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Harrison L, Herrmann A, Quitmann C, Stieglbauer G, Zeitz C, Franke B, Danquah I. Effects of a cafeteria-based sustainable diet intervention on the adherence to the EAT-Lancet planetary health diet and greenhouse gas emissions of consumers: a quasi-experimental study at a large German hospital. Nutr J 2024; 23:80. [PMID: 39026215 PMCID: PMC11256364 DOI: 10.1186/s12937-024-00981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Sustainable diets contribute to improving human health and reducing food-related greenhouse gas emissions (GHGE). Here, we established the effects of a facility-based sustainable diet intervention on the adherence to the EAT-Lancet Planetary Health Diet and GHGE of consumers. METHODS In this quasi-experiment, vegan menus and educational material on sustainable diets were provided in the largest cafeteria of a German hospital for 3 months. Regular customers (> 1/week) in this cafeteria (intervention group) and in all other hospital cafeterias (control group) completed a questionnaire about their sociodemographic and dietary characteristics before and after the intervention period. We calculated difference-in-differences (DID), their 95% confidence intervals (CIs), and p-values for the adherence to the EAT-Lancet Planetary Health Diet Index (PHDI; 0-42 score points) and food-related GHGE. The protocol was registered at the German Clinical Trial Register (reference: DRKS00032620). FINDINGS In this study population (N = 190; age range: 18-79 years; women: 67%; highest level of formal education: 63%), the mean baseline PHDI (25·1 ± 4·8 vs. 24·7 ± 5·8 points) and the mean baseline GHGE (3·3 ± 0·8 vs. 3·3 ± 0·7 kg CO2-eq./d) were similar between the intervention (n = 92) and the control group (n = 98). The PHDI increase was 0·6 points (95% CI: -0·4, + 1·6) higher in the intervention group than in the control group. This trend was stronger among frequent consumers of the vegan menu than among rare and never consumers. No between-group difference was seen for GHGE changes (DID: 0·0; 95% CI: -0·2, + 0·1 kg CO2-eq./d). INTERPRETATION Pending verification in a longer-term project and a larger sample, this quasi-experiment in a big hospital in Germany suggests that offering vegan menus and information material in the cafeteria enhances the adherence to healthy and environmentally friendly diets among regular customers. These findings argue for making sustainable food choices the default option and for improving nutrition literacy. FUNDING Federal Ministry of Economic Affairs and Climate Action (BMWK), Else-Kröner-Fresenius Foundation (EKFS), Robert-Bosch Foundation (RBS).
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Affiliation(s)
- Laura Harrison
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany.
| | - Alina Herrmann
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
| | - Claudia Quitmann
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
| | - Gabriele Stieglbauer
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
| | - Christin Zeitz
- Ifeu - Institut Für Energie- Und Umweltforschung Heidelberg gGmbH, Wilckensstr. 3, Heidelberg, 69120, Germany
| | - Bernd Franke
- Ifeu - Institut Für Energie- Und Umweltforschung Heidelberg gGmbH, Wilckensstr. 3, Heidelberg, 69120, Germany
| | - Ina Danquah
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
- Hertz-Chair Innovation for Planetary Health, Center for Development Research (ZEF), University of Bonn, Genscherallee 3, Bonn, 53113, Germany
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Kokkinopoulou A, Katsiki N, Pagkalos I, Rodopaios NE, Koulouri AA, Vasara E, Papadopoulou SK, Skepastianos P, Hassapidou M, Kafatos AG. Consumption of Ultra-Processed Food and Drink Products in a Greek Christian Orthodox Church Fasting Population. Nutrients 2023; 15:4907. [PMID: 38068765 PMCID: PMC10708049 DOI: 10.3390/nu15234907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
The positive effects of the Mediterranean diet on healthy living are widely known, while the health effects of religious fasting have received increased attention during the last decade. However, no study has focused on the consumption of ultra-processed foods (UPFs) in such populations. Therefore, our aim was to investigate UPF intake and its association with metabolic syndrome (MetS) in a Christian Orthodox church (COC) religious fasting population in Greece. In this cross-sectional study, 400 individuals who follow the Mediterranean diet were included, stratified as COC fasters and non-fasters. Dietary intake data were collected via three 24 h diet recalls and a monthly food frequency questionnaire (FFQ). The NOVA food classification system was used to identify the level of processing and categorize all food items. Fasters consumed significantly less chicken, turkey, and beef and significantly more seafood, fish, snails, soy products, and fresh fruits, in terms of unprocessed or minimally processed foods, as well as significantly more fried potatoes and olives in terms of processed foods when compared with non-fasters. Regarding UPFs, a significantly lower intake of pork sausages, ketchup, and mustard as well as a significantly higher consumption of margarine and tarama dip were recorded in fasters compared with non-fasters. Fasters with MetS more frequently consumed UPFs (such as cheese pastries, biscuits, and cakes) than fasters without MetS (p < 0.05 for all comparisons). Similarly, non-fasters with MetS had an increased intake of UPFs (such as Cypriot bread and Coco Pops breakfast cereals) than non-fasters without MetS. Future research should focus on UPF consumption and its associations with clinical outcomes in such populations, thus providing further data for the potential health effects of COC fasting.
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Affiliation(s)
- Anna Kokkinopoulou
- Department of Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, 70013 Crete, Greece (A.G.K.)
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece (I.P.); (S.K.P.)
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece (I.P.); (S.K.P.)
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | - Ioannis Pagkalos
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece (I.P.); (S.K.P.)
| | - Nikolaos E. Rodopaios
- Department of Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, 70013 Crete, Greece (A.G.K.)
| | - Alexandra-Aikaterini Koulouri
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece (I.P.); (S.K.P.)
| | - Eleni Vasara
- Laboratory of Animal Physiology, Department of Zoology, School of Biology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece (I.P.); (S.K.P.)
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, International Hellenic University, 57400 Thessaloniki, Greece
| | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece (I.P.); (S.K.P.)
| | - Anthony G. Kafatos
- Department of Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, 70013 Crete, Greece (A.G.K.)
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Kokkinopoulou A, Katsiki N, Pagkalos I, Rodopaios NE, Koulouri AA, Vasara E, Papadopoulou SK, Skepastianos P, Hassapidou M, Kafatos AG. Association between Dietary Patterns and Metabolic Syndrome Risk Factors: A Cross-Sectional Study of Christian Orthodox Church Fasters and Non-Fasters in Greece. Foods 2023; 12:3488. [PMID: 37761196 PMCID: PMC10527694 DOI: 10.3390/foods12183488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
It is well known that the Mediterranean diet contributes to healthy living, prevention of non-communicable diseases, and longevity. A cross-sectional study was conducted with participants from Greece who follow the Mediterranean diet and were further divided into two categories: (i) Christian Orthodox Church (COC) religious fasters and (ii) non-fasters. Four-hundred individuals underwent anthropometric measurements, whereas information regarding dietary intake was collected via three 24 h diet recalls and a monthly food frequency questionnaire. Principal component analysis was performed to derive dietary patterns, whereas associations between dietary patterns and metabolic syndrome (MetS) risk factors were investigated with the general linear model. Non-fasters (n = 200) were found to consume significantly more beef, chicken, turkey, sausage, broth, fried potatoes, ketchup, and mustard, while consuming less seafood, snails, soya, tarama salads, fresh fruits, margarine, olives, and decaf coffee. Two distinct dietary patterns were identified in fasters: (i) the "Mixed Diet" and (ii) the "Plant-based/Fasting Diet" pattern. Moreover, three patterns were identified in non-fasters, and were identified as follows: (i) the "Western Diet", (ii) the "Mixed Diet", and (iii) the "Mediterranean-like Diet" pattern. No significant association was observed between dietary patterns and the prevalence of MetS in our population. Further epidemiological studies should evaluate the links between dietary patterns and MetS prevalence within the adult Greek population.
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Affiliation(s)
- Anna Kokkinopoulou
- Department of Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, 71003 Crete, Greece
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | - Ioannis Pagkalos
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Nikolaos E. Rodopaios
- Department of Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, 71003 Crete, Greece
| | | | - Eleni Vasara
- Laboratory of Animal Physiology, Department of Zoology, School of Biology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, International Hellenic University, 57400 Thessaloniki, Greece
| | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Anthony G. Kafatos
- Department of Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, 71003 Crete, Greece
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Vassilopoulou E. Special Issue "Sustainable Nutrition-Healthy People". Nutrients 2023; 15:3199. [PMID: 37513617 PMCID: PMC10383661 DOI: 10.3390/nu15143199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Food security is defined as the situation in which all people have access to their preferred food, [...].
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Affiliation(s)
- Emilia Vassilopoulou
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
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