Reaching Nutritional Adequacy Does Not Necessarily Increase Exposure to Food Contaminants: Evidence from a Whole-Diet Modeling Approach

Association between dietary quality indices and serum polychlorinated biphenyls and organochlorine pesticides levels among Lebanese adults

Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) remain a global concern in both developed and developing countries. Given that diet constitutes the major route of exposure to these pollutants, the objective of the current study is to investigate PCBs and OCPs serum levels in relation to dietary quality indices in a sample of Lebanese adults. Sociodemographic, nutritional, and anthropometric data were obtained from 302 participants in face-to-face interviews. Nutritional intakes from a previously validated quantitative 164-item food frequency questionnaire were used to calculate six a priori dietary indices: Healthy Eating Index (HEI-2015), alternate Healthy Eating Index (aHEI), Diet Quality Index-International (DQI-I), Mediterranean Diet Quality Index (Med-DQI), Med-DQIf, Mediterranean Diet Scale (MDS), and Mediterranean Diet Score (MedDietScore). Serum levels of six indicator PCBs (PCBs 28, 52, 101, 138, 153, 180) and four OCPs (HCB, β-HCH, DDT, and DDE) were investigated in relation to diet quality indices. Individuals with a higher adherence to the HEI-2015 and to the Mediterranean diet assessed by the Med-DQI/Med-DQIf displayed increased levels of OCPs (HCB, βHCH, DDT, and DDE). An inverted U-shaped association was observed between DQI-I and PCBs serum levels (PCBs 138, 153, 180, and ƩPCBs). This is the first study in the Middle East and North Africa region to investigate the association between POPs serum levels and a substantial number of a priori dietary indices. The impact of different food combinations and nutrient interactions on pollutants body burden and toxicity remains to be established in future studies.

Individual Diet Optimization in French Adults Shows That Plant-Based “Dairy-like” Products May Complement Dairy in Sustainable Diets

This study aimed to explore the potential role of plant-based “dairy-like” products (PBDL) in sustainable diets. For each individual from a representative sample of French adults (INCA2 survey 2006–2007; n = 1816), a diet optimized to be more sustainable (nutritionally adequate while having a 30% reduced carbon impact with minimal change from the actual diet and isocaloric content) was modelled. The food content of the optimized diets was compared to actual diets, with a focus on PBDL and dairy products. The presented quantitative results focused on women. Optimized diets contained more plant-based products and less meats than actual diets. PBDL products were present in 7.3% and 55.7% of the subjects’ actual and optimized diets, respectively, increasing significantly from 7 to 48 g/day. Regarding dairy products, cheese decreased (−14 g/day), milk increased (+14 g/day), and yogurt remained constant (87 g/day) between the actual and optimized diets, such that the intake of this food group remained constant (214 g/day). Women for whom PBDL products were introduced as new foods in their optimized diets were found to be those with actual low energy intake (1755 kcal/d on average). As a complement to dairy products, fortified PBDL products may help to achieve more sustainable diets, especially for individuals with low energy intakes.

Meeting nutritional adequacy in the Brazilian population increases pesticide intake without exceeding chronic safe levels

Achieving nutritional adequacy requires an increase in fresh foods consumption, which may increase pesticide intakes. This study aimed to identify required dietary modifications to achieve nutritional adequacy without exceeding the acceptable daily intake (ADI) for pesticides. Data from the National Dietary Survey 2017-2018 were linked to the pesticide database from the Program on Pesticide Residue Analysis in Food. We performed linear programming models to design nutritionally adequate diets constrained by food preferences for different constraints on pesticide intake at the least cost increment. Nutritional adequacy led to an increase in pesticide intakes without exceeding their ADI. Modifications in diets varied according to the model, but, in general, consisted in an increase in fruits and vegetables, dairy, and seafood, and a reduction in rice, red meat, and sugar-sweetened beverages quantities. In conclusion, meeting nutritional adequacy increases pesticide intake compared to the observed diets, without representing a health concern to consumers.

Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of four. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty ● Linear programming is a mathematical approach to evaluating the diets of First Nations ● The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.

Cost of healthy and culturally acceptable diets in Brazil in 2009 and 2018

OBJECTIVE

To estimate the lowest cost of a healthy and culturally acceptable diet and to assess the evolution of its cost in the periods 2008-2009 and 2017-2018.

METHODS

We used data on the individual food consumption and food prices from the Pesquisas de Orçamentos Familiares (Household Budget Surveys), in the 2008-2009 and 2017-2018. The sample strata of each period were aggregated, forming 108 new strata with geographic and economic homogeneity. Linear programming models generated diets for each new stratum, considering the constraints in two models: model 1 (≥ 400g of fruits and vegetables); and model 2 (≥ 400g of fruits and vegetables, < 2300mg of sodium, sodium/potassium ratio < 1, ≥ 500mg of calcium). Each food could progressively deviate 5g from the observed consumption averages until the models found a solution in each of the strata. The objective function was to minimize the total cost of the diet.

RESULTS

The average observed and optimized costs were R$4.96, R$4.62 (model 1) and R$5.08 (model 2) in 2008-2009, and R$9.18, R$8.69 and R$9.87 in 2017-2018. Models 1 and 2 resulted in an increase of up to 6% and 11% in 2008-2009, and of up to 25% and 34% in 2017-2018 in the lowest income strata. The main changes observed in the two models include the reduction in the amounts of sweetened beverages, sweets, sauces, ready-to-eat foods, and an increase in fruits and vegetables, flour, and tubers.

CONCLUSION

The adequate amount of fruits and vegetables resulted in an increase in costs to some population strata. When the adequacy of calcium, sodium, and potassium was considered, we observed a more significant increase in cost, especially in 2017-2018.

Conservative to disruptive diets for optimizing nutrition, environmental impacts and cost in French adults from the NutriNet-Santé cohort

Improving the sustainability of diets requires the identification of diets that meet the nutritional requirements of populations, promote health, are within planetary boundaries, are affordable and are acceptable. Here we explore the extent to which dimensions of sustainability could be optimally aligned and identify more sustainable dietary solutions, from the most conservative to the most disruptive, among 12,166 participants of the NutriNet-Santé cohort. We aim to concomitantly lower environmental impacts (including greenhouse gas emissions, cumulative energy demand and land occupation), increase organic food consumption and study departure from observed diets (considered as a proxy for acceptability). From the most conservative to the most disruptive scenario, optimized diets were gradually richer in fruits, vegetables and soya-based products and markedly poorer in animal-based foods and fatty and sweet foods. The contribution of animal protein to total protein intake gradually decreased by 12% to 70% of the observed value. The greenhouse gas emissions from food production for the diets gradually decreased across scenarios (as a percentage of observed values) by 36-86%, land occupation for food production by 32-78% and energy demand by 28-72%. Our results offer a benchmark of scenarios of graded dietary changes against graded sustainability improvements.

Interactions between environmental pollutants and dietary nutrients: current evidence and implications in epidemiological research

Environmental pollutants and nutrients may be present in the same foodstuffs or dietary patterns; share internal mechanisms of transport, metabolism and cellular uptake; or target the same molecular signalling pathways and biological functions. Lipophilic pollutants and nutrients, like dioxins and polyunsaturated fatty acids, may often converge at all aforementioned levels and thus the interactions become more likely. Despite this fact, the topic seems overlooked in mainstream epidemiological research. In this essay, we illustrate different levels of documented interactions between pollutants and nutrients with experimental, interventional and epidemiological evidence, paying special attention to lipophilic chemicals. We first describe common pollutants and nutrients encountered in diets and the internal lipophilic interface such as adipose tissue and serum lipids. Next, we discuss the preventive effects of nutrients against absorption and the toxic effects of pollutants, as well as the pollutant-induced perturbation of nutrient metabolism. Finally, we discuss the implications of nutrient-pollutant interactions in epidemiology, providing some examples of negative confounding, modification effect and statistical interactions reported for different outcomes including fetal growth, diabetes and cancer. The evidence discussed in this essay supports that the health impacts of chemicals have likely been underestimated due to the high risk of residual and coexposure confounding in diseases where interactions between pollutants and nutrients may occur.

Optimisation modelling to improve the diets of First Nations individuals

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

Optimising healthy and safe fish intake recommendations: a trade-off between personal preference and cost

Individuals may perceive personalised dietary advice as more relevant and motivational than national guidelines. Personal preference and food cost are factors that can affect consumer decisions. The objective of this study was to present a method for modelling and analysing the trade-off between deviation from preference and food cost for optimised personalised dietary recommendations. Quadratic programming was applied to minimise deviation from fish preference and cost simultaneously with different weights on the cost for 3016 Danish adults (whose dietary intake and body weight were recorded in a national dietary survey). Model constraints included recommendations for EPA, DHA and vitamin D and tolerable levels for methyl mercury, dioxins and dioxin-like polychlorinated biphenyls. When only minimising deviation from preference, 50 % of the study population should be recommended to increase fish intake, 48 % should be suggested to maintain current consumption and 2 % should be suggested to decrease fish consumption. When only minimising cost, the vast majority (99 %) should be recommended to only consume herring, which is the least-expensive fish species. By minimising deviation from preference and cost simultaneously with different weights on the cost, personalised optimal trade-off curves between deviation from fish intake preference and fish cost could be generated for each individual in our study population, except for twenty-two individuals (0·7 %) whose contaminant background exposure was too high. In the future, the method of this paper could be applied in the personal communication of healthy and safe food recommendations that fit the preferences of individual consumers.

Risk Benefit Assessment of foods: Key findings from an international workshop

Whilst risk management measures, including food policy, are developed for the protection of public health and the environment, they may also lead to a reduction in health benefits. Policy decisions require then consideration of these necessary trade-offs, which leads to an increasing need to apply formal risk-benefit assessment (RBA) of foods. In this context, the European Food Safety Authority sponsored a Risk-Benefit Assessment Workshop on "past, current and future developments within the risk-benefit assessment of foods (RBA)" held in May 2017. The overall aims of the RBA Workshop were to discuss existing methods, challenges and needs within RBA, and to draft a roadmap for future development of RBA. The specific objectives were to i) identify RBA activities in Europe and globally; ii) discuss how to further develop and optimize RBA methodology; iii) identify challenges and opportunities within RBA; and iv) increase collaboration internationally. The two-day workshop gathered 28 participants from 16 institutions in 11 countries. It included technical presentations of RBA methods and case studies, and two break-out sessions for group discussions. All participants agreed that RBA has substantial potential to inform risk-management decisions in the areas of food safety, nutrition and public health. Several activities to optimize further developments within RBA were suggested. This paper provides a summary of workshop presentations, a discussion of challenges that limit progress in this area, and suggestions of next steps for this promising approach supporting a science-based decision process in the area of risk-benefit management of foods.

Perspective: Food-Based Dietary Guidelines in Europe-Scientific Concepts, Current Status, and Perspectives

Food-based dietary guidelines (FBDGs) are important tools for nutrition policies and public health. FBDGs provide guidelines on healthy food consumption and are based on scientific evidence. In the past, disease prevention and nutrient recommendations dominated the process of establishing FBDGs. However, scientific advances and social developments such as changing lifestyles, interest in personalized health, and concerns about sustainability require a reorientation of the creation of FBDGs to include a wider range of aspects of dietary behavior. The present review evaluates current European FBDGs with regard to the concepts and aspects used in their derivation, and summarizes the major aspects currently discussed to be considered in future establishment or updates of FBDGs. We identified English information on official European FBDGs through an Internet search (FAO, PubMed, Google) and analyzed the aspects used for their derivation. Furthermore, we searched literature databases (PubMed, Google Scholar) for conceptional considerations dealing with FBDGs. A total of 34 out of 53 European countries were identified as having official FBDGs, and for 15 of these, documents with information on the scientific basis could be identified and described. Subsequently, aspects underlying the derivation of current FBDGs and aspects considered in the literature as important for future FBDGs were discussed. Eight aspects were identified: diet-health relations, nutrient supply, energy supply, dietary habits, sustainability, food-borne contaminants, target group segmentation, and individualization. The first 4 have already been widely applied in existing FBDGs; the others have almost never been taken into account. It remains a future challenge to (re)conceptionalize the development of FBDGs, to operationalize the aspects to be incorporated in their derivation, and to convert concepts into systematic approaches. The current review may assist national expert groups and clarifies the options for future development of local FBDGs.

Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review

A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.

Personalised fish intake recommendations: the effect of background exposure on optimisation

National dietary guidelines are directed at the general population. However, these guidelines may be perceived as unrealistic by a substantial part of the population, as they differ considerably from individual consumption patterns and preferences. Personalised dietary recommendations will probably improve adherence, and it has been shown that these recommendations can be derived by mathematical optimisation methods. However, to better account for risks and benefits of specific foods, the background exposure to nutrients and contaminants needs to be considered as well. This background exposure may come from other foods and supplements, and also from environmental sources like the air and the sun. The objective of this study was therefore to analyse the effect of including individual variation in background exposure when modelling personalised dietary recommendations for fish. We used a quadratic programming model to generate recommended fish intake accounting for personal preference by deviating as little as possible from observed individual intake. Model constraints ensure that the modelled intake meets recommendations for EPA, DHA and vitamin D without violating tolerable exposure to methyl mercury, dioxins and dioxin-like polychlorinated biphenyls. Several background exposures were analysed for 3016 Danish adults, whose food intakes and body weights were reported in a national dietary survey. We found that the lower nutrient constraints were critical for the largest part of the study population, and that a total of 55% should be advised to increase their fish intake. The modelled fish intake recommendations were particularly sensitive to the vitamin D background exposure.

A "Fork-to-Farm" Multi-Scale Approach to Promote Sustainable Food Systems for Nutrition and Health: A Perspective for the Mediterranean Region

Mediterranean countries are undergoing dietary and nutritional changes that affect their inhabitants' health, while facing massive environmental challenges. The increasing demand of water in agriculture, the capacity to maintain local food production, and the growing dependence on food imports are interconnected issues that must be addressed to ensure food security and nutrition in the Mediterranean region. Here, we present the conceptual framework and methodologies developed by the MEDINA-Study Group for rethinking food systems toward sustainable consumption and production modes. Based on its multidisciplinary expertise, the MEDINA-Study Group designed a "fork-to-farm" multi-scale approach, stemming from current dietary habits and examining how some options to nutritionally improve these habits might affect the food systems. This approach was developed for research activities in the South of France and Tunisia, two areas with very different diet-agriculture-environment nexus. The conceptual framework is based on the analysis of elements of the food systems (from consumption to production) at different levels (individual, household, regional and national levels). The methods include: (i) modeling options of dietary changes at different scales, in order to nutritionally optimize food consumption-production without increasing the environmental impact, (ii) translating the best-choice changes into possible policy actions, (iii) testing the acceptability and feasibility of these actions with several stakeholders, and (iv) producing guidelines for sustainable food choices and production. The MEDINA-Study Group identified additional issues that could be included in a future framework to help designing ambitious agricultural, food and health policies in the Mediterranean region.

Use of Mathematical Optimization Models to Derive Healthy and Safe Fish Intake

Background

Recommended fish intake differs substantially from observed fish intake. In Denmark, ∼15% of the population consumes the state-recommended fish intake. How much fish individuals eat varies greatly, and this variation cannot be captured by considering the fish intake of the average population.

Objective

We developed a method intended to provide realistic and achievable personalized dietary recommendations based on an individual's body weight and current fish intake. The objective of the study was to propose specific fish intake levels for individuals that meet the recommendations for eicosapentaenoic acid, docosahexaenoic acid, and vitamin D without violating the permitted intake recommendations for methyl mercury, dioxins, and polychlorinated biphenyls.

Methods

Two mathematical optimization models were developed that apply quadratic programming to model personalized recommended fish intake, fulfilling criteria on nutrients and contaminants, while simultaneously deviating as little as possible from observed individual intake. A recommended intake for 8 fish species was generated for each individual in a group of 3016 Danes (1552 women and 1464 men, aged 18-75 y), whose fish intakes and body weights were known from a national dietary survey.

Results

Individual, personal dietary recommendations were successfully modeled. Modeled fish intake levels were compared to observed fish intakes. For women, the average proposed increase in fish intake was 14 g/wk for lean fish and 63 g/wk for fatty fish; and for men these numbers were 12 and 55 g/wk, respectively.

Conclusions

Using fish intake as an example, we show how quadratic programming models may be used to advise individual consumers how to optimize their diet, taking both benefits and risks into account. This approach has the potential to increase compliance with dietary guidelines by targeting the individual consumers and minimizing the need for large and ultimately unrealistic behavior changes.

Food choices to meet nutrient recommendations for the adult Brazilian population based on the linear programming approach

OBJECTIVE

To identify optimal food choices that meet nutritional recommendations to reduce prevalence of inadequate nutrient intakes.

DESIGN

Linear programming was used to obtain an optimized diet with sixty-eight foods with the least difference from the observed population mean dietary intake while meeting a set of nutritional goals that included reduction in the prevalence of inadequate nutrient intakes to ≤20 %.

SETTING

Brazil.

SUBJECTS

Participants (men and women, n 25 324) aged 20 years or more from the first National Dietary Survey (NDS) 2008-2009.

RESULTS

Feasible solution to the model was not found when all constraints were imposed; infeasible nutrients were Ca, vitamins D and E, Mg, Zn, fibre, linolenic acid, monounsaturated fat and Na. Feasible solution was obtained after relaxing the nutritional constraints for these limiting nutrients by including a deviation variable in the model. Estimated prevalence of nutrient inadequacy was reduced by 60-70 % for most nutrients, and mean saturated and trans-fat decreased in the optimized diet meeting the model constraints. Optimized diet was characterized by increases especially in fruits (+92 g), beans (+64 g), vegetables (+43 g), milk (+12 g), fish and seafood (+15 g) and whole cereals (+14 g), and reductions of sugar-sweetened beverages (-90 g), rice (-63 g), snacks (-14 g), red meat (-13 g) and processed meat (-9·7 g).

CONCLUSION

Linear programming is a unique tool to identify which changes in the current diet can increase nutrient intake and place the population at lower risk of nutrient inadequacy. Reaching nutritional adequacy for all nutrients would require major dietary changes in the Brazilian diet.