Nutritional Sustainability: Aligning Priorities in Nutrition and Public Health with Agricultural Production

The MED_EAT-IT approach: A modelling study to develop feasible, sustainable and nutritionally targeted dietary patterns based on the Planetary health diet

In 2019, the EAT-Lancet Commission introduced the Planetary Health Diet (PHD), a guide for creating 2500 kcal/day country-specific sustainable diets that promote health while reducing the environmental impact associated with food systems. The PHD was previously adapted to the Italian food context, resulting in the EAT-IT dietary pattern. However, this adaptation revealed several challenges in terms of nutritional adequacy, feasibility, and environmental impact. This study reports on strategies to improve the previous pattern and align it more closely with the Mediterranean Diet, resulting in the MED_EAT-IT pattern. The study also explores feasible strategies for adapting this pattern to different energy targets, enhancing its scalability and promoting personalized approaches. For the optimization of this pattern, a specific calculation tool was developed to introduce variation to the pattern, considering realistic and feasible serving sizes and frequency of consumption. This tool integrates a defined food ontology, food composition data, and two environmental impact metrics (Carbon and Water Footprint). To optimize nutritional adequacy, several adaptations of the amount within the different food groups were made, for instance by increasing cereals and animal source by 25.5% kcal/day and 36.2% kcal/day respectively compared to EAT-IT. The resulting 2500 kcal/die pattern meets all nutritional requirements except for vitamin D and does not hamper the possibility to limit environmental impact (Carbon Footprint increased only by 12.2% but Water Footprint decreased by 6.3%). Lower energy targets were achieved by modulating amounts of the different food groups to ensure nutritional adequacy. The strategies and tools proposed here could aid in optimizing dietary plans, evaluating their potential for environmental impact reduction, and identifying issues that could hinder their adoption. Furthermore, the analyses carried out pave the way for the potential future development of new or improved foods that may contribute to the optimization of nutritional and environmental impact of diets.

Canadian farmers' perceptions of social sustainability in agriculture

Sustainable food production is an important part of dietetic education and training; however, the focus in the dietetic sphere is often on the environmental aspect. Understanding the multi-dimensional nature of sustainability can enhance dietetic students' sustainability competences-such as empathy and change of perspective, systems thinking, and critical thinking and analysis-to help them in their future careers and strengthen their position in society as trusted and knowledgeable food and nutrition professionals. Enhancing public understanding of sustainable food production is imperative as populations become more urban, are less connected to agriculture, and have expectations for sustainably grown/raised food, often without knowing current food production practices or the multiple aspects of sustainability that must be in place for farmers to meet those demands. The goal of this research was to understand Canadian farmers' perceptions of environmental, economic, and social aspects of sustainable food production. Employing a descriptive qualitative approach and constant comparative analysis, four food and nutrition researchers analyzed interviews from 52 farmers from across Canada. Participants had to be English-speaking, produce food through farming on land, and own or rent the land on which they farm. Telephone/video interviews revealed five overarching social themes: (1) the importance of community and social capital, (2) public perception and social license to operate, (3) lack of infrastructure, and (4) deep connections to personal lives. The final theme, mental health issues (5), reflected the consequences of the multiple sources of stress that can undermine the social sustainability of farmers, farm communities, and food production. These findings may help various audiences appreciate the multiple dimensions of sustainable food production; reflect on their values, perceptions, and actions with regard to agriculture; and enhance their compassion and empathy for all farmers.

The Importance of Philanthropy Foundation for the Future Sustainability of Agriculture and Nutrition: An Opinion Study on Practical Applications, Policies, and Strategies

Food security, food sustainability, and malnutrition represent critical global challenges. Th urgency of comprehensive action is evident in the need for research collaboration between the food industry, agriculture, public health, and nutrition. This article highlights the role of philanthropy, of a non-profit organization, in supporting research and development and filling financial gaps. The article also explores the interplay of nutrition, agriculture, and government and policy, positioning philanthropy as a catalyst for transformative change and advocating for collaborative efforts to comprehensively address global food challenges. In addition, the discussion also underscores the ethical complexities surrounding charitable food aid, especially in terms of the dignity and autonomy of its recipients. The paper concludes by proposing future directions and implications, advocating for diversified intervention portfolios and collaborative efforts involving governments, businesses, and local communities. Apart from that, the importance of answering and alleviating ethical dilemmas related to food charity assistance needs to be a concern for future studies related to philanthropy because of the significant challenges faced by the contemporary food system, which include food security, health, and nutritional sustainability.

Consideration of nutrition and sustainability in public definitions of 'healthy' food: an analysis of submissions to the US FDA

OBJECTIVE

To better understand how the public defines 'healthy' foods and to determine whether the public considers sustainability, implicitly and explicitly, in the context of healthy eating.

DESIGN

We conducted a content analysis of public comments submitted to the US FDA in 2016 and 2017 in response to an invitation for feedback on use of the term 'healthy' on food labels. The analysis explored the ways in which commenters' definitions of 'healthy' aligned with the 2015-2020 Dietary Guidelines for Americans and whether their definitions considered sustainability.

SETTING

The US Government's Regulations.gov website.

PARTICIPANTS

All 1125 unique comments from individuals and organisations.

RESULTS

Commenters' definitions of 'healthy' generally mirrored the recommendations that the Dietary Guidelines for Americans put forth to promote a 'healthy eating pattern'. Commenters emphasised the healthfulness of fruit, vegetables, whole grains, fish and other minimally processed foods and the need to limit added sugars, sodium, saturated and trans fats and other ingredients sometimes added during processing. One-third of comments (n 374) incorporated at least one dimension of sustainability, mainly the environmental dimension. Commenters who mentioned environmental considerations primarily expressed concerns about synthetic chemicals and genetic modification. Less than 20 % of comments discussed social or economic dimensions of sustainability, and less than 3 % of comments (n 30) used the word 'sustainability' explicitly.

CONCLUSIONS

This novel analysis provides new information about the public's perceptions of 'healthy' foods relative to nutrition and sustainability considerations. The findings can be used to advance policy discussions regarding nutrition labelling and guidance.

"We are stewards and caretakers of the land, not exploiters of resources": A qualitative study exploring Canadian farmers' perceptions of environmental sustainability in agriculture

Environmental sustainability in agriculture is a key component of discussions to address the current climate crisis; unfortunately, many people (including researchers) presume that only certain types of agriculture (e.g., organic, local) are environmentally sustainable. Non-farmers also fail to acknowledge that many farm practices, including grazing animals, mitigate climate change. Farmers' perceptions about environmental sustainability are important because their livelihoods, and those of future generations, depend on their commitment to sustainable environmental practices. The purpose of this qualitative research was to understand Canadian farmers' perceptions of environmental sustainability, how they are implementing strategies that contribute to sustainable food production, and the challenges they face. Fifty-two farmers, representing 48 farms and over 1000 years of farming experience, participated in comprehensive in-depth interviews. Four farms were in British Columbia; 13 in the Prairies; 26 in Central Canada; and five in Eastern Canada. A wide variety of farm types (e.g., fruit/vegetables, livestock, grains) and sizes (2 to 6500 acres) were included in the study. Farmers' perceptions of environmental sustainability coalesced into four main themes: (1) definitions of sustainability and environmental sustainability, (2) current practices, (3) farming as an identity, and (4) challenges. Many participants explained that they already use sustainable practices and technology, contrary to prevailing opinion that entire food systems need to be transformed to be sustainable. As new agricultural policies and educational curricula are developed, information provided to students, policy makers, and the public must be accurate, balanced, evidence-based, and respectfully consider all perspectives, especially those of farmers.

Improving Food Systems: A Participatory Consultation Exercise to Determine Priority Research and Action Areas in Viet Nam

With increased burden of malnutrition on global health, there is a need to set clear and transparent priorities for action in food systems at a global and local level. While priority settings methods are available for several adjacent domains, such as nutrition and health policies, setting priorities for food system research has not been documented and streamlined. The challenges involve food systems' multisector, multi-stakeholder and multi-outcome nature. Where data exists, it is not easy to aggregate data from across food system dimensions and stakeholders to make an informed analysis of the overall picture of the food system, as well as current and potential food system trade-offs to inform research and policy. Once research priorities are set, they risk staying on paper and never make their ways to concrete outputs and outcomes. In this paper, we documented and assessed the inclusive process of setting research priorities for a local food system, taking Vietnamese food systems as a case study. From this exercise, we examined how priority setting for food systems research could learn from and improve upon earlier priority setting research practices in other domains. We discussed the lessons for research and policies in local food systems, such as the need for a concrete follow-up plan accompanying the priority setting process.

Data Integration for Diet Sustainability Analyses

Diet sustainability analyses are stronger when they incorporate multiple food systems domains, disciplines, scales, and time/space dimensions into a common modeling framework. Few analyses do this well: there are large gaps in food systems data in many regions, accessing private and some public data can be difficult, and there are analytical challenges, such as creating linkages across datasets and using complex analytical methods. This article summarizes key data sources across multiple domains of food system sustainability (nutrition, economic, environment) and describes methods and tools for integrating them into a common analytic framework. Our focus is the United States because of the large number of publicly available and highly disaggregated datasets. Thematically, we focus on linkages that exist between environmental and economic datasets to nutrition, which can be used to estimate the cost and agricultural resource use of food waste, interrelationships between healthy eating and climate impacts, diets optimized for cost, nutrition, and environmental impacts, and others. The limitations of these approaches and data sources are described next. By enhancing data integration across these fields, researchers can be better equipped to promote policy for sustainable diets.

Sustainable Agri-Food Systems: Environment, Economy, Society, and Policy

Agri-food systems (AFS) have been central in the debate on sustainable development. Despite this growing interest in AFS, comprehensive analyses of the scholarly literature are hard to find. Therefore, the present systematic review delineated the contours of this growing research strand and analyzed how it relates to sustainability. A search performed on the Web of Science in January 2020 yielded 1389 documents, and 1289 were selected and underwent bibliometric and topical analyses. The topical analysis was informed by the SAFA (Sustainability Assessment of Food and Agriculture systems) approach of FAO and structured along four dimensions viz. environment, economy, society and culture, and policy and governance. The review shows an increasing interest in AFS with an exponential increase in publications number. However, the study field is north-biased and dominated by researchers and organizations from developed countries. Moreover, the analysis suggests that while environmental aspects are sufficiently addressed, social, economic, and political ones are generally overlooked. The paper ends by providing directions for future research and listing some topics to be integrated into a comprehensive, multidisciplinary agenda addressing the multifaceted (un)sustainability of AFS. It makes the case for adopting a holistic, 4-P (planet, people, profit, policy) approach in agri-food system studies.

Talking about Sustainability: How the Media Construct the Public’s Understanding of Sustainable Food in Romania

Decades of medical research have focused on analysing the effects of sustainable eating on health and well-being; yet, less attention has been devoted to this subject in communication and media studies research. Recently, however, scholarly attention has shifted towards the way sustainable food is covered in the media. Nevertheless, previous studies analyse sustainable food together with other sustainability challenges, such as climate change. In this article, we focus our attention on analysing media reporting of sustainable food. Relying theoretically on the framing analysis approach coupled with Goody’s five-phase analytical framework in building sustainable food-related behaviours (production, distribution, preparation, consumption and disposal) and by applying the rationale of content analysis, this article examines media coverage of sustainable food with a focus on sustainable food production, distribution, preparation, consumption and disposal. Therefore, the article identifies trends and patterns of media coverage of sustainable food in Romania between 2014 and 2017. Interesting results emerge, showing that Romanian journalists reporting on food-related topics do not have a solid understanding of the field and contribute to the spread of inaccurate information often, resulting from insufficient research or inadequate use of sources. As a result of the lack of in-depth knowledge of those involved in writing about food, the media coverage of sustainable food is strictly reduced to reporting on aspects related to the consumption of fresh fruit and vegetables, framed as the only healthy foods, and recommended diets for specific underlying health conditions (such as obesity, diabetes, hypertension and associated diseases).

Identifying the links between consumer food waste, nutrition, and environmental sustainability: a narrative review

Emerging research demonstrates unexpected relationships between food waste, nutrition, and environmental sustainability that should be considered when developing waste reduction strategies. In this narrative review, we synthesize these linkages and the evidence related to drivers of food waste and reduction strategies at the consumer level in the United States. Higher diet quality is associated with greater food waste, which results in significant quantities of wasted resources (e.g., energy, fertilizer) and greenhouse gas emissions. Food waste also represents waste of micronutrients that could otherwise theoretically fill nutritional gaps for millions of people. To make progress on these multiple fronts simultaneously, nutrition professionals must expand beyond their traditional purview, into more interdisciplinary arenas that make connections with food waste and environmental sustainability.

Nutritional quality and health risk of pepper fruit as affected by magnesium fertilization

BACKGROUND

Magnesium (Mg) fertilization is a promising practice to improve vegetable yield. However, its impacts on vegetable quality and human health have not been examined. Thus, a field experiment was conducted to investigate the effects of varying Mg fertilization rates on yield and quality of pepper (Capsicum annuum L.) fruit. Furthermore, result of the field experiment was linked to pepper consumption data from the China Health and Nutrition Survey (CHNS) in the disability-adjusted life years (DALYs) framework to evaluate the potential health impact of Mg fertilization for the first time.

RESULTS

Compared to control, Mg fertilization increased the 2-year average pepper yield by 25.6%, whereas there was no significant yield improvement when Mg rates exceeded 112.5 kg MgO ha^-1 . Magnesium application increased concentrations of Mg and capsaicinoids, decreased those of calcium (Ca), zinc (Zn) and vitamin C (Vc), and had no effect on potassium (K) and iron (Fe) in pepper fruit. As a result, Mg fertilization decreased the comprehensive nutrition level of pepper by 16.6%. Furthermore, the current health burden of the Chinese adult population associated with pepper consumption is estimated at 21.3 million DALYs per year, with the risk being increased by 5.40 DALYs for per megagram of Mg fertilizer application. Increasing health risk was mainly attributed to decreasing concentrations of Ca and Vc in pepper fruit, though the increased Mg intakes offset the impact of 1.74% to 14.4%.

CONCLUSION

Magnesium fertilization significantly improved the yield but reduced nutritional quality of pepper fruit, and increased human health risks associated with consumption of pepper fruit. © 2020 Society of Chemical Industry.

Selenium and Nano-Selenium Biofortification for Human Health: Opportunities and Challenges

Selenium is an essential micronutrient required for the health of humans and lower plants, but its importance for higher plants is still being investigated. The biological functions of Se related to human health revolve around its presence in 25 known selenoproteins (e.g., selenocysteine or the 21st amino acid). Humans may receive their required Se through plant uptake of soil Se, foods enriched in Se, or Se dietary supplements. Selenium nanoparticles (Se-NPs) have been applied to biofortified foods and feeds. Due to low toxicity and high efficiency, Se-NPs are used in applications such as cancer therapy and nano-medicines. Selenium and nano-selenium may be able to support and enhance the productivity of cultivated plants and animals under stressful conditions because they are antimicrobial and anti-carcinogenic agents, with antioxidant capacity and immune-modulatory efficacy. Thus, nano-selenium could be inserted in the feeds of fish and livestock to improvise stress resilience and productivity. This review offers new insights in Se and Se-NPs biofortification for edible plants and farm animals under stressful environments. Further, extensive research on Se-NPs is required to identify possible adverse effects on humans and their cytotoxicity.

Toward Healthy Diets from Sustainable Food Systems

This article is based on a session at ASN 2019 entitled "Addressing the Four Domains of Sustainable Food Systems Science (Health, Economics, Society and the Environment): What Will It Take to Harmonize the Evidence to Advance the Field?" A summary of presentations is included. The presentations addressed the 4 principal domains of sustainability defined as nutrition/health, economics, environment, and society and the ways in which they are represented in current research. The session also introduced metrics and measures that are specific to each domain. Participants discussed next steps to move toward consensus and collaboration among scientific communities, especially those of health/nutrition science and environmental science. Food systems may need to be restructured to ensure that the global food supply provides adequate calories and nutrients at an affordable cost. Finally, the session addressed strategies to implement research concepts and move toward policies that encourage consumers to choose healthy diets from sustainable food systems.

A View to the Future: Opportunities and Challenges for Food and Nutrition Sustainability

The challenges to achieving sustainability in food and nutrition are daunting. The present paper summarizes 3 individual papers that are part of this special collection. The lynchpin for synthesizing the papers is sustainability and food systems. Within each of these domains are embedded a myriad of factors, each of which are essential for the sustainable transformation of food systems. Controversies surrounding the concepts of a healthy diet, sustainable agricultural production, and maximizing the dietary impacts of food environments are discussed and evaluated in the context of the current food and nutrition landscape.

Use of Mechanistic Nutrition Models to Identify Sustainable Food Animal Production

To feed people in the coming decades, an increase in sustainable animal food production is required. The efficiency of the global food production system is dependent on the knowledge and improvement of its submodels, such as food animal production. Scientists use statistical models to interpret their data, but models are also used to understand systems and to integrate their components. However, empirical models cannot explain systems. Mechanistic models yield insight into the mechanism and provide guidance regarding the exploration of the system. This review offers an overview of models, from simple empirical to more mechanistic models. We demonstrate their applications to amino acid transport, mass balance, whole-tissue metabolism, digestion and absorption, growth curves, lactation, and nutrient excretion. These mechanistic models need to be integrated into a full model using big data from sensors, which represents a new challenge. Soon, training in quantitative and computer science skills will be required to develop, test, and maintain advanced food system models.

Perspective: Understanding the Intersection of Climate/Environmental Change, Health, Agriculture, and Improved Nutrition - A Case Study: Type 2 Diabetes

Efforts to promote health through improved diet and nutrition demand an appreciation of the nutritional ecology that accounts for the intersection of agriculture, food systems, health, disease and a changing environment. The complexity and implications of this ecology is exemplified by current trends and efforts to address nutrition-related non-communicable diseases (NCDs), most prominently type 2 diabetes. The global prevalence of type 2 diabetes continues to rise unabated. Of particular concern is how to address the unhealthy dietary patterns that are contributing to this pandemic in a changing environment. A multi- disciplinary approach is required that will engage those communities that comprise the continuum of effort from research to translation and implementation of evidence-informed interventions, programs and policies. Using the prevention of type 2 diabetes by increasing fruit and vegetable consumption as an exemplar, we argue that the ability to effect positive change in this and other persistent nutrition-related problems can be achieved by moving away from siloed approaches that limit the integration of key components of the diet-health continuum. Ultimately the impact of preventing type 2 diabetes via increased fruit and vegetable consumption will depend on how the entire diet changes, not just fruits and vegetables. In addition, the rapidly changing physical environment that will confront our food production system going forward will also shape the interventions that are possible. Nonetheless, the proposed "team science" approach that accounts for all the elements of the nutrition ecology will better position us to achieve public health goals through safe and sustainable food systems.

Innovation to Create a Healthy and Sustainable Food System: A Science Advisory From the American Heart Association

Current dietary intakes of North Americans are inconsistent with the Dietary Guidelines for Americans . This occurs in the context of a food system that precludes healthy foods as the default choices. To develop a food system that is both healthy and sustainable requires innovation. This science advisory from the American Heart Association describes both innovative approaches to developing a healthy and sustainable food system and the current evidence base for the associations between these approaches and positive changes in dietary behaviors, dietary intakes, and when available, health outcomes. Innovation can occur through policy, private sector, public health, medical, community, or individual-level approaches and could ignite and further public-private partnerships. New product innovations, reformulations, taxes, incentives, product placement/choice architecture, innovative marketing practices, menu and product labeling, worksite wellness initiatives, community campaigns, nutrition prescriptions, mobile health technologies, and gaming offer potential benefits. Some innovations have been observed to increase the purchasing of healthy foods or have increased diversity in food choices, but there remains limited evidence linking these innovations with health outcomes. The demonstration of evidence-based improvements in health outcomes is challenging for any preventive interventions, especially those related to diet, because of competing lifestyle and environmental risk factors that are difficult to quantify. A key next step in creating a healthier and more sustainable food system is to build innovative system-level approaches that improve individual behaviors, strengthen industry and community efforts, and align policies with evidence-based recommendations. To enable healthier food choices and favorably impact cardiovascular health, immediate action is needed to promote favorable innovation at all levels of the food system.

Evaluating the environmental impacts of dietary recommendations

Dietary choices drive both health and environmental outcomes. Information on diets come from many sources, with nationally recommended diets (NRDs) by governmental or similar advisory bodies the most authoritative. Little or no attention is placed on the environmental impacts within NRDs. Here we quantify the impact of nation-specific NRDs, compared with an average diet in 37 nations, representing 64% of global population. We focus on greenhouse gases (GHGs), eutrophication, and land use because these have impacts reaching or exceeding planetary boundaries. We show that compared with average diets, NRDs in high-income nations are associated with reductions in GHG, eutrophication, and land use from 13.0 to 24.8%, 9.8 to 21.3%, and 5.7 to 17.6%, respectively. In upper-middle-income nations, NRDs are associated with slight decrease in impacts of 0.8-12.2%, 7.7-19.4%, and 7.2-18.6%. In poorer middle-income nations, impacts increase by 12.4-17.0%, 24.5-31.9%, and 8.8-14.8%. The reduced environmental impact in high-income countries is driven by reductions in calories (∼54% of effect) and a change in composition (∼46%). The increased environmental impacts of NRDs in low- and middle-income nations are associated with increased intake in animal products. Uniform adoption of NRDs across these nations would result in reductions of 0.19-0.53 Gt CO2 eq⋅a-1, 4.32-10.6 Gt [Formula: see text] eq⋅a-1, and 1.5-2.8 million km2, while providing the health cobenefits of adopting an NRD. As a small number of dietary guidelines are beginning to incorporate more general environmental concerns, we anticipate that this work will provide a standardized baseline for future work to optimize recommended diets further.