crop availability. Our findings indicated the interlinkage between biodiversity and prevailing dietary patterns, and further underlined that biodiversity could constitute a prerequisite for dietary diversity, and hence nutrition security. In addition, this study demonstrated that diets and nutrition should be approached in a broader way within the context of both agro-food and ecological systems.

Vegan and Omnivorous High Protein Diets Support Comparable Daily Myofibrillar Protein Synthesis Rates and Skeletal Muscle Hypertrophy in Young Adults

BACKGROUND

It remains unclear whether non-animal-derived dietary protein sources (and therefore vegan diets) can support resistance training-induced skeletal muscle remodeling to the same extent as animal-derived protein sources.

METHODS

In Phase 1, 16 healthy young adults (m = 8, f = 8; age: 23 ± 1 y; BMI: 23 ± 1 kg/m²) completed a 3-d dietary intervention (high protein, 1.8 g·kg bm^-1·d^-1) where protein was derived from omnivorous (OMNI1; n = 8) or exclusively non-animal (VEG1; n = 8) sources, alongside daily unilateral leg resistance exercise. Resting and exercised daily myofibrillar protein synthesis (MyoPS) rates were assessed using deuterium oxide. In Phase 2, 22 healthy young adults (m = 11, f = 11; age: 24 ± 1 y; BMI: 23 ± 0 kg/m²) completed a 10 wk, high-volume (5 d/wk), progressive resistance exercise program while consuming an omnivorous (OMNI2; n = 12) or non-animal-derived (VEG2; n = 10) high-protein diet (∼2 g·kg bm^-1·d^-1). Muscle fiber cross-sectional area (CSA), whole-body lean mass (via DXA), thigh muscle volume (via MRI), muscle strength, and muscle function were determined pre, after 2 and 5 wk, and postintervention.

OBJECTIVES

To investigate whether a high-protein, mycoprotein-rich, non-animal-derived diet can support resistance training-induced skeletal muscle remodeling to the same extent as an isonitrogenous omnivorous diet.

RESULTS

Daily MyoPS rates were ∼12% higher in the exercised than in the rested leg (2.46 ± 0.27%·d^-1 compared with 2.20 ± 0.33%·d^-1 and 2.62 ± 0.56%·d^-1 compared with 2.36 ± 0.53%·d^-1 in OMNI1 and VEG1, respectively; P < 0.001) and not different between groups (P > 0.05). Resistance training increased lean mass in both groups by a similar magnitude (OMNI2 2.6 ± 1.1 kg, VEG2 3.1 ± 2.5 kg; P > 0.05). Likewise, training comparably increased thigh muscle volume (OMNI2 8.3 ± 3.6%, VEG2 8.3 ± 4.1%; P > 0.05), and muscle fiber CSA (OMNI2 33 ± 24%, VEG2 32 ± 48%; P > 0.05). Both groups increased strength (1 repetition maximum) of multiple muscle groups, to comparable degrees.

CONCLUSIONS

Omnivorous and vegan diets can support comparable rested and exercised daily MyoPS rates in healthy young adults consuming a high-protein diet. This translates to similar skeletal muscle adaptive responses during prolonged high-volume resistance training, irrespective of dietary protein provenance. This trial was registered at clinicaltrials.gov as NCT03572127.

Assessment of the Environmental Impact of Food Consumption in Ireland-Informing a Transition to Sustainable Diets

Dietary changes are required to mitigate the climatic impact of food consumption. Food consumption databases can support the development of sustainable food based dietary guidelines (SFBDG) when linked to environmental indicators. An improved knowledge base is crucial to the transition to sustainable diets, and multiple environmental indicators should be considered to ensure this transition is evidence based and accounts for trade-offs. The current study aimed to quantify the environmental impact of daily diets across population groups in Ireland. Nationally representative food consumption surveys for Irish children (NCFSII; 2017-2018), teenagers (NTFSII; 2019-2020), and adults (NANS; 2008-2010) were used in this analysis. Blue water use (L) and greenhouse gas emissions (GHGe; kgCO₂eq) were assigned at food level to all surveys. Cropland (m²), nitrogen (kgN/t), and phosphorous use (kgP/t) were assigned at the agricultural level for adults. Multiple linear regressions, Spearman correlations, and ANCOVAs with Bonferroni corrections were conducted. Higher environmental impact diets were significantly associated with demographic factors such as age, education status, residential location, and sex, but these associations were not consistent across population groups. The median greenhouse gas emissions were 2.77, 2.93, and 4.31 kgCO₂eq, and freshwater use per day was 88, 144, and 307 L for children, teenagers, and adults, respectively. The environmental impact of the Irish population exceeded the planetary boundary for GHGe by at least 148% for all population groups, however the boundary for blue water use was not exceeded. Meat and meat alternatives (27-44%); eggs, dairy, and dairy alternatives (15-21%); and starchy staples (10-20%) were the main contributors to GHGe. For blue water use, the highest contributors were meat and meat alternatives in children; savouries, snacks, nuts, and seeds in teenagers; and eggs, dairy, and dairy alternatives in adults (29-52%). In adults, cropland use, nitrogen use, and phosphorous use exceeded planetary boundaries by 277-382%. Meat, dairy, and grains were the main contributors to cropland, nitrogen, and phosphorous use (79-88%). The quantified environmental impact of Irish diets provides a baseline analysis, against which it will be possible to track progress towards sustainable diets, and the basis for the development of Sustainable Food Based Dietary Guidelines in Ireland.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+23.4% and +1.4%, respectively) and a decrease in fish (-7.1% and -3.2%, respectively). Temporal trends did not agree between the two datasets for dairy, calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are           used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by Defra (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: FAO-FBS estimates were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses . Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Alternative dietary protein sources to support healthy and active skeletal muscle aging

To mitigate the age-related decline in skeletal muscle quantity and quality, and the associated negative health outcomes, it has been proposed that dietary protein recommendations for older adults should be increased alongside an active lifestyle and/or structured exercise training. Concomitantly, there are growing environmental concerns associated with the production of animal-based dietary protein sources. The question therefore arises as to where this dietary protein required for meeting the protein demands of the rapidly aging global population should (or could) be obtained. Various non-animal-derived protein sources possess favorable sustainability credentials, though much less is known (compared with animal-derived proteins) about their ability to influence muscle anabolism. It is also likely that the anabolic potential of various alternative protein sources varies markedly, with the majority of options remaining to be investigated. The purpose of this review was to thoroughly assess the current evidence base for the utility of alternative protein sources (plants, fungi, insects, algae, and lab-grown "meat") to support muscle anabolism in (active) older adults. The solid existing data portfolio requires considerable expansion to encompass the strategic evaluation of the various types of dietary protein sources. Such data will ultimately be necessary to support desirable alterations and refinements in nutritional guidelines to support healthy and active aging, while concomitantly securing a sustainable food future.

Toward a More Climate-Sustainable Diet: Possible Deleterious Impacts on Health When Diet Quality Is Ignored

BACKGROUND

Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets.

OBJECTIVES

To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs.

METHODS

Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact.

RESULTS

Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men.

CONCLUSIONS

The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

The influence of climate change on food production and food safety

Food security and food safety are two concepts related to food risks. The majority of studies regarding climate change and food risks are related to the security of food provision. The objective of this study was to review the current state of knowledge of the influence of climate change on food production and food safety. The literature search was carried out by specifying each area individually (crops, ranching, fishing, food safety, etc.), including the term "climate change" and other specific factors such as CO₂, ozone, biotoxins, mortality, heat, etc.) The increase in carbon dioxide concentrations together with the increase in global temperatures theoretically produces greater yields in crops destined for human and animal consumption. However, the majority of studies have shown that crop yields are decreasing, due to the increase in the frequency of extreme weather events. Furthermore, these climate anomalies are irregularly distributed, with a greater impact on developing countries that have a lower capacity to address climate change. All of these factors result in greater uncertainty in terms of food provision and market speculation. An increase in average temperatures could lead to an increased risk of proliferation of micro-organisms that produce food-borne illnesses, such as salmonella and campylobacter. However, in developed countries with information systems that document the occurrence of these diseases over time, no clear trend has been determined, in part because of extensive food conservation controls.

Measuring sustainable consumer food purchasing and behavior

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

Five U.S. Dietary Patterns and Their Relationship to Land Use, Water Use, and Greenhouse Gas Emissions: Implications for Future Food Security

The U.S. agri-food system is a driver of climate change and other impacts. In order to achieve environmental targets that limit global mean temperature rise ≤2 °C, a shift in American dietary patterns is critical. The purpose of this study was twofold: (1) to determine the environmental impact (i.e., land use, water use, and GHG emissions) related to consumption of five U.S. dietary patterns (i.e., Current U.S., the Healthy U.S., Mediterranean, Healthy Vegetarian, and Vegan), and (2) to determine the specific impact of each food group in each dietary pattern on the three environmental indicators. This study utilized existing datasets to synthesize information related to the study's environmental indicators and food production and connected these data to the current U.S. diet and the USDA-defined diets. Results indicate that the three omnivore diets contributed the greatest to GHG emissions, land use and water use. The Vegan diet scored the lowest across all indicators, although the water required for plant-based protein nearly offset other water gains. For the omnivore diets, red meat and dairy milk contributed the most to each environmental indicator. By considering sustainability as well as health outcomes in their recommendations in the Dietary Guidelines, the USDA can have a critical role in shifting diets necessary to alter climate change trends.

The revised Healthy Purchase Index (r-HPI): a validated tool for exploring the nutritional quality of household food purchases

BACKGROUND

The Healthy Purchase Index (HPI) assesses the nutritional quality of food purchases (FP) from food group expenditure shares only. However, it was developed from the FP of a disadvantaged population.

OBJECTIVE

To adapt and validate the HPI for a general population.

METHODS

FP were obtained from a representative sample of French households (Kantar WorldPanel) subdivided into two subsamples. The first sample (n = 4375) was used to adapt and validate the score; the second sample (n = 2188) was used to test external validity. The revised-HPI (r-HPI) includes 2 subscores: the diversity subscore and the quality subscore. Diversity subscore points were awarded when expenditure shares were above the 25th percentile for 5 food groups ("Fruits", "Vegetables", "Starches", "Dairy", "Meat, Fish and Eggs"). Regression models between the expenditure shares of each food group and the Mean Adequacy Ratio (MAR) and the Mean Excess Ratio (MER) of FP were used to select quality subscore components and define cut-offs for point allocation. Construct validity was assessed on the first sample using Spearman's correlations between the r-HPI and the four nutritional quality indicators (NRF9.3, MAR, MER, energy density), and also by comparing the r-HPI of monthly FP of sub-populations defined by criteria known to influence diet quality (age, gender, income, education) and between households having a monthly food basket of higher (MAR > median and MER and energy density < median) vs. lower nutritional quality within the population, using Wilcoxon tests or pairwise comparisons of contrasts. External validity was tested by performing the same analyses on the 2nd sample of 2188 households.

RESULTS

The adaptation led to include new components (e.g. red meat) and define new cut-offs (e.g. - 1 point when budget share for red meat > 21%). The r-HPI (mean = 6.50 ± 3.58) was strongly correlated with NRF9.3, MAR, MER and energy density (0.59, 0.52, - 0.41 and - 0.65, respectively, p < 0.01) and poorly correlated with total energy content (- 0.096, p < 0.001). The r-HPI was significantly higher in women (β = 1.41 [0.20], p < 0.01), households having a food basket of higher nutritional quality (β = 4.15 [0.11], p < 0.001), and increased significantly with age, income and education levels. Similar results were obtained in the 2nd sample.

CONCLUSION

We showed the validity of the r-HPI in a large sample of French households. As it does not require food quantity or nutrient content, it can be used as a valuable tool to explore FP behaviours. Cut-offs can be used in health promotion to provide nutri-economic counselling.

Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies

OBJECTIVES

Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality.

METHODS

Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79).

CONCLUSIONS

A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.

COVID-19 Changes Public Awareness about Food Sustainability and Dietary Patterns: A Google Trends Analysis

The COVID-19 pandemic has not only affected healthcare systems and global economies but also directly impacted food security and purchasing behaviors. The aim of this study is to investigate if COVID-19 has induced changes in public interest regarding Food Sustainability and healthy-sustainable dietary patterns across Europe and in European regions. A Google Trends search was performed using the search terms "Food Sustainability + Sustainable Diet + Sustainable Food" (grouped as "Food Sustainability") and the topics "Sustainability", "Healthy Diet", "Mediterranean Diet", and "Flexitarianism" for the years 2010 to 2022. Data were obtained for 12 countries in Europe. The trends in interest after the COVID-19 outbreak were forecast based on previous data. After the COVID-19 outbreak, an increase in Food Sustainability interest was observed and was higher than forecast based on the previous data. A significant interest increase in Sustainability was observed; nevertheless, this increase was smaller than the forecast increase. Mixed results were obtained for dietary patterns across European regions, yet, considering the mean interest for Europe, it seems that the COVID-19 pandemic outbreak dampened the interest in dietary patterns such as the Healthy Diet and Flexitarianism and promoted an interest in the Mediterranean Diet. Understanding consumers' beliefs and behaviors toward food choices is crucial for the transition towards sustainable diets, and definitions of educational and behavioral interventions are essential to this transition.

Association between adherence to the EAT-Lancet diet and risk of cancer and cardiovascular outcomes in the prospective NutriNet-Santé cohort

BACKGROUND

The EAT-Lancet commission proposed, in 2019, a planetary, healthy, and universal dietary pattern. However, this diet has rarely been studied in relation to various health outcomes.

OBJECTIVES

We aimed to prospectively estimate the association between the EAT-Lancet diet and cancer and cardiovascular disease (CVD) risk.

METHODS

The study was conducted in participants of the NutriNet-Santé cohort (2009-2021). The endpoints were the incident outcomes (cancer and CVDs and mortality from these diseases), combined and separately. Adherence to the EAT-Lancet diet was estimated using the EAT-Lancet Diet Index (ELD-I) modeled as quintiles (Qs). Multivariable Cox proportional hazard models were used to estimate HRs and 95% CIs, adjusted for potential confounders and moderators.

RESULTS

A total of 62,382 subjects were included; 2475 cases of cancer and 786 cases of cardiovascular events occurred during a median follow-up of 8.1 y. The sample was 76% female, the mean ± SD age at inclusion was 51.0 ± 10.2 y. The ELD-I ranged from -162 to 332 points with a mean ± SD score of 45.4 ± 25.6 points. In multivariable models, no significant association between the EAT-Lancet diet and the risk of cancer and CVD combined, and separately, was observed. Alcohol consumption was an effect modifier of the association. A significant association was observed among low drinkers (HRQ5vs.Q1: 0.86; 95% CI: 0.73, 1.02; P-trend = 0.02). A higher ELD-I was significantly associated with a lower risk of overall cancer only among females (HRQ5vs.Q1: 0.89; 95% CI: 0.75, 1.05; P-trend = 0.03). Both associations were largely attenuated by BMI.

CONCLUSIONS

Contrary to our hypothesis, our results documented significant associations between adherence to the EAT-Lancet diet and incidence of cancer only in some subgroups, and no association with CVD.This trial was registered at clinicaltrials.gov as NCT03335644.

Effectiveness of current protein recommendations in adolescent athletes on a low-carbon diet

Adolescent athletes require adequate energy and nutrient supply to support growth, development, and the demands associated with exercise and training. However, they are susceptible to nutritional inadequacies affecting their health and physical performance. Food choices with nutrient adequacy and environmental protection is crucial for a sustainable diet. Therefore, we aimed to assess the adequacy of low-carbon diets to meet the protein requirements of adolescent athletes. Therefore, a cross-sectional observational study was conducted with 91 adolescent athletes from sports clubs in Rio de Janeiro who underwent anthropometric and food consumption assessments. To estimate the environmental impact of anthropogenic activities, the sustainability indicators carbon footprint (CF) and water footprint (WF) were used. The CF of the athlete's diet was compared with the benchmark of 1,571 g CO2eq/cap/d estimated by the World Wildlife Fund (WWF). Protein recommendations according to the American Dietetic Association (ADA) for athletes and protein food groups according to the low-carbon EAT-Lancet reference diet were used as references. The results were stratified by sport modality, age, sex, and income range. The Mann-Whitney test was performed, followed by the Kruskal-Wallis test with Dunn's post-hoc test to assess the differences between groups using the statistical program GraphPad PRISM® version 8.0. CF and WF were directly associated with total energy intake, total protein intake, animal-origin protein intake, and the food groups of meat and eggs. Significant differences were observed in the environmental impact of diet based on sports groups and gender. The athletes' profile with higher environmental impact was male, middle-income class, and of any age group. The quartiles of CF of the overall diets were above the 1,571 g CO2eq/cap/d benchmark. Additionally, ADA's recommended range of daily protein consumption was met by most athletes, even in the lowest quartile of CF. Thus, a diet with a lower environmental impact can meet protein recommendations in adolescent athletes. The results found are of interest to the sports and food industries. It could help in designing a balanced diet for athletes as well as ensure less negative environmental impacts of food production and consumption.

Basics of Sustainable Diets and Tools for Assessing Dietary Sustainability: A Primer for Researchers and Policy Actors

Climate change can have economic consequences, affecting the nutritional intake of populations and increasing food insecurity, as it negatively affects diet quality parameters. One way to mitigate these consequences is to change the way we produce and consume our food. A healthy and sustainable diet aims to promote and achieve the physical, mental, and social well-being of the populations at all life stages, while protecting and safeguarding the resources of the planet and preserving biodiversity. Over the past few years, several indexes have been developed to evaluate dietary sustainability, most of them based on the EAT-Lancet reference diet. The present review explains the problems that arise in human nutrition as a result of climate change and presents currently available diet sustainability indexes and their applications and limitations, in an effort to aid researchers and policy actors in identifying aspects that need improvement in the development of relevant indexes. Overall, great heterogeneity exists among the indicators included in the available indexes and their methodology. Furthermore, many indexes do not adequately account for the diets’ environmental impact, whereas others fall short in the economic impact domain, or the ethical aspects of sustainability. The present review reveals that the design of one environmentally friendly diet that is appropriate for all cultures, populations, patients, and geographic locations is a difficult task. For this, the development of sustainable and healthy diet recommendations that are region-specific and culturally specific, and simultaneously encompass all aspects of sustainability, is required.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Structure analysis and quality evaluation of plant-based meat analogs

The growing world's population increases the demand of proteins. Meat products as the major source of high protein food are facing environmental impacts and animal welfare issues. Therefore, plant-based meat analogs are developed and gain a foothold in global markets. The structure design, sensory attributes and nutrient characteristics of meat analogs are crucial points to match the real meat. This review aimed to systematically introduce the structural analysis methods and evaluate meat analog products from quality-related attributes. First, various strategies of analyzing the fibrous structure of meat analogs were illustrated, including microscopic imaging and several optical techniques. Then, representative techniques such as NMR and AFM-IR for analyzing the distribution of moisture and lipid in meat analogs are introduced. In terms of quality, we elaborated on the texture and sensory evaluation methods and dialectically analyzed meat analogs' nutrition, which can provide a guidance for the advanced development of meat analogs.

In natura residues from peach palm heart industry for ruminant feed

Palm heart processing generates a large amount of residues like leaves, sheath and stems that have potential for ruminant feeding. This study aimed to evaluate the effect of in natura peach palm heart (Bactris gasipaes Khunt.) residues on performance, dry matter (DM) digestibility and intake of ruminants. External sheath was the most suitable residue for sheep, cattle and buffaloes feeding, although sheep presented rejection of 43.5 g kg-1. Thereby, assays of apparent and in vitro dry matter digestibility were done under four feeding treatments, which were the exclusive peach palm sheath, and that one mixed with residues of banana and rice, besides citrus pulp. The experiment was carried out under randomized complete design, with five replications. Greater DM intake (p < 0.05) were observed in animals fed with peach palm sheath mixed with rice (1.12 kg day-1) and mixed with citrus pulp (0.91 kg day-1), however there were no difference among treatments regarding the sheep final weight (p > 0.05). Cattle and buffaloes accept different types of peach palm residues, unlike sheep that present a low rejecting for them. Citrus pulp and rice residue raise the roughage quality. Peach palm residues can be an alternative roughage source to feed ruminants.

Food-Level Analysis to Identify Dietary Choices With the Highest Nutritional Quality and Lowest Greenhouse Gas Emissions and Price

Introduction

Food systems are challenged to provide healthy, sustainable and affordable foods. From a consumer perspective, identifying healthy, sustainable and affordable choices based on individual food products rather than diets could promote better shopping choices.

Objective

To identify foods and drinks with the highest nutritional quality and lowest greenhouse gas emissions (GHGE) and price. We also assessed how a combination of these indicators (e.g., nutritional quality, GHGE and price) for food categories aligned with current United Kingdom dietary recommendations.

Materials and Methods

We performed a secondary analysis of the National Diet and Nutrition Survey (NDNS) nutrient databank year 11 (2018/2019). Spearman correlation coefficients were used to assess the strength of relationships between nutritional quality, environmental impact and/or prices per 100 kcal. In addition, we developed an optimized nutritional quality, GHGE and price score for each food or drink item based on the overall medians for each of these indicators.

Results

Median nutritional value was highest for fruit and vegetables, whilst median GHGE and price was lower for starchy carbohydrates, fats and items of which consumption should be limited. The relative proportions of foods considered the most nutritious and with a low GHGE and price in each of the food categories, on a per 100 kcal basis, were comparable to the proportions in the Eatwell Guide, except for the proportion of fruits and vegetables being smaller and the proportion of potatoes, bread, rice, pasta, and other starchy carbohydrates being larger in our analysis.

Conclusion

Public health efforts should consider the impact of dietary choices not only in terms of nutritional quality but also in terms of environmental and economic impact. Our food-based analysis shows a large variation in nutritional quality, GHGE and price within and across food categories, which provides consumers with opportunities for "food swaps" that are more nutritious and have lower GHGE and price.