Territorial and Sustainable Healthy Diets

Insight into the Sustainability of the Mediterranean Diet: The Water Footprint of the Recommended Italian Diet

At present, as we face climate change and natural resource scarcity, one of the major challenges linking humans and the environment is to ensure sufficient, nutritious, safe, and affordable food for a rapidly growing world population. In a nutshell, "feed the world without destroying it". The water footprint (WF), i.e., the withdrawals of fresh water necessary to produce one kilogram of food product, is one of the key indicators of the environmental impact of diets. In this work, the WF of the food patterns suggested by the Italian Food Based Dietary Guidelines, considered a model of the Mediterranean Diet, was evaluated for the first time. The data reported here clearly demonstrate that the suggested Italian dietary patterns have a low WF, the reduction of which by replacing animal foods with plant foods is limited because the suggested consumption of meat is already low. Consumer choice in the consumption of specific products within a food group could further reduce the WF of the diet, underlining the need to provide correct information not only to consumers but also to farmers and producers to encourage them to make water-saving choices.

Current dietary intake of the Japanese population in reference to the planetary health diet-preliminary assessment

Introduction

We sought to assess the Japanese diet by examining the current dietary intake in Japan using the global reference diet from the EAT-Lancet Commission (Planetary Health Diet; PHD), from the perspective of protein intake in different age groups.

Methods

Average dietary intake by food group in the Japan National Health and Nutrition Survey 2019 (NHNS 2019) was converted to the PHD food groups, and the diet gap (DG) (%) of the global reference of the PHD was calculated by age group.

Results

Although the DG of the intake was excessive compared with the global reference of the PHD in most food groups in all age groups (7.1-416%), the intake exceeded the upper limit of the range only for red meat (640%). Red meat had the highest DG among subjects in their 40s, although the DG decreased with increasing age. Protein intake was within the possible range and did not greatly exceed the recommended dietary intake in the Japanese standard.

Discussion

The current Japanese diet contains an excessive intake of red meat in terms of the global reference of the PHD. This trend is similar to that previously reported in various western regions and countries. However, the Japanese diet does not significantly exceed the recommended protein intake for Japanese people, suggesting that the PHD is an environmentally friendly and healthy choice for younger and older age groups in an aging Japanese society. Policy makers need to develop sustainable and healthy food-based dietary guidelines in addition to providing food and nutrition education and developing a food environment that encourages sustainable and healthy choices to support dietary change.

Lifestyle Risk Factors for Overweight/Obesity in Spanish Children

Childhood obesity is one of the main public health concerns in Europe. The aim was to identify possible risk factors associated with overweight/obesity in Spanish preschool and school-age children. The sample (1075 (50.7% girls) children aged 3 to 12) is part of the project 'Alimentando el Cambio' whose objective is to promote healthy lifestyles in schools. Child height and weight were measured, and parents filled out questionnaires related to the children's lifestyle. There was a positive and significant association between sweetened beverage consumption and body mass index (BMI) z-score in both sexes and age groups. There was a negative and significant association between BMI z-score and dairy products in girls of both age groups. There was also a protective effect of regular nut consumption on overweight/obesity in girls 6-12 y. Night-time sleep during weekdays showed a negative association with BMI z-score for older boys and girls. A positive and significant association was found between total screen time and BMI z-score during weekdays. Regarding emotional well-being and self-esteem, having girls 6-12 y laughing and feeling happy and good about themselves in the last week was a protective factor against overweight/obesity. Childhood obesity prevention efforts may benefit from targeting these key risk factors.

Vegan nutrition: a preliminary guide for health professionals

Since the beginning of the 21st century, interest in vegan diets has been rapidly increasing in most countries. Misconceptions about vegan diets are widespread among the general population and health professionals. Vegan diets can be health-promoting and may offer certain important advantages compared to typical Western (and other mainstream) eating patterns. However, adequate dietary sources/supplements of nutrients of focus specific to vegan diets should be identified and communicated. Without supplements/fortified foods, severe vitamin B12 deficiency may occur. Other potential nutrients of focus are calcium, vitamin D, iodine, omega-3 fatty acids, iron, zinc, selenium, vitamin A, and protein. Ensuring adequate nutrient status is particularly important during pregnancy, lactation, infancy, and childhood. Health professionals are often expected to be able to provide advice on the topic of vegan nutrition, but a precise and practical vegan nutrition guide for health professionals is lacking. Consequently, it is important and urgent to provide such a set of dietary recommendations. It is the aim of this article to provide vegan nutrition guidelines, based on current evidence, which can easily be communicated to vegan patients/clients, with the goal of ensuring adequate nutrient status in vegans.

Sustainability Dimensions of the Mediterranean Diet: A Systematic Review of the Indicators Used and Its Results

The concern about sustainability is growing and the Mediterranean diet has been extensively identified as a promising model, with benefits for human and environmental health. This systematic review aims to identify and describe the indicators that have been used to evaluate the sustainability of the Mediterranean diet and the results from their application. A methodology using PRISMA guidelines was followed, and searches were performed in Web of Science, PubMed, Scopus, and GreenFile. A total of 32 studies assessing the sustainability of the Mediterranean diet were identified. Twenty-five of these studies quantified the environmental impact, 7 studies evaluated the nutritional quality, and 12 studies assessed the daily cost of this dietary pattern. A total of 33 distinct indicators were identified, of which 10 were used to assess the environmental dimension (mainly, carbon, water, and ecological footprint), 8 were used to assess the nutritional dimension (mainly Health score and Nutrient Rich Food Index), 1 was used to assess the economic dimension (dietary cost), and 8 used combined indicators. The remaining 6 indicators for the assessment of sociocultural dimension were only identified in 1 study but were not measured. The Mediterranean diet had a lower environmental impact than Western diets and showed a carbon footprint between 0.9 and 6.88 kg CO2/d per capita, a water footprint between 600 and 5280 m3/d per capita, and an ecological footprint between 2.8 and 53.42 m2/d per capita. With regard to the nutritional dimension, the Mediterranean diet had a high nutritional quality and obtained 122 points on the Health score and ranged between 12.95 and 90.6 points on the Nutrient Rich Food Index. The cost of the Mediterranean diet is similar to other diets and varied between 3.33 and 14.42€/d per capita. These findings show that no uniformity in assessing the MDiet's sustainability exists.

Dietary Patterns vs. Dietary Recommendations

Dietary Reference Values (DRVs) are important for developing labeling laws, identifying populations at risk of over- or under-consumption, and promoting public health interventions. However, the process of developing DRVs is quite complex, and they should not be viewed as recommendations ready to use or goals for individuals. Rather, they require interpretation by professionals and can form the basis of dietary advice. On the other hand, focusing on foods rather than macronutrients can assist individuals in understanding a healthy diet by taking into consideration many variables that may help compliance with a healthy dietary style. Evolution, tradition within specific geographical and historical contexts, taste, economic affordability, season-associated local dietary resources, and lifestyle may all explain the increasing popularity of dietary patterns that are highly successful today. Three models (the Mediterranean, New Nordic, and Japanese) have been recently characterized for geographical setting and food composition, as well as the associated lifestyle. Of note, all these three models rely on pyramids sharing a large basis made up of local vegetal resources and a top of red meats (allowed in many cases, but in limited amounts), thus allowing for the urgent demand of sustainability for the planet's health. This mini-review aimed to summarize the meaning of DRVs and to describe the dietary patterns that better contemplate health, diet diversity, and sustainability.

Adherence to the Mediterranean diet and its association with environmental footprints among women of childbearing age in the United Arab Emirates

PURPOSE

To examine the association of adherence to the Mediterranean Diet (MD) with Environmental Footprints (EFPs) among women of childbearing age in the United Arab Emirates (UAE).

METHODS

Data belonging to a nationally representative sample of 482 women (19-50 years) were derived from a previous survey in the UAE. In face-to-face interviews, participants completed questionnaires addressing sociodemographic, physical activity, and dietary intake characteristics; the latter assessed using a multiple pass 24-h recall. The composite Mediterranean (c-MED) index was used to examine the adherence to the MD. Metrics for the EFPs (water use, energy use, and GHG emissions) were calculated using Life Cycle Analyses. Descriptive statistics and linear regressions were used in data analysis.

RESULTS

In the study sample, the distribution of the c-MED scores was skewed to the right, indicating a low adherence to the MD. The lowest contributions to the total c-MED score were observed for legumes (2.9%) and olive oil (1.8%). The EFPs associated with food consumption per 1000 kcal were: water use: 1256.89 ± 544.95 L/day; energy use: 18.01 ± 7.85 MJ/day, and GHG: 2.46 ± 1.46 kg CO_{2 eq}/day. After adjustment for age, energy intake, and potential confounders, being adherent to the MD was associated with 540.57 [95% CI (- 726.6; - 354.54)] units decrease in water use and 0.94 units decrease in GHG emissions [95% CI (- 1.45; - 0.43)].

CONCLUSIONS

The findings of this study revealed an inverse association between adherence to the MD and EFPs. As such, the MD may represent a promising dietary strategy to improve health outcomes and reduce the environmental impact. Public health programs addressing the low adherence to the MD among women of childbearing age in the UAE are warranted.

Dietitians Australia position statement on healthy and sustainable diets

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet-related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective of natural resources and biodiversity, (iii) be culturally acceptable and (iv) be accessible, economically fair and affordable. Dietitians Australia acknowledges that it is critical to prioritise Indigenous knowledges in consultation, policy-making and implementation processes to achieve these recommendations. In facilitating the uptake of healthy and sustainable diets, dietitians are contributing to the transformation of our current food system that is urgently required to nourish present and future generations within planetary boundaries. In developing this position statement, opportunities for future research have been identified including those to advance the professions' capacity to improve environmental sustainability outcomes across all areas of practice. To achieve a population-level shift towards this diet, Dietitians Australia recommends: (i) the development of a National Food and Nutrition Strategy which honours Indigenous knowledges on food systems, (ii) the integration of sustainability principles in Australia's dietary guidelines, (iii) the reorientation of our food environment to prioritise access to healthy and sustainable foods, and (iv) investment in capacity building activities to equip the current and future nutrition and dietetics workforce.

The role of holistic nutritional properties of diets in the assessment of food system and dietary sustainability

Advancing sustainable diets for nutrition security and sustainable development necessitates clear nutrition metrics for measuring nutritional quality of diets. Food composition, nutrient requirements, and dietary intake are among the most common nutrition metrics used in the current assessment of sustainable diets. Broadly, most studies in the area classify animal-source foods (ASF) as having a substantially higher environmental footprint in comparison to plant-source foods (PSF). As a result, much of the current dietary advice promulgates diets containing higher proportions of PSF. However, this generalization is misleading since most of these studies do not distinguish between the gross and bioavailable nutrient fractions in mixed human diets. The bioavailability of essential nutrients including β-carotene, vitamin B-12, iron, zinc, calcium, and indispensable amino acids varies greatly across different diets. The failure to consider bioavailability in sustainability measurements undermines the complementary role that ASF play in achieving nutrition security in vulnerable populations. This article critically reviews the scientific evidence on the holistic nutritional quality of diets and identifies methodological problems that exist in the way the nutritional quality of diets is measured. Finally, we discuss the importance of developing nutrient bioavailability as a requisite nutrition metric to contextualize the environmental impacts of different diets.

Perspective: Striking a Balance between Planetary and Human Health: Is There a Path Forward?

The global adoption of predominantly plant-based sustainable healthy diets will help reduce the risk of obesity- and malnutrition-related non-communicable diseases while protecting the future health of our planet. This review examines the benefits and limitations of different types of plant-based diets in terms of health and nutrition, affordability and accessibility, cultural (ethical and religious) acceptability, and the environment (i.e., the four pillars underlying sustainable healthy diets). Results suggest that, without professional supervision, traditional plant-based diets (vegan, vegetarian and pescatarian diets) can increase the risk of nutritional deficiencies among infants, children/adolescents, adult females, pregnant/lactating women and the elderly. In contrast, flexitarian diets and territorial diversified diets (TDDs, e.g., Mediterranean and New Nordic diets) that include large quantities of plant-sourced foods, low levels of red meat and moderate amounts of poultry, fish, eggs and dairy can meet the energy and nutrition needs of different populations without the need for dietary education or supplementation. Compared to vegan, vegetarian and pescatarian diets, more diverse flexitarian diets and TDDs are associated with reduced volumes of food waste and may be more acceptable and easier to maintain for people who previously followed western diets. Although flexitarian diets and TDDs have a greater impact on the environment than vegan, vegetarian and pescatarian diets, the negative effects are considerably reduced compared to western diets, especially if diets include locally-sourced seasonal foods. Further studies are required to define more precisely optimal sustainable healthy diets for different populations and to ensure that diets are affordable and accessible to people in all countries.

Towards a More Sustainable Nutrition: Complementary Feeding and Early Taste Experiences as a Basis for Future Food Choices

The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the consumption of vegetable, organic and minimally processed foods, as well as regional, seasonal and Fair-Trade products, reducing the ecological impact of the production chain. These eating habits could be established starting from the prenatal period and from infancy during the complementary feeding stage, aiding children to accept of a more variable diet in terms of flavor, taste and texture. In particular, the positive parental role model is an effective method for improving a child’s diet and behaviors. Two healthy plates representing a sustainable diet in early infancy, at 6 and 24 months, are here proposed, in line with the “Planetary Health Diet” approved by the EAT-Lancet Commission. Our work aims to highlight how a sustainable diet is possible since infancy, since the introduction of solid foods.

Which diet has the lower water footprint in Mediterranean countries?

The Mediterranean region is increasingly water scarce, with the food system being the largest driver of water use. We calculate the water resources related to food consumption in nine major Mediterranean countries, by means of the water footprint (WF), for the existing situation (period 2011-2013) as well as the Mediterranean and EAT-Lancet diets. We account for different food intake requirements according to gender and six age groups. These nine countries - Spain, France, Italy, Greece, Turkey, Egypt, Tunisia, Algeria and Morocco - represent 88% of the population of all countries bordering the Mediterranean. As first major observation, we find that the EAT-Lancet diet, a scientifically optimised diet for both nutrition and certain environmental indicators, requires less water resources than the Mediterranean diet, a culturally accepted diet within the region. In terms of water resources use, adherence to the former is thus more beneficial than adherence to the latter. As second major observation, we find that the EAT-Lancet diet reduces the current WF for all nations consistently, within the range -17% to -48%, whereas the Mediterranean diet reduces the WF of the European countries, Turkey, Egypt and Morocco within the range of -4% to -35%. For the Maghreb countries Tunisia and Algeria, the Mediterranean diet WF is slightly higher compared to the current WF and the proportions of food product groups differ. Such dietary shifts would be important parts of the solution to obtain the sustainable use of water resources in Mediterranean countries.

Water Resources for Sustainable Healthy Diets: State of the Art and Outlook

Sustainable healthy diets are high on the research and policy agendas. One of the crucial resources to provide such diets are water resources. This paper provides a brief overview of the current research state regarding this topic, with a focus on the water footprint concept, as latter quantifies water use along a supply chain. The water footprint (WF) quantifies blue and green water consumption, as both these water resources are essential for food and energy production as well as for the environment. Different kinds of information are embedded in a dietary WF and different data sources and modelling approaches exist, leading to WF dietary amounts that are not always directly comparable. A full sustainability assessment of a dietary WF encompasses three components: (1) an equity assessment of the total WF amount; (2) an efficiency assessment for each food item in the diet as well as (3) an impact assessment (blue water stress and green water scarcity) for each food item in the diet. The paper concludes with an outlook on future research on the topic, listing the following points: (1) future clarity in system boundary and modelling assumptions, with comparison of results between different approaches; (2) full sustainability assessments including all three components; (3) dietary footprint family assessments with the WF as one member; (4) WF assessments for multiple dietary regimes with support to the development of local dietary guidelines and (5) assessment of the synergies with LCA-based mid-point (scarcity-weighted WF) and end-point (especially human health) indicators and evaluation of the validity and empirical significance of these two indicators