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de Pee S, Hardinsyah R, Jalal F, Kim BF, Semba RD, Deptford A, Fanzo JC, Ramsing R, Nachman KE, McKenzie S, Bloem MW. Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia. Am J Clin Nutr 2021; 114:1686-1697. [PMID: 34477830 PMCID: PMC8574631 DOI: 10.1093/ajcn/nqab258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals. OBJECTIVES We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously. METHODS We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data. RESULTS The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously. CONCLUSIONS Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously.
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Affiliation(s)
- Saskia de Pee
- United Nations World Food Programme, Rome, Italy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | | | - Brent F Kim
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D Semba
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Deptford
- United Nations World Food Programme, Rome, Italy
| | - Jessica C Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca Ramsing
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shawn McKenzie
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin W Bloem
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Armstrong LE, Barquera S, Duhamel JF, Hardinsyah R, Haslam D, Lafontan M. Recommendations for healthier hydration: addressing the public health issues of obesity and type 2 diabetes. Clin Obes 2012; 2:115-24. [PMID: 25586246 DOI: 10.1111/cob.12006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 10/01/2012] [Accepted: 10/26/2012] [Indexed: 01/04/2023]
Abstract
Given the rapid increase in the prevalence of overweight, obesity, type 2 diabetes and other obesity-related conditions across the world, despite a plethora of evidence-based guidance for clinicians, innovative campaigns aimed at the general public and widespread government public health initiatives, it is clear that a novel approach is required. The importance of fluid intake has been overlooked in campaigns and guidelines and also in the clinical setting, where the question 'what do you drink?' is often omitted. It is a significant oversight that food pyramids and healthy-eating plates across the world omit fluids from their graphics and advice. While guidelines include recommendations on changes in physical activity and diet, often little or no advice is offered on the importance of healthier hydration practices, neglecting to highlight the contribution of beverages high in sugar, alcohol or additives. An interdisciplinary group of experts in medicine, nutrition, physiology and public health discussed issues surrounding healthy-hydration practices in March 2010 in Paris to create a consensus statement on hydration and gain of body weight and provide recommendations.
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Affiliation(s)
- L E Armstrong
- Departments of Kinesiology & Nutritional Sciences, University of Connecticut, Storrs, CT, USA
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