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Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems
Supplementary resource (1)
... FBDGs, which include guidance on both the type and amount of foods (2), represent an opportunity to provide suitable PS guidance to populations. The introduction of regional (e.g., the Nordic Nutrition Recommendations (28)) and more recently global guidelines (e.g., the Planetary Health Diet (29)), underscore the ongoing efforts to establish consistent nutritional standards across geographies. However, these guidelines mostly focus on dietary patterns and total intakes per day, not on recommended portions of specific foods. ...
... Meat, fish & eggs were commonly combined into a "Protein group", occasionally along with other foods with a high protein content such as Pulses or Nuts & seeds. With the emergence of sustainable dietary concerns (29,54), as well as scientific evidence associating red and processed meat consumption with NCDs (55,56), public health bodies are encouraging consumption of more plant-based foods. The importance of providing specific recommendations for meat and non-meat protein sources has been addressed in several recently developed European FBDGs (e.g., Denmark, 2021; France, 2019; Spain, 2022). ...
... The need for a reform of FBDGs, through the sustainability lens, has been stressed by Springmann et al., who pointed out the need for more specific recommendations including suggested minimum values for plant-based foods such as whole grains, nuts, and legumes, and stricter limits for red and processed meat and dairy (57). While no particular trend was identified between the year of publication of the guidelines and the combination of different sources of protein as food groups in our study, the recent issue of regional and global guideline documents which are mainly based on environmental aspects demonstrates the efforts to promote a shift of dietary habits toward sustainable consumption (28,29). ...
Objective
Since large food portion sizes (PS) lead to overconsumption, our objective was to review PS recommendations for commonly consumed food groups reported in Food-Based Dietary Guidelines (FBDGs) globally and to assess variation in PS across countries and regions.
Methods
Consumer-oriented FBDGs from the Food and Agriculture Organization (FAO) online repository were used to evaluate dietary recommendations, PS and number of portions for common food groups. Guidelines were classified for each group as qualitative, quantitative, or missing. A standardized approach was applied to convert PS recommendations given as household measures, cup equivalents, pieces and other measures into grams for cross comparison. Variation of recommended PS of common food groups within and across regions was examined.
Results
Among 96 FBDGs, variations were found both across and within regions. At a regional level, the highest median PS recommendations were seen in Europe for Meat, Fish and Pulses, in the Near East for Dairy products, and in Africa for most grain-based foods. Recommendations for Fruits and Vegetables showed the highest consistency across FBDGs worldwide, whereas guidance on Meat, fish & eggs and Cooked cereals/grains showed discrepancies in the classification of foods into categories, as well as in the number of portions per day.
Discussion
While some variation in PS recommendations across countries can be expected due to cultural and regional dietary practices, inconsistent definitions to refer to a portion and varied derivation methods may further produce discrepancies. Harmonizing development methods for FBDG could help establish more consistent reference portion sizes and therefore provide clearer guidance to consumers.
... In contrast, 667 calories and 499 grams of pulses are needed for the same priority micronutrient value. However, minimally processed pulses provide many other nutrients, protect against DR-NCDs, are one of the most affordable and sustainable healthy foods, and are underconsumed, so they should not be neglected (58,59). Not all ASFs are equal, either. ...
... Low-calorie iron-rich foods like dark green leafy vegetables, which have high iron density per unit energy, are less optimal iron sources for young children due to their relatively low iron density per unit mass, requiring over 100 grams to provide a third of iron requirements (Fig. 3). However, dark green leafy vegetables are among the top sources of priority micronutrients, protect against DR-NCDs, and are affordable (58,62,68). ...
... Studies that model the health and sustainability of global diets need to account for the bioavailability of iron, zinc, and other nutrients, which are reduced among vegan, vegetarian, and flexitarian diets (51). Given the need to moderate ASFs to meet global sustainability targets (58) and parallel efforts to promote alternative ASFs, more research is needed to understand the health implications of replacing ASFs with alternatives, including plant-based, fungi-based, algae-based, insect-based, and cell-based proteins. Issues concerning the essential nutrient bioavailability of alternative ASFs are important to address (83), as are the vast differences in metabolomic profiles between ASFs and their alternatives (84). ...
The world faces a global challenge of how to meet the nutritional needs of a diverse global population through diets. This paper defines the relative nutritional needs across each stage of the life cycle to support human health and identifies who is nutritionally vulnerable. Findings in this paper suggest that there are biological nutritional vulnerabilities stemming from high micronutrient needs per calorie in certain phases of the life cycle, particularly for infants and young children, women of reproductive age, pregnant and lactating women, and older adults, particularly older women. The paper demonstrates the role of micronutrient-dense animal-source foods and plant-source foods important in meeting essential nutrient needs to support healthy growth, development, and aging across vulnerable stages of the life cycle.
... Using IM to guide our research process, we first conducted an analysis of needs and of their main determinants among urban Senegalese adolescent girls to document their consumption of IRF [23]. Results have shown that 83% of them had a daily intake below the recommendation of 84g of animal protein foods from the EAT-Lancet Commission on healthy diets from sustainable food systems [24], which is worrisome. Subsequently, factors underlying this low consumption of IRF were explored using an extended version of the theory of planned behavior/TPB (unpublished data). ...
... No significant change was observed between average daily consumption of IRF before and after interventions (Table 5). Moreover, in the experimental group, the proportion of girls with an estimated intake of IRF greater than or equal to the 84g per day as recommended for animal protein sources by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems [24] was more than double after (36%) as compared to before (16%) interventions (p=0.018). In the control college, this proportion was virtually the same before (19%) and after (20%) interventions (p=0.411, Figure 1). ...
... The importance of affordability has been highlighted in numerous studies that have indicated that price influences adolescents' purchases and selection of healthy nutritious foods [32][33][34][35]. Qualitative research has indicated that improving physical access to healthy foods was perceived by adolescents as a motivating factor to their consumption [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Several studies reviewed by Krølner et al. [32] reported that nutrition interventions should consider different dimensions of healthy food availability in the school environment, such as presence, variety, visibility, quality and cost. ...
... Dietary patterns that prioritize the consumption of unprocessed or minimally processed whole plant foods -encompassing a diverse combination of fruits, vegetables, legumes, and whole grains, while limiting the intake of animal-source foods -along with the avoidance of ultra-processed foods (UPFs), have been recommended to improve both human and planetary health [1][2][3][4] . There is a large body of evidence on the benefits of higher consumption of unprocessed or minimally processed whole plant foods on the nutritional profile of diets, human health, and environmental sustainability 2,3,5 . ...
... Dietary patterns that prioritize the consumption of unprocessed or minimally processed whole plant foods -encompassing a diverse combination of fruits, vegetables, legumes, and whole grains, while limiting the intake of animal-source foods -along with the avoidance of ultra-processed foods (UPFs), have been recommended to improve both human and planetary health [1][2][3][4] . There is a large body of evidence on the benefits of higher consumption of unprocessed or minimally processed whole plant foods on the nutritional profile of diets, human health, and environmental sustainability 2,3,5 . At the same time, the dietary share of UPFs has been consistently associated with the overall deterioration of the nutrient profile of diets 6,7 and a higher risk of several non-communicable diseases (NCDs) [8][9][10][11] . ...
... a Supplementary material is available at: https://osf.io/dxau6/ Although starchy vegetables such as potato and manioc are part of the Brazilian dietary pattern, particularly in specific geographical regions, the Nova-WPF score was based on food items with consistent literature on their protective effects on human health [1][2][3][4] . Therefore, these items were not included in the screener. ...
OBJECTIVE
To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification.
METHODS
This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day.
RESULTS
The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64–0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69–0.88).
CONCLUSIONS
These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.
... It has been argued that (prophylactic) gastrostomies might be related to long term swallowing dysfunction based on the 'use-it-or-lose-it' paradigm of dysphagia rehabilitation, but the literature remains controversial on this side effect. [53][54][55][56] The present study did not evaluate long-term swallowing function after CRT/BRT with or without gastrostomy insertion. Differences in feeding tube policy between the cancer centers, as shown by our nationwide survey 57 could be considered a limitation of the current study. ...
... Sustainable diets focus on lowering the environmental impact of food production systems and providing healthy diets, sufficient in essential nutrients, for the entire population. 53 For the general, healthy population this includes a transition towards more plant-based nutrition while lowering the intake of animal products. Consuming a mainly plant-based diet, reduces the risk of developing obesity, diabetes, cardiovascular diseases, and some types of cancer. ...
... Hospital dietetic services in the Netherlands are paid from a fixed hospital budget. This is in contrast to medical specialists who receive budget for every new HNC patient by opening a Diagnose Treatment Combination (DTC).53 From this case-based budget all hospital services from first consultation until the completion of treatment should be paid, but strangely allied health services do not receive any payment from this DTC. ...
... Swiss agriculture today is heavily characterized by livestock farming, particularly the rearing of ruminants. However, both globally and within Switzerland, livestock production and the consumption of animal products face increasing criticism due to their resource intensity and environmental impact [1][2][3][4]. ...
... The debate surrounding ruminant farming is polarized. On one side, critics highlight the significant environmental footprint of ruminant production, citing methane emissions from digestion and the high demand for water and land [4][5][6]. In contrast, proponents argue that ruminants play a key role in sustainable food systems, as they can convert inedible raw materials, such as roughage, into valuable food products [7][8][9]. ...
... At the same time, the studies, both globally and for Switzerland, show that the changes of a feed-no-food scenario primarily lead to a reduction in the monogastric population and that the quantities of available beef and milk decrease significantly less. From a nutritional point of view, however, this contradicts the dietary recommendations of the EAT-Lancet Commission, which primarily recommend a strong reduction in beef [4,29]. ...
As roughage consumers, ruminants have the unique ability to convert raw materials that are otherwise inedible for humans into valuable food products, thereby making them crucial to Swiss agriculture, particularly in mountainous regions. This article reviews the current state of grassland-based livestock farming in Switzerland and provides an overview of several studies that explore potential future scenarios for livestock production, along with their projected impacts. The scenarios discussed illustrate how grassland-based livestock systems could serve as a viable alternative for promoting more sustainable livestock production in the future. All of the studies examined justify grassland-based farming within the framework of a “feed-no-food” strategy, in which arable land is prioritized for human food production. This approach has several consequences: reduced availability of animal feed, fewer livestock, an increase in arable land for human food production, higher levels of plant-based food output, and enhanced self-sufficiency. However, these scenarios also call for a significant reduction in livestock production and consumption, which hinges on the willingness of society, the economy, and policymakers to embrace such changes.
... In the light of escalating environmental challenges such as climate change and a devastating loss of biodiversity, the agricultural livestock production needs to be fundamentally questioned and restructured to make a sustainable contribution to the food security of a still growing world population while safeguarding functioning ecosystems (Willett et al., 2019;Foley et al., 2011). Approximately 75 % of the world's total agricultural land and 35 % of the total crop production volume are devoted to raising livestock (Foley et al., 2011). ...
... Animal-sourced products play a crucial role in improving food security and economic selfsufficiency in many regions of the world, particularly where grazing systems are implemented on land unsuitable for crop cultivation (O'Mara, 2012). However, there is large consensus that reaching sustainable levels of land use and food production, as well as promoting human health, necessitates a reduction in the consumption of animal products, particularly in the global North (Willett et al., 2019;Boix-Fayos and de Vente, 2023). The average protein consumption in European countries, for instance, is twice the current recommendation (FAO, 2023;FAO/WHO, 2021), while at the same time the EU is highly dependent on imported plant protein to feed their livestock, coming primarily from South America (European Commission, 2018). ...
CONTEXT: In modern intensive dairy farming, cows are increasingly held indoors and fed arable crops instead of grass to maximize individual animal performance. This leads to environmental issues such as high farm-level nutrient surpluses and loss of grassland plant species diversity as well as a growing competition between food
and feed.
OBJECTIVE: We conducted this study to define a threshold of concentrate supplementation that ensures a net contribution to the protein supply and evaluate the environmental performance of dairy farms when this level of supplementation is shifted.
METHODS: In a first step, we calculated the hePCR (human-edible protein conversion ratio) of 52 dairy farms across a pedo-climatic gradient with varying feeding strategies. Based on farm management data and vegetation surveys, we analyzed the relationship between hePCR and different components of environmental and productive performance, with special interest on farm nutrient balances, grassland biodiversity and grass-based milk production.
RESULTS AND CONCLUSIONS: Our results show that higher concentrate supplementation levels significantly reduce the efficiency of converting plant protein into food. A critical threshold was identified at a concentrate milk proportion of 30 % or 177 g of concentrate feed per kilogram of milk produced, beyond which net protein contribution shifts to net consumption. Furthermore, we show critical interlinkages between a high protein efficiency and an enhanced environmental performance of the farms, such as higher grassland Shannon diversity and reduced nutrient surpluses. Our study suggests grass-based dairy farming as an integrated solution for enhancing net protein output while simultaneously safeguarding critical ecosystem functions.
SIGNIFICANCE: We are in urgent need of sustainable agricultural practices that align an efficient food production with the reduction of negative environmental impacts. Our study is the first that shows direct positive interlinkages between the protein conversion efficiency of dairy farms and their environmental outcome as based on multi-annual management data and comprehensive vegetation surveys.
... 26 The production and high consumption of ultra-processed food also fosters an unsustainable food system, which encourages monocultures, impacts environmental health and degrades food crops. 23,27 However, we must emphasize that diet is an important modifiable risk factor and altering a pathogenic DP by adopting a healthy diet has a positive impact on human health, preventing illness and early death. 27 Considering the nutritional recommendations at this stage of the life cycle, consumption should be assessed in a targeted way. ...
... 23,27 However, we must emphasize that diet is an important modifiable risk factor and altering a pathogenic DP by adopting a healthy diet has a positive impact on human health, preventing illness and early death. 27 Considering the nutritional recommendations at this stage of the life cycle, consumption should be assessed in a targeted way. Certainly, food and nutritional guidance for women during prenatal care, the puerperium, the immediate postpartum period and throughout the first year is considered strategic. ...
Objectives: to identify dietary patterns (DP) ofpostpartum women and to evaluate the effect of food insecurity, age, and level of schooling on unhealthy DP. Methods: Cohort carried out by non-probabilistic consecutive sampling process in a city in the Northeast region in Brazil, between 2017-2018. From the food frequency questionnaires, DP were derived by principal component analysis in the 3rd (n=207), 6th (n=195), and 12th month (n=183) postpartum. The associations between DP and the independent variables were investigated using mixed effects logistic regression model. Results: two dietary patterns were identified: predominantly healthy DP (PHDP) and predominantly ultra-processed DP (PUPDP). It was found that the higher the age (OR= 0.92; CI95%= 0.85-0.99; p=0.031) and the level of schooling (OR= 0.81; CI95%= 0.70-0.93; p=0.003), the lower the chance of adherence to PUPDP. Families with some level of food insecurity were more likely to adhere to PUPDP (OR= 1.55; CI95%= 1.01-2.37;p=0.044). Conclusion: adherence to PUPDP increases with the level of food insecurity. The higher age and level of schooling decrease adherence to this DP. These findings provide support for the association between food insecurity, age and education with adherence to PUPDP, suggesting the needfor effective measures to ensure food security, particularly for vulnerable populations.
... In terms of consumption according to food group, assessments indicate that the Slovenian diet is unbalanced, with excessive intake of meat, sugar, fat, and salt and insufficient intake of fruits, vegetables, and dairy products [85]. Research indicates that Slovenian meat consumption is approximately four times greater than the recommended level and six times greater than the Planetary Health Diet standard [85][86][87]. While some young adults are interested in reducing meat consumption, many of them continue to follow meat-heavy diets due to societal norms. ...
... A 2023-2025 action plan is being created to support national nutrition and physical activity programs, which are aligned with the Council's initiatives and open for public review. The Council endorses the "Planetary Health Diet", which consists mainly of plant-based products but includes some animal products and is linked to lower risks of diabetes, cardiovascular disease, cancer, and mortality, as shown by a recent systematic review [19,87,101]. ...
This research re-evaluates the prevalence of obesity in a cohort of 432 Slovenian adults two years after an initial population-based cross-sectional examination, utilizing the World Health Organization's body mass index (BMI) and total body fat percentage (FAT%) classifications. Herein, a medically approved electrical bioimpedance monitor was used to analyse body composition, and the results revealed a significant increase in the percentage of individuals classified as having overweight or obesity on the basis of BMI, from 40.7% initially to 45.2% at follow-up (FU); however, these percentages were notably higher in males than in females. The increases in body mass, BMI, fat mass, and FAT% were observed mainly in adult females, whereas in adult males, the increases in BM and BMI were attributed to fat-free mass (FFM) rather than fat mass. In this study, BMI was also compared with the FAT% obesity classification, and the BMI classification was shown to result in significantly fewer participants with obesity in both measures. However, the proportion of participants with obesity based on the two classifications did not differ substantially between the initial and FU measurements. In this study, mixed linear models were used to analyse overall trends and subgroup variations and highlight the importance of considering sex, age, and time of measurement when assessing body composition metrics. These findings emphasize the need for personalized health assessments and the importance of measuring body composition to evaluate adult obesity more accurately for both clinical assessments and public health policies. The state, in collaboration with social initiatives and industrial stakeholders, should prioritize these data and advance public health through innovative educational and awareness initiatives that are founded on robust scientific principles and that empower and promote the adoption of a healthy, active lifestyle.
... To restore and sustain human and planetary health, a fundamental social change in diets is needed. (2,36,37) Public official (38) and unofficial dietary guidelines (39) promote dietary transformation towards an increased proportion of (healthy) plant foods. The results of our four-month RCT with adults in Sweden suggest that both our treatment approachesproviding factual information or social cues in the form of the consumption of other group membersare unsuccessful in achieving this. ...
Numerous public initiatives aim to influence individual food choices by informing about what is considered 'healthy', 'climate-friendly', and generally 'sustainable' food. However, research suggests that rather than public authorities, social influence is more likely to affect people's behaviour. Using a randomised controlled trial, this study investigated if and how the two kinds of influences (factual versus social) could affect the real-life, self-reported intake of plant-and animal-based foods. In a four-month randomised controlled trial, a self-selected sample of adults living in Sweden (N = 237) tracked their daily food consumption several times per week using a tailored mobile phone app. Participants were randomised into one of three groups: two treatment groups receiving factual or social information about plant-and animal-based food consumption, or a control group receiving no information. Pre-and post-questionnaires provided additional background information about the participants. Participants' food habits varied from week to week, and an explorative analysis pointed to a slight decrease in the consumption of animal-based food in the group that received social information. However, the longer-term patterns remained relatively constant in all groups, showing no substantial shift regardless of the kind of cues that the participants received. By investigating the roles of two common types of information about food and dietary change, the results contribute to discussions about how and by whom effective and efficient measures can be implemented to transform food habits. The results suggest there is limited potential for sustained and substantial behavioural changes through both social and factual information campaigns.
... This study focuses on the demand for wheat in India does. Considering that wheat is the second most important staple in these countries and that their populations are expected to expand by 2050, it is critical to assess future wheat demand in order to plan strategically for investments that would protect food security in China and India (Willett et al., 2019). Growing challenges to global sustainable development include food insecurity, hunger, and malnutrition. ...
This thesis focuses on enhancing wheat productivity and food security by investigating genetic and phenotypic variations in wheat anther morphology under normal and heat stress conditions. Using high-throughput image-based phenotyping with Python-based techniques, the study analyzed 177 bread wheat genotypes, revealing significant variability in anther size traits. A genome-wide association study (GWAS) with 50K SNP data identified key marker-trait associations, highlighting genetic regions and prospective genes influencing anther length and width. This research provides valuable insights for developing resilient wheat cultivars with improved pollination and yield potential, addressing critical challenges in global agriculture.
... The balancing act of maintaining food security, human health, and sustainability remains a global challenge. As a response to this challenge, global organizations such as the Food and Agriculture Organization and the World Health Organization have advocated for the reduction of animal protein production and consumption in favor of promoting plant-based diets (Godfray et al., 2018;Sabaté & Soret, 2014;Willett et al., 2019). Moreover, the sat-urated fat and cholesterol content of red meat conflict with current dietary recommendations (Dietary Guidelines Advisory Committee, 2020). ...
The objective of this study was to characterize the nutritional profile of plant‐based meat alternatives (PBMA) and ground beef (GB). Beyond Beef (BEY); Impossible Burger (IMP), a third available product of plant‐based protein, including SWEET EARTH, Incogmeato, Open Nature, and Good & Gather (GEN); and two lean levels of GB (regular [80%–85% lean, regular ground beef] and Lean [>93% lean, lean ground beef, LGB]) were purchased from retail stores across the United States. Proximate composition, mineral content, fatty acid profile, amino acid profile, and B‐vitamin content were measured in raw products. Generally, PBMA had increased ash content which coincided with increased mineral concentration compared to GB, namely sodium, calcium, and zinc (p < 0.05). Similar trends were observed for B‐vitamins. The fatty acid profile of IMP was primarily saturated due to lauric acid (12:0) and myristic acid (14:0) concentrations. Both BEY and GEN were highly unsaturated because of linoleic acid concentration (18:2n6). LGB possessed the greatest total amino acid concentration and total essential amino acid content (p < 0.05). Phenylalanine was increased in PBMA compared to GB (p < 0.05). Overall, these data show differences and similarities between the nutritional profile of PBMA and GB. However, the bioavailability of these nutrients and associated health outcomes, particularly in PBMA, require further investigation.
... These plantbased meat analogs provide sustainable and healthy alternatives to meat and have noticed increasing acceptance among consumers who prefer a sustainable and healthy diet . Similarly, the EAT-Lancet Commission also recommended reducing meat and dairy consumption and increasing plant-based diets comprising more legumes, beans, and nuts (Willett et al. 2019). Thus, meat analogs could play a vital role in ensuring the sustainability of global food security ( Fig. 1.1). ...
Various alternatives to meat in the form of plant-based meat alternatives are becoming popular among consumers and occupy a significant market share. As compared to conventional meat products, meat analogs have inherent merits of lower environmental impact/ footprint (land, water, and carbon), the potential to supply high-quality protein to the burgeoning population, and the absence of animal welfare and ethical issues. The present focus of the food industry is to develop advanced meat analogs mimicking the physical, functional, and sensory qualities of conventional meat. Various advanced technologies are applied in the processing of plant proteins for texturization and improving functionality, such as electrospinning, extrusion, sonication, high-pressure processing, antisolvent precipitation, mechanical elongation, shear structuring/Couette shear cell, mechanical elongation, freeze-alignment, and 3D/4D printing. The application of unconventional and sustainable sources of plant proteins could further improve sustainability in the future. However, the high level of processing, organoleptic attributes, and lack of bioactive compounds are some challenges faced by the meat analog industry.
... Two dietary imbalances are receiving particular attention. First, in many high-income countries, it is reported there is too low an intake of nutritious plant-source foods relative to animal-source foods [27,28]. Second, in an increasing number of countries around the world, it is reported there is too low an intake of minimally processed nutritious foods relative to UPFs [10,27,[29][30][31]. ...
Background
A healthy and sustainable diet is a prerequisite for population and planetary health. The evidence of associations between dietary patterns and health outcomes has now been synthesised to inform more than 100 national dietary guidelines. Yet, people select foods, not whole dietary patterns, even in the context of following specific diets such as a Mediterranean diet, presenting challenges to researchers, policymakers and practitioners wanting to translate dietary guideline recommendations into food-level selection guidance for citizens. Understanding the fundamentals that underpin healthy and sustainable diets provides a scientific basis for helping navigate these challenges. This paper’s aim is to describe the fundamentals of a healthy and sustainable diet.
Results
The scientific rationale underpinning what is a healthy and sustainable diet is universal. Everyone shares a physiological need for energy and adequate amounts, types and combinations of nutrients. People source their energy and nutrient needs from foods that are themselves sourced from food systems. The physiological need and food systems’ sustainability have been shaped through evolutionary and ecological processes, respectively. This physiological need can be met, and food systems’ sustainability protected, by following three interlinked dietary principles: (i) Variety – to help achieve a nutritionally adequate diet and help protect the biodiversity of food systems. (ii) Balance – to help reduce risk of diet-related non-communicable diseases and excessive use of finite environmental resources and production of greenhouse gas emissions. (iii) Moderation – to help achieve a healthy body weight and avoid wasting finite environmental resources used in providing food surplus to nutritional requirements.
Conclusion
The fundamentals of a healthy and sustainable diet are grounded in evolutionary and ecological processes. They are represented by the dietary principles of variety, balance and moderation and can be applied to inform food-level selection guidance for citizens.
... Adopting a healthy and sustainable diet, which includes reducing meat consumption, could prevent an estimated 10.9 to 11.6 million deaths annually as over consumption of meat in some countries could cause diseases may prevent death rate. Also, it could reduce greenhouse gas emissions, limit anthropogenic global warming to below 2 °C, protect environmental biodiversity, and decrease competition for water and other natural resources [107]. Various types of meat analogues, including cultured meat, mycoprotein, and plantbased meat, offer promising alternatives [106]. ...
Background
High protein sources especially animal protein is being used widely in people’s diet. Ensuring a healthy and sustainable diet should be a global priority. Compared to diets rich in animal products, plant-based diets are more sustainable because they have less environmental impact. Aim of this article is to review mushroom’s sustainability.
Main body
Using meat analogues like mushrooms seems to be a good option because their taste and texture are alike meat and they are sustainable healthy foods as they are good environmental choice due to their less water and land footprint but they are not a cost-benefit food.
Conclusion
Mushroom is a good nutritional and environmental meat substitute as it has less water and land footprint but not as a cost-benefit meat alternative. Therefore, the governments should make policies to use mushroom as an economical meat alternative and a source of protein for all consumers.
... this aligns with the research conducted by chaiumporn (2017), who emphasized the importance of dietary habits, balanced food consumption, sufficient income to purchase food, and consumption of high-quality food free from toxins and chemicals to maintain good health. this was also reflected in a study by Willett et al. (2019), who found that consuming a diverse range of foods can reduce the risk of diseases, as the consumption of different types of foods contributes to good health. Analyzing the benefits of various nutrients and the effects of food on diseases indicates that earning enough to access good quality food and making informed food choices can positively affect overall health and reduce the risk of diseases. ...
This study aims to study: 1) The level of food security in the community, 2) The promotion of food security learning in the community, and using a mixed-methods approach by conducting quantitative and qualitative research. For quantitative research, a questionnaire-based survey was conducted on 309 households. Data were analyzed to determine frequency, percentage, mean, and standard deviation. For the qualitative research, an interview form and an observation record form were used. Interviews and observations with key informants were conducted, selecting 10 households. The data were analyzed, summarized, and presented through a qualitative analysis. The findings of the study were as follows: 1) The level of food security in the community in all aspects was high. 2) The promotion of food security learning in the community focus on diverse, safe, and mindful eating at the individual level while ensuring economic means for healthy food. At the household level, emphasis is placed on nutritional knowledge, efficient meal planning using local ingredients, and budgeting to maintain health without financial stress. Community-level principles advocate sustainable agriculture, local food consumption, and resource sharing to enhance access to nutritious food. These strategies aim to bolster educational efforts, agricultural development, preservation of local food traditions, promotion of food tourism, and support for local markets.
... The benefit of this shift is reported to be higher in males with a peak of up to 0.8 mg/day for adolescents and a recovery of iron adequacy of up to 0.14 mg/day (Table S1, supplementary material). Wholegrain foods are being actively promoted as part of a healthy, sustainable diet profile, based on the need for higher intakes of plant-based dietary fiber-containing foods and lower consumption of meat and fattier animal products [65,66]. The evidence from scientific literature supports the benefits of dietary grain intake in the prevention of type 2 diabetes, cardiovascular disease, and colorectal, pancreatic, and gastric cancers and suggests the consumption of two to three servings per day (~45 g) of whole grains to achieve a public health goal [67]. ...
Background and aim: Cereals’ iron content is a major contributor to dietary iron intake in Europe and a potential for biofortification. A simulation of daily iron intake from wheat and rice over the next 20 years will be quantified. Methods: Food items, and energy and iron intake by age classes are estimated using the Italian dietary survey (IV SCAI). Iron intake and adequacy estimation trends were categorized in four scenarios compared to a baseline (basic scenario; only climate change effects): over wheat and rice biofortification effects (scenario 1); over the shift in whole wheat consumption of up to 50% of the total amount of wheat-based foods (scenario 2); over the shift in brown rice consumption up to 100% of the total amount of rice (scenario 3); over the cumulative effects of biofortifications and whole wheat and brown rice consumption (scenario 4). Results: Increasing the iron intake from wheat and rice biofortification and the shift in whole wheat consumption is similar and sufficient to recover the baseline iron depletion effect due to climate change. The shift in brown rice consumption produces a negligible increment in iron intake. The cumulative effects of the corrective actions considered in the scenarios can significantly reduce the iron intake inadequacy, despite not reaching the recommended levels. Conclusions: Corrective actions including biofortification and whole grain consumption are still far from ensuring the full recovery in children and females of fertile age as at-risk groups of iron deficiency. Further actions are needed considering other biofortified food sources, fortified foods, and/or dietary food diversification.
... Since gut microbiome is associated with all these disorders, the effects of legume consumption on gut microbiome have been considered and drawing attention on the modulation gut microbiome due to their protein, fiber and phytochemical contents (Queiroz-Monici et al. 2005, Mitchell et al. 2009, Clemente and Olias 2017, Kasprzak-Drozd et al. 2021. In addition to their effects on health and gut microbiome, legumes also have prominent place in the matter of sustainability because of their low carbon and water footprints (Tilman and Clark 2014, Willett et al. 2019, Röös et al. 2020, Semba et al. 2021). On the other hand, due to their high protein content, legumes appear to be a good choice for meat substitution in the daily diets of people who follow the vegan/vegetarian eating trends which is growing around the world (Sexton, Garnett, andLorimer 2022, Thomopoulos et al. 2022). ...
The gut microbiome plays a crucial role in human health, affecting metabolic, immune, and cognitive functions. While the impact of various dietary components on the microbiome is well-studied, the effect of legumes remains less explored. This review examines the influence of legume consumption on gut microbiome composition, diversity, and metabolite production, based on 10 human and 21 animal studies. Human studies showed mixed results, with some showing increased microbial diversity and others finding no significant changes. However, legume consumption was linked to increases in beneficial bacteria like Bifidobacterium and Faecalibacterium. Animal studies generally indicated enhanced microbial diversity and composition changes, though these varied by legume type and the host’s health. Some studies highlighted legume-induced shifts in bacteria associated with better metabolic health. Overall, the review emphasizes the complexity of legume-microbiome interactions and the need for standardized methodologies and longitudinal studies. While legumes have the potential to positively affect the gut microbiome, the effects are nuanced and depend on context. Future research should investigate the long-term impacts of legume consumption on microbiome stability and its broader health implications, particularly for disease prevention and dietary strategies.
... The cultivation of crops, livestock, and aquatic species occupies over a third of the Earth's land and ocean areas, impacting global ecosystems and affecting human health and well-being [1][2][3]. Food systems need to evolve to be more sustainable and fair, which necessitates a collaborative approach to knowledge creation across various disciplines [4]. The United Nations Sustainable Development Goals call for food systems to be transformed into more sustainable and equitable models [5]. ...
Foodborne disease presents a substantial challenge to researchers, as foliar water intake greatly influences pathogen internalization via stomata. Comprehending plant-pathogen interactions , especially under fluctuating humidity and temperature circumstances, is crucial for formulating ways to prevent pathogen ingress and diminish foodborne hazards. This study introduces a computational model utilizing neural networks to anticipate pathogen internalization via stomata, contrasting with previous research that emphasized biocontrol techniques. Computational modeling assesses the likelihood and duration of internalization for bacterial pathogens such as Salmonella enterica (S. enterica), considering various environmental factors including humidity and temperature. The estimated likelihood ranges from 0.6200 to 0.8820, while the internalization time varies from 4000 s to 5080 s, assessed at 50% and 100% humidity levels. The difference in internalization time, roughly 1042.73 s shorter at 100% humidity, correlates with a 26.2% increase in the likelihood of internalization, rising from 0.6200 to 0.8820. A neural network model has been developed to quantitatively predict these values, thereby enhancing the understanding of plant-microbe interactions. These methods will aid researchers in understanding plant-pathogen interactions, especially in environments characterized by varying humidity and temperature and are essential for formulating strategies to prevent pathogen ingress and tackle foodborne illnesses within a technologically advanced context.
The consumption of Fisheries and Aquaculture Products (FAP) can contribute to the transition of our food system towards greater sustainability. However, in order to implement effective food policies aimed at promoting sustainable FAP consumption, data on individual consumption behavior are lacking. Based on a consumer survey carried out on the French market in 2023, the aim of this article was to gain a deeper understanding of the current consumption patterns in place in France in order to identify potential levers for aligning French FAP consumption with public health and resource conservation objectives. Using an ordered probit model and Welch’s t-tests, our results show that French FAP consumption is currently driven by few people (the elderly, connoisseurs, and high-income households). In line with our findings, actions are proposed to guide French FAP consumers towards more sustainable behavior. In particular, we discuss the need to inform and educate consumers better. The promotion of local “under-utilized” species, the integration of environmental considerations into existing food policies, or even the need to exploit “out-of-home” consumption venues to promote sustainable FAP consumption among occasional consumers are discussed as interesting possibilities.
The high emissions intensity of terrestrial animal source food (TASF) and projected increasing demand in low- and middle-income countries (LMIC) have spurred interest in the development of animal-free alternatives and manufactured food items that aim to substitute for meat, milk, and eggs with the promise of reduced environmental impact of producing food. The developing world is the source of 75% of global emissions from ruminants and will house 86% of the world’s human population by 2050. The adoption of cost-effective, genetic, feed and nutrition practices, and improving livestock health in LMIC are seen as the most promising interventions to reduce emissions resulting from projected increased TASF demand though 2050. Genetic improvement is a particularly attractive approach to productivity enhancements, as such improvements are permanent and cumulative. Alternative proteins may play a role in addressing demand for affordable sources of nutrient-dense foods, however, price will be a major factor influencing adoption given 3.1 billion people globally (42%) were currently unable to afford a healthy diet in 2021. Additionally, there is currently a mismatch between the location of alternative protein companies, and both projected increased TASF demand and emissions. To date, the vast majority (>81%) of these companies are based in high-income countries. The sustainability implications of replacing TASF with alternative proteins at scale needs to consider not only environmental metrics but also the wider economic and social sustainability impacts, given the essential role that livestock play in the livelihoods and food security of approximately 1.3 billion people.
Encouraging consumption of plant-based food products can help mitigate the impact of dietary choices on climate change. Research suggests that modifying environments in which people make purchasing decisions has the potential to achieve behavioral changes toward sustainable consumption. We examine the impact of two behavioral interventions, carbon footprint labeling, and product categorization, to promote sustainable food selection in an online grocery shopping environment. Online grocery shopping data collected from 2,359 US participants show that carbon footprint labels increased the selection of plant-based food products by 37% and categorization increased it by 25%. A combination of both nudges increased plant-based food selection by 32%. Participants underestimated the environmental impact of different types of foods despite exposure to carbon footprint information. As the global market for online grocery shopping continues to grow, this study presents a potential for simple and scalable interventions in online shopping environments to encourage sustainable choices.
Reduced consumption of animal-sourced food (ASF) has been recommended for environmental and human health objectives; however, ASF can be important for food security and diet affordability. We explored country-level relationships among various metrics of food supply, socioeconomic context, food security, diet affordability, and agricultural greenhouse gas emissions (GHGe) to characterize how optimal inclusion ranges for ASF vary with socioeconomic factors and food system goals. Data from 2015 to 2022 for 153 countries were sourced to generate Bayesian Networks representing relationships among the studied food system metrics. Networks were used in simulations to characterize optimal ASF inclusion to achieve environmental, food security, or diet affordability goals based on individual country data. Results are most appropriately interpreted in aggregate rather than as representations of specific countries due in large part to data limitations. Across countries simulated, median total ASF inclusion in the food supply to support food security, GHGe, or affordability objectives was 18.2% ± 12.1%, 11.9% ± 6.8%, and 17.6% ± 8.5%, respectively. Joint optimization for these goals resulted in median ASF inclusion of 15.1% ± 7.2%, with notable regional differences. Although ASF increases were supported in most developing regions, decreases were supported in developed countries. The reported SD in optimal ASF inclusion were considerable, and represented between-country variation. Empirical relationships of food categories to goals consistently favored dairy and egg products over meats. These results support previous literature highlighting the environmental intensity of ASF, but also indicate that moderate ASF supplies contribute to multiple food system goals simultaneously.
The Planetary Health Diet (PHD), also known as the EAT-Lancet reference diet, was developed to optimize global dietary quality while keeping the environmental impacts of food production within sustainable planetary boundaries. We calculated current national and global adherence to the PHD using the Planetary Health Dietary Index (PHDI). In addition, we used data on diet and mortality from three large US cohorts (n = 206,404 men and women, 54,536 deaths) to estimate the total and cause-specific mortality among adults 20 y of age and older that could be prevented by shifting from current diets to the reference PHD. The PHDI varied substantially across countries, although adherence was universally far from optimal (mean PHDI = 85 out of 140). By improving the global PHDI to 120, approximately 15 million deaths (27% of total deaths) could be prevented annually. Estimates of preventable deaths due to this shift ranged from 2.5 million for cardiovascular diseases to 0.7 million for neurodegenerative diseases. Our analysis suggests that adopting healthy and sustainable diets would have major direct health benefits by reducing mortality due to multiple diseases and could contribute substantially to achieving the United Nations Sustainable Development Goals. These numbers of preventable deaths are based on evidence that human biology is similar across racial and ethnic groups, but the exact numerical estimates should be interpreted with caution because some assumptions used for the calculations build on limited data. Refinement of these estimates will be possible when additional regional data on diet and mortality become available.
Animal-sourced foods (ASFs) are among the most contentious topics in the broader public debates about sustainable food systems, climate change, biodiversity loss, and healthy nutrition. This focus on ASFs is unsurprising, as their production and consumption directly relate to numerous key sustainability dimensions, both in positive and negative ways. In this article, we review global trends in ASF production and consumption. We also analyze how more sustainable patterns of ASF production and consumption could be achieved in different world regions and what role plant-based alternatives and other types of technical and social innovations could play.
Reducing meat and dairy intake has been identified as a necessary strategy for mitigating the high environmental impacts food systems are currently having on climate change, biodiversity loss associated with land-use changes, and freshwater use. Having a choice of dedicated meat and milk replacements available to consumers can help in the transition toward more plant-based diets, but concerns about nutritional and health impacts and high costs can impede uptake. Here, we conduct a multicriteria assessment of 24 meat and milk alternatives that integrates nutritional, health, environmental, and cost analyses with a focus on high-income countries. Unprocessed plant-based foods such as peas, soybeans, and beans performed best in our assessment across all domains. In comparison, processed plant-based products such as veggie burgers, traditional meat replacements such as tempeh, and plant milks were associated with less climate benefits and greater costs than unprocessed foods but still offered substantial environmental, health, and nutritional benefits compared to animal products. Our findings suggest that a range of food products exist that when replacing meat and dairy in current diets would have multiple benefits, including reductions in nutritional imbalances, dietary risks and mortality, environmental resource use and pollution, and when choosing unprocessed foods over processed ones also diet costs. The findings provide support for public policies and business initiatives aimed at increasing their uptake.
En función de la carencia de antecedentes que analicen desde un enfoque integral lo alimentario-nutricional, vinculado a lo socio-cultural en personas con diabetes tipo 2 (DM2) en la provincia de Misiones, el estudio tuvo por objetivo describir y analizar loshábitos alimentarios y su relación con el estado nutricional en personas de 30 a 70 años con diagnóstico de DM2.Se realizó un estudio descriptivo mixto, de muestreo intencional. Las personas con DM2 fueron contactadas a través de profesionales de la salud que se desempeñan en el subsector público, en localidades de cuatro de las seis zonas sanitarias que dividen la provincia y resultan representativas de la diversidad socio-cultural y demográfica, y que aceptaron participar con firma del consentimiento informado por escrito. Se realizaron encuentros cara a cara con las personas con DM2 en su domicilio, toma demedidas antropométricas, cuestionario de frecuencia de consumo (CFC), entrevista semiestructurada grabada en base a tópicos según objetivo del estudio (datos biográficos, nivel socio-económico, educativo, patología, tratamientos; selección de alimentos, preparación, consumo estacionalidad, distribución -buscando indagar en los porqués de tales elecciones).La muestra se compuso por 19 personas con DM2, edad promedio de 53 años. Con relación al nivel de educativo, el 44% no había completado el ciclo inicial o medio, el 33% había completado el inicial, y solo el 17% el medio. Sólo el 11% de las personas poseía normo peso, mientras que el resto presentaba sobrepeso (42%) y la mayor parte de la muestra obesidad en diferentes grados (47%). Los resultados del procesamiento del CFC permitieron identificar tres perfiles de alimentación. Moderno, asociado a zonas urbanas; tradicional, asociado a zonas rurales; y mixto, asociado a zonas peri-urbanas: Las condiciones que definen comida a partir de preparaciones sabrosas, saciantes, energético proteicas y cocidas, determinan estados nutricionales en desmedro del control metabólico de las personas adultas con DM2 en la provincia de Misiones. Así, las cantidades de calorías, las combinaciones realizadas y los métodos de elaboración generan preparaciones con elevada carga glucémica. A su vez, se observa baja frecuencia de ingesta de alimentos que favorecerían niveles glucémicos protectores en ambos sexos (alimentos enteros de origen vegetal, principalmente).
Background
Dietary shift towards more plant-based options is increasingly popular, but the quantity of ultra-processed foods (UPFs) they contain is largely unknown. This study assessed the level of UPF and minimally processed food consumption among regular and low red meat eaters, flexitarians, pescatarians, vegetarians and vegans in a large dataset of United Kingdom (UK) adults.
Methods
This is a cross-sectional analysis of the UK Biobank participants recruited between December 19, 2006, and October 1, 2010. Responses to food frequency questions were used to identify diet types for vegans (never eating any animal-based foods); vegetarians (never eating meat/fish); pescatarians (never eating meat); flexitarians (consumed fish/meat under twice a week); low red meat eaters (consumed fish/poultry more than once a week but red/processed meat under twice a week); and regular red meat eaters (consumed red/processed meat more than once a week). Consumption of all food and drinks collected in 24-h recalls between April 29, 2009, and June 28, 2012, were categorised using the Nova classification. The primary outcomes are the consumption of UPFs and minimally processed foods, expressed as a percentage of daily food intake (grams/day). Multivariable linear regression assessed the mean percentage point difference in UPF and minimally processed food consumption between diet types.
Findings
This study included 199,502 UK Biobank participants (mean age 58.2 [standard deviation 7.9] years; 55.1% women). The mean UPF consumption was 24.2%, 21.9%, 22.0%, 20.4%, 23.8%, and 22.7% among 75,091 regular red meat eaters, 70,144 low red meat eaters, 45,057 flexitarians, 4932 pescatarians, 4119 vegetarians and 159 vegans, respectively. The adjusted results suggested that compared with regular red meat eaters, UPF consumption was 1.3 percentage points higher among vegetarians (95% confidence interval [CI]: 0.9, 1.7) and lower among low red meat eaters (−1.3, 95% CI: −1.4, −1.1), flexitarians (−0.8, 95% CI: −1.0, −0.7), and pescatarians (−1.6, 95% CI: −1.9, −1.2). The UPF consumption in vegans were not significantly different from regular red meat eaters (1.2 percentage points, 95% CI: −0.7, 3.2). Minimally processed food consumption was higher in all other types of diet than regular red meat eaters, with an adjusted percentage point difference ranged from 0.4 (95% CI: 0.005, 0.9) for vegetarians to 3.2 (95% CI: 1.0, 5.5) for vegans compared with regular red meat eaters.
Interpretation
This UK-based study found higher UPF consumption in vegetarian diets and lower in diets with a modest amount of meat or fish. It is important that policies which encourage the urgently needed transition to more sustainable dietary patterns also promote rebalancing diets towards minimally processed foods.
Funding
10.13039/501100000272National Institute for Health and Care Research (NIHR) 10.13039/501100012349School for Public Health Research, 10.13039/501100000321World Cancer Research Fund.
Food analogues are an important part of the food industry. However, the current attention on food analogues is mainly focused on plant-based products, while ignoring the substantial role played by marine biomaterials in food analogues. In addition, the main technologies used to process marine biological resources into food analogues are molding and cooking process, extrusion technology, and three-dimensional (3D) printing technology. Therefore, this section focuses on reviewing a synthesis on the application of marine biomaterials (including fish, crustaceans, shellfish, and cephalopods, not including algae) in meat analogues and the main processing technologies. In particular, surimi produced from fish has been widely used to simulate crab, shrimp, lobster, and scallop meat. The proteins of marine food can act as gelling and filling agents in the preparation of meat analogues. Additionally, healthy lipids (phospholipid omega-3 polyunsaturated fatty acids) and a large number of micronutrients can provide essential nutrients for humans. Therefore, marine biomaterials have great potential for the production of food analogues.
The aim of this study is to determine the sustainable and healthy eating behaviors and ecological footprint awareness of teachers from different branches. For this purpose, 270 teachers from different branches participated in the study. The research data were collected in the internet environment through the online survey link sent to the participants. The survey includes individual characteristics, sustainable and healthy eating (SHE) behaviors scale and awareness scale for reducing ecological footprint (ASREF). 64.8% of the participants are female and 34.9% are male teachers. The total mean score of the teachers' SHE behaviors scale was 4.1±1.15 and no significant difference was found according to gender. It was determined that the highest score in the sub-dimensions was in avoiding food waste, and the lowest score was in the reduction of meat consumption and local food sub-dimensions. The total score of the teachers' ASREF was 3.9±0.88. There was no significant difference in total score and sub-dimensions according to gender. When the SHE behaviors scale were evaluated according to the branch, it was determined that in basic education and sports branches was higher than in verbal, language and arts and numerical branches (p=0.031). The total score of SHE behaviors scale of the teachers was found to be higher in those who received nutrition education (4.4±1.15) than those who did not (4.0±1.12) (p=0.001). It was determined that the reduction of meat consumption and low-fat sub-dimension were statistically significantly negatively correlated with BMI (p
Resumo Objetivos: identificar padrões alimentares (PA) de mulheres pós-parto e avaliar o efeito da insegurança alimentar, da idade e do nível de escolaridade no PA não saudável. Métodos: Coorte realizada por processo de amostragem consecutiva não probabilística em município da região Nordeste do Brasil, entre 2017-2018. A partir dos questionários de frequência alimentar, foram derivados PA por análises de componentes principais no 3º (n=207), 6º (n=195) e 12º mês (n=183) pós-parto. As associações entre os PA e as variáveis independentes foram investigadas utilizando modelo de regressão logística de efeitos mistos. Resultados: foram identificados dois padrões alimentares: PA predominantemente saudável (PAPS) e PA predominantemente ultraprocessado (PAPUP). Identificou-se que quanto maior a idade (OR= 0,92; IC95%= 0,85-0,99; p=0,031) e o nível de escolaridade (OR= 0,81; IC95%= 0,70-0,93; p=0,003), menor foi a chance de adesão ao PAPUP. Famílias com algum nível de insegurança alimentar apresentaram maior chance de aderir ao PAPUP (OR= 1,55; IC95%= 1,01-2,37; p=0,044). Conclusão: a adesão ao PAPUP aumenta com o nível de insegurança alimentar. A maior idade e nível de escolaridade diminuem a adesão a esse PA. Esses achados fornecem suporte para a associação entre insegurança alimentar, idade e escolaridade com a adesão ao PAPUP, sugerindo a necessidade de medidas eficazes para garantir a segurança alimentar, particularmente para populações vulneráveis.
Promoting sustainable diets requires identifying those foods that balance nutritional quality, environmental impact, and cost, and taking cultural preferences into account. However, research on the sustainability of dietary habits in non-adult populations are limited. This cross-sectional study aims to investigate the relationship between different sustainability indicators and identify sustainable foods among those culturally acceptable by Portuguese children and adolescents. Dietary intake of 521 children and 633 adolescents was determined using food-diaries and 24-h recalls, respectively. Nutritional, environmental, and economic indicators were assessed for each food item identified as culturally acceptable among Portuguese children and adolescents. Spearman correlations were computed to assess the relationship between sustainability indicators. A sustainability score (0-3) was calculated to identify the most sustainable foods. Nutritional quality was positively correlated with greenhouse gas emissions and cost and inversely correlated with food industrial processing. Only around 10% of foods received a maximum sustainability score, namely fresh and processed vegetables, fresh fruit and fruit jars, legumes, pasta, rice and other grains, potatoes and other starchy tubers, natural and 100% fruit juices, and nectars. Overall, the most nutritious foods tend to have a higher environmental impact and cost, and few food options are simultaneously nutrient-rich, environmentally friendly and affordable.
Unhealthy diets have become a leading contributor to death and disability globally. The current Chinese diet falls short of a healthy diet, including too much meat, oil, salt, and sugar while having insufficient levels of whole grains, fruits, nuts, and milk. Transforming Chinese dietary patterns has become urgent. This paper compares the effectiveness of information framing effects on enhancing Chinese consumers' healthy diet choices, varied by information content, source, and presentation. The survey is conducted across six Chinese cities, with a sample of 3150 urban consumers. Chinese consumers' healthy diet choices are measured using an online discrete choice experiment. Four different diet patterns were used to label each of the product alternatives in the experiment, which varied in taste and cost. Results reveal that compared to positive information; negatively framed healthy information is more effective in increasing Chinese consumers' valuations for healthy diets. Consumer valuation of a healthy whole diet is significantly enhanced when the information is from social celebrities, compared to information from a scientific source. Moreover, when health information is disclosed via social media, its effectiveness in promoting healthy diet choices is significantly reduced. Our findings have implications for designing and implementing nutrition policies and programs in China and other developing countries.
Objectives: This study aimed to identify the predictors of eating more plant-based foods and legumes in terms of previous changes in consumption, habitual frequency of consumption, intention to reduce the amount of meat consumed, and health and environmental identities. Methods: A cross-sectional survey was conducted between June and September 2023 in 881 Polish adults. Based on two self-descriptors, four groups of respondents were identified: no health identity and no environmental identity (nHI-nEI), health identity but no environmental identity (HI-nEI), no health identity but environmental identity (nHI-EI), and both health identity and environmental identity (HI-EI). A logistic regression analysis was used to verify associations between habitual eating of red meat, white meat, and legumes, changes in their intake over the past two years, familiarity with plant-based substitutes for animal products, health, and environmental identity, declared intentions to eat less meat, and the intentions to eat more plant-based food and eat more legumes next year. Results: Individuals were more likely to increase their consumption of plant foods (OR: 1.99, p = 0.001), including legumes (OR: 1.79, p = 0.045), when they represented the HI-EI group, had increased their consumption of legumes in the past two years (OR: 2.91, p = 0.009, and OR: 2.15, p = 0.017, respectively), declared an intention to reduce meat (OR: 8.02, p < 0.001, and OR: 12.08, p < 0.001, respectively), but also occasionally consumed plant-based meat substitutes (OR: 1.76, p = 0.002, and OR: 2.61, p < 0.001, respectively). However, individuals were more likely to increase their consumption of plant foods, but not legumes, if they currently consumed legumes frequently (OR: 1.36, p = 0.009, and OR: 1.22, p = 0.111, respectively) and had previously limited their consumption of red meat (OR: 2.40, p < 0.001, and OR: 1.09, p = 0.717, respectively). Conclusions: The habitual frequency of eating red and white meat did not predict the increased consumption of plant foods in the future. It is equally important to increase people’s awareness of the impact of the food they consume on health and the environment to support their health and pro-environmental motivation for food choices. Public health and sustainability campaigns should develop new methods to reach populations less willing to change.
Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication that seriously endangers maternal and infant health, posing a medical and economic burden worldwide. Several dietary patterns have been recommended for women of childbearing age, demonstrating a positive role in preventing and managing GDM. However, these dietary patterns may not fully take environmental factors into account when addressing global food sustainability and planetary health. In this context, the EAT-Lancet Commission proposed a diet in 2019 aimed at both health improvement and environmental sustainability, which can potentially reduce the prevalence of diet-related diseases. Nevertheless, the role of the EAT-Lancet reference diet in preventing and managing GDM has not been fully evaluated. Therefore, we conducted a literature search to assess the existing evidence for the association between the EAT-Lancet reference diet components and GDM. Based on the current evidence available in the PubMed database from inception to 31 October 2024, women of childbearing age are recommended to consume whole grains, fish, soy products, olive oil, full-fat dairy products, nuts, and moderate amounts of fruits while reducing red meat and sugar-sweetened beverage intake to lower the risk of GDM. There remains inconsistency regarding the association between tubers or starchy vegetables, vegetables, eggs, and poultry and the risk of GDM. In conclusion, current research on the association between diet and GDM is limited and offers suggestions for methodologies to obtain robust evidence regarding the association between the EAT-Lancet reference diet and GDM.
The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
Background
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations.
Methods
We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
Findings
In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.
Interpretation
By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.
Background
Sustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and environmental modelling framework for more than 150 countries, we examined three different approaches to sustainable diets motivated by environmental, food security, and public health objectives.
Methods
In this global modelling analysis, we combined analyses of nutrient levels, diet-related and weight-related chronic disease mortality, and environmental impacts for more than 150 countries in three sets of diet scenarios. The first set, based on environmental objectives, replaced 25–100% of animal-source foods with plant-based foods. The second set, based on food security objectives, reduced levels of underweight, overweight, and obesity by 25–100%. The third set, based on public health objectives, consisted of four energy-balanced dietary patterns: flexitarian, pescatarian, vegetarian, and vegan. In the nutrient analysis, we calculated nutrient intake and changes in adequacy based on international recommendations and a global dataset of nutrient content and supply. In the health analysis, we estimated changes in mortality using a comparative risk assessment with nine diet and weight-related risk factors. In the environmental analysis, we combined country-specific and food group-specific footprints for greenhouse gas emissions, cropland use, freshwater use, nitrogen application, and phosphorus application to analyse the relationship between the health and environmental impacts of dietary change.
Findings
Following environmental objectives by replacing animal-source foods with plant-based ones was particularly effective in high-income countries for improving nutrient levels, lowering premature mortality (reduction of up to 12% [95% CI 10–13] with complete replacement), and reducing some environmental impacts, in particular greenhouse gas emissions (reductions of up to 84%). However, it also increased freshwater use (increases of up to 16%) and had little effectiveness in countries with low or moderate consumption of animal-source foods. Following food-security objectives by reducing underweight and overweight led to similar reductions in premature mortality (reduction of up to 10% [95% CI 9–11]), and moderately improved nutrient levels. However, it led to only small reductions in environmental impacts at the global level (all impacts changed by <15%), with reduced impacts in high-income and middle-income countries, and increased resource use in low-income countries. Following public health objectives by adopting energy-balanced, low-meat dietary patterns that are in line with available evidence on healthy eating led to an adequate nutrient supply for most nutrients, and large reductions in premature mortality (reduction of 19% [95% CI 18–20] for the flexitarian diet to 22% [18–24] for the vegan diet). It also markedly reduced environmental impacts globally (reducing greenhouse gas emissions by 54–87%, nitrogen application by 23–25%, phosphorus application by 18–21%, cropland use by 8–11%, and freshwater use by 2–11%) and in most regions, except for some environmental domains (cropland use, freshwater use, and phosphorus application) in low-income countries.
Interpretation
Approaches for sustainable diets are context specific and can result in concurrent reductions in environmental and health impacts globally and in most regions, particularly in high-income and middle-income countries, but they can also increase resource use in low-income countries when diets diversify. A public health strategy focused on improving energy balance and dietary changes towards predominantly plant-based diets that are in line with evidence on healthy eating is a suitable approach for sustainable diets. Updating national dietary guidelines to reflect the latest evidence on healthy eating can by itself be important for improving health and reducing environmental impacts and can complement broader and more explicit criteria of sustainability.
Funding
Wellcome Trust, EAT, CGIAR, and British Heart Foundation.
The food system is a major driver of climate change, changes in land use, depletion of freshwater resources, and pollution of aquatic and terrestrial ecosystems through excessive nitrogen and phosphorus inputs. Here we show that between 2010 and 2050, as a result of expected changes in population and income levels, the environmental effects of the food system could increase by 50–90% in the absence of technological changes and dedicated mitigation measures, reaching levels that are beyond the planetary boundaries that define a safe operating space for humanity. We analyse several options for reducing the environmental effects of the food system, including dietary changes towards healthier, more plant-based diets, improvements in technologies and management, and reductions in food loss and waste. We find that no single measure is enough to keep these effects within all planetary boundaries simultaneously, and that a synergistic combination of measures will be needed to sufficiently mitigate the projected increase in environmental pressures.
Evidence shows the importance of food systems for sustainable development: they are at the nexus that links food security, nutrition, and human health, the viability of ecosystems, climate change, and social justice. However, agricultural policies tend to focus on food supply, and sometimes, on mechanisms to address negative externalities. We propose an alternative. Our starting point is that agriculture and food systems’ policies should be aligned to the 2030 Agenda for Sustainable Development. This calls for deep changes in comparison with the paradigms that prevailed when steering the agricultural change in the XXth century. We identify the comprehensive food systems transformation that is needed. It has four parts: first, food systems should enable all people to benefit from nutritious and healthy food. Second, they should reflect sustainable agricultural production and food value chains. Third, they should mitigate climate change and build resilience. Fourth, they should encourage a renaissance of rural territories. The implementation of the transformation relies on (i) suitable metrics to aid decision-making, (ii) synergy of policies through convergence of local and global priorities, and (iii) enhancement of development approaches that focus on territories. We build on the work of the “Milano Group,” an informal group of experts convened by the UN Secretary General in Milan in 2015. Backed by a literature review, what emerges is a strategic narrative linking climate, agriculture and food, and calling for a deep transformation of food systems at scale. This is critical for achieving the Sustainable Development Goals and the Paris Agreement. The narrative highlights the needed consistency between global actions for sustainable development and numerous local-level innovations. It emphasizes the challenge of designing differentiated paths for food systems transformation responding to local and national expectations. Scientific and operational challenges are associated with the alignment and arbitration of local action within the context of global priorities.
Dariush Mozaffarian and colleagues review strategies governments can use to improve nutrition and health © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.
The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement, and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change, which concluded that anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be “the greatest global
health opportunity of the 21st century”. The Lancet Countdown is a collaboration between 24 academic institutions and intergovernmental organisations based in every continent and with representation from a wide range of disciplines. The collaboration includes climate scientists, ecologists, economists, engineers, experts in energy, food, and transport systems, geographers, mathematicians, social and political scientists, public health professionals, and doctors. It reports annual indicators across five sections: climate change impacts, exposures, and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The key messages from the 40 indicators in the Lancet Countdown’s 2017 report are summarised below.
A large body of research has explored opportunities to mitigate climate change in agricultural systems; however, less research has explored opportunities across the food system. Here we expand the existing research with a review of potential mitigation opportunities across the entire food system, including in pre-production, production, processing, transport, consumption and loss and waste. We detail and synthesize recent research on the topic, and explore the applicability of different climate mitigation strategies in varying country contexts with different economic and agricultural systems. Further, we highlight some potential adaptation co-benefits of food system mitigation strategies and explore the potential implications of such strategies on food systems as a whole. We suggest that a food systems research approach is greatly needed to capture such potential synergies, and highlight key areas of additional research including a greater focus on low- and middle-income countries in particular. We conclude by discussing the policy and finance opportunities needed to advance mitigation strategies in food systems.
Benefits of a Mediterranean diet for cognition have been suggested, but epidemiologic studies have been relatively small and of limited duration. To prospectively assess the association between long-term adherence to a Mediterranean dietary pattern and self-reported subjective cognitive function (SCF). Prospective observational study. The Health Professionals’ Follow-up Study, a prospective cohort of 51,529 men, 40–75 years of age when enrolled in 1986, of whom 27,842 were included in the primary analysis. Mediterranean diet (MD) score, computed from the mean of five food frequency questionnaires, assessed every 4 years from 1986 to 2002. Self-reported SCF assessed by a 6-item questionnaire in 2008 and 2012, and validated by association with genetic variants in apolipoprotein-4. Using the average of 2008 and 2012 SCF scores, 38.0% of men were considered to have moderate memory scores and 7.3% were considered to have poor scores. In a multivariate model, compared with men having a MD score in the lowest quintile, those in the highest quintile had a 36% lower odds of a poor SCF score (odds ratio 0.64, 95% CI 0.55–0.75; P, trend < 0.001) and a 24% lower odds of a moderate SCF score (OR 0.76, 95% CI 0.70–0.83; P, trend < 0.001). Both remote and more recent diet contributed to this relation. Associations were only slightly weaker using baseline dietary data and a lag of 22 years. Long-term adherence to the Mediterranean diet pattern was strongly related to lower subjective cognitive function. These findings provide further evidence that a healthy dietary pattern may prevent or delay cognitive decline.
Is active restoration the best approach to achieve ecological restoration success (the return to a reference condition, that is, old-growth forest) when compared to natural regeneration in tropical forests? Our meta-analysis of 133 studies demonstrated that natural regeneration surpasses active restoration in achieving tropical forest restoration success for all three biodiversity groups (plants, birds, and invertebrates) and five measures of vegetation structure (cover, density, litter, biomass, and height) tested. Restoration success for biodiversity and vegetation structure was 34 to 56% and 19 to 56% higher in natural regeneration than in active restoration systems, respectively, after controlling for key biotic and abiotic factors (forest cover, precipitation, time elapsed since restoration started, and past disturbance). Biodiversity responses were based primarily on ecological metrics of abundance and species richness (74%), both of which take far less time to achieve restoration success than similarity and composition. This finding challenges the widely held notion that natural forest regeneration has limited conservation value and that active restoration should be the default ecological restoration strategy. The proposition that active restoration achieves greater restoration success than natural regeneration may have arisen because previous comparisons lacked controls for biotic and abiotic factors; we also did not find any difference between active restoration and natural regeneration outcomes for vegetation structure when we did not control for these factors. Future policy priorities should align the identified patterns of biophysical and ecological conditions where each or both restoration approaches are more successful, cost-effective, and compatible with socioeconomic incentives for tropical forest restoration.
Significance
Most nations recently agreed to hold global average temperature rise to well below 2 °C. We examine how much climate mitigation nature can contribute to this goal with a comprehensive analysis of “natural climate solutions” (NCS): 20 conservation, restoration, and/or improved land management actions that increase carbon storage and/or avoid greenhouse gas emissions across global forests, wetlands, grasslands, and agricultural lands. We show that NCS can provide over one-third of the cost-effective climate mitigation needed between now and 2030 to stabilize warming to below 2 °C. Alongside aggressive fossil fuel emissions reductions, NCS offer a powerful set of options for nations to deliver on the Paris Climate Agreement while improving soil productivity, cleaning our air and water, and maintaining biodiversity.
Global declines in insects have sparked wide interest among scientists, politicians, and the general public. Loss of insect diversity and abundance is expected to provoke cascading effects on food webs and to jeopardize ecosystem services. Our understanding of the extent and underlying causes of this decline is based on the abundance of single species or taxonomic groups only, rather than changes in insect biomass which is more relevant for ecological functioning. Here, we used a standardized protocol to measure total insect biomass using Malaise traps, deployed over 27 years in 63 nature protection areas in Germany (96 unique location-year combinations) to infer on the status and trend of local entomofauna. Our analysis estimates a seasonal decline of 76%, and mid-summer decline of 82% in flying insect biomass over the 27 years of study. We show that this decline is apparent regardless of habitat type, while changes in weather, land use, and habitat characteristics cannot explain this overall decline. This yet unrecognized loss of insect biomass must be taken into account in evaluating declines in abundance of species depending on insects as a food source, and ecosystem functioning in the European landscape.
Background:
The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.
Methods:
We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.
Findings:
Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.
Interpretation:
Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.
Funding:
The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
Background:
The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.
Methods:
The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.
Findings:
During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76-0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.
Interpretation:
High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.
Funding:
Full funding sources listed at the end of the paper (see Acknowledgments).
Background
This systematic review (PROSPERO: CRD42015025276) employs a realist approach to investigate the effect of “real-world” policies targeting different aspects of the food environment that shape individual and collective nutrition.
Objectives
We were interested in assessing intermediate outcomes along the assumed causal pathway to “policy success”, in addition to the final outcome of changed consumption patterns.
Data sources
We performed a search of 16 databases through October 2015, with no initial restriction by language.
Study eligibility criteria
We included all publications that reported the effect of statutory provisions aimed at reducing the consumption of energy-dense foods and beverages in the general population. We allowed all methodological approaches that contained some measure of comparison, including studies of implementation progress.
Study appraisal and synthesis methods
We reviewed included studies using the appraisal tools for pre-post and observational studies developed by the National Heart, Lung, and Blood Institute. Given the considerable heterogeneity in interventions assessed, study designs employed, and outcome measures reported, we opted for a narrative synthesis of results.
Results and implications
Results drawn from 36 peer-reviewed articles and grey literature reports demonstrated that isolated regulatory interventions can improve intermediate outcomes, but fail to affect consumption at clinically significant levels. The included literature covered six different types of interventions, with 19 studies reporting on calorie posting on chain restaurant menus. The large majority of the identified interventions were conducted in the US. Early results from recent taxation measures were published after the review cut-off date but these suggested more favorable effects on consumption levels. Nevertheless, the evidence assessed in this review suggests that current policies are generally falling short of anticipated health impacts.
Significance
The strong focus on species extinctions, a critical aspect of the contemporary pulse of biological extinction, leads to a common misimpression that Earth’s biota is not immediately threatened, just slowly entering an episode of major biodiversity loss. This view overlooks the current trends of population declines and extinctions. Using a sample of 27,600 terrestrial vertebrate species, and a more detailed analysis of 177 mammal species, we show the extremely high degree of population decay in vertebrates, even in common “species of low concern.” Dwindling population sizes and range shrinkages amount to a massive anthropogenic erosion of biodiversity and of the ecosystem services essential to civilization. This “biological annihilation” underlines the seriousness for humanity of Earth’s ongoing sixth mass extinction event.
Global agricultural feeds over 7 billion people, but is also a leading cause of environmental degradation. Understanding how alternative agricultural production systems, agricultural input efficiency, and food choice drive environmental degradation is necessary for reducing agriculture's environmental impacts. A meta-analysis of life cycle assessments that includes 742 agricultural systems and over 90 unique foods produced primarily in high-input systems shows that, per unit of food, organic systems require more land, cause more eutrophication, use less energy, but emit similar greenhouse gas emissions (GHGs) as conventional systems; that grass-fed beef requires more land and emits similar GHG emissions as grain-feed beef; and that low-input aquaculture and non-trawling fisheries have much lower GHG emissions than trawling fisheries. In addition, our analyses show that increasing agricultural input efficiency (the amount of food produced per input of fertilizer or feed) would have environmental benefits for both crop and livestock systems. Further, for all environmental indicators and nutritional units examined, plant-based foods have the lowest environmental impacts; eggs, dairy, pork, poultry, non-trawling fisheries, and non-recirculating aquaculture have intermediate impacts; and ruminant meat has impacts ~100 times those of plant-based foods. Our analyses show that dietary shifts towards low-impact foods and increases in agricultural input use efficiency would offer larger environmental benefits than would switches from conventional agricultural systems to alternatives such as organic agriculture or grass-fed beef.
Background:
Eggs are a good source of nutrients for growth and development. We hypothesized that introducing eggs early during complementary feeding would improve child nutrition.
Methods:
A randomized controlled trial was conducted in Cotopaxi Province, Ecuador, from March to December 2015. Children ages 6 to 9 months were randomly assigned to treatment (1 egg per day for 6 months [n = 83]) and control (no intervention [n = 80]) groups. Both arms received social marketing messages to encourage participation in the Lulun Project (lulun meaning "egg" in Kichwa). All households were visited once per week to monitor morbidity symptoms, distribute eggs, and monitor egg intakes (for egg group only). Baseline and end point outcome measures included anthropometry, dietary intake frequencies, and morbidity symptoms.
Results:
Mothers or other caregivers reported no allergic reactions to the eggs. Generalized linear regression modeling showed the egg intervention increased length-for-age z score by 0.63 (95% confidence interval [CI], 0.38-0.88) and weight-for-age z score by 0.61 (95% CI, 0.45-0.77). Log-binomial models with robust Poisson indicated a reduced prevalence of stunting by 47% (prevalence ratio [PR], 0.53; 95% CI, 0.37-0.77) and underweight by 74% (PR, 0.26; 95% CI, 0.10-0.70). Children in the treatment group had higher dietary intakes of eggs (PR, 1.57; 95% CI, 1.28-1.92) and reduced intake of sugar-sweetened foods (PR, 0.71; 95% CI, 0.51-0.97) compared with control.
Conclusions:
The findings supported our hypothesis that early introduction of eggs significantly improved growth in young children. Generally accessible to vulnerable groups, eggs have the potential to contribute to global targets to reduce stunting.
Cultured meat production is an innovative and emerging process to produce animal meat in laboratories, using tissue-engineering techniques. This novel approach to produce meat involves in vitro culture of the animal muscle tissues rather than rearing whole animals to obtain animal flesh for consumption. Conventional meat production results in several adverse consequences such as poor nutritional value of meat, food-borne diseases, depletion of environmental resources, pollution etc., associated with animal slaughter. Cultured meat, on the other hand, is essentially an animal-free harvest produced in controlled conditions. Cultured meat can provide healthier, safer, and disease-free meat to consumers, as well as mitigate the negative environmental effects associated with traditional meat production. Academically, this new method is considered adequately efficient to supply meat and meat products to consumers. However, in vitro cultured meat production is still in the early stages of development and requires in-depth research and advanced technical skills for optimized production and commercialization. This review focuses on the history and development of cultured meat production, with insights on the advantages, consequences, and potential of animal-free meat harvest.
We evaluated the relations of red meat, poultry, fish and shellfish, as well as heme iron intake, with risk of type 2 diabetes (T2D).The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. Usual diet was evaluated by a validated 165-item semi-quantitative food-frequency questionnaire at recruitment. Physician-diagnosed T2D was self-reported during two follow-up interviews in 1999-2004 and 2006-2010. During a mean follow-up of 10.9 years, 5207 incident cases of T2D were reported. The multivariate-adjusted HR (95% CI) for T2D comparing highest versus the lowest quartiles was 1.23 (1.14, 1.33) for red meat (P for trend < 0.001), 1.15 (1.06, 1.24) for poultry (P for trend = 0.004), and 1.07 (0.99, 1.16) for fish/shellfish (P for trend = 0.12). After additional adjustment for heme iron, only red meat intake remained significantly associated with T2D risk (1.13; 1.01, 1.25; P for trend = 0.02). Heme iron was associated with increased T2D risk even after additionally adjusted for red meat (1.14; 1.02, 1.28; P for trend = 0.03).In conclusion, red meat and poultry intake was associated with an increased risk of T2D. These associations were mediated by heme iron, for poultry completely but partially for red meat.
Objective To determine the association of different types of meat intake and meat associated compounds with overall and cause specific mortality.
Design Population based cohort study.
Setting Baseline dietary data of the NIH-AARP Diet and Health Study (prospective cohort of the general population from six states and two metropolitan areas in the US) and 16 year follow-up data until 31 December 2011.
Participants 536 969 AARP members aged 50-71 at baseline.
Exposures Intake of total meat, processed and unprocessed red meat (beef, lamb, and pork) and white meat (poultry and fish), heme iron, and nitrate/nitrite from processed meat based on dietary questionnaire. Adjusted Cox proportional hazards regression models were used with the lowest fifth of calorie adjusted intakes as reference categories.
Main outcome measure Mortality from any cause during follow-up.
Results An increased risk of all cause mortality (hazard ratio for highest versus lowest fifth 1.26, 95% confidence interval 1.23 to 1.29) and death due to nine different causes associated with red meat intake was observed. Both processed and unprocessed red meat intakes were associated with all cause and cause specific mortality. Heme iron and processed meat nitrate/nitrite were independently associated with increased risk of all cause and cause specific mortality. Mediation models estimated that the increased mortality associated with processed red meat was influenced by nitrate intake (37.0-72.0%) and to a lesser degree by heme iron (20.9-24.1%). When the total meat intake was constant, the highest fifth of white meat intake was associated with a 25% reduction in risk of all cause mortality compared with the lowest intake level. Almost all causes of death showed an inverse association with white meat intake.
Conclusions The results show increased risks of all cause mortality and death due to nine different causes associated with both processed and unprocessed red meat, accounted for, in part, by heme iron and nitrate/nitrite from processed meat. They also show reduced risks associated with substituting white meat, particularly unprocessed white meat.
Animal products, i.e. meat, milk and eggs, provide an important component in global diets, but livestock dominate agricultural land use by area and are a major source of greenhouse gases. Cultural and personal associations with animal product consumption create barriers to moderating consumption, and hence reduced environmental impacts. Here we review alternatives to conventional animal products, including cultured meat, imitation meat and insects (i.e. entomophagy), and explore the potential change in global agricultural land requirements associated with each alternative. Stylised transformative consumption scenarios where half of current conventional animal products are substituted to provide at least equal protein and calories are considered. The analysis also considers and compares the agricultural land area given shifts between conventional animal product consumption. The results suggest that imitation meat and insects have the highest land use efficiency, but the land use requirements are only slightly greater for eggs and poultry meat. The efficiency of insects and their ability to convert agricultural by-products and food waste into food, suggests further research into insect production is warranted. Cultured meat does not appear to offer substantial benefits over poultry meat or eggs, with similar conversion efficiency, but higher direct energy requirements. Comparison with the land use savings from reduced consumer waste, including over-consumption, suggests greater benefits could be achieved from alternative dietary transformations considered. We conclude that although a diet with lower rates of animal product consumption is likely to create the greatest reduction in agricultural land, a mix of smaller changes in consumer behaviour, such as replacing beef with chicken, reducing food waste and potentially introducing insects more commonly into diets, would also achieve land savings and a more sustainable food system.
We assess progress toward the protection of 50% of the terrestrial biosphere to address the species-extinction crisis and conserve a global ecological heritage for future generations. Using a map of Earth's 846 terrestrial ecoregions, we show that 98 ecoregions (12%) exceed Half Protected; 313 ecoregions (37%) fall short of Half Protected but have sufficient unaltered habitat remaining to reach the target; and 207 ecoregions (24%) are in peril, where an average of only 4% of natural habitat remains. We propose a Global Deal for Nature—a companion to the Paris Climate Deal—to promote increased habitat protection and restoration, national-and ecoregion-scale conservation strategies, and the empowerment of indigenous peoples to protect their sovereign lands. The goal of such an accord would be to protect half the terrestrial realm by 2050 to halt the extinction crisis while sustaining human livelihoods.
With a growing number of prospective cohort studies, an updated dose–response meta-analysis of milk and dairy products with all-cause mortality, coronary heart disease (CHD) or cardiovascular disease (CVD) have been conducted. PubMed, Embase and Scopus were searched for articles published up to September 2016. Random-effect meta-analyses with summarised dose–response data were performed for total (high-fat/low-fat) dairy, milk, fermented dairy, cheese and yogurt. Non-linear associations were investigated using the spine models and heterogeneity by subgroup analyses. A total of 29 cohort studies were available for meta-analysis, with 938,465 participants and 93,158 mortality, 28,419 CHD and 25,416 CVD cases. No associations were found for total (high-fat/low-fat) dairy, and milk with the health outcomes of mortality, CHD or CVD. Inverse associations were found between total fermented dairy (included sour milk products, cheese or yogurt; per 20 g/day) with mortality (RR 0.98, 95% CI 0.97–0.99; I² = 94.4%) and CVD risk (RR 0.98, 95% CI 0.97–0.99; I² = 87.5%). Further analyses of individual fermented dairy of cheese and yogurt showed cheese to have a 2% lower risk of CVD (RR 0.98, 95% CI 0.95–1.00; I² = 82.6%) per 10 g/day, but not yogurt. All of these marginally inverse associations of totally fermented dairy and cheese were attenuated in sensitivity analyses by removing one large Swedish study. This meta-analysis combining data from 29 prospective cohort studies demonstrated neutral associations between dairy products and cardiovascular and all-cause mortality. For future studies it is important to investigate in more detail how dairy products can be replaced by other foods.
Electronic supplementary material
The online version of this article (doi:10.1007/s10654-017-0243-1) contains supplementary material, which is available to authorized users.
Background
Information about the global structure of agriculture and nutrient production and its diversity is essential to improve present understanding of national food production patterns, agricultural livelihoods, and food chains, and their linkages to land use and their associated ecosystems services. Here we provide a plausible breakdown of global agricultural and nutrient production by farm size, and also study the associations between farm size, agricultural diversity, and nutrient production. This analysis is crucial to design interventions that might be appropriately targeted to promote healthy diets and ecosystems in the face of population growth, urbanisation, and climate change.
Methods
We used existing spatially-explicit global datasets to estimate the production levels of 41 major crops, seven livestock, and 14 aquaculture and fish products. From overall production estimates, we estimated the production of vitamin A, vitamin B12, folate, iron, zinc, calcium, calories, and protein. We also estimated the relative contribution of farms of different sizes to the production of different agricultural commodities and associated nutrients, as well as how the diversity of food production based on the number of different products grown per geographic pixel and distribution of products within this pixel (Shannon diversity index [H]) changes with different farm sizes.
Findings
Globally, small and medium farms (≤50 ha) produce 51–77% of nearly all commodities and nutrients examined here. However, important regional differences exist. Large farms (>50 ha) dominate production in North America, South America, and Australia and New Zealand. In these regions, large farms contribute between 75% and 100% of all cereal, livestock, and fruit production, and the pattern is similar for other commodity groups. By contrast, small farms (≤20 ha) produce more than 75% of most food commodities in sub-Saharan Africa, southeast Asia, south Asia, and China. In Europe, west Asia and north Africa, and central America, medium-size farms (20–50 ha) also contribute substantially to the production of most food commodities. Very small farms (≤2 ha) are important and have local significance in sub-Saharan Africa, southeast Asia, and south Asia, where they contribute to about 30% of most food commodities. The majority of vegetables (81%), roots and tubers (72%), pulses (67%), fruits (66%), fish and livestock products (60%), and cereals (56%) are produced in diverse landscapes (H>1·5). Similarly, the majority of global micronutrients (53–81%) and protein (57%) are also produced in more diverse agricultural landscapes (H>1·5). By contrast, the majority of sugar (73%) and oil crops (57%) are produced in less diverse ones (H≤1·5), which also account for the majority of global calorie production (56%). The diversity of agricultural and nutrient production diminishes as farm size increases. However, areas of the world with higher agricultural diversity produce more nutrients, irrespective of farm size.
Interpretation
Our results show that farm size and diversity of agricultural production vary substantially across regions and are key structural determinants of food and nutrient production that need to be considered in plans to meet social, economic, and environmental targets. At the global level, both small and large farms have key roles in food and nutrition security. Efforts to maintain production diversity as farm sizes increase seem to be necessary to maintain the production of diverse nutrients and viable, multifunctional, sustainable landscapes.
Funding
Commonwealth Scientific and Industrial Research Organisation, Bill & Melinda Gates Foundation, CGIAR Research Programs on Climate Change, Agriculture and Food Security and on Agriculture for Nutrition and Health funded by the CGIAR Fund Council, Daniel and Nina Carasso Foundation, European Union, International Fund for Agricultural Development, Australian Research Council, National Science Foundation, Gordon and Betty Moore Foundation, and Joint Programming Initiative on Agriculture, Food Security and Climate Change—Belmont Forum.
Background Information about the global structure of agriculture and nutrient production and its diversity is essential to improve present understanding of national food production patterns, agricultural livelihoods, and food chains, and their linkages to land use and their associated ecosystems services. Here we provide a plausible breakdown of global agricultural and nutrient production by farm size, and also study the associations between farm size, agricultural diversity, and nutrient production. This analysis is crucial to design interventions that might be appropriately targeted to promote healthy diets and ecosystems in the face of population growth, urbanisation, and climate change.
Malnutrition is a global challenge with huge social and economic costs; nearly every country faces a public health challenge, whether from undernutrition, overweight/obesity, and/or micronutrient deficiencies. Malnutrition is a multisectoral, multi-level problem that results from the complex interplay between household and individual decision-making, agri-food, health, and environmental systems that determine access to services and resources, and related policy processes. This paper reviews the theory and recent qualitative evidence (particularly from 2010 to 2016) in the public health and nutrition literature, on the role that agriculture plays in improving nutrition, how food systems are changing rapidly due to globalization, trade liberalization, and urbanization, and the implications this has for nutrition globally. The paper ends by summarizing recommendations that emerge from this research related to (i) knowledge, evidence, and communications, (ii) politics, governance, and policy, and (iii) capacity, leadership, and financing.
Background
Although nut consumption has been associated with a reduced risk of cardiovascular disease and all-cause mortality, data on less common causes of death has not been systematically assessed. Previous reviews missed several studies and additional studies have since been published. We therefore conducted a systematic review and meta-analysis of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality.
Methods
PubMed and Embase were searched for prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The burden of mortality attributable to low nut consumption was calculated for selected regions.
Results
Twenty studies (29 publications) were included in the meta-analysis. The summary RRs per 28 grams/day increase in nut intake was for coronary heart disease, 0.71 (95% CI: 0.63–0.80, I² = 47%, n = 11), stroke, 0.93 (95% CI: 0.83–1.05, I² = 14%, n = 11), cardiovascular disease, 0.79 (95% CI: 0.70–0.88, I² = 60%, n = 12), total cancer, 0.85 (95% CI: 0.76–0.94, I² = 42%, n = 8), all-cause mortality, 0.78 (95% CI: 0.72–0.84, I² = 66%, n = 15), and for mortality from respiratory disease, 0.48 (95% CI: 0.26–0.89, I² = 61%, n = 3), diabetes, 0.61 (95% CI: 0.43–0.88, I² = 0%, n = 4), neurodegenerative disease, 0.65 (95% CI: 0.40–1.08, I² = 5.9%, n = 3), infectious disease, 0.25 (95% CI: 0.07–0.85, I² = 54%, n = 2), and kidney disease, 0.27 (95% CI: 0.04–1.91, I² = 61%, n = 2). The results were similar for tree nuts and peanuts. If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013.
Conclusions
Higher nut intake is associated with reduced risk of cardiovascular disease, total cancer and all-cause mortality, and mortality from respiratory disease, diabetes, and infections.
Electronic supplementary material
The online version of this article (doi:10.1186/s12916-016-0730-3) contains supplementary material, which is available to authorized users.
Stabilizing greenhouse gas (GHG) emissions from croplands as agricultural demand grows is a critical component of climate change mitigation. Emissions intensity metrics - including carbon dioxide equivalent emissions per kilocalorie produced ('production intensity') - can highlight regions, management practices, and crops as potential foci for mitigation. Yet the spatial and crop-wise distribution of emissions intensity has been uncertain. Here, we develop global crop-specific circa 2000 estimates of GHG emissions and GHG intensity in high spatial detail, reporting the effects of rice paddy management, peatland draining, and nitrogen (N) fertilizer on CH 4, CO 2 and N 2 O emissions. Global mean production intensity is 0.16 Mg CO 2 e M kcal'1, yet certain cropping practices contribute disproportionately to emissions. Peatland drainage (3.7 Mg CO 2 e M kcal'1) - concentrated in Europe and Indonesia - accounts for 32% of these cropland emissions despite peatlands producing just 1.1% of total crop kilocalories. Methane emissions from rice (0.58 Mg CO 2 e M kcal -1), a crucial food staple supplying 15% of total crop kilocalories, contribute 48% of cropland emissions, with outsized production intensity in Vietnam. In contrast, N 2 O emissions from N fertilizer application (0.033 Mg CO 2 e M kcal'1) generate only 20% of cropland emissions. We find that current total GHG emissions are largely unrelated to production intensity across crops and countries. Climate mitigation policies should therefore be directed to locations where crops have both high emissions and high intensities. © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
This book takes a transdisciplinary approach and considers multisectoral actions, integrating health, agriculture, environment, economy, and socio-cultural issues, to comprehensively explore the topic of sustainable diets. Consideration is given to the multi-dimensional nature of diets and food systems, and the book explores the challenging issues connecting food security and nutrition to sustainability, culture, tradition, and a broader range of scientific topics. The first section, 'Grand Challenges' (chapters 1-9), positions sustainable diets in the multi-perspective context of food systems. Within the current international debate, it introduces some overarching wicked problems, resistant to resolution in spite of the dire consequences of inaction. The chapters cover multi-sectoral policy, public health, sustainable food systems, climate change, biodiversity loss, agro-ecology, indigenous peoples, the role of cities, and food and waste. The contributions in the second section, 'Qualitative and Quantitative Approaches' (chapters 10-17) discuss the topic of sustainable diets from different cultural, sectoral and disciplinary angles. The issues are analysed with data and methods derived from social sciences, clinical sciences and experimental sciences. Perspectives and solutions, with evidence, are presented to underpin policies and interventions. The last section, 'Moving Forward' (chapters 18-29) deals with selected innovations, initiatives, projects, case studies and programmes enhancing sustainable diets by linking nutrition to food systems.
This study was conducted to investigate body mass index (BMI), levels of cholesterol and triglycerides in prison inmates at the Institution for Reform and Rehabilitation in Southern Libya to be considered as an indication about their health and the provided foods. The results of this study showed that 26.5% of BMI of the prison inmates were found to be higher than the normal levels. Generally, the average level of cholesterol and triglycerides concentrations were found to be within normal range 142.6 mg/dl and 135.4 mg/dl, respectively. The findings also established that there were a significant relationship and direct correlation between BMI levels and age and concentration of cholesterol and triglycerides levels. The results of this showed that the served foods for these prison inmates are well balanced as indicated by their cholesterol and triglycerides levels.
Background: The role of total calcium intake in the prevention of hip fracture risk has not been well established.
Objective: The objective of the study was to assess the relation of calcium intake to the risk of hip fracture on the basis of meta-analyses of cohort studies and clinical trials.
Results: In women (7 prospective cohort studies, 170 991 women, 2954 hip fractures), there was no association between total calcium intake and hip fracture risk [pooled risk ratio (RR) per 300 mg total Ca/d = 1.01; 95% CI: 0.97, 1.05]. In men (5 prospective cohort studies, 68 606 men, 214 hip fractures), the pooled RR per 300 mg total Ca/d was 0.92 (95% CI: 0.82, 1.03). On the basis of 5 clinical trials (n = 5666 women, primarily postmenopausal, plus 1074 men) with 814 nonvertebral fractures, the pooled RR for nonvertebral fractures between calcium supplementation (800–1600 mg/d) and placebo was 0.92 (95% CI: 0.81, 1.05). On the basis of 4 clinical trials with separate results for hip fracture (6504 subjects with 139 hip fractures), the pooled RR between calcium and placebo was 1.64 (95% CI:1.02, 2.64). Sensitivity analyses including 2 additional small trials with <100 participants or per-protocol results did not substantially alter results.
Conclusions: Pooled results from prospective cohort studies suggest that calcium intake is not significantly associated with hip fracture risk in women or men. Pooled results from randomized controlled trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible. For any nonvertebral fractures, there was a neutral effect in the randomized trials.
Background
Observational cohort studies and a secondary prevention trial have shown inverse associations between adherence to the Mediterranean diet and cardiovascular risk.
Methods
In a multicenter trial in Spain, we assigned 7447 participants (55 to 80 years of age, 57% women) who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was a major cardiovascular event (myocardial infarction, stroke, or death from cardiovascular causes). After a median follow-up of 4.8 years, the trial was stopped on the basis of a prespecified interim analysis. In 2013, we reported the results for the primary end point in the Journal. We subsequently identified protocol deviations, including enrollment of household members without randomization, assignment to a study group without randomization of some participants at 1 of 11 study sites, and apparent inconsistent use of randomization tables at another site. We have withdrawn our previously published report and now report revised effect estimates based on analyses that do not rely exclusively on the assumption that all the participants were randomly assigned.
Results
A primary end-point event occurred in 288 participants; there were 96 events in the group assigned to a Mediterranean diet with extra-virgin olive oil (3.8%), 83 in the group assigned to a Mediterranean diet with nuts (3.4%), and 109 in the control group (4.4%). In the intention-to-treat analysis including all the participants and adjusting for baseline characteristics and propensity scores, the hazard ratio was 0.69 (95% confidence interval [CI], 0.53 to 0.91) for a Mediterranean diet with extra-virgin olive oil and 0.72 (95% CI, 0.54 to 0.95) for a Mediterranean diet with nuts, as compared with the control diet. Results were similar after the omission of 1588 participants whose study-group assignments were known or suspected to have departed from the protocol.
Conclusions
In this study involving persons at high cardiovascular risk, the incidence of major cardiovascular events was lower among those assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet. (Funded by Instituto de Salud Carlos III, Spanish Ministry of Health, and others; Current Controlled Trials number, ISRCTN35739639.)
There is growing evidence that cereals and legumes play important roles in the prevention of chronic diseases. Early epidemiologic studies of these associations focused on intake of dietary fiber rather than intake of grains or legumes. Generally, these studies indicated an inverse association between dietary fiber intake and risk of coronary artery disease; this observation has been replicated in recent cohort studies. Studies that focused on grain or cereal intake are fewer in number; these tend to support an inverse association between intake of whole grains and coronary artery disease. Studies on the association of dietary fiber with colon and other cancers have generally shown inverse relations, but whether these relations are attributable to cereals, other fiber sources, or other factors is less clear. Although legumes have been shown to lower blood cholesterol concentrations, epidemiologic studies are few and inconclusive regarding the association of legumes with risk of coronary artery disease. It has been hypothesized that legumes, in particular soybeans, reduce the risk of some cancers, but epidemiologic studies are equivocal in this regard. Overall, there is substantial epidemiologic evidence that dietary fiber and whole grains are associated with decreased risk of coronary artery disease and some cancers, whereas the role of legumes in these diseases appears promising but as yet inconclusive.
Background
Standard diet quality assessment tools, which measure micronutrient sufficiency and food consumption related to disease and applicable to different populations, are needed to track progress in meeting the Sustainable Development Goals related to hunger, food security, and nutrition. Diet quality scores have been constructed for high- and low-income countries, but none are simple to administer or applicable internationally.
Objective
We prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a new Prime Diet Quality Score (PDQS), and the risk of ischemic heart disease (IHD) in 3 US cohorts.
Design
In total, 75,045 women (baseline age 43–63 y), 43,966 men (aged 40–75 y), and 93,131 younger women (aged 27–44 y) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed multiple times using food frequency questionnaires and the 3 diet quality scores were computed for each individual. The association with IHD was modeled with Cox proportional hazard models, controlling for potential confounders.
Results
During follow-up, we ascertained 2908 incident IHD cases in the Nurses’ Health Study, 3722 in the Health Professionals Follow-up Study, and 505 in the Nurses’ Health Study II. The FGI was not associated with total IHD in any cohort. The PDQS was significantly associated with IHD in all 3 cohorts separately and the pooled RR for each SD increase was 0.89 (95% CI: 0.87, 0.91). This was significantly different than the pooled RR of 0.93 for MDDW (95% CI: 0.90, 0.96) and the RR of 0.98 for the FGI (95% CI: 0.95, 1.01). The association did not appear to differ by age.
Conclusion
We found that the PDQS with the most detailed differentiation of healthy and unhealthy foods was associated with a lower risk of IHD in a high-income country. On the other hand, diet quality scores that do not account for unhealthy foods had a limited association with IHD.