Healthy and Climate-Friendly Eating Patterns in the New Zealand Context

Policy approaches to decarbonising the transport sector in Aotearoa New Zealand: modelling equity, population health, and health-system effects

BACKGROUND

Health co-benefits are a key potential advantage of transport decarbonisation policy. However, health effects will occur in the context of existing transport-health inequities and decarbonisation policies will themselves affect inequities. This research examines the effects of national decarbonisation pathways for transport on population health, health inequity, and health-system costs in Aotearoa New Zealand.

METHODS

We modelled the health, health-system, and environmental impacts of two pathways to net zero for transport developed by the New Zealand Climate Change Commission using a proportional multistate lifetable model. The behaviour pathway emphasises a mixed approach, including reduced driving, increased cycling and use of public transport, and light vehicle electrification, and the technology pathway focuses on vehicle electrification. We used data from transport, environmental, population health, and health-care sources to populate the model. We simulated changes in health effects through the pathways of physical activity, air pollution (PM2·5 and NO2), and injury for the Aotearoa New Zealand population from 2018 to 2050. We modelled impacts for Māori (the Indigenous People of Aotearoa) and non-Māori. For each pathway to net zero, we calculated changes in overall health-adjusted life-years (HALYs), age-standardised HALYs, and rate ratios for Māori and non-Māori. We also calculated changes in health-system costs and transport greenhouse gas emissions. 95% uncertainty intervals (95% UIs) were derived for all model outputs by use of a Monte Carlo simulation.

FINDINGS

Both pathways show improvements in population health, reductions in health-system costs, and reduced lifecycle greenhouse gas emissions compared with baseline, although health gains were substantially larger in the behaviour pathway. For example, an extra 2100 HALYs (95% UI 1500-3100) were gained in the behaviour scenario compared with baseline. Health gains were 20-30% larger for Māori than non-Māori in both pathways, although more HALYs were gained by Māori in the behaviour pathway. For the cohort aged 0-4 years in 2018, healthy life expectancy differences between Māori and non-Māori reduced by 0·5% in the behaviour pathway over their lifetime. HALYs gained by Māori and non-Māori were altered substantially depending on assumptions about the equity of the implemented pathway.

INTERPRETATION

Decarbonising transport might improve overall population health, save the health system money, and reduce health inequities between Māori and non-Māori. Pathways that increase physical activity have a larger effect on population health than those that rely on low-emission vehicles. The effects on inequity between Māori and non-Māori are larger in the behaviour pathway than in the technology pathway but dependent on how equitably policies supporting decarbonisation are implemented.

FUNDING

Health Research Council of New Zealand and University of Otago.

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.

Cereal dietary fiber regulates the quality of whole grain products: Interaction between composition, modification and processing adaptability

The coarse texture and difficulty in processing dietary fiber (DF) in cereal bran have become limiting factors for the development of the whole cereal grain (WCG) food industry. To promote the development of the WCG industry, this review comprehensively summarizes the various forms and structures of cereal DF, including key features such as molecular weight, chain structure, and substitution groups. Different modification methods for changing the chemical structure of DF and their effects on the modification methods on physicochemical properties and biological activities of DF are discussed systematically. Furthermore, the review focusses on exploring the interactions between DF and dough components and discusses the effects on the gluten network structure, starch gelatinization and retrogradation, fermentation, glass transition, gelation, and rheological and crystalline characteristics of dough. Additionally, opportunities and challenges regarding the further development of DF for the flour products are also reviewed. The objective of this review is to establish a comprehensive foundation for the precise modification of cereal DF, particularly focusing on its application in dough-related products, and to advance the development and production of WCG products.

The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults

OBJECTIVE

This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns.

DESIGN

The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet.

SETTING

New Zealand.

PARTICIPANTS

Adults, aged ≥ 15 years (n 23 292).

RESULTS

The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian.

CONCLUSIONS

Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

Discretionary foods and drinks in Norwegian children and adolescents' diet: data from the national dietary survey Ungkost 3

OBJECTIVE

This study aimed to identify the amount of discretionary foods and drinks consumed by Norwegian children and adolescents, describe how such products contribute to the intake of total energy and nutrients, and study the distribution in intake of discretionary foods and drinks across different meals. Secondly, the aim was to explore factors associated with those children and adolescents having the highest consumption of discretionary foods and drinks.

DESIGN

Secondary analysis of data from a national survey of dietary intake among Norwegian children and adolescents.

SETTING

Schools in fifty randomly selected municipalities in Norway.

PARTICIPANTS

The study population included 636 pupils in 4th grade (9-11 years) and 687 pupils in 8th grade (12-14 years).

RESULTS

Discretionary foods and drinks contributed to about 20 % of the children and adolescents' total energy intake. These products contributed to about two-thirds of the participants' intake of added sugar, and limited amounts of dietary fibre, vitamins and minerals. The quartile which had the lowest proportion of their energy intake from discretionary foods and drinks seemed to have a higher intake of whole grains, and fish and seafood.

CONCLUSIONS

Almost all 4th and 8th graders in Norway consumed discretionary foods and drinks, and these products contributed to a substantial proportion of the total energy intake and limited amounts of nutrients. Those children and adolescents consuming the least discretionary foods and drinks had a higher intake of whole grains, fish and seafood, indicating healthier and more sustainable food habits.

Meat-Free Mondays in Hospital Cafés in Aotearoa, New Zealand

Current human meat consumption levels contribute to environmental degradation and are a risk factor for non-communicable diseases. Globally, meat-reduction policy interventions are limited. Meat-Free Mondays (MFMs) is a global campaign to reduce meat consumption to improve planetary and human health. We conducted a mixed methods evaluation of MFMs at three District Health Boards (DHBs) (one not considering a MFM policy, one that had trialled MFMs and one implementing MFMs) to investigate attitudes towards MFMs and barriers and enablers to implementation. An online staff survey and eleven semi-structured interviews with food service managers, café managers and sustainability managers were conducted. Of the 194 survey participants, 51% were actively cutting back on meat, mainly for health, environmental concerns and enjoyment of plant-based dishes, and 59% were positive towards MFMs. Qualitative analysis using a general inductive approach identified four themes: (1) 'Change and choice' (impact on personal choice), (2) 'Getting it right' (product and price, food quality, health, customer retention and sales), (3) 'Human and planetary health' (hospitals as leaders in healthy, sustainable diets), (4) 'Implementation success' (communication and education). Recommendations for implementation of MFMs included seeking feedback from other DHBs, wide consultation with food service staff, cultural and dietitian food service support and providing evidence of the success of MFMs and alternatives to MFMs.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Nutrient content and cost of canned and dried legumes and plant-based meat analogues available in New Zealand supermarkets

AIMS

Plant-based eating patterns are recommended for human and planetary health. Plant-based protein sources in supermarkets include traditional options and plant-based meat analogues. This cross-sectional survey examined the nutritional content, healthiness, cost and labelling of these products.

METHODS

Nutrient content and claims on canned legumes (plain [N = 64] and flavoured [N = 25]), canned baked beans (N = 23), dried legumes (N = 21), tofu (plain [N = 8] and flavoured [N = 5]), falafels (N = 14), meat analogues (meat-free burgers [N = 11], meat-free sausages [N = 10] and 'other' meat-free products [N = 20]) were obtained from a database of packaged foods in New Zealand. Mean (SD) energy, protein, total fat, saturated fat, sodium and dietary fibre content (per 100 g) was calculated for each category. Healthiness was assessed using an estimated Health Star Rating (Rating ≥3.5 considered 'healthy'). Product data were linked with household purchasing data from the 2019 Nielsen IQ® consumer panel to calculate mean purchase price/100 g/category. The number and type of nutrition claims were compared across categories.

RESULTS

The highest mean protein content was 'other' meat-free products (14.8 ± 6.9 g/100 g). Meat-free sausages had the highest sodium and saturated fat content (643 ± 148 mg/100 g, 3.7 ± 4.5 g/100 g). Overall, few meat analogues (N = 5, 12%) scored an estimated Health Star Rating ≥3.5. Dried legumes were the cheapest plant protein (mean ± SD) purchase price = NZ $0.30 ± 0.16/100 g), compared with 'other' meat-free products (purchase price = NZ $2.57 ± 0.88/100 g). The most common nutrition claims on meat analogues were about protein content. Dietary fibre claims were the most common on canned and dried legumes.

CONCLUSION

Meat analogues offer convenience, however, may be less healthy and more expensive than traditional plant-based proteins. This study assists dietitians in providing accurate consumer messaging about healthy plant-based proteins.

Agricultural Methane Emissions in China: Inventories, Driving Forces and Mitigation Strategies

Identification of the spatial distribution, driving forces, and future trends of agricultural methane (AGM) emissions is necessary to develop differentiated emission control pathways and achieve carbon neutrality by 2060 in China, which is the largest emitter of AGM. However, such research is currently lacking. Here, we estimated China's AGM emissions from 2010 to 2020 and then decomposed six factors that affect AGM emissions via the LMDI model. The results indicated that the AGM emissions in China in 2020 were 23.39 Tg, with enteric fermentation being the largest source, accounting for 43.9% of the total emissions. A total of 39.3% of the AGM emissions were from western China. The main driver of AGM emission reduction was emission intensity, accounting for 59% and 33.7% of methane emission reduction in the livestock sector and rice cultivation, respectively. Additionally, higher levels of urbanization contributed to AGM emission reductions, accounting for 31.3% and 43.0% of the livestock sector and rice cultivation emission reductions, respectively. Based on the SSP-RCP scenarios, we found that China's AGM emissions in 2060 were reduced by approximately 90% through a combination of technology measures, behavioral changes, and innovation policies. Our study provides a scientific basis for optimizing existing AGM emission reduction policies not only in China but also potentially in other high AGM-emitting countries, such as India and Brazil.

Why understanding food choice is crucial to transform food systems for human and planetary health

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices. Calls to transform food systems for human and planetary health highlight the importance of understanding individual food choice. Understanding what, how and why people eat the way they do is crucial to successful food systems transformations that achieve both human and planetary health goals. Little is known about how food choice relates to climate. To clarify potential paths for action, we propose that individual food choice relates to climate change through three key mechanisms. First, the sum of individual food choices influences the supply and demand of foods produced and sold in the marketplace. Second, individual food decisions affect type and quantity of food waste at the retail and household level. Third, individual food choices serve as a symbolic expression of concern for human and planetary health, which can individually and collectively stimulate social movements and behaviour change. To meet the dietary needs of the 2050 global population projection of 10 billion, food systems must transform. Understanding what, how and why people eat the way they do, as well as the mechanisms by which these choices affect climate change, is essential for designing actions conducive to the protection of both human and planetary health.

The neglected potential of red and processed meat replacement with alternative protein sources: Simulation modelling and systematic review

BACKGROUND

What we eat is fundamental to human and planetary health, with the current global dietary transition towards increased red meat intakes and ultra-processed foods likely detrimental.

METHODS

We modelled five red and processed meat replacement scenarios to consider health, equity, greenhouse gas emissions (GHGe), and cost outcomes using an established multistate life table model using data from New Zealand as a case study of a developed, westernised country. Current red and processed meat intakes were replaced with: minimally or ultra-processed plant based meat alternatives, cellular meat, or diets in line with EAT-Lancet or Heart Foundation recommendations on red meat intake. We then conducted a systematic review of literature from database inception to 14 November 2022 to identify implemented population-level meat replacement strategies which could inform evidence-based recommendations to achieve any benefits observed in modelling. PROSPERO CRD42020200023.

FINDINGS

When compared with current red and processed meat intakes, all red and processed meat replacement scenarios were nutritionally adequate and improved overall Quality Adjusted Life Years (159-297 per 1000 people over life course for the five scenarios modelled). Age standardised per capita health gain for Māori was 1.6-2.3 times that of non-Māori. Health system cost savings were $2530-$5096 per adult, and GHGe reduced 19-35%. Finally, grocery cost varied (↓7%-↑2%) per modelled scenario when compared with baseline costs. The greatest benefits for all outcomes were achieved by meat replacement with minimally-processed plant-based foods, such as legumes. The systematic review identified only two implemented population-level strategies to reduce meat intakes within the academic literature.

INTERPRETATION

All meat replacement scenarios considered indicated appreciable health gains and GHGe reductions. Replacement with minimally-processed plant-based foods appeared consistently superior than other scenarios. Evidence of real-world population strategies to achieve these benefits however is currently lacking.

FUNDING

Healthier Lives National Science Challenge (Grant UOOX1902).

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

AIM

We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ).

METHODS

Risk factor data for CVD in NZ were extracted from the GBD using the "GBD Results Tool." We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by the domain-specific interventions that delivered the highest health gains and cost-savings.

RESULTS

Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion; both 3% discount rate). Other potential considerations for prioritization included the potential for total health gain that includes non-CVD health loss and potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities.

CONCLUSIONS

We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Addressing high systolic blood pressure would be the top ranked domain if policy-makers focused just on the size of the health loss. But if policy-makers wished to maximize health gain and cost-savings using evaluated interventions, dietary interventions would be prioritized, e.g., food taxes and subsidies.

Black soldier fly, Hermetia illucens as a potential innovative and environmentally friendly tool for organic waste management: A mini-review

The application of black soldier fly (BSF), Hermetia illucens based technology to process organic wastes presents a practical option for organic waste management by producing feed materials (protein, fat), biodiesel, chitin and biofertilizer. Therefore, BSF organic wastes recycling is a sustainable and cost-effective process that promotes resource recovery, and generates valuable products, thereby creating new economic opportunities for the industrial sector and entrepreneurs. Specifically, we discussed the significance of BSF larvae (BSFL) in the recycling of biowaste. Despite the fact that BSFL may consume a variety of wastes materials, whereas, certain lignocellulosic wastes, such as dairy manure, are deficient in nutrients, which might slow BSFL development. The nutritional value of larval feeding substrates may be improved by mixing in nutrient-rich substrates like chicken manure or soybean curd residue, for instance. Similarly, microbial fermentation may be used to digest lignocellulosic waste, releasing nutrients that are needed for the BSFL. In this mini-review, a thorough discussion has been conducted on the various waste biodegraded by the BSFL, their co-digestion and microbial fermentation of BSFL substrate, as well as the prospective applications and safety of the possible by-products that may be generated at the completion of the treatment process. Furthermore, this study examines the present gaps and challenges on the direction to the efficient application of BSF for waste management and the commercialization of its by-products.

Nutritional assessment of plant-based beverages in comparison to bovine milk

Plant-based beverages (PBB) are often marketed and used by consumers as alternatives to ruminant milks, particularly bovine milk (hereafter referred to as milk). However, much research has established that there is variation in nutritional composition among these products, as well as demonstrating that they are largely not nutritional replacements for milk. A survey of the prices and nutrition labels of PBB available in New Zealand supermarkets was undertaken. Selected almond, coconut, oat, rice, and soy PBB products were then analyzed for nutritional content, including energy, fat, protein, amino acid, bioavailable amino acid, and trace element contents. Finally, the protein and calcium contents of well-mixed and unshaken products were analyzed to ascertain the impact of colloidal stability on nutrient content. All PBB groups were more expensive than milk on average, while their declared nutrient contents on package labels was highly variable within and between groups. Analyses of selected PBB revealed that soy products had the most similar proximate composition to milk, while all other PBB groups contained less than 1.1 g protein per 100 mL on average. Many PBB were fortified with calcium to a similar concentration as that in milk. Shaken and unshaken samples showed divergent protein and calcium content for several PBB products but had no effect on the composition of milk, indicating that the nutrient content of PBB at the point of consumption will be dependent on whether the product has been shaken. Only the soy PBB had comparable amino acid content and bioavailability to milk. Overall, our results demonstrate the diversity in composition and nutritional properties of PBB available in New Zealand. While the existent environmental footprint data on PBB shows that they generally have lower carbon emissions than milk, milk currently accounts for approximately 1% of the average New Zealand resident’s consumption-based emissions. Except for calcium-fortified soy PBB, none of the commercially available PBB had nutritional compositions that were broadly comparable to milk.

Dietary Change and Global Sustainable Development Goals

Food production for human consumption is a leading cause of environmental damage in the world and yet over two billion people suffer from malnutrition. Several studies have presented evidence that changes in dietary patterns across the world can lead to win-win outcomes for environmental and social sustainability and can complement ongoing technological and policy efforts to improve the efficiency of agricultural production. However, the existing evidence have been compiled in “silos” by a large range of researchers across several disciplines using different indicators. The aim of this quantitative review is to bring together the existing knowledge on heterogeneity of current dietary patterns across the world and how a transition toward healthy diets in different countries can aid in progress toward multiple global Sustainable Development Goals (SDGs). We first summarize the nutritional quality, economic cost, and environmental footprint of current diets of over 150 countries using multiple indicators. Next, we review which shifts in dietary patterns across different world regions can help toward achievement of SDG2 (Zero hunger), SDG3 (Good health and wellbeing), SDG 6 (Clean water and sanitation), SDG13 (Climate action), SDG14 (Life below water), and SDG15 (Life on land). Finally, we briefly discuss how to enable the shift toward sustainable dietary patterns and identify the research and data gaps that need to be filled through future efforts. Our analysis reveals that dietary change is necessary in all countries as each one has unique priorities and action items. For regions such as Sub-Saharan Africa and South Asia, increased intake of nutrient dense foods is needed to address deficiency of essential nutrients like folate, potassium, and vitamin A. For North America and Europe, shifting toward more plant-based diets would be healthier and simultaneously reduce the per capita environmental footprints. The results can be useful for policymakers in designing country-specific strategies for adoption of sustainable dietary behaviors and for food industry to ensure the supply of sustainable food items customized with regions' need.

Can a Greenhouse Gas Emissions Tax on Food also Be Healthy and Equitable? A Systemised Review and Modelling Study from Aotearoa New Zealand

Policies to mitigate climate change are essential. The objective of this paper was to estimate the impact of greenhouse gas (GHG) food taxes and assess whether such a tax could also have health benefits in Aotearoa NZ. We undertook a systemised review on GHG food taxes to inform four tax scenarios, including one combined with a subsidy. These scenarios were modelled to estimate lifetime impacts on quality-adjusted health years (QALY), health inequities by ethnicity, GHG emissions, health system costs and food costs to the individual. Twenty-eight modelling studies on food tax policies were identified. Taxes resulted in decreased consumption of the targeted foods (e.g., -15.4% in beef/ruminant consumption, N = 12 studies) and an average decrease of 8.3% in GHG emissions (N = 19 studies). The "GHG weighted tax on all foods" scenario had the largest health gains and costs savings (455,800 QALYs and NZD 8.8 billion), followed by the tax-fruit and vegetable subsidy scenario (410,400 QALYs and NZD 6.4 billion). All scenarios were associated with reduced GHG emissions and higher age standardised per capita QALYs for Māori. Applying taxes that target foods with high GHG emissions has the potential to be effective for reducing GHG emissions and to result in co-benefits for population health.

Potential effect of real-world junk food and sugar-sweetened beverage taxes on population health, health system costs and greenhouse gas emissions in New Zealand: a modelling study

Poor diet is a major risk factor for excess weight gain and obesity-related diseases, including cardiovascular diseases, type 2 diabetes mellitus, osteoarthritis and several cancers. This paper aims to assess the potential impacts of real-world food and beverage taxes on change in dietary risk factors, health gains (in quality-adjusted life years (QALYs)), health system costs and greenhouse gas (GHG) emissions as if they had all been implemented in New Zealand (NZ). Ten taxes or tax packages were modelled. A proportional multistate life table model was used to predict resultant QALYs and costs over the remaining lifespan of the NZ population alive in 2011, as well as GHG emissions. QALYs ranged from 12.5 (95% uncertainty interval (UI) 10.2 to 15.0; 3% discount rate) per 1000 population for the import tax on sugar-sweetened beverages (SSB) in Palau to 143 (95% UI 118 to 171) per 1000 population for the excise duties on saturated fat, chocolate and sweets in Denmark, while health expenditure savings ranged from 2011 NZ$245 (95% UI 188 to 310; 2020 US$185) per capita to NZ$2770 (95% UI 2140 to 3480; US$2100) per capita, respectively. The modelled taxes resulted in decreases in GHG emissions from baseline diets, ranging from −0.2% for the tax on SSB in Barbados to −2.8% for Denmark’s tax package. There is strong evidence for the implementation of food and beverage tax packages in NZ or similar high-income settings.

Modeling the Contribution of Meat to Global Nutrient Availability

An increasing global population requires increasing food and nutrient availability. Meat is recognized as a nutrient dense food, particularly notable for its high-quality protein content, B vitamin and mineral content. However, it is not known how important meat is currently in nourishing the global population. The DELTA Model was used to calculate the contribution of meat (defined as animal flesh, excluding fish and seafood) to the global availability of 29 nutrients. This model utilizes global food production and use data, coupled with data for food waste, food nutrient composition and nutrient bioavailability to calculate the total amount of each nutrient available for consumption by the global population. Around 333 million tons of meat were produced globally in 2018, 95% of which was available as food, constituting ~7% of total food mass. Meat's contribution to nutrient availability was disproportionately higher than this: meat provided 11% of global food energy availability, 29% of dietary fat and 21% of protein. For the micronutrients, meat provided high proportions of vitamins: A (24%), B1 and B2 (15% each), B5 (10%), B6 (13%), and B12 (56%). Meat also provided high proportions of several trace elements: zinc (19%), selenium (18%), iron (13%), phosphorous (11%), and copper (10%). Meat is a poor contributor to fiber, magnesium and vitamins C and E. Meat was responsible for 16% (cystine) to 32% (lysine) of global availability of the bioavailable indispensable amino acids included in the model, due partly to the high digestibility of these nutrients from meat (83–100%). Of the total meat mass available as food in 2018, 23% was ruminant meat, 34% poultry meat, 32% pig meat, 2% other meat, and 9% offal and fats. The disproportionate contribution of meat to the global availability of nutrients emphasizes its important place in delivering nutrition to the current global population.

A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial

BACKGROUND

The trend of flexitarian eating patterns is on the rise, with young adults among the biggest adopters claiming health and environmental reasons to reduce red meat intake. Nutrient-dense meat and animal products are often the lynchpin of these diets, even when consumed only occasionally and in moderate amounts. Red meat provides forms and concentrations of essential proteins, lipids, and micronutrients that are scarce in exclusively vegetarian regimens.

OBJECTIVE

The aim of this study is to consider the effects of moderate consumption of lean red meat as part of an otherwise vegetarian balanced diet and its impact on biomarkers of sustained health and well-being.

METHODS

A cohort of healthy, young (20-34 years old, n=80) male and female participants will take part in a 2-arm, parallel randomized controlled trial (RCT) for a duration of 12 weeks, with a 3-month posttrial follow-up. The trial will commence with a 2-week assessment period followed by allocation to the intervention arms. The intervention will include the consumption of red meat or meat alternatives 3 times per week for 10 weeks. Blood samples of the participants will be collected to measure changes in erythrocyte fatty acid distribution, circulating amino acids, neurotransmitters, markers of mineral status, and inflammatory markers. Questionnaires to assess well-being and mental health will be undertaken every 2 weeks. Body composition, physical function, and blood parameters will be assessed at allocation (t₀), week 5 into the intervention (t₅), and post intervention (t₁₀).

RESULTS

The protocol has been developed using the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) checklist and the outcomes will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial was approved by the New Zealand Ministry of Health's Health and Disability Ethics Committees (protocol 20/STH/157). The results of this study will be communicated via publication.

CONCLUSIONS

To our knowledge, this is the first RCT investigating the overarching health consequences of consuming pasture-fed red meat or no meat as part of a healthy diet.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/30909.

A Rapid Review of the Environmental Impacts Associated with Food Consumption in Australia and New Zealand

PURPOSE OF REVIEW

The 2013 Australian Dietary Guidelines (ADG) have been criticised for making only brief reference to sustainability considerations. With the ADG currently under review, the purpose of this rapid review was to determine the environmental impacts associated with food consumption in Australia and New Zealand.

RECENT FINDINGS

Of the 20 articles included, greenhouse gas emissions (GHGe) were the most common environmental indicator (n = 12), followed by water use and water footprint (n = 7), and carbon footprint (n = 3). Whilst there are commonalities between different environmental indicators such as the large impact of discretionary food consumption on GHGe, cropland scarcity footprint, and water scarcity footprint, there is wide variation in these indicators for other food groups. Furthermore, modelling of current food consumption data to the recommended diet does not necessarily result in improvement of all indicators. The next iteration of the ADG should promote consumption of foods and dietary patterns that are associated with positive health and environmental outcomes.

Use of the DELTA Model to Understand the Food System and Global Nutrition

BACKGROUND

Increasing attention is being directed at the environmental, social, and economic sustainability of the global food system. However, a key aspect of a sustainable food system should be its ability to deliver nutrition to the global population. Quantifying nutrient adequacy with current tools is challenging.

OBJECTIVE

To produce a computational model illustrating the nutrient adequacy of current and proposed global food systems.

METHODS

The DELTA Model was constructed using global food commodity balance sheet data, alongside demographic and nutrient requirement data from UN and European Food Safety Authority sources. It also includes nutrient bioavailability considerations for protein, the indispensable amino acids, iron, and zinc, sourced from scientific literature.

RESULTS

The DELTA Model calculates global per capita nutrient availability under conditions of equal distribution and identifies areas of nutrient deficiency for various food system scenarios. Modeling the 2018 global food system showed that it supplied insufficient calcium (64% of demographically weighted target intake) and vitamin E (69%), despite supplying sufficient macronutrients. Several future scenarios were modeled, including variations in waste; scaling up current food production for the 2030 global population; plant-based food production systems; and removing sugar crops from the global food system. Each of these scenarios fell short of meeting requirements for multiple nutrients. These results emphasize the need for a balanced approach in the design of future food systems.

CONCLUSIONS

Nutrient adequacy must be at the forefront of the sustainable food system debate. The DELTA Model was designed for both experts and nonexperts to inform this debate as to what may be possible, practical, and optimal for our food system. The model results strongly suggest that both plant and animal foods are necessary to achieve global nutrition. The model is freely available for public use so that anyone can explore current and simulated global food systems.

Perceptions of Vegan Food among Organic Food Consumers Following Different Diets

This article identifies consumer segments for vegan food by analysing perceptions of vegan food among food organic consumers following different diets: vegans, vegetarians, former vegetarians, flexitarians, and omnivores. The analysis is based on responses to a quantitative consumer survey for which 503 participants were recruited from customers at German grocery stores by quota sampling according to diet and region. From the responses to an open-ended question eliciting the participants’ associations with vegan food, the analysis finds that vegans and vegetarians perceive vegan foods primarily as being beneficial for animal welfare, healthy, and environmentally friendly, while those who ate meat perceive vegan food primarily as containing no animal ingredients and as being healthy. The respondents’ varying assessments of the taste, diversity, and environmental benefits of vegan food were found to differ in relation to the various diets they followed, as did their assessments of how long the vegan trend is likely to last. A cluster analysis based on the consumers’ perceptions and attitudes revealed three consumer groups: “vegan fans”, “enjoyment sceptics”, and “originality-sceptics”. Scepticism about the originality of vegan food was found in all diet groups. These findings can help inform more effective targeting of consumer needs for vegan organic food.

Sustaining planetary health through systems thinking: Public health's critical role

Understanding and responding to adverse human health impacts of global environmental change will be a major priority of 21st century public health professionals. The emerging field of planetary health aims to face this challenge by studying and promoting policies that protect the health of humans and of the Earth's natural systems that support them. Public health, drawing on its experience of guiding policies to improve population health, has contributed to planetary health's development. Yet, few public health practitioners are familiar with planetary health's systems-oriented approaches for understanding relationships between economic development, environmental degradation, and human health. In this narrative review, we present key planetary health concepts and show how systems thinking has guided its development. We discuss historical approaches to studying impacts of economic development on human health and the environment. We then review novel conceptual frameworks adopted by planetary health scientists to study and forecast impacts of policies that influence human health and Earth's natural systems at varying spatiotemporal scales. We conclude by presenting examples of how applying the "Doughnut" model (an economic framework where the needs of people are met without overshooting the world's ecological limits) could guide policies for promoting health co-benefits to humans and natural systems.

Cost and greenhouse gas emissions of current, healthy, flexitarian and vegan diets in Aotearoa (New Zealand)

Objective

To compare the costs and climate impact (greenhouse gas emissions) associated with current and healthy diets and two healthy and environmentally friendly dietary patterns: flexitarian and vegan.

Design

Modelling study

Setting

Aotearoa (New Zealand).

Main outcome measures

The distribution of the cost and climate impact (kgCO₂e/kg of food per fortnight) of 2 weekly current, healthy, vegan and flexitarian household diets was modelled using a list of commonly consumed foods, a set of quantity/serves constraints for each, and constraints for food group and nutrient intakes based on dietary guidelines (Eating and Activity Guidelines for healthy diets and EAT-Lancet reference diet for vegan and flexitarian diets) or nutrition survey data (current diets).

Results

The iterative creation of 210–237 household dietary intakes for each dietary scenario was achieved using computer software adapted for the purpose (DIETCOST). There were stepwise differences between diet scenarios (p<0.001) with the current diet having the lowest mean cost in New Zealand Dollars (NZ$584 (95% CI NZ$580 to NZ$588)) per fortnight for a family of four) but highest mean climate impact (597 kgCO₂e (95% CI 590 to 604 kgCO₂e)), followed by the healthy diet (NZ$637 (95% CI NZ$632 to NZ$642), 452 kgCO₂e (95% CI 446 to 458 kgCO₂e)), the flexitarian diet (NZ$728 (95% CI NZ$723 to NZ$734), 263 kgCO₂e (95% CI 261 to 265 kgCO₂e)) and the vegan diet, which had the highest mean cost and lowest mean climate impact (NZ$789, (95% CI NZ$784 to NZ$794), 203 kgCO₂e (95% CI 201 to 204 kgCO₂e)). There was a negative relationship between cost and climate impact across diets and a positive relationship within diets.

Conclusions

Moving from current diets towards sustainable healthy diets (SHDs) will reduce climate impact but generally at a higher cost to households. The results reflect trade-offs, with the larger constraints placed on diets, the greater cost and factors such as nutritional adequacy, variety, cost and low-emissions foods being considered. Further monitoring and policies are needed to support population transitions that are country specific from current diets to SHD.

Lifetime climate impacts of diet transitions: a novel climate change accounting perspective

Dietary transitions, such as eliminating meat consumption, have been proposed as one way to reduce the climate impact of the global and regional food systems. However, it should be ensured that replacement diets are indeed nutritious and that climate benefits are accurately accounted for. This study uses New Zealand food consumption as a case study for exploring the cumulative climate impact of adopting the national dietary guidelines and the substitution of meat from hypothetical diets. The new GWP* metric is used as it was designed to better reflect the climate impacts of the release of methane than the de facto standard 100-year Global Warming Potential metric (GWP100). A transition at age 25 to the hypothetical dietary guideline diet reduces cumulative warming associated with diet by 7 to 9% at the 100th year compared with consuming the average New Zealand diet. The reduction in diet-related cumulative warming from the transition to a hypothetical meat-substituted diet varied between 12 and 15%. This is equivalent to reducing an average individual's lifetime warming contribution by 2 to 4%. General improvements are achieved for nutrient intakes by adopting the dietary guidelines compared with the average New Zealand diet; however, the substitution of meat items results in characteristic nutrient differences, and these differences must be considered alongside changes in emission profiles.

Life Cycle Assessment of Protected Strawberry Productions in Central Italy

Agricultural activities in Europe cover half of the total area of the continent and are simultaneously a cause of environmental impact and victims of the same impact. Horticultural or fruit crops are considered highly intensive and often employ many crop inputs such as fertilizers, pesticides, and various materials. Strawberry falls into this group, and it has grown in acreage and production more than others globally. The aim of this study is to compare the environmental impact of two strawberry cultivation systems in central Italy, a mulched soil tunnel and a soilless tunnel system. The method used to assess the impact is LCA, widely applied in agriculture and supported by international standards. The data used are mainly primary, related to 2018, and representative of the cultivation systems of central Italy. For impact assessment, the method selected was the CML_IA baseline version. From the results obtained, the two systems show a similar impact per kg of strawberries produced (e.g., for global warming: 0.785 kg CO2 eq for soilless, 0.778 kg CO2 eq for mulched soil tunnel). Reduced differences can be observed for the use of crop inputs (greater for the tunnel) and the use of materials and technology (greater for soilless). The mitigation measures considered concern the replacement of the packaging (excluding plastic) and the growing medium of the soilless using perlite and compost from insect breeding.

Default Vegetarianism and Veganism

This paper describes a pair of dietary practices I label default vegetarianism and default veganism. The basic idea is that one adopts a default of adhering to vegetarian and vegan diets, with periodic exceptions. While I do not exhaustively defend either of these dietary practices as morally required, I do suggest that they are more promising than other dietary practices that are normally discussed like strict veganism and vegetarianism. For they may do a better job of striking a balance between normative concerns about contemporary farming practices and competing considerations of life. Additionally, I argue that framing discussions in terms of defaults is useful for various reasons: it helps organize agreements and disagreements, it more accurately reflects the way people conceptualize their dietary practices, and it presents a more dialectically effective view.

Climate Change, Food Supply, and Dietary Guidelines

Food production is affected by climate change, and, in turn, food production is responsible for 20-30% of greenhouse gases. The food system must increase output as the population increases and must meet nutrition and health needs while simultaneously assisting in achieving the Sustainable Development Goals. Good nutrition is important for combatting infection, reducing child mortality, and controlling obesity and chronic disease throughout the life course. Dietary guidelines provide advice for a healthy diet, and the main principles are now well established and compatible with sustainable development. Climate change will have a significant effect on food supply; however, with political commitment and substantial investment, projected improvements will be sufficient to provide food for the healthy diets needed to achieve the Sustainable Development Goals. Some changes will need to be made to food production, nutrient content will need monitoring, and more equitable distribution is required to meet the dietary guidelines. Increased breastfeeding rates will improve infant and adult health while helping to reduce greenhouse gases.