The Complementary Roles for Plant-Source and Animal-Source Foods in Sustainable Healthy Diets

Association between maternal antibiotic exposure and emotional and behavioural problems in children at four years of age: A biomonitoring-based prospective study

BACKGROUND

Maternal exposure to multiple antibiotics exposure during pregnancy has attracted extensive attention, but biomonitoring studies linking prenatal antibiotic exposure to emotional and behavioural problems in children are limited.

METHODS

A total of 2475 pregnant women from the Ma'anshan Birth Cohort were included, and the Strengths and Difficulties Questionnaire was completed when their children turned four years of age. The levels of 41 maternal urinary antibiotics and two metabolites were measured during the first, second and third trimesters. Generalized estimating equations and binary logistic regression models were applied to analyse the associations between maternal antibiotic exposure and emotional and behavioural problems in children and to determine the sensitive period, respectively. A quantile-based g-computation (QGC) approach was employed to examine the combined effects of multiple antibiotics on emotional and behavioural problems in children.

RESULTS

Overall, florfenicol and preferred-as-veterinary antibiotic (PVA) exposure during pregnancy increased the risk of emotional problems in children, and ofloxacin exposure increased the risk of hyperactivity-inattention. Maternal exposure to trimethoprime, ciprofloxacin, florfenicol, other antibiotics and PVA exposure during the first trimester was positively associated with emotional problems in children. Second-trimester trimethoprime concentrations and third-trimester ciprofloxacin concentrations were positively associated with hyperactivity-inattention. Third-trimester veterinary antibiotic (VA) exposure was negatively associated with hyperactivity-inattention, and second-trimester VA and PVA exposure was negatively associated with peer problems. The QGC model revealed that mixed antibiotic exposure in the first trimester exacerbated the risk of childhood emotional problems (the contribution of ciprofloxacin is prominent), and mixed antibiotic exposure in the second trimester increased the risk of hyperactivity-inattention (the contribution of trimethoprime is prominent).

CONCLUSION

Maternal mixed antibiotic exposure during the first and second trimesters increases the risk of emotional problems and hyperactivity-inattention in children at four years of age.

Circular food system approaches can support current European protein intake levels while reducing land use and greenhouse gas emissions

Protein transition and circular food system transition are two proposed strategies for supporting food system sustainability. Here we model animal-sourced protein to plant-sourced protein ratios within a European circular food system, finding that maintaining the current animal-plant protein share while redesigning the system with circular principles resulted in the largest relative reduction of 44% in land use and 70% in greenhouse gas (GHG) emissions compared with the current food system. Shifting from a 60:40 to a 40:60 ratio of animal-sourced proteins to plant-sourced proteins yielded a 60% reduction in land use and an 81% GHG emission reduction, while supporting nutritionally adequate diets. Differences between current and recommended total protein intake did not substantially impact minimal land use and GHG emissions. Micronutrient inadequacies occurred with less than 18 g animal protein per capita per day. Redesigning the food system varied depending on whether land use or GHG emissions were reduced-highlighting the need for a food system approach when designing policies to enhance human and planetary health.

Quantifying cost of disease in livestock: a new metric for the Global Burden of Animal Diseases

BACKGROUND

Increasing awareness of the environmental and public health impacts of expanding and intensifying animal-based food and farming systems creates discord, with the reliance of much of the world's population on animals for livelihoods and essential nutrition. Increasing the efficiency of food production through improved animal health has been identified as a step towards minimising these negative effects without compromising global food security. The Global Burden of Animal Diseases (GBADs) programme aims to provide data and analytical methods to support positive change in animal health across all livestock and aquaculture animal populations.

METHODS

In this study, we present a metric that begins the process of disease burden estimation by converting the physical consequences of disease on animal performance to farm-level costs of disease, and calculates a metric termed the Animal Health Loss Envelope (AHLE) via comparison between the status quo and a disease-free ideal. An example calculation of the AHLE metric for meat production from broiler chickens is provided.

FINDINGS

The AHLE presents the direct financial costs of disease at farm-level for all causes by estimating losses and expenditure in a given farming system. The general specification of the model measures productivity change at farm-level and provides an upper bound on productivity change in the absence of disease. On its own, it gives an indication of the scale of total disease cost at farm-level.

INTERPRETATION

The AHLE is an essential stepping stone within the GBADs programme because it connects the physical performance of animals in farming systems under different environmental and management conditions and different health states to farm economics. Moving forward, AHLE results will be an important step in calculating the wider monetary consequences of changes in animal health as part of the GBADs programme.

FUNDING

Bill & Melinda Gates Foundation, the UK Foreign, Commonwealth and Development Office, EU Horizon 2020 Research and Innovation Programme.

The role of dairy food intake for improving health among black Americans across the life continuum: A summary of the evidence

Decades of health data show major health disparities occurring at every life stage between Black and White Americans. These disparities include greater mortality rates among Black mothers and their offspring, higher levels of malnutrition and obesity among Black children and adolescents, and a higher burden of chronic disease and lower life expectancy for Black adults. Although nutrition is only one of many factors that influence human health and well-being across the life continuum, a growing body of research continues to demonstrate that consuming a healthy dietary pattern is one of the most dominant factors associated with increased longevity, improved mental health, improved immunity, and decreased risk for obesity and chronic disease. Unfortunately, large percentages of Black Americans tend to consume inadequate amounts of several essential nutrients such as vitamin A, vitamin D, calcium, and magnesium; and simultaneously consume excessive amounts of fast foods and sugar-sweetened beverages to a greater degree than other racial/ethnic groups. Therefore, strategies that can help improve dietary patterns for Black Americans could make up a major public health opportunity for reducing nutrition-related diseases and health disparities across the life course. A key intervention strategy to improve diet quality among Black Americans is to focus on increasing the intake of nutrient-rich dairy foods, which are significantly underconsumed by most Black Americans. Compared to other food group, dairy foods are some of the most accessible and affordable sources of essential nutrients like vitamin A, D, and B12, calcium, magnesium, potassium, selenium, and zinc in the food supply, as well as being some of the primary sources of several health-promoting bioactive compounds, including polar lipids, bioactive proteins and peptides, oligosaccharides, and live and active cultures in fermented products. Given the complex relationships that many Black Americans have with dairy foods, due to issues with lactose intolerance, and/or negative perceptions about the health effects of dairy foods, there is still a need to examine the role that dairy foods play in the health and well-being of Black Americans of all ages and life stages. Therefore, the National Medical Association and its partners have produced multiple reports on the value of including adequate dairy in the diet of Black Americans. This present summary paper and its associated series of evidence reviews provide an examination of an immense amount of research focused on dairy intake and health outcomes, with an emphasis on evidence-based strategies for improving the health of Black Americans. Overall, the findings and conclusions from this body of research continue to indicate that higher dairy intake is associated with reduced risk for many of the most commonly occurring deficiencies and diseases impacting each life stage, and that Black Americans would receive significantly greater health benefits by increasing their daily dairy intake levels to meet the national recommendations than they would from continuing to fall short of these recommendations. However, these recommendations must be considered with appropriate context and nuance as the intake of different dairy products can have different impacts on health outcomes. For instance, vitamin D fortified dairy products and fermented dairy products like yogurt - which are low in lactose and rich in live and active cultures - tend to show the greatest benefits for improved health. Importantly, there are significant limitations to these research findings for Black Americans, especially as they relate to reproductive and child health, since most of the research on dairy intake and health has failed to include adequate representation of Black populations or to sufficiently address the role of dairy intake during the most vulnerable life stages, such as pregancy, lactation, fetal development, early childhood, and older age. This population and these life stages require considerably more research and policy attention if health equity is ever to be achieved for Black Americans. Sharing and applying the learnings from this summary paper and its associated series of evidence reviews will help inform and empower nutrition and health practitioners to provide more evidence-based dietary recommendations for improving the health and well-being of Black Americans across the life course.

The SHED Index: A Validation Study to Assess Sustainable HEalthy Diets in Portugal

This study aims to adapt and validate the Sustainable HEalthy Diet (SHED) Index for the Portuguese adult population, which was developed to assess sustainable and healthy eating patterns. Data were collected using a web-based questionnaire administered through interviews with 347 individuals aged between 18 and 65 years old. The SHED Index evaluates 30 items, allowing for the assessment and scoring of sustainable and healthy eating patterns. The higher the SHED Index score, the more sustainable and healthier the diet. A semi-quantitative food frequency questionnaire was used to assess the participants' dietary intake. The criterion validity was examined by testing the relationship between the SHED Index score and adherence to the Mediterranean Diet. Reproducibility was assessed by determining agreement and reliability with test-retest. Construct validity was confirmed based on established criteria. A higher SHED Index score was associated with moderate to high adherence to the Mediterranean diet, while it was inversely related to the proportion of animal-sourced foods in the overall food intake (r = -0.281, p < 0.001). Good reliability and agreement were found for the SHED Index score. Our findings suggest that the SHED Index is a valid and reliable tool for assessing sustainable and healthy diets in the Portuguese adult population.

Dietary consumption of beef and red meat: a scoping review and evidence map on cognitive outcomes across the lifespan

OBJECTIVE

Mixed evidence exists on the impact of beef consumption on cognition. The goal was to create an evidence map capturing studies assessing beef consumption and cognition to reveal gaps and opportunities in the body of literature.

DESIGN

A scoping review was conducted to locate studies up to March 2022 using PubMed and backwards citation screening. Data were extracted by two independent reviewers with conflict resolution, and a database was created and made publicly available.

SETTING

Intervention and observational studies.

PARTICIPANTS

Humans of any age, sex and/or health status, without moderate to severe cognitive impairment and/or abnormalities.

RESULTS

Twenty-two studies were identified that quantified beef or red meat intake and assessed cognition. Six studies assessed beef intake, with the remaining studies describing intake of red meat that may or may not include beef. Nine articles described randomised controlled trials (RCT), mostly conducted in children. Thirteen described observational studies, primarily conducted on adults and seniors. The most common cognitive domains measured included intelligence and general cognition, and memory. The majority of controlled studies were rated with high risk of bias, with the majority of observational trials rated with serious or greater risk of bias.

CONCLUSIONS

Red meat and beef intake and cognition is largely understudied. There is a significant lack of replication across study designs, populations, exposures and outcomes measured. The quality of the research would be considerably enhanced by focused assessments of beef intake (and not red meat in general) and specific cognitive domains, along with improved adherence to reporting standards.

Plant to animal protein ratio in the diet: nutrient adequacy, long-term health and environmental pressure

Background

Animal and plant protein sources have contrasting relationships with nutrient adequacy and long-term health, and their adequate ratio is highly debated.

Objective

We aimed to explore how the percentage of plant protein in the diet (%PP) relates to nutrient adequacy and long-term health but also to environmental pressures, to determine the adequate and potentially optimal %PP values.

Methods

Observed diets were extracted from the dietary intakes of French adults (INCA3, n = 1,125). Using reference values for nutrients and disease burden risks for foods, we modeled diets with graded %PP values that simultaneously ensure nutrient adequacy, minimize long-term health risks and preserve at best dietary habits. This multi-criteria diet optimization was conducted in a hierarchical manner, giving priority to long-term health over diet proximity, under the constraints of ensuring nutrient adequacy and food cultural acceptability. We explored the tensions between objectives and identified the most critical nutrients and influential constraints by sensitivity analysis. Finally, environmental pressures related to the modeled diets were estimated using the AGRIBALYSE database.

Results

We find that nutrient-adequate diets must fall within the ~15-80% %PP range, a slightly wider range being nevertheless identifiable by waiving the food acceptability constraints. Fully healthy diets, also achieving the minimum-risk exposure levels for both unhealthy and healthy foods, must fall within the 25-70% %PP range. All of these healthy diets were very distant from current typical diet. Those with higher %PP had lower environmental impacts, notably on climate change and land use, while being as far from current diet.

Conclusion

There is no single optimal %PP value when considering only nutrition and health, but high %PP diets are more sustainable. For %PP > 80%, nutrient fortification/supplementation and/or new foods are required.

Risk Assessment of Micronutrients Deficiency in Vegetarian or Vegan Children: Not So Obvious

Vegetarian diets have gained in popularity worldwide and therefore an increasing number of children may be exposed to the resulting nutritional consequences. Among them, the risk of micronutrient shortfall is particularly of concern. This narrative review aims to assess and discuss the relevance of micronutrient deficiency risk based on the available data. It mainly draws attention to iron, zinc, iodine, and vitamins B12 and D intake. Diets that are more restrictive in animal source foods, such as vegan diets, have a greater likelihood of nutritional deficiencies. However, the actual risk of micronutrient deficiency in vegetarian children is relatively difficult to assert based on the limitations of evidence due to the lack of well-designed studies. The risk of vitamin B12 deficiency must be considered in newborns from vegan or macrobiotic mothers and children with the most restrictive diet, as well as the risk of iron, zinc, and iodine deficiency, possibly by performing the appropriate tests. A lacto-ovo-vegetarian diet exposes a low risk if it uses a very varied diet with a sufficient intake of dairy products. Vegan and macrobiotic diets should be avoided during pregnancy and childhood. There is a need for education and nutrition guidance and the need for supplementation should be assessed individually.

Application of a New Carbohydrate Food Quality Scoring System: An Expert Panel Report

Carbohydrate foods (≥40% energy from carbohydrates) are the main source of energy in the US diet. In contrast to national-level dietary guidance, many regularly consumed carbohydrate foods are low in fiber and whole grains but high in added sugar, sodium, and/or saturated fat. Given the important contribution of higher-quality carbohydrate foods to affordable healthy diets, new metrics are needed to convey the concept of carbohydrate quality to policymakers, food industry stakeholders, health professionals, and consumers. The recently developed Carbohydrate Food Quality Scoring System is well aligned with multiple key healthy messages on nutrients of public health concern from the 2020-2025 Dietary Guidelines for Americans. Two models are described in a previously published paper: one for all non-grain carbohydrate-rich foods (e.g., fruits, vegetables, legumes) known as the Carbohydrate Food Quality Score-4 (CFQS-4), and one for grain foods only known as the Carbohydrate Food Quality Score-5 (CFQS-5). These CFQS models provide a new tool that can guide policy, programs, and people towards improved carbohydrate food choices. Specifically, the CFQS models represent a way to unify and reconcile diverse ways to describe different types of carbohydrate-rich foods (e.g., refined vs. whole, starchy vs. non-starchy, dark green vs. red/orange) and make for more useful and informative messaging that better aligns with a food's nutritional and/or health contributions. The present paper's aims are to show that the CFQS models can inform future dietary guidelines and help support carbohydrate food recommendations with other health messages aimed at promoting foods that are nutrient-dense, fiber-rich, and low in added sugar.

Nutritionally adequate and environmentally respectful diets are possible for different diet groups: an optimized study from the NutriNet-Santé cohort

BACKGROUND

Research has shown that vegetarian diets have a low environmental impact, but few studies have examined the environmental impacts and nutritional adequacy of these diets together, even though vegetarian diets can lead to nutritional issues.

OBJECTIVES

Our objective was to optimize and compare 6 types of diets with varying degrees of plant foods (lacto-, ovolacto-, and pescovegetarian diets and diets with low, medium, and high meat content) under nutritional constraints.

METHODS

Consumption data in 30,000 participants were derived from the French NutriNet-Santé cohort using an FFQ. Diets were optimized by a nonlinear algorithm minimizing the diet deviation while meeting multiple constraints at both the individual and population levels: nonincrease of the cost and environmental impacts (as partial ReCiPe accounting for greenhouse gas emissions, cumulative energy demand, and land occupation, distinguishing production methods: organic and conventional), under epidemiologic, nutritional (based on nutrient reference values), and acceptability (according to the diet type) constraints.

RESULTS

Optimized diets were successfully identified for each diet type, except that it was impossible to meet the EPA (20:5n-3) + DHA (22:6n-3) requirements in lacto- and ovolactovegetarians. In all cases, meat consumption was redistributed or reduced and the consumption of legumes (including soy-based products), whole grains, and vegetables were increased, whereas some food groups, such as potatoes, fruit juices, and alcoholic beverages, were entirely removed from the diets. The lower environmental impacts (as well as individual indicators) observed for vegetarians could be attained even when nutritional references were reached except for long-chain n-3 (omega-3) fatty acids.

CONCLUSIONS

A low-meat diet could be considered as a target for the general population in the context of sustainable transitions, although all diets tested can be overall nutritionally adequate (except for n-3 fatty acids) when planned appropriately.This trial was registered at clinicaltrials.gov as NCT03335644.

Recognizing the importance of protein quality in an era of food systems transformation

A transformation of current food systems is needed to nourish the growing global population in more sustainable ways. To support this, some are advocating for a shift to plant-based or -exclusive diets. These recommendations – typically borne out of concerns for the environment – often fail to account for unintended nutritional consequences, which could be particularly pronounced for protein intake. While there is enough protein to meet current global needs, the issue of protein quality is often overlooked and oversimplified. High-quality protein, including from animal source foods (ASF), is needed to meet nutritional demands in low- and middle-income countries (LMIC), particularly among vulnerable population groups. In high-income countries (HIC), protein quality is important for at-risk populations who have higher protein requirements and lower energy and/or protein intakes. Further, as the global population increases, driven primarily by population growth in LMIC, it is possible that protein production will need to increase in HIC to support exports to help feed the global population. The global dialogue and resulting dietary recommendations must therefore become more nuanced to consider the interaction between nutritional value and environmental impact to help better reflect trade-offs across multiple domains of sustainability. Nutritional life cycle assessments are one way to help accomplish this nuance and evaluate how all types of food production systems should be refocused to improve their environmental efficiency and nutritional impact.

A New Carbohydrate Food Quality Scoring System to Reflect Dietary Guidelines: An Expert Panel Report

Existing metrics of carbohydrate food quality have been based, for the most part, on favorable fiber- and free sugar-to-carbohydrate ratios. In these metrics, higher nutritional quality carbohydrate foods are defined as those with >10% fiber and <10% free sugar per 100 g carbohydrate. Although fiber- and sugar-based metrics may help to differentiate the nutritional quality of various types of grain products, they may not aptly capture the nutritional quality of other healthy carbohydrate foods, including beans, legumes, vegetables, and fruits. Carbohydrate food quality metrics need to be applicable across these diverse food groups. This report introduces a new carbohydrate food scoring system known as a Carbohydrate Food Quality Score (CFQS), which supplements the fiber and free sugar components of previous metrics with additional dietary components of public health concern (e.g., sodium, potassium, and whole grains) as identified by the Dietary Guidelines for Americans. Two CFQS models are developed and tested in this study: one that includes four dietary components (CFQS-4: fiber, free sugars, sodium, potassium) and one that considers five dietary components (CFQS-5: fiber, free sugars, sodium, potassium, and whole grains). These models are applied to 2596 carbohydrate foods in the Food and Nutrient Database for Dietary Studies (FNDDS) 2017−2018. Consistent with past studies, the new carbohydrate food scoring system places large percentages of beans, vegetables, and fruits among the top scoring carbohydrate foods. The whole grain component, which only applies to grain foods (N = 1561), identifies ready-to-eat cereals, oatmeal, other cooked cereals, and selected whole grain breads and crackers as higher-quality carbohydrate foods. The new carbohydrate food scoring system shows a high correlation with the Nutrient Rich Food (NRF9.3) index and the Nutri-Score. Metrics of carbohydrate food quality that incorporate whole grains, potassium, and sodium, in addition to sugar and fiber, are strategically aligned with multiple 2020−2025 dietary recommendations and may therefore help with the implementation of present and future dietary guidelines.

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.

Food Systems Transformation for Child Health and Well-Being: The Essential Role of Dairy

Malnutrition, in all its forms, during the critical stages of child growth and development can have lifelong impacts on health and well-being. While most forms of malnutrition can be prevented with simple dietary interventions, both undernutrition and overnutrition remain persistent and burdensome challenges for large portions of the global population, especially for young children who are dependent on others for nourishment. In addition to dietary factors, children's health also faces the growing challenges of climate change, environmental degradation, pollution, and infectious disease. Food production and consumption practices both sit at the nexus of these issues, and both must be significantly transformed if we are to achieve the 2030 Sustainable Development Goals. Food sources (i.e., animal-source foods vs. plant-source foods), food production practices, the effects of food processing, the impacts of a more globalized food system, and food loss and waste have all been receiving growing attention in health and sustainability research and policy discussions. Much of this work points to recommendations to reduce resource-intensive animal-source foods, heavily processed foods, and foods associated with excessive waste and pollution, while simultaneously increasing plant-source options. However, some of these recommendations require a little more nuance when considered in the context of issues such as global child health. All types of foods can play significant roles in providing essential nutrition for children across the globe, and for improving the well-being and livelihoods of their families and communities. Dairy foods provide a prime example of this need for nuance, as both dairy production practices and consumption patterns vary greatly throughout the world, as do their impacts on child health and food system sustainability. The objective of this narrative review is to highlight the role of dairy in supporting child health in the context of food system sustainability. When considering child health within this context it is recommended to take a holistic approach that considers all four domains of sustainability (health, economics, society, and the environment) to better weigh trade-offs, optimize outcomes, and avoid unintended consequences. To ensure that children have access to nutritious and safe foods within sustainable food systems, special consideration of their needs must be included within the broader food systems transformation narrative.