Environmental Nutrition: A New Frontier for Public Health

Quantifying the locality of the food supply in a large healthcare organisation

AIM

Shocks to the food system (such as extreme weather events, wars, and pandemics) are felt by institutional food systems. For hospitals, these shocks affect the quantity, quality, and variety of foods that can be offered to patients. One strategy to buffer the hospital food supply from external threats is to prioritise ingredients produced locally. Thus, the aim of the current research is to describe the country of origin of all foods purchased by a large, metropolitan healthcare organisation and to identify opportunities for improving the locality of the food supply.

METHODS

This study was of a cross-sectional, observational design. The country of origin for all foods procured over a 1-year period by a large, urban healthcare organisation was determined by proportion of food budget spend. State of origin was identified for fresh fruit, vegetables, and meat. The organisation was in Queensland, Australia and utilised a cook-fresh, room-service foodservice model. Descriptive analysis was used to to determine the number of items and the proportion of budget spend on all foods produced in Australia, and by food category. Similar descriptive statistics were generated to determine the proportion of the budget spend on fresh fruits, vegetables and meats produced in Queensland.

RESULTS

Over the 1-year period, 659 individual food items were purchased by the hospital foodservice, and 502 food items were included in the anlaysis. In total, 53% of the food budget was spent on Australian foods (100% Australian ingredients) and almost all fruit (73%) and vegetables (91%) were Australian grown. Procuring fresh fruit (28%), vegetables (35%), and meat (46%) from within the state was less common, and this may reflect the primary states of production across Australia, and seasonal variability of the food supply.

CONCLUSIONS

Findings offer priority areas for improving the locality of the food supply. Future research to determine if procuring more foods locally has benefits to consistency of the food supply is warranted.

Arid/semi-arid flora as a treasure trove of bioactives and bioenergy: the case for underutilized desert legumes towards environmental sustainability

As the spectre of climate change gains in strength with each passing moment, many of our mundane food crops like rice face the heat, leading to uncertain yields and unforeseen disease outbreaks. Subsequently, mankind is forced to look for alternative food choices that should primarily come from indigenous plants that are less demanding in terms of usage of water and application of chemical-based fertilizers/pesticides. There are plants growing in the wild in the arid and semi-arid zones of Rajasthan, India, that can come to the rescue, with an added potential for development into valuable functional foods-i.e., not only as source of carbohydrates, proteins, and micro-nutrients but also that of health benefiting nutraceuticals (like antioxidant flavonoids) and relevant enzymes. The other parts (non-edible) of these plants have often also been traditionally validated via diverse ethnomedicinal practices; these could also be useful bioenergy sources. Keeping in mind the broader aim of looking at future functional foods that are also required to be environmentally sustainable, the current report: (a) reviews the extant literature on underutilized legumes from arid/semi-arid zones, (b) discusses current status with respect to biological activities present therein, and (c) suggests pertinent research questions and solution paths in the domains of bioactives, bioenergy, and sustainable environment.

Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar

It is estimated that billions of people around the world are affected by micronutrient deficiencies. Madagascar is considered to be particularly nutritionally vulnerable, with nearly half of the population stunted, and parts of the country facing emergency, near famine-like conditions (IPC4). Although Madagascar is generally considered among the most undernourished of countries, empirical data in the form of biological samples to validate these claims are extremely limited. Our research drew data from three studies conducted between 2013-2020 and provided comprehensive biomarker profile information for 4,710 individuals from 30 communities in five different ecological regions during at least one time-point. Estimated prevalences of nutrient deficiencies and inflammation across various regions of rural Madagascar were of concern for both sexes and across all ages, with 66.5% of the population estimated to be deficient in zinc, 15.6% depleted in vitamin B12 (3.6% deficient), 11.6% deficient in retinol, and lower levels of iron deficiency (as indicated by 11.7% deficient in ferritin and 2.3% deficient assessed by soluble transferrin receptors). Beyond nutrient status biomarkers, nearly one quarter of the population (24.0%) exhibited chronic inflammation based on high values of α-1-acid glycoprotein, and 12.3% exhibited acute inflammation based on high values of C-reactive protein. There is an 8-fold difference between the lowest and highest regional observed prevalence of vitamin B12 deficiency, a 10-fold difference in vitamin A deficiency (based on retinol), and a 2-fold difference in acute inflammation (CRP) and deficiencies of zinc and iron (based on ferritin), highlighting strong geographical variations in micronutrient deficiencies across Madagascar.

Sociodemographic patterning of dietary profiles among Inuit youth and adults in Nunavik, Canada: a cross-sectional study

OBJECTIVES

Country (traditional) foods are integral to Inuit culture, but market food consumption is increasing. The Qanuilirpitaa? 2017 Nunavik Health Survey (Q2017) reported similar country food consumption frequency compared to that in 2004; however, examining food items individually does not account for diet patterns, food accessibility, and correlations between food items. Our objective was to identify underlying dietary profiles and compare them across sex, age, ecological region, and food insecurity markers, given the links among diet, health, and sociocultural determinants.

METHODS

Food frequency and sociodemographic data were derived from the Q2017 survey (N = 1176). Latent profile analysis identified dietary profiles using variables for the relative frequencies of country and market food consumption first, followed by an analysis with those for country food variables only. Multinomial logistic regression examined the associations among dietary profiles, sociodemographic factors, and food insecurity markers (to disassociate between food preferences and food access).

RESULTS

Four overall dietary profiles and four country food dietary profiles were identified characterized by the relative frequency of country and market food in the diet. The patterns were stable across several sensitivity analyses and in line with our Inuit partners' local knowledge. For the overall profiles, women and adults aged 30-49 years were more likely to have a market food-dominant profile, whereas men and individuals aged 16-29 and 50+ years more often consumed a country food-dominant profile. In the country food profiles, Inuit aged 16-29 years were more likely to have a moderate country food profile whereas Inuit aged 50+ were more likely to have a high country food-consumption profile. A low country and market food-consumption profile was linked to higher prevalence of food insecurity markers.

CONCLUSION

We were able to identify distinct dietary profiles with strong social patterning. The profiles elucidated in this study are aligned with the impact of colonial influence on diet and subsequent country food promotion programs for Inuit youth. These profiles will be used for further study of nutritional status, contaminant exposure, and health to provide context for future public health programs.

Nutraceutical and flavor profiles in underutilized desert legumes of India: gene editing strategies towards sustainable food development

Climate change has posed a challenge for food security all over the world in the form of fluctuating crop yields and novel disease outbreaks in plants. Human society's overdependence on a few food crops does not seem a wise precedence. There are numerous underutilized/orphan/neglected legumes growing in the Indian desert regions that can come to the rescue and act as balanced and sustainable sources of nutrients and health-benefitting nutraceuticals. However, challenges such as low plant yield, unidentified metabolic pathways and off-flavor in the food products derived from them prevent the realization of their full potential. Conventional breeding techniques are too slow to achieve the desired modifications and cater to the sharply rising demand for functional foods. The novel gene editing tools like CRISPR-Cas provide more precise tool to manipulate the target genes with or without introduction of foreign DNA and therefore, have better chances to be accepted by governments and societies. The current article reports some of the relevant 'gene editing' success stories with respect to nutraceutical and flavor profiles in the popular legumes. It highlights gaps and future potential, along with areas requiring caution, in underutilized edible legumes of the Indian (semi) arid regions like Prosopis cineraria, Acacia senegal and Cyamopsis tetragonoloba.

An Approach for Integrating and Analyzing Sustainability in Food-Based Dietary Guidelines

International organizations, governments, researchers, and activists have proposed the need for deeper integration of sustainability considerations in national food-based dietary guidelines (FBDGs). Yet, as recent scholarship advances the conversation, questions remain around how to effectively frame and address the interconnectedness of multiple sustainability domains. Little systematic analysis has evaluated how current FBDGs have integrated complex messages about socially, environmentally, and economically sustainable consumption practices with nutrition and health messages. This study had two nested objectives: (i) to examine the validity of an existing sustainable diets framework by assessing how sustainability concepts have been framed and included in national FBDGs available from 2011 to 2019 and (ii) to describe a novel analysis approach that augments an existing framework which integrates sustainability domains and can be adapted for use by future FBDGs. A qualitative content analysis was used to examine sustainability concepts found in 12 FBDGs and supporting documents available in English that were developed for use in 16 countries across Europe, North and South America, and Asia as of 2019—from a global review of those published prior to 2016 and gray literature review of publications between 2016 and 2019. Health domains were the primary frame found across the FBDGs examined, but documents also commonly incorporated agricultural, sociocultural, and economic sustainability principles. Analyzed documents were used to adapt an existing policy analysis framework into a “Sustainability in FBDGs Framework.” This proposed framework contributes a novel analysis approach and has five core domains that are interconnected: health and nutrition, food security and agriculture, markets and value chains, sociocultural and political, and environment and ecosystems. This study adds to the growing body of literature related to sustainable food systems and dietary guidelines by presenting how sustainability framing in FBDGs can be used to further develop a comprehensive framework for integrating sustainability domains. While this project helps to validate previous work, further analyses of FBDGs which have emerged since this study and those not available in English are needed to improve the guidance approach described here and for assessing the incorporation of sustainability domains in future FBDGs. This work is useful in informing processes for policy developers to integrate sustainability considerations into their national FBDGs.

Comprehensive Evaluation of Metabolites and Minerals in 6 Microgreen Species and the Influence of Maturity

BACKGROUND

Microgreens are the young leafy greens of many vegetables, herbs, grains, and flowers with potential to promote human health and sustainably diversify the global food system. For successful further integration into the global food system and evaluation of their health impacts, it is critical to elucidate and optimize their nutritional quality.

OBJECTIVES

We aimed to comprehensively evaluate the metabolite and mineral contents of 6 microgreen species, and the influence of maturity on their contents.

METHODS

Plant species evaluated were from the Brassicaceae (arugula, broccoli, and red cabbage), Amaranthaceae (red beet and red amaranth), and Fabaceae (pea) plant families. Nontargeted metabolomics and ionomics analyses were performed to examine the metabolites and minerals, respectively, in each microgreen species and its mature counterpart.

RESULTS

Nontargeted metabolomics analysis detected 3321 compounds, 1263 of which were annotated and included nutrients and bioactive compounds. Ionomics analysis detected and quantified 26 minerals including macrominerals, trace minerals, ultratrace minerals, and other metals. Principal component analysis indicated that microgreens have distinct metabolite and mineral profiles compared with one another and with their mature counterparts. Several compounds were higher (P  < 0.05; fold change ≥2) in microgreens compared with their mature counterparts, whereas some were not different or lower. In many cases, compounds that were higher in microgreens compared with the mature counterpart were also unique to that microgreen species.

CONCLUSIONS

These data provide evidence for the nutritional quality of microgreens, and can inform future research and development aimed at characterizing and optimizing microgreen nutritional quality and health impacts.

Food Next Door: From Food Literacy to Citizenship on a College Campus

Industrial agriculture and food corporations have produced an abundance of food that is highly processed, nutritionally poor, and environmentally burdensome. As part of a healthy campus initiative, generated to address these and other food production and consumption dilemmas, a student-run “local and sustainable” food establishment called Food Next Door (FND) was created. This intrinsic case study evaluated food literacy in health science students, faculty, and staff first as a pilot to build the case for FND and further explicated customers’, volunteers’, and leads’ experiences with FND, identifying potential pathways from food literacy to citizenship. Ten returning customers, eight recurring nutrition student volunteers, and three graduate student leads participated in interviews that were analyzed for themes and subthemes. The findings show a progression in themes. Customers’ experiences highlight FND’s fresh, flavorful food, smiling and supportive staff, and personal transformation. Volunteers’ themes identified greater awareness of new foods and plant-based eating, acquiring new knowledge and skills in commercial kitchens, and deepening their connection to food, each other, and to where food comes from. Leads’ themes show opportunities to gain managerial skills, a deeper understanding of food and skills from being immersed in value-based food systems, and confidence in peer teaching. Experiencing and becoming part of the food value chain through FND built food literacy, shifted values, and transformed students into food citizens.

The next protein transition

Background

Meeting the UN Sustainable Development Goals requires a relatively rapid transition towards a circular economy. Therefore, a multidisciplinary perspective is required to sketch why a transition from diets based primarily on animal proteins towards diets based primarily on plant proteins products is extremely urgent for both food security and sustainability.

Scope and approach

This review starts out by identifying ecological, economic and social aspects of sustainable food consumption. Subsequently, it is argued how protein supply is underlying and linking the top-3 of anthropogenic impacts based on the planetary boundaries concept, i.e. 1) biodiversity loss, 2) nitrogen cycle acceleration, and 3) carbon cycle acceleration (resulting in climate change). These environmental impacts associated with current Western food consumption need to be reduced urgently. In order to address the inefficiencies inherent to current dietary patterns, therefore, a ranked list of more sustainable options is proposed, based on their order of magnitude. Addressing consumers, industry, and governmental stakeholders plus cultural aspects, challenges and options are sketched.

Key findings and conclusions

Clearly, a dietary transition from primarily animal towards plant protein products is required. Fortunately, new dietary guidelines are increasingly taking sustainability into account and the contours of a diet transition are slowly emerging.

Drivers and Inhibitors in the Acceptance of Meat Alternatives: The Case of Plant and Insect-Based Proteins

Insects as an alternative protein source has gained traction for its advantageous environmental impact. Despite being part of many traditional food cultures, insects remain a novelty in Western cultures and a challenging concept for many. Even though plant-based protein alternatives are not facing the same barriers, product unfamiliarity and limited exposure hinder adoption, which could be detrimental to growth within the food sector. This study is aimed at evaluating plant- and insect-based proteins as alternative dietary proteins. A model indicating the drivers of consumer attitudes towards meat-alternative proteins and consumer willingness to try, buy, and pay a premium was tested. Further, 3091 responses were collected using surveys in nine countries: China, USA, France, UK, New Zealand, Netherlands, Brazil, Spain, and the Dominican Republic. Structural Equation Modelling was used to analyze the data. We found that consumer’s behavioral intentions towards both plant-based and insect-based alternatives are inhibited by food neophobia but to an extent, are amplified by the perceived suitability and benefits of the protein, which in turn are driven by nutritional importance, environmental impact, healthiness, and sensory attributes for both alternatives. The expectation of the nutritional value of meat is the strongest (negative) influence on perceived suitability/benefits of plant-based protein and willingness to try, buy, and pay more for plant-based proteins, but it only has a relatively small impact on the suitability/benefits of insect-based protein and no impact on willingness to try, buy, and pay more for insect-based proteins. Overall, we conclude that consumer adoption towards meat alternatives is complex and is strengthened by the perceived suitability/benefits of the protein and general importance of perceived food healthiness and sustainability. Conversely, adoption is hindered by dietary factors and the experiential importance of meat and food neophobia.

Food Diversity and Indigenous Food Systems to Combat Diet-Linked Chronic Diseases

Improving food and nutritional diversity based on the diversity of traditional plant-based foods is an important dietary strategy to address the challenges of rapidly emerging diet- and lifestyle-linked noncommunicable chronic diseases (NCDs) of indigenous communities worldwide. Restoration of native ecosystems, revival of traditional food crop cultivation, and revival of traditional knowledge of food preparation, processing, and preservation are important steps to build dietary support strategies against an NCD epidemic of contemporary indigenous communities. Recent studies have indicated that many traditional plant-based foods of Native Americans provide a rich source of human health-relevant bioactive compounds with diverse health benefits. Based on this rationale of health benefits of traditional plant-based foods, the objective of this review is to present a state-of-the-art comprehensive framework for ecologically and culturally relevant sustainable strategies to restore and integrate the traditional plant food diversity of Native Americans to address the NCD challenges of indigenous and wider nonindigenous communities worldwide.

Review: An integrated graphical tool for analysing impacts and services provided by livestock farming

Livestock farming is criticized for negatively impacting the environment, concerns about animal welfare and the impact of excessive meat consumption on human health. However, livestock farming provides other underappreciated and poorly communicated benefits to society in terms of employment, product quality, cultural landscapes and carbon storage by grasslands. Few attempts have been made so far to simultaneously consider the services and impacts provided by livestock production. Here, we propose an integrated graphical tool, called the 'barn' to explicitly summarize the synergies and trade-offs between services and impacts provided by livestock farming. It illustrates livestock farming interacting with its physical, economic and social environment along five interfaces: (i) Markets, (ii) Work and employment, (iii) Inputs, (iv) Environment and climate, (v) Social and cultural factors. This graphical tool was then applied by comparing two contrasting livestock production areas (high livestock density v. grassland-based), and the dominant v. a niche system within a crop-livestock area. We showed the barn could be used for cross-comparisons of services and impacts across livestock production areas, and for multi-level analysis of services and impacts of livestock farming within a given area. The barn graphically summarizes the ecological and socio-economic aspects of livestock farming by explicitly representing multiple services and impacts of different systems in a simple yet informative way. Information for the five interfaces relies on available quantitative assessments from the literature or data sets, and on expert-knowledge for more qualitative factors, such as social and cultural ones. The 'barn' can also inform local stakeholders or policy-makers about potential opportunities and threats to the future of livestock farming in specific production areas. It has already been used as a pedagogical tool for teaching the diversity of services and impacts of livestock systems across Europe and is currently developed as a serious game for encouraging knowledge exchange and sharing different viewpoints between stakeholders.

Plant-Based Diets: Considerations for Environmental Impact, Protein Quality, and Exercise Performance

Plant-based diets provide well-established physical and environmental health benefits. These benefits stem in part from the degree of restriction of animal-derived foods. Historically, meat and other animal-derived proteins have been viewed as an integral component of athletes' diets, leading some to question the adequacy of vegetarian or vegan diets for supporting athletic performance. The purpose of this review is to examine the impact of plant-based diets on human physical health, environmental sustainability, and exercise performance capacity. Based on currently available literature, it is unlikely that plant-based diets provide advantages, but do not suffer from disadvantages, compared to omnivorous diets for strength, anaerobic, or aerobic exercise performance. However, plant-based diets typically reduce the risk of developing numerous chronic diseases over the lifespan and require fewer natural resources for production compared to meat-containing diets. As such, plant-based diets appear to be viable options for adequately supporting athletic performance while concurrently contributing to overall physical and environmental health. Given the sparse literature comparing omnivore, vegetarian, and vegan athletes, particularly at the elite level, further research is warranted to ascertain differences that might appear at the highest levels of training and athletic performance.

Healthy and sustainable diet and physical activity: the rationale for and experiences from developing a combined summary score

Aims: First, to describe the rationale for developing a combined summary score, the Healthy and Sustainable Dietary and Physical Activity habits (HSDPA) score, incorporating four selected dietary and physical activity aspects: (a) the New Nordic Diet, (b) local and sustainable foods, (c) active transportation and (d) non-exercise outdoor activities. Secondly, to describe the experiences from constructing the HSDPA score. Methods: Relevant literature covering the four aspects of interest was reviewed to secure a well-grounded rationale and a theory-based approach. To measure compliance with such a broad approach targeting diet, physical activity, health and environmental sustainability, the HSDPA score was constructed including one subscale for each aspect. The four subscales were constructed from questionnaire items and were equally weighted, entailing a range from 0-10 points, hence the total HSDPA score ranged from 0-40 points. Results: In retrospect, we believe that the rationale for creating the HSDPA score is reasonable. Still, emphasizing fewer, but the most relevant aspects, such as reduced meat consumption and active transportation, may represent a more functional solution than the broad approach suggested herein, both for promoting public health and environmental sustainability, and for developing a feasible measurement tool. Conclusions: Our experiences illustrate the importance of methodological perspectives and scrutiny related to both the development and testing of complex summary scores. Nevertheless, we think that combined summary scores could be applicable for use within epidemiological studies and for measuring the effects of interventions, if accounting for the methodological limitations as far as possible.

The Mediterranean diet, an environmentally friendly option: evidence from the Seguimiento Universidad de Navarra (SUN) cohort

OBJECTIVE

How food is produced and consumed has consequences for ecosystems, such as resource use and greenhouse gas (GHG) emission among others. The Mediterranean diet (MedDiet) was proposed as a sustainable dietary model, due to its nutritional, environmental, economic and sociocultural dimensions. However, further evidence is needed. Thus, our objective was to evaluate the impact on resource (land, water and energy) use and GHG emission of better adherence to the MedDiet in a Mediterranean Spanish cohort.

DESIGN

We analysed the dietary pattern of participants through a validated FFQ. The outcomes were land use, water and energy consumption and GHG emission according to MedDiet adherence. The specific environmental footprints of food item production and processing were obtained from different available life-cycle assessments.

SETTING

Spanish university graduates.

SUBJECTS

Participants (n 20 363) in the Seguimiento Universidad de Navarra (SUN) cohort.

RESULTS

Better adherence to the MedDiet was associated with lower land use (-0·71 (95 % CI -0·76, -0·66) m2/d), water consumption (-58·88 (95 % CI -90·12, -27·64) litres/d), energy consumption (-0·86 (95 % CI -1·01, -0·70) MJ/d) and GHG emission (-0·73 (95 % CI -0·78, -0·69) kg CO2e/d). A statistically significant linear trend (P<0·05) was observed in all these analyses.

CONCLUSIONS

In this Mediterranean cohort, better adherence to the MedDiet was an eco-friendly option according to resource consumption and GHG emission.

A Bridge Back to the Future: Public Health Ethics, Bioethics, and Environmental Ethics

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three "fields" of ethics to promote a healthier planet.

"Eat as If You Could Save the Planet and Win!" Sustainability Integration into Nutrition for Exercise and Sport

Today's industrial food production contributes significantly to environmental degradation. Meat production accounts for the largest impact, including greenhouse gas emissions, land and water use. While food production and consumption are important aspects when addressing climate change, this article focuses predominantly on dietary change that promotes both health for planet and people with focus on athletes. Healthy, sustainable eating recommendations begin to appear in various governmental guidelines. However, there remains resistance to the suggested reductions in meat consumption. While food citizens are likely to choose what is good for them and the planet, others may not, unless healthy eating initiatives integrate creative food literacy approaches with experiential learning as a potential vehicle for change. This concept paper is organized in three sections: (1) Environmental impact of food; (2) health and sustainability connections; and (3) application in sports and exercise. For active individuals, this article focuses on the quantity of protein, highlighting meat and dairy, and quality of food, with topics such as organic production and biodiversity. Finally, the timing of when to integrate sustainability principles in sport nutrition is discussed, followed by practical applications for education and inclusion in team, institutional, and event operations.