The Alignment of Recommendations of Dietary Guidelines with Sustainability Aspects: Lessons Learned from Italy's Example and Proposals for Future Development

Environmental and Health Sustainability of the Mediterranean Diet: A Systematic

The Mediterranean diet (MD) has been shown to be a healthy dietary pattern (DP), and lately it is increasingly being studied as a sustainable DP. The aim of this study is to analyze whether the MD is a sustainable and healthy DP accounting for its carbon footprint, water footprint (WF), land use (LU), and/or energy use, based on the existing scientific literature. We conducted a systematic review following PRISMA guidelines and registered in PROSPERO (CRD42022309916). We included 35 studies: 25 modeling studies, seven cross-sectional and three longitudinal. Twenty-four studies compared the sustainability of the MD with that of other dietary patterns; 21 assessed the sustainability of the MD versus dietary consumption data; and nine evaluated the MD's adherence and its environmental impacts. A total of 29 studies analyzed the carbon footprint, 11 the LU, 20 the WF, and seven the energy use of the MD. Six articles assessed the health aspect of the diet apart from the environmental impact. The MD showed high nutritional quality, ranging between 122 and 178 points on the health score and between 13.51 and 90.6 points on the nutrient-rich food index. Using the results for environmental footprints in the same measurement units, we were able to quantitatively compare the most frequently assessed diets with MD. When compared with other diets, 91% of the studies referred to the MD as a sustainable DP, and most of the articles in which its adherence was assessed obtained an inverse correlation with the environmental footprints. Environmental footprints of the MD ranged from 1.03-5.08 kg CO2-eq/person-day for greenhouse gas emissions (GHGE), 257.2-2735.2 l/person-day for WF, and 4-14.8 m2/person-day and 2.85-3.32 m2*year/day for LU. In summary, the available evidence suggests that, in general, the MD is a sustainable and healthy DP, which aligns with planetary health.

What should I eat today? Evidence, guidelines, dietary patterns and consumer's behavior

Over the past century, dietary recommendations emphasizing food patterns as means to deliver essential nutrients have garnered widespread acceptance. The necessity for foods supplying vital nutrients and energy throughout various life stages requires the involvement of local resources and cultural practices to prevent nutrient deficiency diseases. Since the 1980s, dietary guidelines aimed at adverting chronic diseases have relied on epidemiological research to predict which dietary patterns correlate with reduced risk of chronic disease or links to health outcomes. Dietary guidelines have been broad, typically recommending avoiding excess or deficiency of single nutrients. Efforts to fine-tune these recommendations face challenges due to a scarcity of robust scientific data supporting more specific guidance across the life cycle. Consumers have become skeptical of dietary guidelines, because media coverage of new studies is often in conflict with accepted nutrition dogma. Indications to align individual and planet's health have been issued supporting the concept of sustainable dietary patterns. Whether we really have a science-based databank to support dietary guidelines is still a matter of ongoing debate, as presented in this paper.

Nexus of food waste and climate change framework: Unravelling the links between impacts, projections, and emissions

This communication explores the intricate relationship between food waste and climate change, considering aspects such as impacts, projections, and emissions. It focuses on the pressing issue of waste generation and its potential consequences if current trends persist, and emphasises the importance of efficient solid waste management in improving environmental quality and fostering economic development. It also highlights the challenges faced by developing countries in waste collection and disposal, drawing comparisons with the waste utilisation methods used by developed nations. The review delves into the link between food waste and climate change, noting the paradoxical situation of food wastage against the backdrop of global hunger and malnutrition. It underscores the scientific evidence connecting food waste to climate change and its implications for food security and climate systems. Additionally, it examines the environmental burden imposed by food waste, including its contribution to greenhouse gas emissions and the depletion of resources such as energy, water, and land. Besides environmental concerns, this communication also highlights the ethical and socioeconomic dimensions of food waste, discussing its influence on Sustainable Development Goals, poverty, and social inequality. The communication concludes by advocating for collective action and the development of successful mitigation strategies, technological solutions, and policy interventions to address food waste and its climate impacts. It emphasises the need for collaboration, awareness, and informed decision-making to ensure a more sustainable and equitable future.

Adherence to Mediterranean Diet and its main determinants in a sample of Italian adults: results from the ARIANNA cross-sectional survey

Introduction

Over the last years, many Mediterranean countries, including Italy, have witnessed a shift away from the Mediterranean Diet, thus contributing to the high rates of overweight and obesity. The survey "Adherence to Mediterranean Diet in Italy (ARIANNA)" aimed to evaluate the Adherence to Mediterranean Diet (AMD) and its main determinants in the Italian population.

Materials and methods

This study started on March 2023 and was addressed to adults aged ≥17 years, born and resident in Italy, proficient in Italian. Data are collected electronically through a voluntary, anonymous and self-administered questionnaire on the project website. Univariate and then multivariate logistic regressions were performed to evaluate associations between AMD and demographic characteristics, socio-economic status, health status, and lifestyle.

Results

On a total of 3,732 completed questionnaires, the 87.70% of the respondents was female and the 71.28% was 17-40 years old. The 83.82% of the respondents had medium AMD, 11.33% low and only 4.85% high. The multivariate analysis revealed that being male (p < 0.001), aged >40 years (p < 0.05), workers (p ≤ 0.001), and unemployed (p < 0.05), determined the probability of having a lower AMD. Vegans and vegetarian's diets positively contributed to a higher AMD (p < 0.001).

Discussion

These results highlighted a medium AMD in the Italian adult participants and suggested the necessity to implement tailored public health intervention strategies to improve food habits.

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.

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

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

How Much Do Front-Of-Pack Labels Correlate with Food Environmental Impacts?

Nutrient profiling and front-of-pack labeling (FOPL) have been developed to categorize food products as more or less healthy based on their nutrient content and to easily communicate this information to consumers. The goal is to change individual food choices toward a healthier diet. Since global climate change has recently become an urgent matter, this paper also aims to investigate the correlations between different food health scales, including some FOPLs currently adopted by one or more countries, and several sustainability indicators. For this purpose, a food sustainability composite index has been developed to summarize environmental indicators and compare food scales. Results indicate, as expected, that well-known healthy and sustainable diets are strongly correlated with both environmental indicators and the composite index, while FOPLs based on portions or on 100 g show moderate and weak correlation values, respectively. Within-category analysis has not found any associations that explain these results. Hence, 100 g standard, on which FOPLs are usually developed, seems not to be the ideal basis for developing a label that aspires to communicate healthiness and sustainability in a unique format, as required by the need for simple messaging. On the contrary, FOPLs based on portions appear to be more likely to achieve this goal.